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

Menopause-- The End? . . . or the Beginning? Rhonda starts today's podcast, as usual, with a warm endorsement from Sally, a podcast fan who really liked Podcast 355 on the topic of "Relationship Problems: Be Gone!" She said the role-play demonstrations were "incredible" and especially helpful. We'll keep that in mind and see if we can do some more role-playing demonstrations in future podcasts, along with instructions so you can practice at home, as well. This can be extremely helpful if you want to master the techniques we describe. They may sound simple, but they're not! In our recent podcast on free practice groups (put LINK), you can find many virtual practice groups you can join from home to practice many of the techniques in TEAM-CBT with like-minded colleagues and become part of the growing TEAM-CBT community. We now have many excellent and free practice groups for the general public as well as and training groups for shrinks. Today, Mina returns to the show with a new problem—pre-menopausal symptoms that are scaring her and casting a shadow on her future as well as her marriage with her husband, Maurice. Menopause is a topic that freaks many people out, due to feelings of anxiety and shame which can sometimes be intense. Today, menopause will be out in the open and front and center. However, Meina is confused because so many problems and feelings are swirling around in her head, and she doesn't quite know where to start. At the start of the session, Mina's Brief Mood Survey indicated mild depression, severe anxiety, moderate to severe anger, and greatly diminished feelings of happiness and relationship satisfaction, thinking of her husband, Maurice.f If you review Mina's Daily Mood Log. you can see that the Upsetting Event is irregular periods due to menopause. You can also see that Mina is struggling with fairly feelings of depression, anxiety, shame, inadequacy, loneliness, embarrassment, hopelessness, frustration and anger, and she's giving herself some intensely negative messages, like "My body is falling apart," and "My husband will leave me," and "I'll get osteoporosis and die in pain like my grandmother," and more. During the initial Empathy phase of the session, Mina described quite a lot of personal and professional concerns, as well as somatic complaints of various kinds. Sometimes, in the past, Mina has developed numerous somatic complaints that terrify her, because she has interpreted them as possible serious diseases, like multiple sclerosis. However, excellent physical evaluations rarely or never provide any medical evidence or explanation for her symptoms. This pattern of obsessing about somatic symptoms is actually quite common. Many general practice doctors report that as many as a third of their patients complaining of pain, dizziness, and so forth do not have any medical disease that could possibly explain the symptoms. In fact, in his classic book, Caring for Patients, the late Dr. Allen Barbour from Stanford reported that about half of these types of patients experience a disappearance of their somatic symptoms when they identify some conflict or problem that they've been avoiding, and then take steps to express their feelings or solve the repressed problem. Pretty much every time, this has been true of Mina, too. It often turns out that she is upset about something she is sweeping under the rug, and the Hidden Emotion Technique has proved extremely helpful in pinpointing the hidden feeling or conflict. Then, as soon as she acts on this information, and expresses her feelings, the somatic problems immediately disappear. So, our first task in today's session was to see if the same thing was happening. It turned out that she was quite upset with her husband, Maurice, so we did a Relationship Journal to see if we could get a better understanding of what was going on. Her complaint was that Maurice did not want to talk about "difficult feelings." Instead, he suggests they go for a nature walk or watch a movie. So, she felt sad, anxious, rejected, hurt, frustrated, and alone. But, as is the case nearly 100% of the time, when we examined a brief interaction between them—what did he say and what did she say next—it became clear that she was actually pushing him away and putting him down. This was understandably painful for Mina to see, and a bit embarrassing, but she was super brave, and saw how she could use the Five Secrets to respond to Maurice in a radically different and more inviting manner. As an aside, the person who seeks treatment for a relationship problem will nearly always discover that they have actually be causing the very problem they're complaining about. If Mina's husband had come to us for help, he would have made the exact same shocking discovery—that HE was causing the problem he was complaining about. I call this strange but fascinating phenomenon the "theory of interpersonal relativity." Mina feared abandonment, but discovered that her real problem was that she w

361: Cultivating Delight Today we feature Dr. Angela Krumm, Clinical Director at the Feeling Good Institute (FGI) in Mountain View, Ca, and Zane Pierce, LMFT, a Level 3 TEAM therapist at FGI, on a novel and arguably controversial tool which is not aimed at reducing negative feelings, but rather boosting positive feelings. Zane Pierce Rhonda, as usual, starts the podcast with a wonderful email from Andrew who really enjoyed Podcast 357, on what David learned on the streets of Palo Alto in the wild and wonderful latter half of the 1960s. Then Angela described her Journey to Delight, which may be silly and goofy, or wonderful, or perhaps a little of each. She was inspired by a podcast interview she heard with Ross Gay, who wrote the popular Book of Delight, a book of ultra short essays he wrote every day for a year, starting on his 42nd birthday, describing "common place" things he noticed that were amazing, inspiring, or delightful. An example was noticing a weed with a beautiful flower growing out of a crack in an ugly piece of concrete. Then Angela noticed that she felt "neutral" during and after a pleasant family hike on a pleasant and beautiful day, with the people she loved. She asked herself, "Why did I only feel neutral? And can something be done to cultivate greater delight and joy in our daily lives? She asked herself, "I want to be more open to delight in my life—is it possible to cultivate delight? And if so, how?" She reasoned that since we have more than 100 TEAM-CBT to reduce and eliminate negative feelings, like depression, anxiety, shame, inadequacy, and even anger, couldn't we create some methods for boosting positive feelings? Could we focus, for example, not just on how to challenge and crush our negative internal dialogues, but also on how to cultivate more positive self-talk? Can we "elevate" our more neutral moments. In order to set the agenda, she did a Cost-Benefit Analysis during one of her Thursday morning training groups with the therapist at FGI. She asked David, Rhonda and Zane to list some really GOOD reasons NOT to try to cultivate greater delight in our lives, including: People who are hurting and struggling need compassion. It's important to see the truth and reality of the negative realities we confront every day in our personal lives as well as on the news. Negative feelings can motivate us to work hard. Negative feelings and self-criticisms often show that we have high standards and humility. And many more. She encouraged us to list the reasons to focus on the beautiful and awesome things we sometimes ignore or overlook going on all around us all the time, including: the possibility of feeling more joy, slowing down in life, and being more present in the moment. Angela described an informal experiment she set-up to i see if adding positive self-talk to otherwise neutral activities could increase delight. Forty two therapists participated in small groups of four to do some shared activities, while some completed the activities solo. Participants completed my 5-item Happiness Scale as well as a sixth item measuring feelings of "delight" prior to and after the experiment. The experiment was simple—engage in a neutral or common place activity. The key variable was to actively add positive self-talk to the activity. And of course there was a requirement that the positive self-talk has to be 100% true (e.g., can't lie to yourself or say fake positive things). In the small group, Zane and Angela walked through a park and several participants decided to swing on the park's swing set. Their positive self-talk motivated them to try out the swings, which was quite "delightful." Then they walked separately, adding positive talk to their activities and observations. Zane described his "journey to delight," noticing a sickly Giant Redwood that was struggling and nearly dead. But, he found green sprouts coming out of it, as the tree was still struggling to grow and survive. Zane also spotted a hummingbird on his walk. Adding positive self-talk to otherwise neutral activities increased his happiness score by 50% (swinging at the park and 20% (observing nature). This was especially poignant since Zane tragically lost his beloved younger brother to suicide just two months ago. This was devastating, and one of the most difficult periods of his life. He said, "It turned my world upside down." Our hearts go out to Zane, and we are grateful that you, Zane, could share this special time with us today, given the tragic and horrible circumstances you've had to face. I have many happy memories with Zane, who used to be a faithful and beloved member of my Sunday morning hiking group. We had to abandon the Sunday hikes during the Covid pandemic, and now I'm limited in my walking due to low back pain. I hope to get the hikes going again one day. Zane and his wonderful wife, Daisy have appeared on some of the most popular podcast episodes in the past, including # 79: "What's the Secret of a 'Meaningful'

360: The Story of Indrani "Why can't I get close to my daughter who I love so much?" Today, we present Part 2 of the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your "inner" dialogue, which is the conversation you're having with yourself about the conflict, and the "outer" dialogue, which is what happens when you try to get close to the person you love. And today's session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you've been giving yourself about h problem with the person you love so much. You can see Indrani's Daily Mood Log if you click HERE. As you can see, she's been telling herself that her daughter has shut her out of her life, and that she'll die alone/ That's incredibly sad! And she's also telling herself that all of her friends have wonderful relationships with their daughters "and I don't" and she's blaming herself for the problem: "I deserve this treatment," and "nothing I do pleases her." You can also see the intensity of Indrani's negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don't realize this, so we think there's something wrong with the other person. But how can this be? If you look at Step 2 of Indrani's RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful "death" of the "self." But this "Great Death" is instantly followed by a "Great Rebirth.!" At the end of the session, a Tuesday group members named Keren, said this to Indrani: "You wowed me!" One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today's podcast, you'll hear the initial T = Testing and E = Empathy. In part 2, in next week's podcast, you'll hear the M = Methods, including Jill and David's incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she'd been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani's Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani's initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani's amazing Journey this evening! PS I emailed Indrani this morning to see how she's doing, and recevied this wonderful reply: I'm still feeling great…very light and hopeful. I've listened to the audio. I sound goofy at times but loved re-living the moment when the truth dawned on me and how I felt immediately afterwards. My daughter Soni ( like the Japanese electronic company :) is coming on Thursday. I would've been filled with intense anticipatory anxiety but now I can't wait to give her a big hug and use what I've learnt to connect with her. I'm looking forward to watching the video with Soni. Thank you so much Dr. Burns and Jill! Thanks for listening! Rhonda, Jill, and David

359: The Story of Indrani "Why can't I get close to my daughter who I love so much?" Today, we present the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your "inner" dialogue, which is the conversation you're having with yourself about the conflict, and the "outer" dialogue, which is what happens when you try to get close to the person you love. And today's session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you've been giving yourself about h problem with the person you love so much. You can see Indrani's Daily Mood Log if you click HERE. As you can see, she's been telling herself that her daughter has shut her out of her life, and that she'll die alone/ That's incredibly sad! And she's also telling herself that all of her friends have wonderful relationships with their daughters "and I don't" and she's blaming herself for the problem: "I deserve this treatment," and "nothing I do pleases her." You can also see the intensity of Indrani's negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don't realize this, so we think there's something wrong with the other person. But how can this be? If you look at Step 2 of Indrani's RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful "death" of the "self." But this "Great Death" is instantly followed by a "Great Rebirth.!" At the end of the session, a Tuesday group members named Keren, said this to Indrani: "You wowed me!" One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today's podcast, you'll hear the initial T = Testing and E = Empathy. In part 2, in next week's podcast, you'll hear the M = Methods, including Jill and David's incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she'd been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani's Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani's initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani's amazing Journey this evening! Thanks for listening! Rhonda, Jill, and David

Are the "physical" symptoms of depression specific or non-specific? How do you treat schizophrenia with TEAM? Why don't more shrinks help themselves? Healthy vs unhealthy negative feelings-- what's the difference? Questions answered in this podcast: 1. Laura asks: Why don't you include the physical symptoms of depression in your assessment tests? 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? 3. Author not known: Why don't the therapists you treat with TEAM treat themselves using self-help techniques? 4. Zach: How does David understand the difference between healthy and unhealthy emotions? Is there any overlap between EFT (Emotionally Focused Therapy) and David's TEAM-CBT? The following are David's written responses to these questions. However, in the podcast, Rhonda and David discuss them, and their answers together may differ or enlarge on the material below. Also, in some cases, the written answers contain additional information not included in the live podcast. 1. Laura asks: Why don't you include the physical symptoms of depression in your assessment tests? Author: Laura asks a question about post #248: "David and Rhonda Answer Your Questions about Exercise, Empathy, Euphoria, Exposure, Psychodynamic Therapy, and more!" Comment: Fabulous, David. Bless you. Have you done a show on assessments? I'll be honest about my confusion. Some of the measures that you have developed almost seem too simple to be accurate. For example, the depression test isn't sensitive to any of the physical manifestations of the illness. Anyway, I was just curious about that. David's Reply Thanks, Laura! Good questions! First, the so-called physical symptoms of depression are non-specific and not uniquely associated with depression. Only the core emotional symptoms are good indicators of depression: feeling down, hopeless, worthless, unmotivated, and not enjoying life. If you want to measure physical symptoms, they won't give you much information about depression, but at least they need to be worded correctly, which they aren't in most assessment tols. For example, you can measure weight gain, OR weight loss, in single and separate items, but not in the same item. But if you go to a mall and ask how many people have had weight gain, you'll probably find that more than 50% report weight gain, but this is rarely due to depression, rather it is due to overeating! Similarly, a significant fraction will say yes to a question about weight loss, and in the vast majority of cases this will be due to dieting, not depression. Similarly with the other poorly thought out physical symptoms, like trouble sleeping. The reliability of my depression measures has typically been .95 or better, as compared with measures like the Beck or PHQ9 that have only .78 to .80 reliability coefficients (called "coefficient alpha.") I have observed a phenomenal lack of critical thinking behind most current psychological tests for depression, anxiety, and other variables of interest to clinicians and researchers. You also asked about apps for anxiety, like OCD, as opposed to depression. The Feeling Good App causes rapid and significant reductions in, not one, but seven categories of negative feelings, including feelings of depression, anxiety, guilty/shame, inadequacy, loneliness, hopelessness and anger. Thanks so much! Finally, I have to confess my bias toward trying hard to make things simple, so we can all understand what we're talking about! When things are overly complicated or hard to "get," I usually feel fairly suspicious about the person who is trying to "teach." In college I always had the policy that if I can't understand what the teacher is trying to say, the teacher has a problem! My thinking today is pretty similar! I've always appreciated teachers who keep things simple for us mere mortals who appreciate having things explained clearly and in everyday words. Best, david 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? Hi David, Do you have any schizophrenia thought experiments? Most of my clients struggle with voices. I tell them there is always a good voice, which I believe is the Holy Spirit woven into every person at birth. I also tell them to welcome the voices and listen for what they need, because the voices need to be welcomed back into the body - the "family" - of the person, according to Internal Family Systems. I welcome your thoughts. I am not a therapist so anything I say or do needs to fit my role as a recovery coach. Fred South Bend, Indiana David's Reply. Thanks, Fred, great question. I have treated many individuals with schizophrenia, but they have rarely or never asked for help with the voices they hear. I like to set the agenda for each patient, finding out what they specifically want help with. And individuals with schizophrenia respond very well to TEM-CBT, both the individual treatment model for depression and anxiety, as well as the interpersonal model for re

Podcast 357: Stories from the 60s, Part 1 Today's podcast will be a little different. I had the good fortune to be alive in Palo Alto, California during the late 1960s. For me, it was a magical era of happenings, the Haight-Ashbury District in San Francisco, psychedelics, war protests, civil rights activity, cool music, learning about life, and cutting an awful lot of medical school classes! But what I learned on the streets was far more valuable in my later career as a psychiatrist, working with real people with real problems, than anything I learned in medical school. It was an era of magic, to be honest. In fact, to me, California has always had the feel of magic. And that magic is still alive and well, happening every day, at least in my life. Let me know if you like these stories. I shared them at my weekly Stanford training group, and publish the recording of that evening's training session here, with trepidation. Some of the stories are pretty far out. If you like them, and want more, I have a lot more, which I've listed below. Just let me know, and I'll gladly start babbling again. . . IF I haven't been arrested! If you'd like to see one of the R-rated but gorgeous Larry Keenan photos taken at my "Uptightness" happening, you can see it at this link: Look for the photo called "The Kiss." https://www.larrykeenan.com/prints Larry Keenan, a brilliant young commercial photographer at the time, attended my "uptightness" happening and took many fantastic photos that day. Larry became a famed photographer of many of the greats of the "Hippy Era," like Bob Dylan, Neil Cassady, Lawrence Ferlinghetti, and a host of others. Sadly, Larry passed away several years ago, but I will always be grateful to him for the gorgeous and now-famous photos he created that day in the infamous but glorious 60's! Warmly, david Part 1 (in this podcast) Psychodrama / encounter David gets put down: Rob Krist's encounter group The return of tears: My first psychodrama marathon The pompous professor: False front / tragic surprise Spiritual Desert experience: Sadness as celebration Dating / Relationships / R-Rated Having fun and making a movie: "Uptightness" Part 2 (not yet recorded: let me know if you'd like a Part 2!) More Stanford stories not yet covered: let me know if interested! Husain Chung and the crazy teen from LA: When a stallion wants to run A frightening encounter with Vic Lovell: And a mentor's advice Threats from unwanted guests: Fighting back with paradox Bar next to the Free University Coffee House: Outrageous works, even with Hell's Angels Inside the Free University Coffee House: How I met my wife The day we bombed Cambodia: Triggering a riot at Stanford, beaten by police, motorcycle smashed to bits, handcuffed, arrest announced on the campus radio station, escaped The bearded man on the quad near the Stanford student union—Telling me to "sit with open hands" Ken Kesey and his merry pranksters in the Stanford student union—they were dressed in pajamas or clown outfits and Neil Cassady was juggling hammers) The tape recorder experiment: Bizarre week, unexpected conclusion Medical School Stanford medical school interview: Unexpected outcome The day that Gene Altman and I attended class: Totally weird Broken jaw: Anger, fear, and intense pain that suddenly vanished Getting kicked out of neuropathology class Encounter at the Medical School: Psychiatry and Psychotherapy—Are they Relevant or Obsolete? Featuring Hussain Chung Missing graduation ceremony: Didn't pick up my diploma until years later Homeless in Carmel Valley: Saved by Ramadan, Subud Re-entry: The Highland Hospital Emergency Room Dr. Allen Barbour's Medical Outpatient Clinic Hidden emotion 1: One of Stanford's first coronary artery bypass patients Hidden emotion 2: Doc, what happened? I'm not dizzy anymore! Hidden emotion 3: Help! I need emergency surgery NOW! Here's the Stanford group feedback from group after telling stories 1 – 5 Positive Feelings about the Training Not at all true Somewhat true Moderately true Very true Completely true N/A 1. I felt I could trust my trainer. 0 0 0 0 17 1 My trainer paid careful attention to what I said 0 0 0 0 7 11 My trainer critiqued my work in a sensitive manner. 0 0 0 0 7 11 I felt good about the training I received. 0 0 0 0 17 1 Overall, I was satisfied with my most recent training session. 0 0 0 0 17 1 Negative Feelings during Training Not at all true Somewhat true Moderately true Very true Completely true Sometimes I felt uncomfortable during the training. 18 0 0 0 0 Sometimes I felt defensive during the training. 18 0 0 0 0 Sometimes I felt frustrated during the training. 18 0 0 0 0 Sometimes I felt anxious during the training. 18 0 0 0 0 Sometimes I felt insecure during the training. 16 2 0 0 0 Helpfulness of the Training Not at all true Somewhat true Moderately true Very true Completely true N/A I expect to use these ideas with patients I am now treating 0 0 2 1 11 4 What I am learning seems useful in my clinical

Ask David: Burn Out; When Challenging Thoughts Doesn't Work; and more! Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. Joseph asks if it's okay to take a break when you get "burned out." Below, David expands on this and describes the difference between "healthy" and "unhealthy burnout." 2. Joseph also asks why your feelings might not change when you challenge your negative thought with a positive thought that's 100% true. 3. Dan asks about Step 4 of the Relationship Journal, which is the most difficult and important step in the TEAM interpersonal model—see exactly how you're forcefully causing and reinforcing the very relationship problem you're complaining about. For example, if the person doesn't "listen," you'll see that you're forcing them not to listen. If she or he doesn't open up and express feelings, you'll see that you prevent them from opening up. And if you think your partner doesn't treat you in a loving and respectful way, you'll suddenly see exactly why this is happening—if you have the courage to take look and see: But if fact, this is one of the "Great Deaths" of the "self" in TEAM-CBT, and very few folks are willing to "die" in this way. 4. Finally, Clay asks about EMDR. He's been treated with it without success. David and Matt weigh in with their thoughts about EMDR. This question was not addressed on the podcast, since some practitioners of EMDR might be offended by David and Matt's thinking, but they did describe their thoughts in the show notes below. If you are an EMDR enthusiast, you might prefer NOT to read our comments. Joseph writes: Thanks, David, for sharing so much on the podcasts! I have a couple questions. Personally, I find that when I'm burnt out, I get a lot more anxious automatic thoughts. While it's definitely good to combat these distorted thoughts by replacing them with realistic ones, my takeaway is that it's also sometimes wise to change our lives / circumstances (e.g. to take a break). By the way, I also wanted to ask if you've ever faced a situation where you are convinced that a thought is distorted and irrational (and you know what the realistic thought is), but you still can't shake it off? I sometimes get stuck when I already know the "right answer" (ie. what the realistic thoughts are based on the methods you've taught), but I just can't seem to get my brain to fully believe it. For example, I was recently on vacation and a small blip made me think "my vacation is ruined!". I immediately identified it as all-or-nothing thinking, and replaced it with "my vacation is still going very well even if it's not perfect" (and I'm convinced this thought is true), but somehow my mind kept going back to the automatic thought again and again. Curious if you've ever experienced this. Thanks again so much for your time and your teaching; just wanted to say I really appreciate it! :) Regards Joseph David's Reply to Joseph. Thanks for the great questions. We address both of them on an upcoming podcast. Here's the quick response. Yes, it is okay to take a break when you feel "burned out." However, you can get "burned out" in a healthy or unhealthy way. For example, after I edit for two or three hours, which I love, my brain gets "burned out." So I take a break and come back later, maybe even a day later, and I feel refreshed and filled with enthusiasm about writing and editing some more, because I love these activities. When I was in private practice in Philadelphia, I saw 17 patients back to back on Wednesdays. That way, I could have a three day weekend. Actually, I loved it and as the day went on, I got higher and higher. At the end I was exhausted, but exhilarated. I was never "burned out" because I loved what I was doing, and the clinical work was SO rewarding! However, sometimes I made a mistake and a patient would get very upset, sometimes angry with me, or felt hurt. THAT was when I got suddenly burned out and exhausted. But it wasn't because of my work, or the conflict, but rather my thoughts about it, which generally involved a combination of self criticism and frustration with the patient, both the result of distorted thoughts, generally Self-Directed and Other-Directed Should Statements. And THAT kind of "burned out" won't improve with a break. The answer is challenging and changing your own inner dialogue, as well as your dialogue with the other person, using the "failure" in the relationship as an opportunity to listen and support and create a deeper and more meaningful relationship. With regard to your second excellent question, we explored that in depth in the podcast, and also made it a problem for our listeners to think about. So tune in for the answers! This is a popular question I've been answering for more than 40 years, and the answers tell us a great deal about how cognitive therapy actually works. Thanks so much, Joseph! Subject: Relationship Journal Gem I Found Dan (a f

355: Relationship Problems: Be Gone! Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss relationship problems, and how to overcome them. We also give instructions on the Paradoxical Invitation, one of the most important and difficult techniques for TEAM-CBT therapists to learn. We started today's podcast interviewing Tania Ahern and Andy Persson who give a plug for the upcoming TEAM-CBT intensive from August 14 to 17, 2023 in Bristol, and incredible British city with an outstanding TEAM-CBT training program in store for you. Many notable TEAM experts will be presenting, including Drs. Leigh Harrington, Heather Clague, Marius Wirga, Stirling Moorey, Mike Christensen and many other notable teachers. Special thanks to Peter Spurrier for being a fantastic TEAM therapist and organizer! I will also be there virtually doing a keynote address, a Q and A session, and a live TEAM-CBT demo with a workshop volunteer. The amazing Mike Christensen will be my co-therapist. Hope to see you there! Go to TEAMCBT.UK for registration and more information. Today we focus on relationship problems, starting with a real example, which often makes for the best teaching. Rhonda recently spent time with her son and daughter-in-law to help with their new twin babies. Rhonda's daughter-in-law had a very difficult delivery, and was in the hospital for several weeks following the birth of the babies. Rhonda worked relentlessly cooking and cleaning for them, feeding the babies, changing their diapers, and comforting them, and providing help for the new mom, who was overwhelmed and fearful of bathing the babies, thinking she might hurt them when attempting to bathe them. As so often happens in real life, Rhonda ran into a severe conflict with her daughter-in-law and responded with anger, and we all so often do. She reveals how terrible she and her daughter-in-law felt, and how she saved the day after deciding to have a "redo" of the interaction, using the Five Secrets of Effective Communication. Rhonda, Matt and David described one of the most difficult therapy tools in TEAM-CBT, the Paradoxical Invitation Step, and contrasted it with the Straightforward Invitation. Rhonda also mentioned some podcasts for further information on the Relationship Journal and the Interpersonal Model in TEAM-CBT. There are even more, but here are some that might interest you. My book, Feeling Good Together, is also a must-read for anyone wanting to make profound changes in the way you connect with the people you love, as well as your patients if you're a shrink! # Podcast Title Min 054 Interpersonal Model (Part 1) — "And It's All Your Fault!" Healing Troubled Relationships 54 055 Interpersonal Model (Part 2) — "And It's All Your Fault!" Three Basic Assumptions 27 056 Interpersonal Model (Part 3) — "And It's All Your Fault!" Interpersonal Decision-Making and Blame Cost-Benefit Analysis 46 057 Interpersonal Model (Part 4) — "And It's All Your Fault!" The Relationship Journal 44 226 The "Great Death" in a Corporate / Institutional Setting 56 227 Echoes of Enlightenment 43 We finished today's podcast with some entertaining role-playing exercises, using the Five Secrets of Effective Communication in interactions with extremely difficult individuals. This gave me the chance to role-play some incredibly obnoxious and practically impossible to please. My favorite role! Enjoy! Warmly, Rhonda, Matt, and David

Grass Roots TEAM-CBT Completely FREE Practice / Training Groups Today we interview four courageous pioneers of free and low-cost TEAM-CBT for the masses, featuring Brandon Vance, MD, Patricia O'Neil, Ana Teresa Silva, DVM and Nicholas Santascoy, PhD. Many of you are already familiar with Brandon Vance and Heather Clague's awesome online Feeling Great Book Clubs which will start again, running from September 13, 2023, through December 6, 2023. The book clubs are popular and have gotten wonderful reviews. They are a fun and engaging way to structure your reading, discuss the book, see demonstrations, practice tools, ask experts questions and connect with others around the world who are working on Feeling Great – and no one is turned away for lack of funds. Sound interesting? You can learn more and join here. But you may not be aware of a growing number of fantastic totally free self-help groups springing up for people around the world. These groups offer training in different aspects of TEAM-CBT. For example, Patricia offers DAILY (!) practice sessions that focus on the use of the Daily Mood Journal. You can also join free 5-secrets practice groups groups that focus on changing habits groups that practice a variety of TEAM tools a book club focused on When Panic Attacks and more! All these groups are free and open to anyone worldwide. To see the growing list, go to https://www.feelinggreattherapycenter.com/free. This list is invaluable, and check the link from time to time because the offerings will likely continue to expand. Keep in mind that these are NOT therapy groups, but layperson-led self-improvement groups. Brandon and Rhonda remarked that these free groups are part of a heart-warming movement which continues the culture of generosity that David has created, starting with David's decades-long free weekly training groups for mental health professionals. The new self-help groups also carry the spirit of relating to others with deep empathy. The goal is to create an atmosphere of giving and support in mutual healing. A second goals is to learn to appreciate each other despite our differences. And so, the ripples that David has created continue to spread, and you can become a part of this process! Nicholas Santascoy is a research psychologist, academic coach and learning specialist who discovered Feeling Good in 2005. He found it tremendously helpful and years later, began working with a TEAM therapist who suggested Brandon's Book Club. When the book club reached the Daily Mood Journal section, he asked if he could start a free DMJ practice group, which he did, and it's still going on each week, more than two years later. He was thoughtful about the group's structure, making it clear to the participants from the beginning that he is NOT a therapist and that this is not therapy. It is simply a place to practice TEAM with support – an important disclaimer for any non-therapist running a practice group. In his groups, each person spends 10 minutes at the start working on some common task, like describing an upsetting event for a Daily Mood Log, or suggesting positive reframing for a negative thought or feelings, and so forth. Or they might go through a sequence starting with one negative emotion, one negative thought, one cognitive distortion, one positive reframe, and one positive thought. His group has also worked with the exercises described in the two free chapters on habits and addictions offered at the bottom of Dr. Burns' website. Nicholas described working with a man with intense performance anxiety who had an upcoming job interview with a panel of eight individuals who were evaluating him. He was intimidated and anxious, but reluctant to give up his anxiety for a number of reasons. First, he was convinced that if he didn't worry, he wouldn't prepare effectively. In addition, he was convinced that he needed anxiety to do his best during the interview. Nicholas encouraged him to test these beliefs with experiments. He discovered, much to his surprise, that he was still strongly motivated to prepare for the interview when he was feeling relaxed and confident. He also recorded his interview and reviewed it afterwards. He was surprised to discover that his best performance during the interview was when his anxiety had dropped to zero. Ana Teresa Silva is a Portuguese veterinary doctor who decided she wanted to work with people and became a coach in 2020. Ana Teresa developed a free Portuguese Five Secrets practice group in May of 2021. This quickly became an international group in English, free and open to anyone, and ran for two years and got rave reviews from participants. After that, she handed over the leadership to Linda Roth, M.Ed. This kind of group, in my (David's) opinion is incredibly important because learning the Five Secrets is a lot like learning to play the piano. It's possible to make beautiful music, but the Five Secrets are challenging to learn. Practice, combined with humility and the

353: The Inner Scoop on "No" Practice! The "Inner" and "Outer" Dialogues— The "Inner" and "Outer" Solutions As you know, I have created many powerful communication techniques, including the Five Secrets of Effective Communication and more. One of the additional techniques is called "No" Practice, and it's designed for people who have trouble saying "no," or setting limits with other people. Essentially, you do a role-play with a colleague or therapist who keeps pestering you with pushy demands, and you have to practice saying "No" in a polite but firm and assertive way. Sounds simple, right? But it's not! People have many reasons for not wanting to say "No." For example, you may be afraid of hurting the other person's feelings, or letting them down, or running the risk that they may get mad at you if you don't say, "Yes." In addition, you may feel like you'll miss out on some special activity if you say no, so you end up way over-committed. In this session, you will meet an exceptionally compassionate and highly trained young psychiatrist named Lee, who asked for help with a problem relating to some of his patients. My co-therapist is Dr. Jill Levitt, who is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California. Lee explained how he struggles with saying "no" when patients make inappropriate requests, like pushing for a medication they're addicted to, and wanting premature discharge from the inpatient unit when they have unrecognized safety issues. Instead, he seems to get drawn into long explanations of his thinking and why he's declining the other person's requests, sometimes for half an hour, and ends up frustrated when the other person still doesn't "get it" and with himself for spending the time. People often think that therapy is easy, and that people just need encouragement, advice, or behavioral practice to change the way we interact with others. But as you will vividly see in this session, that is often not the case, and things that may seem simple or obvious can seem almost impossibly difficult to learn. Why does this happen? Why is it so difficult for people to learn new and seemingly simple verbal skills? Well, to find the answer, we have to go back to the teachings of the Buddha and Epictetus, who taught us that our negative feelings do NOT result from what's happening, but from our thoughts. What does this mean? Well, Lee is an incredibly intelligent and compassionate young psychiatrist, and he's clearly highly motivated, and yet he seems very slow in learning how to say "no." Can his thoughts illuminate his apparent resistance to learning a new approach? During the session, Dr. Levitt reminded us of the fact that whenever you are involved in a conflict with someone, or any interaction for that matter, there are always two dialogues going on: the Inner and Outer Dialogues, and if you ignore either one of them, you may have difficulties triggering change. The Outer Dialogue involves what you say to the other person, and what they say next, and how you respond. For example, Patient says: "Doctor, I want to get discharged from the hospital." Lee says: "No, I can't do that because you'd be in danger and without a place to live. You'd be living on the streets, and it wouldn't be safe for you." Patient (who is in a state of psychosis) responds: "No doctor, I'll be okay, because I'm living with Michael Jackson." Then Lee tries to explain his thinking again, and then the patient asks to be discharged from the hospital again. And this cycle repeats itself many times, over and over, for as much as an hour. And they both end up frustrated and a bit miffed. Why is it so hard for Lee to say no in a kindly way and then move on to some other activity? That's where the Inner Dialogue can be so important. It appears that Lee has two types of distortions that interfere with his ability / willingness to say "no." Self-Directed Should Statements. Lee appears to believe that he "should" be able to explain his thinking to any patient. He wants to convey respect, responsiveness, and care when denying a request. This is, of course, an expression of his high standards, his compassion, and his desire to communicate clearly to his patients. But, as is so often the case, Lee takes this goal a little to far, think he should "always" be able to do this, regardless of how psychotic or confused or demanding a patient might be. Essentially, the healthy pursuit of excellence as a psychiatrist has gone a little too far and has arguably morphed into a self-defeating kind of medical perfectionism. Self-Directed Shoulds typically trigger feelings of guilt, shame, anxiety, and inadequacy. They are often accompanied by several other distortions, including All-or-Nothing Thinking, Mind-Reading, and Self-Blame, to name just a few. Other-Directed Should Statements. Lee appears to think that his patients "should" understand and acknowledge his thinking if he's being reasonable and realistic. He may

Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? 2. How do you help clients control their anger? 3. How can you use TEAM if you are only allowed to see clients for 15 to 20 minutes? 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? The answers on the show are live and will differ considerably from the information below, which is primarily to document the full questions that the fans submitted. 1. When a client expresses concerns in multiple areas of their life, such as mood, relationships, and habits, is there a particular hierarchy that you follow? In particular, what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? I'm particularly interested in your perspective on the hesitancy within the therapeutic community to treat individuals with co-occurring depression and anxiety, alongside marijuana habits or addictions that they do not wish to address. How do you approach and navigate this complex situation, and what are your thoughts on effectively addressing the client's mental health concerns while considering the impact of their substance use on the therapeutic process? With the increasing acceptance and use of medical and recreational marijuana, do you believe it is still morally or ethically justifiable to turn away clients who use marijuana and express no desire to quit? It appears to be a prevalent practice, and I would appreciate your insights on this matter. Casey Zeigler Matt: Great Question, Casey! For me it depends on the pattern of usage and reasons for using Marijuana. For example, if someone gets anxious and then uses marijuana to reduce their anxiety, then I'd be unable to help them treat their anxiety if they weren't willing to set marijuana aside, for a while, to practice some new methods. I might ask, 'imagine you could feel calm and relaxed, but didn't need marijuana to accomplish this. What would it be worth to you, to have that ability? For example, would you be willing to go through an uncomfortable period of deprivation and awkwardly failing at methods to reduce your anxiety, in order to get there?" David: in a Harvard study years ago, individuals with benzo addictions were randomly assigned to two withdrawal groups: Klonopin-only slow withdrawal, and Klonopin slow withdrawal plus group (I think) CBT. The success in terms of numbers of patients who successfully withdrew was far greater in the CBT group. Or, if they used Marijuana to avoid feeling depressed, I'd wonder if they would be willing to set that aside temporarily, in order to prove that they could feel great without Marijuana. My approach is to identify what the patient wants and to be realistic about the approach to achieve those results. There's also long-term data showing that daily use of marijuana is associated with worse mental health, in the long-term. David: I think these decisions have to be individualized, and consultation with a colleague when in doubt can be very helpful.2. I have a question about anger. How do you help clients control their anger? 2. How do you help clients control their anger? I was going to mention it to you as a good topic to cover anyway in a podcast, because it is the one emotion that has not particularly been dealt with in the podcast. This is ironic, since anger is apparently the one emotion we don't acknowledge!). I did a search and there were only two that touched on it and neither covered how someone can learn to control their anger. I have had several clients who talk of how they snap at their children or partners and want to learn to deal with it. Does it work to use a daily mood log in these cases, as the emotions are more like explosive reactions, and maybe less easy to defeat with distortion-free positive thoughts? Thanks Andy Perrson Matt: Thanks, Andy! I can help people overcome anger, but they probably don't want the type of help I can offer! David: individuals beta testing the Feeling Good app have shown dramatic and rapid anger reductions. In a group or individual therapy context, I would use TEAM systematically. I do not typically "throw methods" at feelings, problems, diagnoses, etc. I treat humans, finding out what's going on in their lives, conceptualizing the problem, melting away resistance, and choosing methods based on all of that. All that being said, the CBA or Paradoxical CBA are almost always the first techniques with anyone who is angry: vignette about the angry doctor and the angry banker. 3. Do you have any tips to use TEAM skills for very short time session(about 15 to 20 minutes). I am not yet running my private practice. I am employed in other person's private clinic as a psychiatrist and usually prescribe pills and the time per patient is

A Second Visit to David and Jill's Tuesday TEAM Training Group at Stanford Last week, you "sat in" on our Tuesday training group at Stanford and learned about two of the four most important techniques in the treatment of perfectionism, or any other Self-Defeating Belief. (For a list of 23 common Self-Defeating Beliefs, click here.) The Cost-Benefit Analysis (CBA): You weight the advantages against the disadvantages of trying to be perfect. The Semantic Technique, to find out how to word your new belief if you decide that your perfectionism belief isn't working for you The purpose of those two techniques is to provide intellectual change. Tonight, you will join us again as we aim for emotional change at the gut level. This will be our agenda for the students in the class you will observe: 1. Please describe an example of a specific time when you felt upset due to perfectionism. What were your negative thoughts? How were you feeling? What was happening? 2. Downward Arrow Technique: Suppose you weren't perfect, or you failed or screwed up in some way. Why would that be upsetting to you? What would that mean to you. 3. Externalization of Voices (Optional: possibly we will do this, maybe just mention it, depending on time.) 4. Experimental Technique / Examine the Evidence 5. Feared Fantasy 6. Wrap-up and Teaching Points As you can see, some exercises will be performed in the large group, with everyone present and contributing, and some exercises will be in the small, breakout groups. The small groups provide more time for participants to practice. We plan on recording both of the small groups so you can observe the training techniques we use for mental health professionals. Last week our focus was motivational, so we asked: is to your advantage to aim for perfection? How will this mind set help you and how will it hurt you? Tonight, one of the key techniques will focus on TRUTH: is it TRUE that you need to aim for perfection? We will be using the Experimental Technique and / or Examine the Evidence to see if we can answer this question. In addition, we will go into an Alice-in-Wonderland Nightmare World and meet an imaginary monster who claims superiority because she or he really is perfect and really has achieved incredibly more than anyone. This can sometimes help us answer two questions: Is it possible to be or become a "more worthwhile" or "superior" human being? Would it be desirable if you could? I hope you enjoyed this new format of "dropping in" on my Tuesday training group at Stanford. Let Rhonda and me know what you think. It was just an experiment, and we want to know what you might have liked or disliked about it. Thanks! Our free weekly Tuesday and Wednesday training groups are open to therapists of all persuasions from all around the world. For information including the requirements, you can contact: Tuesday night training group with David and Jill, Contact Ed Walton: [email protected] Wednesday mid-day group with Dr. Rhonda Barovsky and Richard Lam, Contact Ana Teresa Silva: [email protected]

Tuesday TEAM Training Group at Stanford In 1980 I published an article entitled "The Perfectionist's Script for Self-Defeat" in Psychology Today Magazine, in an attempt to get some publicity for my (then) new book, Feeling Good. At the time, it was the cover feature and became the most popular article in the history of that magazine. Perfectionism is definitely one of the most common themes I have confronted in my clinical work and teaching over the past many decades. If you would like to take a look, you can check it out at this link. They had fantastic colorful illustrations, including a bleeding dart board wtih a dart in the bullseye, and sadly you'll only get the text in black an white at the link. It seems that almost everyone succumbs to this mindset from time to time, and it can cause many negative moods. But at the same time, the attempt to be perfect brings many benefits at the same time. This can be a dilemma. The next several podcasts will be based on a two-week perfectionism class I developed for the weekly Stanford TEAM-CBT training group that I direct along with my esteemed colleague, Dr. Jill Levitt. This podcast class is suitable for therapists and non-therapists alike. These podcasts will give you the opportunity to "attend" the group and witness the procedures we use to train therapists. You will have the opportunity to practice the same techniques the students will practice when we break into small groups. I would encourage you to turn off your podcast temporarily so you can practice the exact same techniques on your own when we break into small groups for practice. For example, in the first class you are about to hear, we will spend 20 minutes doing a Cost-Benefit Analysis for perfectionism. You will find a blank CBA if you click HERE. I would encourage you to practice the same thing for 20 minutes during each practice group. During the first breakout group, you can spend 20 minutes listing the advantages and disadvantages or perfectionism. Ask yourself, "how might this mindset help me? And how might it hurt me?" You can use this blank CBA. After listing the advantages and disadvantages, weigh them against each other on a 100-point scale, and put two numbers adding up to 100 in the two circles at the bottom. For example, if the advantages are greater, you might put 75 and 25 in the two circles. If they are about equal, you can put 50 and 50. And if the disadvantages are somewhat stronger, you might put 40 and 60 in the circles. Remember, it's not the number of items in the columns, but how you feel about them overall. Sometimes, one powerful advantage might feel much more important than the five disadvantages, and sometimes one powerful disadvantage might feel more important than numerous advantages. Part of the fun (hopefully) of this podcast is that you'll get to hear the questions and suggestions of many of the 45 or so students in the class that night. As you will hear, we have a multi-cultural rainbow group with therapists from around the world. We started Part 1 of the Perfectionism Master Class with these important two questions: What is perfectionism? How would you define it? What is the difference between perfectionism and the healthy pursuit of excellence? Then we went on to the Cost-Benefit Analysis (CBA) in small groups. I forgot to record my small group, but you will hear a long list of advantages and disadvantages discussed when the large group reconvenes. As I mentioned about, I would encourage you to do your own CBA while we are in the small group. When we reconvened in the large group, we talked about the therapeutic strategies you would use once the patient has balanced the advantages against the disadvantages of perfectionism, including Sitting with Open Hands with patients who are reluctant to give up their perfectionism. I also discussed my strategy of aiming for "average" or even "below average," as opposed to perfection. As I've aged, I've actually lowered my standards so low that everything looks pretty awesome to me! And my productivity, as well as the quality of my work, has actually improved greatly as a result. This paradoxical strategy may seem foolish to many devoted perfectionists at first, but it has proven exceedingly powerful and helpful in my life since I screw up so often! Seeing failures and mistakes as opportunities to learn and grow, rather than signs of failure or inadequacy, has been huge for me. Joy seems to spark my creativity and productivity way better than feelings of shame and anxiety. After the CBA exercise, we used the Semantic Technique to revise the perfectionistic belief, like, "I should always try to be perfect," or "My worthwhileness as a human being depends on my performance (or achievements, etc.). The goal, as you will see, is to reword the belief with this goal in mind: Your new belief can reduce or eliminate most or all of the disadvantages or perfectionism while preserving most or all of the advantages. We DID record Jill's smal

Six Cool Ask David Questions from Carlos and Greg Carlos asks: 1. Are your tools available in Spanish? 2. Is there any evidence that TEAM can help patients with Borderline Personality Disorder (BPD)? 3. How do you get patients with BDP to stop jumping from problem to problem? 4. How do you get them to stop endless venting during therapy sessions? Greg asks: 5. What comes first, thoughts or feelings? 6. Can't a genuinely negative or tragic event directly cause negative feelings, without having to have negative thoughts? Dear Dr. Burns: 1. I would like to use your BMS but I mostly work with patients in Mexico. Has there been any standardization of your tests in any Spanish speaking country? David and Rhonda address this. You can email Victoria Chicural, who is one of the TEAM-CBT leaders in Mexico (along with Silvina Carla Bucci), at [email protected] and ask her about access to TEAM-CBT forms that have been translated into Spanish. 2. I am wondering if TEAM has proven to be effective in the treatment of BPD (Borderline Personality Disorder). I use it a lot, but I have found quite a few challenging elements. David describes his published work, indicating an excellent response to TEAM-CBT in patients with BPD. 3. People suffering from BPD usually have trouble prioritizing tasks and activities. The same happens when it comes to setting objectives. Because of their emotion dysregulation, they usually decide to work on one objective, and later on, they sometimes say: "Well, this objective is not THAT important anymore. Let's do another." For them, doing the specificity part can be really challenging because their perspective changes very quickly and they usually go back to the former objective when they're being challenged by a similar situation!!! How do you get them to prioritize objectives and not to switch from one to another so quickly? Or, do you think I could be making a mistake when setting objectives? David describes the strategies he has developed for coping with this type of clinical problem, including the development of his Concept of Self-Help Memo that he required every new patient to fill out prior to their first therapy session. 4. BPD usually come up with a lot of material to the session. They may be facing complex PTSD but also dysfunctionality at work, at school, etc. They want to say everything in a single session even if we have agreed to follow one single objective. Many sessions turn into endless talking without getting anywhere - some of them argue they need to vent out what they feel - but as time goes by, they complain that therapy is not working! How do you deal with a patient who is overwhelmed with numerous factors in a session where you have a previously set objective? David describes the strategies he has developed for coping with this type of clinical problem, Carlos S Bouchanm, Clinical Psychologist David's Response Hi Carlos, I think these would make for excellent Ask David podcast questions. If so, can we use your name and read your questions? I reported on the effectiveness of the forerunner of TEAM in the treatment of BPD is the Journal of Clinical and Consulting Psychology in the 1990s. TEAM was specifically developed for this population, since 28% of my patients in Philadelphia had BPD. In the live podcast, I will address the excellent questions you asked about treating individuals with BPD. Thanks! David From: Greg Hi David, Thanks for everything you do and for the great podcast! I have another couple questions possibly for the "Ask David" segment of the podcast. 5. Can you say some more about automatic thoughts? CBT is based on the idea that we're thinking things that produce feelings, but with an automatic thought it just kind of pops up and is there. It's not like actively, intentionally thinking it. Other schools of thought (for example Somatic Experiencing) posit that feelings from the nervous system occur first and that the thoughts are actually the product of that, which seems to run counter to the CBT view. This has been a little challenging and confusing. David and Rhonda discuss this, including new research on the causal links between emotions and thoughts. 6. How do you apply TEAM CBT to worries about real and true things, like a real diagnosis or a tragic event? It would seem that it's not just one's thoughts about it, but an actual threat or upsetting event causing feelings because that is simply how one would feel about. Maybe the thinking is accurate? This, too, has been particularly challenging and confusing, so I'd love to hear more on this. David and Rhonda discuss how thoughts trigger all of your feelings, even after a genuinely tragic event. Thank You, Greg L. David's Response Thanks, Gary. These are great questions, and perhaps we can address them om an Ask David podcast! There are strong, clear answers that might be interesting or helpful, as nearly everyone has these questions! Best, david Thanks for joining us today! Rhonda, and David

A British Family Doctor on Burnout, Recovery and T.E.A.M in 10 Minute Consultations! Today, Rhonda and David interview Dr. Tom Gedman, a family doctor in England and one of the founders of TEAM-UK, along with Dr. Peter Spurrier who has also been a guest on a Feeling Good Podcast. Rhonda started the podcast with a kind email from an enthusiastic podcast fan who loved our podcasts with Dr. Mark Noble (#167 and #265) on the "Brainology" of TEAM-CBT. He said these podcasts were "pure gold" and appreciated a look behind the curtains to see how TEAM actually worked at the level of the brain. Tom described his burn out episodes, which started during his third year of medical school, resulting from a familiar theme—the belief that he was inferior and just not "good enough." His inferiority complex was a severe, total body experience, with "horrible thoughts" for six months. After he recovered, he worried about going into that state again. And the stress returned again during his medical internship. He explained that as a General Practitioner (GP) in the British medical system, you only have ten minutes for each patient, and felt like all the pressure was on him to get it right, and stated that "the pressure broke me." In Britain, you can get free therapy as a GP, and went to Dr. Peter Spurrier for help. Peter was using the TEAM-CBT he'd learned when he came to California the previous summer for one of David's four-day intensives, and Tom described him as "a natural. We made a deep connection right away and the Positive Reframing really clicked!" Tom's negative thoughts included: 1. I'm not good enough. 2. I'll fail my patients. 3. I'll do them harm. 4. I'm not smart enough. 5. I'll never be normal. He explained that the last thought triggered feelings of hopelessness, which really was the worst emotion of all. He discovered the Feeling Good Podcasts and listened to about 200 of them in just two weeks! And after two or three hour-long sessions with Peter, he recovered and actually felt like he was on a "high" for about six months. He says, "I had almost limitless confidence!" Then he had an as-predicted relapse which disappeared after a 30-minute tune-up with Peter. Tom said that the he'd always admired Carl Rogers, who emphasized empathy, and began using the Five Secrets of Effective Communication in his medical practice. This helped him clinically, and he discovered that "you don't always have to 'help;' skillful listening is often enough. For example, patients often have to wait for months to be seen medically, and they're angry and frustrated at first. I acknowledge their frustration and let them know that I feel sad as well. This calms them down immediately." He also gave an example of how trying to "help" a man with agoraphobia simply put the man into a state of rage. "I tried to convince him that exposure would be good for him, but we just got into an argument, and he threatened to report me to the authorities to have my medical license revoked! That experience taught me something really important about 'helping.' Many people have intense resistance and just want to be heard and understood." For example, one of his patients was in tears because of her father's Parkinson's Disease. The patients was helped greatly by learning He that her emotional distress was actually her love for her father, and she suddenly felt proud of her "symptoms." Another patient with a massive opiate addiction opened up about a severely disturbing childhood incident he'd never before talked about, and then was able to cut his opiate use "way down." We also discussed Tom's new plans for his medical practice, working with indigent individuals, and explored the possibility of testing my Feeling Good App with this population for free to see how they would take to it. He discovered that a group in England has "stolen" my names, and also have a "Feeling Good App" and a "Feeling Good Podcast," which causes me considerable distress. We may have to rename our app the "Real Feeling Good App," or some such name! Dr. Tom can be reached at BlueprintMedical.co.UK or at DrTomGedman.com. Tom, Rhonda, and I would also like to urge any listeners in or near England to attend the upcoming four day TEAM-CBT intensive in England from August 14 – 17th. This four day training conference will be awesome and only costs 440 pounds. Participants will receive 38 CPD points as well as credits in the TEAM-CBT certification program. For more information about the conference, go to www.TEAMCBT.UK. Thanks for listening! Rhonda, Tom, and David

Live Therapy with Veena: Part 3 of 3 Relapse Prevention Training In the last two weeks, you heard Parts 1 and 2 of our live work with Veena, a young woman who felt devastated for fear she would be unable to conceive. One week after the work with Veena, I received a request from colleagues to have a Tuesday evening session at Stanford on Relapse Prevention Training (RPT). Jill and I decided to demonstrate the RPT techniques with Veena so we could demonstrate this technique in real time with a real situation. Prior to the role play demonstrations that you will hear, I presented the highlights of RPT with four PowerPoint slides. Here are the guidelines when working with a patient who is depressed: 1. Do RPT immediately when the patient has recovered, and before you discharge the patient. This means that the patient's scores on the Brief Mood Survey will be low and the patient is feeling terrific. If the patient's scores are still elevated, they have still not recovered completely, and need more therapy work. 2, Inform the patient that the likelihood of relapse is 100%. Relapse is defined as one minute or more of feeling upset. By that definition, most of us relapse frequently, perhaps every day. However, these relapses do not have to be a problem if you anticipate them and know how to deal with them. 3. When they relapse, they will typically experience two kinds of negative thoughts. First, the negative thoughts that had previously will return. So, in Veena's case, she will again be probably telling herself that "I cannot be happy without a kid," "my in-laws will judge me and sideline me," and so forth. Veena imagined having a relapse and prepared a Daily Mood Log prior to the training group. If you would like, you can review it here. 4. In addition, nearly everyone who relapses will have thoughts like these: This relapse proves that the therapy did not work. I'm a failure. I'm a hopeless case and I'll be depressed forever. When I thought I'd recovered I was just fooling myself. I've been he same worthless person the whole time. My recovery was just a fluke. It's crucial to challenge these thoughts with the Externalization of Voices technique ahead of time, BEFORE the patient relapses. That's because they can easily see the many distortions in these thoughts when they're in a good mood. But if you don't do RPT, and wait until the patient relapses, the patient may be devastated, or even suicidal, and you, the therapist, will have lost much or all of your credibility. In contrast, when I prepare the patient for relapse, I tell them that their first relapse will actually be a GOOD thing, because when they pull out of the relapse, then they'll know for sure that they have the tools they need to defeat their negative thoughts whenever they're upset for the rest of their life. And that is the crucial difference between FEELING better, which is what happens the first time they recover, and GETTTING better, which is what happens when they recover from their first relapse. I had them record their role-playing with me defeating their relapse thoughts with Externalization of Voices, and tell them to listen to that recording whenever they relapse. And that if they can't pull out of the relapse on their own, they can always come back for a session or two for a tune-up. I also tell my patients I hope they will relapse often, because if they don't ever relapse, I won't ever see them again, and this is a sad thought since I've just gotten to know them and really like them. When I was in clinical practice, relapses were rare. Only a handful of patients ever returned for a tune-up, and it was almost always one or two sessions and then they were on their way again. Of course, this was not a controlled outcome study, since I was in private practice, but it was definitely encouraging. In summary, RPT can save you from a lot of grief when your patients relapse, and it may even save the lives of some of them. It doesn't take long, 30 minutes or so at most, but the payoffs can be tremendous. Thank you for listening today! Veena, Rhonda, Jill, and David

Live Therapy with Veena: Part 2 of 3 Last week you heard the first half of the session with Veena, a young woman who was devastated by a medical problem that may make it difficult or impossible to conceive the child she is dreaming of. Today, you will hear the inspiring and dramatic conclusion of her story, along with the feedback comments from the individuals in David and Jill's Tuesday training group who witnessed the live work. A = Assessment of Resistance Jill asked if she felt ready to roll up her sleeves and get to work on some aspect of what she'd been telling us, and she was. Jill then asked what she was hoping to get from tonight's session. If we could offer a "Miracle Cure," what would that look like? She said, "I'd feel a lot less guilty and responsible, so I would no longer feel like the problem was my fault. I'd know that I did my best and that I can be okay even if people don't like me or judge me. Jill asked the Magic Button question, and she said that she love to see her guilt go all the way to zero, but not her many other negative feelings, like depression, anxiety, inadequacy, self-consciousness, hopelessness, upset, insecurity and self-doubt. With Positive Reframing in mind, we listed many of the positives in these negative feelings, including: Sadness. This feeling shows that I care for people and want to give them the best. It shows that I also care for my own dreams of having a baby. And it shows how much I love my mother. Anxiety, worry. This is a warning signal, reminding me to be alert and do my best, and do what the doctors require. Guilt. Shows that I'm humble and willing to be accountable and examine what I've done and look at my own mistakes. Self-Consciousness. Protects me by making me cautious so I don't just blurt out everything. Defectiveness. I see my flaws, and allows me to get closer to others, and to feel happy for the success of others. Hopelessness. When I told my husband I felt hopeless, he became SO supportive. Also, I gave myself some space so I could create an action plan. You can see the goals Veena set for each emotion on her Daily Mood Log if you click HERE. Veena with her in-laws M = Methods During the methods phase of the session, we used a variety of techniques, especially Externalization of Voices with the Acceptance Paradox, Self-Defense, and the CAT (Counterattack Technique.) We did quite a few role-reversals, which is typical, before Veena got to wins that were "huge." There were lots of tears and laughter, and eventually Veena blew all of her negative thoughts out of the water. It was inspiring to observe this process, and to be a part of it. You can see her final Daily Mood Log if you click HERE. I think it is fair to say the Veena experienced a kind of enlightenment which was profound. Final T = Testing You can see Veena's end-of-session Brief Mood Survey and Evaluation of Therapy Session if you click HERE. You can also see her final Daily Mood LOG if you click here. Our work with Veena was some of the most inspiring work that I can recall. It was tremendously mood-uplifting, and took on a spiritual quality. You will have to listen to the session to get a feel for how majestic it was. But in my opinion, Veena did not just recover, but she achieved enlightenment, which including discovering how to love herself and her extended family as well! The following is an email I sent Veena the next morning: Hi Veena, Thanks. You were totally awesome last night, thanks so much for your contribution. I am sure the podcast will reach huge numbers of people and make a big impact on peoples' lives. I cannot remember a more exciting and loving session. We will see what the groups thinks in the feedback. I did not copy or read the chats during the session, but perhaps you or Jill did. . . We will invite you to join us on a podcast recording to get some follow-up information from you, as folks will be very interested, for the two-part podcast. Yes, I think we really were walking on holy ground last night! Thanks so much for making that happen! I am trying to recall (and will do more of this) the teaching points from last night, and a few seem important to me. They seem awfully basic and simple, but still of towering importance and have to be "seen" to be understood at a deep level. 1. In TEAM, even when a problem is "real," it is still our thoughts that create our emotions. Our thoughts really DO create all of our feelings. 2. Those thoughts can be subtly distorted in all kinds of ways and seem determined to trick us into believing things that are not true. And even super smart people, like Veena, can be fooled. 3. We are not aiming for improvement, although that is obviously desirable, but a dramatic transformation of the human spirit and outlook. 4. Warmth, tenderness, and compassion—for others and for yourself--are important and powerful. 5. There is a strong mind-body connection, and healing your soul can often help to heal your body. 6. Good therapy can sometimes b

Live Therapy with Veena "It's all my fault!" The star of today's 2-part podcast is Veena Mulchandani, a 28-year old certified Indian TEAM therapist who has just learned that her difficulties becoming pregnant result from an infection in one of her fallopian tubes. Veen feels devastated and fears that she might never be able to have a child. She also fears that her husband and extended family will judge and reject her, since there is so much pressure in Indian culture for women to have babies. And although she has many medical options, including IVF, she is intensely fearful that they might not be successful. My beloved colleague, Dr. Jill Levitt, will be my co-therapist for today's session. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California (www.feelinggoodinstittute.com). Today you will hear part 1 (T = Testing and E = Empathy), and next week you will hear the exciting conclusion (A = Assessment of Resistance and M = Methods), along with some follow-up. Part 3 will be the Relapse Prevention Training we did one week after treating Veena. Jill and I treated Veena in our Tuesday evening training group at Stanford. We feel that personal work is an essential part of the training of any therapist. Veena with her two very beloved nephews who she considers being a mother to T = Testing and E = Empathy At the start of the session, we reviewed Veena's Brief Mood Survey just prior to the start of the session. You can review it if you click on it here. Veena was tearful and said that to make matters worse, her mother has been recently diagnosed with brain cancer, and although she is doing "okay," she is not doing "great." Veena explained that she has always dreamed of being a mother, and feels like she is lettinhttps://feelinggood.com/wp-content/uploads/2023/04/01-BMS-wt-ETS_veena-1.pdfg down the many people who love her and want to see her have a baby. She and her husband first talked about having children when Veena was 24, but they decided to defer that for a few years because of the intense demands of her graduate schooling. Now Veena is blaming herself, thinking she "should" have gotten pregnant when she was 24. I mentioned to Veena that my parents tried but were unable to create a pregnancy, so they finally adopted 3 children. Then I came along unexpectedly, after they had given up. I also said that I've treated many women who felt like they couldn't become pregnant, who then became pregnant. You can listen to the dramatic podcasts featuring my session with Daisy and her husband, Zane (#79 and #80) as well as podcasts 268 and 269 featuring a session with Carly (Click here for list of podcasts with links). Both women became pregnant shortly after those sessions, and I hope we can do the same for Veena! However, the key is overcoming the tremendous despair, shame, anxiety, and disappointment that the woman feels, so that the body can heal and prepare for the pregnancy. You can see Veenas partially completed Daily Mood Log if you click here. As you can see, her negative feelings are extreme, and she is telling herself that I may never be a mother. I will ruin Sumit's (her husband's) life with her. My marriage may go "down the line" because of the absence of a kid. It's all my fault for postponing the pregnancy when I was 24. My in-laws, who love me so much, may start ignoring me because I cannot give them an heir. I will always be looked down on and sidelined by my own people. My mother is ill, and I will not be a good daughter if I cannot give her a grandchild. There is no meaning to life without children. My own body cannot suffice for my baby. Her belief in these thoughts ranged from 60 to 80 or more, and she rated most at 100%. Veena with parents I asked Veena how she was feeling after opening up in front of so many colleagues in the Tuesday group. She said she felt sensitive and exposed, and was afraid they don't understand and will also judge her for not starting earlier with attempts to become pregnant. Although we were still in the Empathy phase of the session, I suggested she might want to do an experiment to find out how they were feeling. Although this idea made her anxious, she asked quite a number of the Tuesday group members how they felt, and received an outpour of warmth, love, tenderness, and support. We asked Veena how we were doing in terms of Empathy. Did we understand how she was thinking? How she was feeling inside? And did she feel accepted. She gave us an A+, and so we were ready to move on to the A = Assessment of Resistance, which you will hear at the start of next week's podcast. Thank you for listening today! Veena, Rhonda, Jill, and David

Making Space for Grief Featuring Thai-An Truong, LPC, LADC Today, we feature a popular podcast guest, Thai-An Truong who joins us from Oklahoma. Thai-An is a level 5 Certified TEAM therapist and trainer who specializes in post-partum problems as well as anxiety disorders, with a special focus on OCD. Today Thai-An describes a TEAM-CBT technique to help with grief. She believes that empathy is always crucial, and emphasizes that people who have lost a loved one need to be encouraged to express and accept their feelings and to make space for their grief. However, because empathy alone may not be enough, it is often helpful to go beyond empathy and offer specialized techniques to help the patient deal with feelings of grief and loss. In her work specializing in women struggling with post-partum depression, she has seen many women grieving over a loss—such as the loss of a pregnancy, or the loss of a parent when their child is young, or the loss of an infant at birth, or during the first couple months after delivery. She said that the entire TEAM model can be invaluable, including the initial Testing and Empathy, the Daily Mood Log to detect the grieving patient's (often distorted) negative thoughts, as well as the Assessment of Resistance (the positive reframing step, and the Methods. Healthy grief is often complicated by feelings such as depression, guilt, anger, and more. These feelings can complicate and get in the way of healthy grieving. For example, Rhonda treated a woman who was struggling with guilt over the death of her son, who was in great pain because of advanced, metastatic cancer. At one point, she told him that it was okay to "let go," and her son died shortly after that. But then, she felt guilty and blamed herself for his death, thinking he might have lived several more days if she had not said that. Thai-An said that losing a son or daughter is one of the greatest pains a parent can have. You may beat up on yourself with "I should have done X" or "I shouldn't have said or done Y." But these negative, self-critical thoughts and feelings will nearly always be expressions of your core values as a human being, and your love for the child you lost. This can sometimes be eye-opening, and a relief for the person who is grieving. Thai-An has struggled with grief. She told us about the loss of one of her best friends 16 years ago. He was like a brother, a young man with bipolar manic-depressive illness. At times during manic episodes, he would get high and go out "teaching" on the streets. During one of these episodes something tragic happened—Thai-An was unable to find out what—but her friend was found dead in an alley. Thai-An felt a profound sadness and regret, and to compound the problem, her friend's mother cut ties with Thai-An, who didn't even know if a funeral was held or was able to ask any questions about what happened to him.. Thai-An felt understandably hurt and angry,. She recently found out he was buried near a Buddhist Temple in Houston, Texas. She emphasized the value of maintaining a ritual with the person who has died so as to continue the relationship. For example, a woman had a beautiful baby boy who died of an overwhelming infection shortly after he was born. This woman loves nature, and thinks of her son whenever she gardens. For example, when she sees a little bird, she thinks, "that little bird looks just like him!" Thai-An feels that a wide variety of rituals can nurture the bond with the person who died. You might light a candle, or even bake a cake for the baby or person you have lost. The goal is not to achieve some kind of "closure" that is so often emphasized in the media, but rather to continue a positive and meaningful relationship with the person you have lost. Thai-An illustrated a therapeutic technique she calls the Grief Method that involves doing a role-play with the person who has died. The therapist first gathers messages that the grieving patient would like to share with their deceased loved one. The therapist then takes on the role of the patient as the patient takes on the role of the person who has diedThis gives the patient the chance to have a conversation with the love one they have lost. In the following role play, Rhonda played the role of Sam, the young man who died of overwhelming cancer, and Thai-An played the role of his mother, who was grieving and feeling guilty about her son's tragic death. Thai-An (as Mother): Hi Sam, I really miss you every single day. Rhonda (as Sam): Hi Mom, you're the person I miss the most. Thai-An (as Mother): I'm sorry we had an argument shortly before you died. Rhonda (as Sam): It's no big deal. . . We got into little fights pretty often. . . but we always got over it. Thai-An (as Mother): I regret that I left when the doctor told me to leave the room. I should have stayed, so I could be with you when you died. Rhonda (as Sam): I understood that they pushed you to leave the room, and I know that you would have stayed if t

The Invitation Step in Family Life: "Dad! Don't give me that psychology crap!" Today we are joined by our beloved Mike Christensen and his wonderful daughter, Caelyn, for a discussion of one of the humblest but most important and challenging tools in TEAM-CBT, the Invitation Step. We will focus on how this can be important in family life as well. Caelyn will be entering college in the fall, and plans to major in psychology, but she has already picked up a lot of TEAM-CBT from her dad. We'll tell you more about her at the end of the show notes. The invitation step is the bridge from the E = Empathy phase of TEAM-CBT to the A = Assessment of Resistance, but you don't issue an invitation until you get an "A" in Empathy from your patient. This generally takes about 25 minutes or so with a new patient if you empathize skillfully using the Five Secrets of Effective Communication. There are two types of Invitations: the Straightforward and the Paradoxical. The Straightforward Invitation is for reasonably cooperative and motivated individuals who are struggling with individual mood problems, like depression and anxiety, and it's fairly simple. You simply say something along these lines: Jim (or whatever the patient's name is), you've told me some pretty heartbreaking and painful problems you're confronting, including X, Y, and Z, and I'd love to help you change the way you've been thinking and feeling. I'm wondering if this might be a good time to roll up our sleeves and get to work, or if you need more time to talk and vent, because that's important and I don't want to jump in before you're ready. Typically, the person will say "I'm ready," and you're all set to set the agenda for the session and reduce the patient's resistance to change using the many familiar TEAM-CBT techniques, like Miracle Cure Question, Magic Button, Positive Reframing, Magic Dial, and more. The Paradoxical Invitation is for patients who seem unmotivated or even oppositional, and is intended for patients who are struggling with Relationship Problems or Habits and Addictions. Unlike the Straightforward Invitation, your assumption is that the patient probably is NOT asking for help, but just wants to vent, so you might say something along these lines: Sarah (or whatever the patient's name is), you've told me some pretty upsetting things about your conflict with your sister ever since you were young. You say she constantly criticizes you and says things that aren't really true, and that you've tried everything, but nothing works. For example, she insists that you look down on her because you have a PhD, and she didn't graduate from college, and when you tell her that's not true she just gets enraged. I can understand how frustrating that must be for you. I've got some really cool tools that might help you turn things around and develop a more loving relationship with her, and I think you'd really learn these tools quickly because you're clearly very smart, but I'm not hearing that you're asking for that. I'm thinking that you mainly wanted to let me know how difficult and impossible she is. Am I reading you right? I'd love to work with you on your relationship, but would totally understand if that isn't what you're looking for. So, in the Paradoxical Invitation, you're asking the patient to put their cards on the table and acknowledge that they're NOT looking for help. This prevents a power struggle and you can ask them if there's something they DO want help with. At the start of today's podcast, Mike pointed out that the Invitation Step is not only important in therapy, but in family life as well. For example, a lot of parents ask him, "How do I help my teen?" Well, the first answer is to stop trying to help and use the Five Secrets of Effective Communication to listen and understand where your teen is coming from. This is actually hard to do, because so many parents struggle with the compulsion to throw "help" at their kids, and this usually just creates a lot of tension. At the same time, Mike emphasizes that many parents ask, "Well, what do I do when I'm doing empathizing?" Mike says, "That's the time to issue your invitation. If I don't do that, Caelyn gets irritated and says, "Don't' give me that psychology crap!" If I jump in and try to help or give advice (which is what all parents do almost all of the time) it just ends up in a power struggle. Mike sometimes asks this question: "Did you just want to get that off your chest? What do you want going forward?" Mike and Caelyn did some role-playing to illustrate how this is done, including bad parent technique and excellent parent technique. Caelyn described a disturbing interaction with an angry customer where she works, and Mike first played the "bad dad" and then the "good dad". Caelyn was delightfully wise and skillful and is heading for a great career in counseling or psychology. For more on this topic, you might want to listen to the podcast #164 on "How to help and how NOT to help!"

The Outer Bully Featuring Matthew May, MD Today we are proud to be joined again by our old pal, Matthew May, MD. This is a special two-part edition of Ask David, focusing on two of the most important problems that trigger emotional and interpersonal suffering. Last week, Matt led our discussion of the Inner Bully that causes the lion's share of internal suffering in the world. Feelings of depression and anxiety always result from the harsh distorted messages we give ourselves, telling ourselves we're "less than," or "defective," or "unlovable," and so forth. However, the world is also filled with Outer Bullies who can be threatening, even violent. Today we describe how you can often deal with the Outer bully with the Five Secrets of Effective Communication (LINK). Today's podcast was inspired by a question submitted by Guillermo, one of our podcast fans: Hello, Dr Burns I've seen some cases of bullying lately in schools. Would the 5 secrets help a kid who is being bullied in school? (Not physical bullying). I have a son who will be going to middle school next year and wonder about this. David's Reply Hi Guillermo, Thanks, I might read question on podcast and address it. Might have two consecutive shows on the "inner bully" and then the "outer bully." I know one thing for sure, although I am not an expert in this area, and haven't worked much with kids. But ultimately, only your thoughts can upset you. The words and criticisms of others will never upset you, unless you buy into them. So, the good old Daily Mood Log is always the first step. Once you no longer find bullying threatening, it becomes much easier to deal with it. The bully relies on getting you all scared and terrified and hurt and so forth. Warmly, david Matt began today's podcast with a real case description working with a violent, involuntarily hospitalized, 6'6" patient weighing 300 pounds snuck into his office while Matt was dictating his notes, locked the door, and announced that he was going to kill Matt because the involuntary hospitalization was "illegal." The man had been brought to the hospital by the police in a psychotic manic state because of bizarre behavior at his home that troubled the neighbors. Matt was terrified and said, "That was just one occasion when the Five Secrets of Effective Communication saved my life!" Link to Five Secrets Here's what Matt said to the man. I will indicate the communication technique(s) in each sentence in parentheses at the end of each sentence: "You're right! (Disarming Technique) You served your country and fought for our freedom (Stroking) and now we're taking away your freedom. (Disarming Technique) I feel the same way you do, (I Feel Statement). Can you tell me more about what you've been going through? (Inquiry)" The man was taken aback and immediately sat down and began to open up. Matt continued to empathize, using the Five Secrets, and after a few minutes the patient fell asleep in his chair. He was then transferred to a higher security hospital ward. Essentially, Matt sided with him, rather than getting defensive or arguing, and saw the truth in what the man was saying, in spite of the fact that he was floridly psychotic, and treated the man with respect. David summarized the case of a colleague of his who was kidnapped by a violent serial rapist. She also used the Five Secrets, which transformed the entire nature of the interaction, and the rapist gave himself up to the police. He also described being bullied by two violent teenagers in a gigantic jeep when he was driving home from the drugstore, where he'd rented an enormous carpet cleaner. David's use of the Five Secrets in response to violent threats prevented violence, but also turned a potentially hostile and abusive interaction into a joyous and warm one. We concluded with Bullying Practice, saying the worst imaginable things to each other, like "David, you're a terrible person," or "Matt, you're a bad therapist," or "Rhonda, you're an insignificant person," and then responding with the Five Secrets. It was an unexpectedly fun exercise, and the Five Secrets triumphed big time every time! The Outer Bully had no chance at all! However, this level of skill requires that you've mastered your own inner Bully, so you're not buying into what the bully says to you. This gives you a sense of peace and confidence that makes the Five Secrets a piece of cake, so to speak! David, Rhonda, and Matt want to emphasize that we make the Five Secrets look really easy and almost magical. Nothing can be further from the truth. We do hope to inspire you with examples of what's possible, but mastering these powerful tools takes an enormous amount of dedication, determination, and practice. If you'd like to learn more, I would strongly recommend reading David's book, Feeling Good Together, and doing the written exercises while reading. This would be an excellent first step! (Include book cover with link to Amazon.) Here, by the way, is an interesting link t

Featuring Matthew May, MD Today, Part 1. The Inner Bully Next week, Part 2. The Outer Bully There are two types of dialogues that can get us in trouble. The first is your "Inner Dialogue." Your Inner Dialogue sometimes consists of negative thoughts and perceptions of yourself and the world, which are often dominated by the familiar cognitive distortions that trigger internal mood problems, like depression, anxiety, guilt, shame, inadequacy, loneliness, hopelessness, and more. Examples would be "I'm a failure because . . . " or "I should be better than I am," or "I'm really going to blow it when I give my talk, and a myriad of variations on these themes. Your Inner Dialogue often consists of mean-spirited things you say to yourself, much like the schoolyard bully who intimidates younger, weaker children. The only difference is that you are doing this to yourself, often without noticing or realizing what that voice inside your brain is up to. When you challenge and crush these distorted perceptions, you can CHANGE the way you FEEL. Your Outer Dialogue consists of the things you say when you have with interactions with other people, and this can be especially important when you're dealing with others who are critical of you, or even threatening you with violence. The strategies are quite different from the strategies you might use to challenge and defeat your Inner bully. Today, Rhonda, Matt and I will demonstrate various strategies for defeating the Inner Bully. Next week, in Part 2, we will demonstrate strategies for defeating the Outer Bully! Those strategies, in extreme cases, might even save your life one day, as you'll see next week. Rhonda starts the podcast by reading an awesome comment by certified TEAM-CBT therapist Dan Prine, who commented in a kindly way on podcast 334, where we interviewed Michael Yapko on hypnosis. Then we focus on multiple techniques to challenge two negative thoughts with a variety of strategies. The first negative thought is one we've seen on a number of occasions from women who had abortions as teenagers, and then experienced extreme depression and guilt later in life because of their thought, "I'm a bad person because I murdered my baby." Using role-playing, we illustrated E = Empathy, using the Five Secrets of Effective Communication, followed by A = the Assessment of Resistance, using the Magic Button, Positive Reframing, and Magic Dial, followed by M = Methods. Methods included Examine the Evidence, the Double Standard Technique, the Externalization of Voices (with Self-Defense, the Acceptance Paradox, and the CAT, or Counter-/Attack Technique, along with the Socratic Technique, and more. Then we focused on a thought familiar to Rhonda during moments of insecurity and self-doubt: "I don't matter!" This thought has plagued Rhonda since she was a child. She recalled her father often saying, "c"Who are you? You don't matter!" She told herself, "he's saying that because I don't matter." Even the memory causes great pain and agitation. Of course, on some level, her father's comments never had any effect on her. Only your thoughts can cause you to feel one way or another. But this was devastating to Rhonda because she believed what her father said, which is understandable, and those thoughts caused the pain. We again illustrated many approaches to challenging this thought, but one of the techniques that was most helpful was the CAT. During the Externalization of Voices, the Positive Rhonda said this to her Inner Bully: "I'm not going to listen to you anymore! I've had enough of your BS!" Thank you for listening today. Remember to tune in to the Outer Bully next week! Rhonda, Matt, and David

Sexual Abuse / Emotional Eating Personal Work with Orly, Part 2 of 2 Last week, you heard the first half of our live session on Emotional Eating, featuring Orly. Today, you will hear the second half and exciting conclusion and follow-up on that therapy session. A = Assessment of Resistance (previously called Paradoxical Agenda Setting) Orly did want help, but there were a number of directions / conceptualizations we could have pursued, including: Working on the distorted negative thoughts that were triggering intense negative feelings and robbing Orly of self-esteem. This would involve the use of the Daily Mood Log. Working on relationship conflicts with the Relationship Journal. Working on the addiction to binging, using the Habit and Addiction Log and the Triple Paradox if you click HERE. Exposure work to help Orly overcome her Emotophobia. That's a term I coined that means "fear of strong emotions." Orly shared a number of additional negative thoughts: I need to take care of myself because in truth I really am unlovable. I'm not entitled to feel traumatized because he did not hurt me. If I get excited or upset, and I don't eat, I might go crazy. If I feel strong emotions, I'll end up rejected and alone. Orly said she already had the tools for working on her negative thoughts and her relationship problems, but really wanted help with #3 and #4. So we first worked with her Triple Paradox that she brought to the session. This is a key tool in working with any habit or addiction, and Orly did an amazing job with it. You' will enjoy that portion of the session and learn a great deal if you pay close attention. M = Methods We did a little work with Orly's tempting thoughts from her Habit and Addiction log (click here to review.) Orly was extremely effective in challenging the tempting thoughts. Thanks to Jill's brilliant guidance, we next decided to focus on cognitive flooding (exposure,) and gave Orly the assignment of scheduling one hour every evening for the next three weeks experiencing negative feelings and simply tolerating them, refusing to give in to the urge to binge.' We also made her accountable, asking her to record her moods during each flooding session and to send a report the Tuesday group the following morning. Either "Mission Accomplished" or "I stubbornly refused." T = End of Session Testing You can click to see Orly's Brief Mood Survey and Evaluation of Therapy Session at the end of the session. As you can see, she reported significant improvements in all of her feelings, and gave Jill and David perfect scores on the Empathy and Helpfulness Scales, as well as the other therapy process scales. Group Q and A After live work, we spent 30 minutes responding to questions and comments from the group participants. If you like, you can review just a few of the many comments in the feedback from the training group. Absolutely superb training! Thank you, Orly for the gift of your amazing personal work. And, thank you David and Jill for another magnificent teaching and healing session. I love the interplay between David and Jill. I loved Jill's empathy. I was so happy to get to know Orly better, and felt so close to her after the session. I was touched by her candor and disclosing about her abuse and life experiences. Unbelievable session, more like a miracle. A lifelong deep emotional issue to flow towards resolution in a couple of hours happens only in TEAM therapy. This was so very real; Orly was so open and insightful and vulnerable. Jill's identification of the choice point as to what to work on, and specifically, the option to focus on emotophobia--the anxiety around feeling intense emotions--and hence, exposure/flooding as treatment, struck me as so great, so much deeper than I'd initially expected. Jill's explanation that she focusses on the thoughts that drive the behavior in the HAL encapsulates it well. I loved the focus on feeling more. Recently, I read an article that stated CBT encourages clients to feel less and I didn't agree that was true at all. Tonight's session supported the sense of doubt I had. I thought the flooding concept was extremely helpful. Follow-Up Today, we recorded a live follow-up with Orly and Jill. Orly is doing great, and was very inspired. Jill made some (as usual) brilliant teaching points as well. If you like, you can also review one of her evening Emotional Eating Flooding sessions. Thanks again for listening! See you all next week. Warmly, Rhonda, Jill, Orly, and David

Sexual Abuse / Emotional Eating Personal Work with Orly, Part 1 of 2 In today's podcast, you will hear the first of a two part series on Emotional Eating, featuring Orly, an Israeli psychologist who experienced sexual abuse at age 6 when she was a "skinny little girl." After that, she began devouring her grandmother's delicious cookies, and suddenly gained a great deal of weight. She continued binging for more than 50 years whenever she was excited or upset. This led to a pattern of dramatic swings in weight of 100 pounds or more over and over again. And now, Orly has decided she wants to end this pattern. My dear colleague, Dr. Jill Levitt, will be my co-therapist in this single, 2 hour-session that was conducted in front of my TEAM-CBT Tuesday training group at Stanford. Part of therapist training involves doing your own personal work, although this is not a requirement, it is recommended. That's because the patient experience gives you a much deeper appreciation for how the therapy works. Rhonda, Jill and I want to thank Orly for permission to publish her highly personal work, and hope you find it immensely educational—so you can see exactly how TEAM-CBT works in real time with real people—and inspirational as well. Nearly all of us are pretty flawed in one way or another or many, and learning how to accept our flawed selves and celebrate is one of the deeper goals of the therapy. Today, we will cover the T = Testing and E = Empathy phases of the treatment. Next week, you will hear the exciting conclusion of our work with Orly, as well as the follow-up. Will she really be able to resolve a severe problem that has defied a solution for more than 50 years in a single TEAM therapy session? Let's check it out! Part 1 of the personal work with Orly T = Testing At the start of the session, we reviewed Orly's scores on the Brief Mood Survey that she completed just prior to her session. She scored only 3 out of 20 on the depression test (minimal), zero on suicidal thoughts and urges, 5 out of 20 on anxiety (mild), and 2 out of 20 on anger (minimal.) Her happiness score was 16 out of 20 (very happy with a little room for improvement), and her relationship score with her daughter was 18 out of 30, indicating lots of room for improvement. She indicated she'd done a great deal of homework in preparation for the session. You can also see her scores on nine mood dimensions if you take a look at her molestation Daily Mood Log. As you can see, her scores were quite high, and you can also review many of her negative thoughts when she was growing up. For example, at age 8 she told herself, "I am the fattest kid here. I will never be beautiful or desirable." You can also see her Habit and Addiction Log (HAL) just prior to binging after a backpacking trip if you look HERE. Once again, you can see that all of her negative feelings were intense, and rated in the range of 90 to 100. You can also see her tempting thoughts, like "I can afford it since I spent so many calories during the hike." E = Empathy David and Jill empathized while Orly told her graphic story of sexual abuse from a young man while growing up on a farm in Israel around the time of the "Six Day War" in 1967. She explained that he had been like an "older brother," and she didn't quite understand what had happened, since there was no Hebrew word for sexual abuse, and the subject was never discussed in public or with children. As she grew up, she learned to be independent, and felt like she was "different" and never really fit in. She developed a strong connection with nature and with spiritual values, and served as a park ranger during her military service in Israel. After her military service and an undergraduate degree from the Hebrew University, she set out to backpack in South America for a year and then settled in Los Angeles. She was married, and had a daughter who she considers her most important relationship, However, it was a troubled marriage and Orly and her husband were divorced when her daughter was 6. For quite a while, her daughter "blamed me for the divorce and for many other things." Eventually, she settled down in the United States and decided to become a psychologist after going to therapy, which was "the only diet I had never tried." In 2020 she got some medical help from her doctor and started hiking extreme distances and heights, and lost a tremendous amount of weight. Nonetheless, she still finds herself "eating her feelings" and engaged in binge eating every once in a while. She also joined our Tuesday training group at Stanford, and said that it made an enormous impact on her life and on her clinical practice, and began at times to think, "Maybe there's NOT something wrong with me." She said the group made her an effective therapist and "I got to liking myself just a little bit!" She said the group also helped her tremendously with relationships. I believe she was referring to the five Secrets of Effective Communication that we have dem

Good Grief—Featuring Mike Christensen Mikes' beloved friend, Kris Yip, word-ranked bicyclist who suddenly and tragically died. Mikes' beloved dog and best friend, Josie, who died the day before the podcast was recorded In today's podcast we feature one of our favorite people, Mike Christensen. Mike is a Certified Level 5 Master TEAM CBT Therapist and Trainer, and is the Director Feeling Good Institute, Canada. Mike is a Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors and holds a Master of Arts in Counselling Psychology degree. His diverse background in business, community organizations, and family support roles has provided Mike with a wide array of experience in leadership, administration, parenting training, and team building. He provides advanced level online training with the Feeling Good Institute for therapists around the world and is currently co-authoring a book with Maor Katz on Deliberate Practice of TEAM-CBT. Mike specializes in treating depression and anxiety, with experience and training in addictions, PTSD, and relationship challenges. Today, Mike comes to us today with a personal issue, grief and loss. The day before the recording Mike's beloved dog, Josie, died, and this came on the heels of the death of one his best friends, Kris Yip, a month earlier. Kris had died suddenly and unexpectedly at the age of 47. Kris was 7 or 8 years younger than Mike, and appeared to be the perfect example of health and fitness, so his loss was an unexpected and devastating punch in the gut. Mike explained that Kris was a celebrity in the bicycling community. He was the Canadian national champion and war ranked 59th in the world. However, he was humble and never promoted himself. Instead, he always focused on others, encouraging even those who were just beginners. Mike has also been a competitive bicyclist, and Kris had invited Mike to join an online racing team consisting of four friends who got together daily on stationary bikes linked by videos on the internet so they could talk while biking. In January of 2023, while riding, Kris's heart suddenly stopped. A friend of Kris called Mike to say, "Kris is gone!" This was devastating to Mike, who said: "He was the fittest of our group. The impact was profound." He had trouble sleeping and was in disbelief. He said, "It felt surreal. It felt like something is wrong. He told himself, "I should be able to keep it together without falling apart." Mike also told himself that Kris, was too young to go, and missed him tremendously. Mike thought of Kris's mom, and how much she was suffering, so he spent a week with Kris' family and friends in Prince George. Which was where Mike was born, and his brother and his other biking buddies live. He said, "We cried together and were together." He explained, "Whenever I got on my bike to ride, Kris was always there. He'd always say, 'Let's ride.' I miss his voice." He also said that during his rides, you could see Kris' face on the video feed, and he was always struggling, digging deep, suffering, but loving it! Mike said that all of his losses, including his sister, his son, and Kris, were actually double losses, because "I lost not only what had been, but what was to come in the future, and didn't." Mike said, "Kris was so humble, so I want to brag for him. He always cared and made all of us feel so encourage and inspired!" Mike mentioned some of the positives he saw in the pain of grief: It honors the depth of the love and the depth of our relationship with Kris. Our grief has motivated us to cherish our riding group and to cling together even more closely. Tears can be the purest form of love. Tears allow us to keep the other person alive in our hearts and minds. I mentioned how I talk to three people I've lost every day when I do my "slogging:" my beloved cat Obie, and two dear colleagues I've lost, Ann Hantz in Philadelphia and Marilyn Coffy from Oakland. Mike described how touched he was when visiting Kris' family, and how his mom had arranged all of Kris' bicycles in the garage, ready to be ridden, with all of his racing jerseys on display. Mike confessed that also felt angry and often thought: "You bugger. It should have been someone else!" Mike has endured many tragic losses in his life, including the devastating death of his older sister when he was just 15, and the tragic loss of his son, Graeme Michael, who died shortly before birth. Mike reminded us about the various conceptualizations we use in TEAM-CBT, which can include individual mood problems (like depression or anxiety), personal relationship problems, habits and addictions, and "non-problems." A non-problem refers to people who do not have distorted negative thoughts or problems that need to be solved—they just have strong and appropriate negative feelings, and the job of the therapist is simple: resist trying to "help," and instead use the Five Secrets of Effective Communication to listen and give the grieving per

Amy and her "fab fiancé," Randy Kolin! Secrets of Flirting, Sex Appeal and True Love! Today Rhonda and David interview Amy Berner, who has fallen in love and has quite a story to tell! Today is Valentine's Day (we recorded this on February 14, 2023), so we thought a love story would be a ray of joy for all of you, whether you are in a loving relationship or still looking for one! But first, Rhonda and David briefly interview Jeremy Karmel, the co-CEO of David's Feeling Good App. Jeremy tells his dramatic personal story that led to the creation of the app, and solicits for people who might want to join us for beta testing, which has gotten very busy of late. David also present some amazing data from a small, four-week beta test in December involving around 45 beta testers. The findings appeared to indicate that beta users experience far greater warmth and understanding from the app than from the people in their lives, which is on the sad side, since at the time users applied for the app, they only estimated 55% (on a scale from 0 to 100) warmth and understanding from the people in their lives, and roughly 85% from the digital "David" they interacted with in the app. We'll see if those amazing findings hold up in two larger replication studies now in progress. If you think you might be interested in being a beta tester, please sign up at www.feelinggood.com/app. Rhonda also gave an endorsement for the upcoming second World Congress on TEAM-CBT in Warsaw, Poland this year, March 30-April 2, 2023. It sounds exciting. I will be there is a variety of capacities including conducting a personal session with Jill Levitt, PhD. Please check it out! And, as usual, she read a compelling comment from one of our regulars, Irish Brain, who wrote: "Another amazing podcast for the collection!" Amy Berner is a licensed marriage and family therapist who works with adults and teens online in California. She loves helping her clients heal from heartache, depression, and anxiety. You can find her at the FeelingGreatTherapyCenter.com. Amy's love story started at a women's group that Rhonda was also in more than a year ago. It turns out that Rhonda is quite the match-maker, and has arranged dates for large numbers of her friends and colleagues, including Amy. However, Amy was feeling insecure, as so many of us might, before this date. To help her, Rhonda suggested the Feared Fantasy Exercise, and asked Amy to list some of the things she was afraid her blind date might be thinking, but not saying, when they met. When you do the FF, one person plays the role of the "Date from Hell" who not only thinks these awful things about you, but gets right up in your face and says them. This list of awful things the Date from Hell might say included: "I'm just doing Rhonda a favor in dating you." "You look a lot older than your picture!" "I haven't gotten over my last relationship yet." "You're not smart enough." "You're just not very interesting." We demonstrated the FF on the podcast, and Amy knocked them out of the park, using humor plus the Acceptance Paradox. She said that when they'd done that at the women's group, in greatly reduced Amy's fear and trepidation prior to their first date. Amy said she was also greatly helped by being in my small practice group the following Tuesday at our weekly psychotherapy training group. We were working on the "Interpersonal Downward Arrow," a technique I developed that quickly illuminates the roles people play in problematic relationships. Amy discovered that she was playing the role of the inadequate, inferior, insecure person, and this was illuminating. One bad thing about this role is that it quickly becomes a self-fulfilling prophecy because if you see yourself as inferior, you will chase, and come across as insecure, and that will cause the other person, in most cases, to reject you. David suggested a technique he described in his book, Intimate Connections (which you can see below). called the Queen Bee Phenomenon. Instead of playing the insecure role, you give yourself all kinds of positive messages about how sexy and awesome and desirable you are. Once you get into that mind-set, this mind-set can also act as a self-fulfilling prophecy. That's because of the Burns Rule, which states that in any relationship, especially at the start, one person will be the pursued, and the other person will be the pursuer. The pursued person has all the power, and the pursuer is usually rejected. So why not utilize the Queen Bee Phenomenon and let the guys chase you? This idea was transformative for our wonderful Amy, who is now happily, giddily, engaged, and she tell her story today with her typical wit, humor, and charm. She emphasized another important concept from Intimate Connections. Self-love has to come first. Once you chose to love and like yourself, your fear of being alone disappears, and you discover that you can be incredibly happy when you're alone. Then, you will no longer "need" men; and as a res

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2 Mariusz and his wondaful family. Last week, you heard Part 1 of the personal work that Rhonda and I did with Dr. Mariusz Wirga, which included initial T = Testing and E = Empathy. Today, you'll hear the conclusion of our work, including the Assessment of Resistance, Methods, final Testing and follow-up. I am repeating this darling photo Mariusz's beloved cat, with his tail strait up, showing pride and love for Mariusz! Orangina at her favorite scratching post, with tail straight in the air to show pride and love for Mariusz! A = Assessment of Resistance Once we empathized, we issued a Straightforward Invitation, asking Mariusz if he needed more time to talk and have us listen, or was ready to focus on the problem and see what we might do to help. Mariusz wanted to get to work, and said his goal for the session was to reduce his perfectionism, but when I asked the Magic Button question, he said he would not press it, even if the Magic Button would bring about a sudden and dramatic elimination of all of his negative thoughts and feelings. So, together, we listed the many positives and advantages of his negative thoughts and feelings, including: My anxiety keeps me on my toes. My feelings of inadequacy keep me humble. My hopelessness protects me from disappointment in the session with Rhonda and David isn't effective. My hopelessness and loneliness show how much I care. My hopelessness shows how helpless I feel to free myself from the many pressures and heavy weights I have been carrying for many years. My negative thoughts and feelings show how much I care for others, including my wife and kids. My suffering with depression and anxiety increases my compassion and understanding of my patients who are suffering and frightened. My anxiety protects me from danger. My anxiety is motivating. My self-criticisms show that I have high standards. My loneliness shows that I welcome intimacy and close relationships. My sadness shows that I am realistic and willing to look at the dark side of life. As you likely know, this process is called Positive Reframing, which is looking at the positive side of things that appear to be negative. Effective Positive Reframing isn't just listing positives from a list or book, like Feeling Great, It's suddenly "seeing" something that you hadn't previously realized, and having an "ah-ha" moment. So, I asked Mariusz if he could see any additional positives in his fairly intense feelings of sadness and depression. To help him, I primed the pump a little bit by pointing out that sadness and depression are the feelings you have when you've lost something or someone your really cared about, or when you notice that something incredibly important is missing from you life. At this point, Mariusz became tearful and said he'd been very lonely as a child. Saying this gave him a "choking pain." But he said he always turned away from his pain, and distracted himself, with work and activities. He said "I was an obedient child, and I was an only child. Both of my parents worked. "You say something is missing. I think what is missing is life I'm too busy. I'm always distracting myself. But I'm afraid that if I slow down, I won't be able to pay my bills. I believe that 95%. Then I'll be a burden. I'll lose the respect of my family." At the end of the Positive Reframing, he set his goals for the session, which you can see if you click on his Daily Mood Log again. As you can see, he did not seem to want to reduce his feelings to super low levels, which was surprising to me. M = Methods Rhonda suggested we could do a Feared Fantasy and asked what he thoughts others would think about him, but never dare to say, if he did slow down and they judged him. They'd think: You're unreliable. We won't include you anymore. We hate you. We reject you. We'll tell the world about you. And his worst core fear was ending up in a homeless camp. We did role reversals using the Feared Fantasy Technique until he hit the ball out of the park, and did the same using the Externalization of Voices to defeat the negative thoughts on his Daily Mood Log. When you listen to the session, you'll see that there was a lot of tenderness at this point, and we discussed our love for cats, and what we can learn from them—the joys of being average and loved and loving your life. We gave Mariusz several homework assignments: Finish your Daily Mood Log in writing, completing the Positive Thoughts and make sure you've crushed all of you negative thoughts. Experiment with being open and vulnerable with loved ones (wife and family) as well as colleagues. Practice saying no to colleagues who make requests on your time, and cut down on activities that are not cost-effective. T = End of Session Testing You can find Mariusz final Daily Mood Log if you click HERE, and his end of Session Brief Mood Survey if you click HERE, and his Patient's Report of Therapy

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 1 Mariusz and his wondaful family. In today's episode, Rhonda and I do live TEAM-CBT with Psychiatrist Mariusz Wirga, MD, who has struggled with perfectionism his entire life. Our training philosophy for TEAM-CBT involves doing your own personal work for a variety of reasons, including: 1. When you sit in the patient's seat, you develop a radically different perception of the value of the various components of TEAM, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. 2. When you experience your own recovery, or "enlightenment," you have a crystal clear vision of what's actually involved in rapid, effective treatment. 3. You will be able to tell your patients, "I understand how you feel because I've been there myself, and it will be my pleasure to show you the path out of the woods." This message makes a highly beneficial impact on most patients. Bio sketch, by Rhonda Among his many other accomplishments, Mariusz organized the highly successful first world congress for TEAM-CBT in Warsaw, Poland in 2022. He is planning a second four-day TEAM-CBT intensive in Warsaw from March 30 to April 2, 2023. If you are interested in attending, you can learn more at www.teamcbt.eu or www.teamcbt.pl. Mariusz says, " "For the first time ever we will teach a parallel track for business and corporate applications of TEAM CBT at the 4-Day Warsaw Intensive (www.teamcbt.eu & www.teamcbt.pl). It will be taught by our singular Dr. Leigh Harrington, with Polish psychologist and TEAM CBT therapist Patrycja Sawicka-Sikora. In 2023, there will also be major TEAM-CBT conferences in Bristol, UK (August 14-17, 2023, www.feelinggood.uk.com ) and Mexico City (November 6-9, 2023, www.teamcbt.mx )" In today's podcast we will listen to the Testing and Empathy portions of his session. Next week, you will hear the Assessment of Resistance and Methods and exciting conclusion of his session. T = Testing We began by reviewing Mariusz's scores on the pre-session Brief Mood Survey, which you can review. We will, of course, ask him to take this test at the end of the session, so we can see how effective or ineffective we were in helping him change the way he's thinking and feeling. Mariusz's beloved cat, Orangina, played a featured role in his session with Rhonda and David! E = Empathy We discussed his anxiety which had spiked in apprehension of today's live session. He had several negative thoughts that we elicited with a brief Downward Arrow Technique. The percents indicate how strongly he believed each one. I will be talking about private issues, and people will think less of me. 70% Then people will be less likely to want to see me for therapy. 50% My patients might be disappointed in me. 50% This could affect me financially, and I won't be able to pay the bills, and my daughter's wedding is coming up. 50% (Mariusz, my estimate on % belief.) If that happens, my wife and kids will turn against me. (Need % belief that you had at the time, Mariusz.) My also reviewed the Daily Mood Log that Mariusz prepared prior to today's session. Feel free to review it. As you can see, he woke up in the middle of the night and remembered that he'd forgotten to send a form he promised to send to a patient whom he'd seen two days earlier. You can also see that his negative feelings were very elevated, ranging from 60% to 85% for loneliness, embarrassment, sadness, inadequacy, frustration and anger, to 100% for guilt, shame, and anxiety. If you review his DML, you will also see that he'd recorded 10 self-critical thoughts, and many of them were Should and Shouldn't Statements. For example, "I should have sent her the homework. I shouldn't have made such a basic therapy error." He also identified the many distortions in each thought. All-or-Nothing Thinking, which is the mother of perfectionism, was present in most of them. Other common distortions included Should Statements, Overgeneralization, Magnification, and Self-Blame, to name just a few. Mariusz's belief in all of his negative thoughts was high. You may recall the two requirements for feeling upset: 1. Your mind has to be filled with negative thoughts. 2. You have to believe those thoughts. Mariusz also described his extremely busy and demanding schedule, including the groups he runs in the hospital for cancer patients, his clinical practice, research, teaching, organizing large international TEAM-CBT conferences, and more. His hectic schedule means he always has to be moving fast, so mistakes and slip ups are fairly common. That's when he beats up o himself, gets anxious, and has trouble sleeping, which compounds everything. He also beats up on himself and feels guilty for falling behind in some of his commitments. Rhonda and I empathized, using the Five Secrets of Effective Communication, and then Rhonda asked him to grade our empathy. He gave us an A+. Orangina at her favorite scrat

What IS Hypnosis? Transcending Old Myths Today, Rhonda and I interview Dr. Michael Yapko, a clinical psychologist and expert in clinical applications of hypnosis. Michael D. Yapko, Ph.D. is a clinical psychologist residing near San Diego, California. He is internationally recognized for his groundbreaking work in applying clinical hypnosis, especially in the active treatment of depression. He has taught in more than 30 countries across six continents, and all over the United States. He has been a vocal critic of the medical model of depression and instead advocates for a social perspective, suggesting the problem is less in your biochemistry and more in your circumstances and perspectives. His YouTube lecture on "How to Recover from Depression" has now been viewed nearly 5 million times. Dr. Yapko is the author of 16 books, including his newest book for professionals called Process-Oriented Hypnosis, and his classic hypnosis text, Trancework (5th edition). His popular general audience books include Depression is Contagious and Breaking the Patterns of Depression. His works have been translated into 10 languages. He is also the Chief Content Advisor for MindsetHealth, a digital hypnotherapy mental health app. More information about Dr. Yapko's work is available on his website: www.yapko.com. On the personal side, Dr. Yapko is happily married to his wife, Diane, a pediatric speech-language pathologist. Together, they enjoy hiking in the Great Outdoors in their spare time. Michael's first experience with hypnosis was as an undergraduate psychology student at the University of Michigan. He went to a clinical course on the topic of hypnosis which featured a live hypnosis demonstration. The demonstration subject was a woman who was suffering with intense chronic leg pain following a traumatic auto accident three years earlier. The relentless pain had disabled her and greatly impacted her life on many levels. Michael said he listened to her sad story in skeptical awe, unable to imagine what the hypnotist could possibly say to someone suffering so much that would be helpful to her. He was deeply absorbed in observing every nuance of the interaction wondering what help hypnosis might offer in such dramatic circumstances. The initial phase of the interaction was simply a series of suggestions for relaxing and focusing her attention. He gradually offered suggestions to visualize the pain as a dark, viscous liquid that could flow down her leg, out of her foot, into her shoe, and then spill out onto the floor as a "harmless puddle of pain." And it was gooey! After re-alerting her from hypnosis, she became tearful and reported that she was pain-free for the first time in almost three years! The change in her appearance was both obvious and deeply impressive. Observing this dramatic demonstration of hypnosis for reducing chronic pain was a transformative experience for Dr. Yapko. He literally thought in that moment that hypnosis had remarkable potentials and that he would dedicate himself to learning all he could about the intricacies of hypnosis and its merits in a wide array of clinical interventions. The demonstration blew Dr. Yapko's young mind and led to a 50-year career practicing, studying, writing about, and teaching clinical hypnosis to health care professionals worldwide. Although he has recently retired from active clinical practice, he continues to offer trainings and says his fascination with hypnosis is just as strong as ever today. There are a number of striking areas of overlap between Michael's use of methods of clinical hypnosis and traditional Cognitive Therapy. For example, he routinely uses the Experimental Technique, and gives experiential homework assignments to help patients "see" or discover something that they have not previously seen or realized that would be helpful to them. This can be important when treating patients who hold rigid beliefs that can become the basis for emotional distress. However, the types of experiential experiments Michael suggests are sometimes more ambiguous in their purpose, and are sometimes more paradoxical, but all are designed to lead the patients to a shift in their mindset. In one example, Michael described a severely depressed woman who felt like a victim and constantly compared herself to others she actually knew very little, if anything, about. Then she felt terrible about herself because she was convinced that everyone else was happy and had beautiful, problem-free, ideal lives and she didn't. She had developed unrealistic perceptions of other people on the basis of little or no actual data. These thoughts made her miserable and she was convinced she was the only one who had been singled out for misery. Of course, we can see many of the familiar cognitive distortions, including Mind-Reading, which is assuming, without evidence, that we know how other people are thinking and feeling or how their lives are going. For most people, this process is so reflexive and

Ask David: Featuring Matt May, MD What causes anxiety? Is recovery permanent? What if the cognitive distortions aren't helpful? Do hormones cause anxiety and depression? What's the role of vitamins and nutrition? How do Exposure and Response Prevention work? And many more answers to your questions! In today's podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below. But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is! Hi Dr. Burns: I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it! "I've replaced my copy close to ten times, as I keep lending it to friends who never give it back." https://girlboss.com/blogs/read/feeling-good-david-burns-review Have a great day! Rob Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well. When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous. David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time! What if your client/patient understands the Cognitive Distortions but doesn't believe them to be true? David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that's triggering your anxiety or depression, you will almost instantly feel relief. And here's the precise answer to your question. When someone says, "I understand the distortions but it doesn't help," they still believe their negative thoughts. Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist's efforts to "help." Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person's nutrition? Could it be that vitamins that are lacking? David's Answer. First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings. In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother's negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared! People want to "biologize" emotional problems, and I started out as a "biological psychiatrist" and researcher, but found the biological explanations to be erroneous and unhelpful. Could you please give a brief overview about Exposure with Response Prevention for OCD treatment. Thank you! David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth. END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST The answers to the questions below were written by Dr. Burns but not discussed on the Podcast. Questions can I ask to overcome the Cognitive Distortion "jumping to conclusions"? That is the toughest for me. David's Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common f

Ask David: Featuring Matt May, MD How can I help my son? Is rapid recovery just "First Aid?" Do early "attachment wounds" cause anxiety? What's the Hidden Emotion Model? Are anxious people overly "nice?" And more! In today's podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below. Guillermo asks: How can I get close to my 11 year old son? Hi, Dr Burns Thank you for all the knowledge you share through your books and your podcasts. "the way you think creates the way you feel" has changed the way i view life. I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said "just throw it away" and i raised my voice and said "I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?" (I was rude and loud) To which, he got startled and teary eyed and said "no". And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him. I later came to his room and apologized for my behavior and gave him a hug. I said "im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me" and i gave him a hug. That same night I heard podcast 278 or 279 and you said "the road to enlightenment is a lonely one, my friend" when responding to someone asking about the other person in a relationship. I thought, damn that's true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize. I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this? Thank you again for all you do, Guillermo David's answer: I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?" In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing! Warmly, david ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required? David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any "first aid" problem! Matt's Answer: I agree with a lot of this. While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to 'relapse', at some point in the future. Educating people about this is important and part of 'Relapse Prevention'. Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences. As the Buddhists say, 'we all drift in and out of enlightenment'. Relapses, the 'drifting in-and-out' is a sign of a healthy brain. Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts. While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you'll occasionally go back to old habits in thinking. So, achieving optimal mental health requires an ongoing practice with the methodology. Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place. If it was Exposure, you'll have to keep on doing that. If it was talking back to your negative thoughts, then you'll have to do that, occasionally, etc. This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection. Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery. That is to say, 'Enlightenment' is not a 'perfect' mental state but an acceptance of an imperfect one. If this seems distasteful, Enlightenment may not be what you're after! For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery. You'll still need Relapse Prevention, including a commitment

What's the Antidepressant Myth? Have We Been Scammed? Today, Rhonda and I interview one of our heroes, Dr. Irving Kirsch, who is a giant in depression research and a fun, down-to-earth human being at the same time! Dr. Kirsch is Associate Director of the Program in Placebo Studies and the Therapeutic Relationship, and a lecturer on medicine at the Harvard Medical School (Beth Israel Deaconess Medical Center). He is also Emeritus Professor of Psychology at the University of Hull (UK) and the University of Connecticut (USA). Dr. Kirsch has published 10 books, more than 250 scientific journal articles and 40 book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. He originated the concept of response expectancy. This is the expectation that people have that a given treatment or intervention will be helpful. Kirsch's 2002 meta-analysis on the efficacy of antidepressants influenced official guidelines for the treatment of depression in the United Kingdom. His 2008 meta-analysis was covered extensively in the international media and listed by the British Psychological Society as one of the "10 most controversial psychology studies ever published." His book, The Emperor's New Drugs: Exploding the Antidepressant Myth, has been published in English, French, Italian, Japanese, Turkish, and Polish, and was shortlisted for the prestigious "Mind Book of the Year" award. It was also the topic of a 60 Minutes segment on CBS and a 5-page cover story in Newsweek. In 2015, the University of Basel (Switzerland) awarded Irving Kirsch an Honorary Doctorate in Psychology. In 2019, the Society for Clinical and Experimental Hypnosis honored him with their "Living Human Treasure Award." In today's podcast, we cover a wide range of topics, including a patient-level reanalysis of all of the data on the effects of antidepressant medications versus placebos submitted to the FDA. This analysis included more than 70,000 depressed individuals and indicated something troubling and surprising. The difference in improvement between individuals treated with antidepressants and individuals receiving antidepressant medications was only 1.8 points on the Hamilton Rating Scale for Depression. This test can range from 0 to 50, and a difference of 1.8 points is not clinically significant. In addition, the beneficial antidepressant effects observed in both the placebo and "antidepressant" groups are large, with reductions of around 10 points or so on the Hamilton Scale. These were the shocking discoveries that led to his popular book, The Emperor's New Drugs (LINK), and to his appearance on the Sunday evening 60 Minutes TV show. In addition, Dr. Kirsch agreed that tiny difference between the "effects" of antidepressants vs placebos could be the result of problems in the experimental design used by drug companies. Because they give patients in the placebo groups pills with inactive ingredients, there are no side effects in the placebo groups. This makes it fairly easy for individuals to guess what group they were assigned to—the "real" antidepressant group or the placebo group. This might account for the differences in the groups, since many individuals in the medication groups may think, "Hey, I'm getting some side effects. I must be in the antidepressant group. That's terrific!" This thought would be expected to trigger some mood elevation, but it's the thought, and not the pill, that causes this. In contrast, some individual in the placebo groups may have the thought, "Hey, I'm not getting any of the side effects they described. I must be in the placebo group!" And this thought may trigger disappointment, and a worsening of depression. This would contribute to differences between the drug and placebo groups in drug company outcome studies with new chemicals that they hope to get approved as "antidepressants." This problem could easily be corrected by the use of active placebos, like atropine, which produces dry mouth, a side effect of many antidepressants and has been used as an active placebo in a small number of trials. Most of the studies using active placebos have failed to show any significant effect of the antidepressant over the active placebo. Drug companies have been reluctant to implement this change in their research designs, perhaps due to the fear that it will "erase" the tiny differences that they have been reporting. This would be of potential concern since billions of dollars are at stake if the FDA gives you permission to call your new chemical an "antidepressant." We also discussed Dr. Kirsch's unlikely journey to Harvard. When he was in England, planning to return to the United States, he asked a colleague at Harvard if it would be possible for him to get a library card so he'd have access to articles in research journals. His colleague told him that it was difficult to obtain a library card for people not affiliated with Harvard. However, they were willing to offer him a position as Instructor on

Integrating TEAM-CBT with Martial Arts Training! Podcast Episode 330, Featuring Dor Star Our guest today is Dor Star. Dor is an educational counselor (MA) and a level 2 TEAM practitioner who works with children in Israel who have emotional and interpersonal problem. He works with children as young as four years old, but most of his work is with children ages seven to twelve years old. The children he works with experience various challenges and difficulties such as: Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, tantrums, outbursts of anger, all kinds of anxieties, social difficulty, bullying and much more. His work is unique because he works mainly in small groups (4-6 participants) using martial arts and sports as therapeutic tools. In his work Dor uses the TEAM model with some adaptation, because of the children's ages and sports methods, with great success! In fact, one can say that he discovered for himself, and for his patients, a new way to use the TEAM model. He also teaches sports and martial arts trainers who are interested in entering the field of child therapy. Dor describes his first encounter with TEAM-CBT, which blew him away, but he was initially frustrated because he was thinking of his conventional ways of dealing with kids VS TEAM. But after a few weeks he discovered that he could use the TEAM structure to improve his approach, and wow, did he ever start to shine, as did his results with TEAM. Today's podcast was really a breath of fresh air! Dor began with T = Testing, and describes how he developed simple assessment tools to rate how his children (aged 4 to 11) were feeling at the start and end of his classes, but also how they felt about him. He uses simple questions like "Did I understand you today? How well did I listen?" He also asks them, "How much fun was the session," and "How did you grade yourself?" Then they grade him on a scale from 0 (the worst) to 10 (the best.) So, it's quick, easy, and . . . shocking. Dor says: "I found out that I wasn't nearly as effective as I thought. Sometimes the kids thought the class was fun, but I got really low grades on Empathy, as well as how depressed, anxious and angry they were feeling at the start and end of each group session. Essentially, I discovered that I wasn't achieving almost any of my goals for my kids. This was disturbing at first, and I had to let my ego die. But I decided to try to view it as valuable information that I might be able to use to learn and grow." For example, I had one of the most amazing sessions with an 11 year who was smiling the entire time. I was absolutely certain it was one of my best sessions ever. But when I asked him for my grade, he gave me a 3 out of 10! When I asked why, he explained that at the start I didn't introduce myself or ask him about himself! So, in this simple but compelling way, Dor has used the T = Testing to transform the entire way he works with kids! I believe he's had the same experiences I've had with the T = Testing component of TEAM. Dor has made his patients his teachers, and this has led to some amazing and revolutionary developments in his approach. Dor emphasizes the importance of E = Empathy, and says that "the Five Secrets of Effective Communication" are incredible! For example, if they're having a rage attack, or a temper tantrum, you can tell them they are absolutely right in the way they're thinking and feeling." He also uses what he calls the Five Ways of Love. Verbally expressing respect and liking Giving service: tying a child's shoes, giving them some water during the training. These small acts can create feelings of trust and connection. Spending time with them, paying attention to them. This is especially important because so many are angry and try to push others away. They are good at getting other people to reject them and not want to spend time with them. Giving gifts, something they can take home and show to their parents. Making physical contact with them during the martial arts training, playing with them, having fun. I (David) would note that physical contact might be something to be careful with. Of course, when you are teaching martial arts, it may be perfectly justified and desirable. I came from the psychotherapy perspective, and I have been trained that ANY touching of a patient other than shaking hands at the initial and final sessions is grounds for a malpractice suit as well as an ethics charge. Dor also made some really illuminating comments on the A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) At the initial evaluation, he talks to the teachers, parents, and students. The agendas from teachers and parents are things like "he has an anger problem" or a problem paying attention in class, or whatever. However, 90% of the time, the children frequently are unaware of those agendas, or have no interest in the goals of the teachers and parents. Instead, he finds out what the

Ask David: Featuring Matt May, MD 329: How can you deal with a "narcissist?" In today's Ask David, we respond to a listener who requested a podcast on the topic of narcissism, including how to deal with them, so we will focus on these topics. The following show notes were prepared prior to the actual podcast to provide a structure. For more great information, listen to the podcast, as much more was covered! David What is the definition of "narcissistic personality disorder"? Narcissism involves: Grandiose fantasies and feelings, thinking that you are superior to others Lack of empathy for others Extreme self-centeredness Intolerance to criticism or disapproval Urges for revenge on anyone who crosses you. We do not know whether these are just extremes of personality characteristics that everyone has in varying degrees, or whether it actually consists of a "disorder" that is qualitatively different and distinct. But it is definitely true that all of the characteristics I have bulleted above do exist to some degree in most, if not all, human beings. How do you treat narcissistic patient? I do not treat diagnoses, just human beings. This is a radical departure from the way many mental health professionals approach their work. No matter who I'm treating, I always start with the T and E of TEAM (Test and Empathy) and then move on to A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) The main idea is to find out what, if anything, the patient wants help with. It would be rare for someone with narcissistic qualities to want help with their narcissism. Generally, they want help with a troubled relationship or with feelings of depression, anxiety, or anger. Then I would ask them to zero in on one specific moment when they were upset and wanting help, and deal with Outcome and Process Resistance. If the patient can convince me that she or he does want help, then I move on to M = Methods, and the methods would have to do with the nature of the problem they want help with. I once presented a case illustrating rather dramatic and rapid recovery in a patient I was treating for depression and anxiety. To my way of thinking, it was a great outcome. However, during the Q and A I got an angry rebuke from a therapist in the audience who pointed out that I hadn't treated the patient's "obvious narcissism." This is the "great divide." I don't feel like it's my calling to evangelize for any model of "ideal mental health." For the most part, and there are always exceptions to every rule, I do not impose my agenda on the patients, but try to work with what they want to change. I might suggest possible ways we could work together, but in the final analysis it is up to the patient. I liken my role to that of a plumber. If you've got a broken toilet, give me a call and I'll fix it. But I don't go from door to door promoting copper pipes! How can you deal with narcissistic individuals in the real world? Once again, it depends on the specific moment that you want help with. However, I always like to emphasize the value of the Disarming Technique and Stroking when interacting with someone with strong narcissistic tendencies. The goal, in my opinion, might be on "dealing with them skillfully" as opposed to "changing" them or "winning." For example, (David can give example of Erik's friend when growing up.) What are the causes of narcissism? Scientists do not know, for the most part, what causes most of the so-called "mental disorders" listed in the Diagnostic and Statistical Manual of the American Psychiatric Association, but it seems possible, even likely, that there could be genetic and environmental causes, and the environmental causes could have to do with the past (childhood influences) and present. For example, when people begin to experience significant success, in academics, sports, or some other field, others begin to admire them and want to be with them. This can fire up our egos, and can feel good. And as they level of fame and status increases, the attraction of others intensifies, and eventually people fear saying no or contradicting the narcissistic person who has such power. So, the narcissistic person is constantly reinforced, even for bad behavior or irrational beliefs, with little or no negative feedback to correct his or her course of actions and thinking. Some experts also point to profound feelings of shame and insecurity under the surface, which might also be genetic, at least in part, or triggered by adverse childhood experiences. What you have to let go of to relate to someone who is narcissistic? To my way of thinking, you have to give up the idea that the narcissistic person is going to take you seriously or care about you, You may also have to give up the notion that you are going to "change" or "help" them. You may have to use a more manipulative approach, using lots of Disarming and Stroking, instead of being so sincere and serious. This involves "letting go," and moving forward with yo

"Overcoming Toxic Shame" Join Dr. Jill Levitt and me at our fabulous new workshop Sunday, February 5th, 2023 8:30am - 4:30pm PST - 7 CE units Click here for information and registration In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her. Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients! In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING! Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world. You can reach Dr. Burns at [email protected].

Live Therapy with Cody, Part 2 of 2 Last week we presented the first of our session with Cody, a young man wanting help with his fairly severe social anxiety since childhood. My co-therapist for this session was Dr. Rhonda Barovsky, the Feeling Good Podcast co-host, and Director, Feeling Great Therapy Center. Today, you will hear the exciting conclusion of his session, and the follow-up as well! Part 2 M = Methods We focused on cognitive work and interpersonal exposure techniques as well. I will leave it to you to listen to the podcast, as I became so engrossed in what we were doing that I stopped taking notes. However, we used a number of tools within the group, including: Identify the Distortions in his thoughts Examine the Evidence Externalization of Voices Self-Disclosure Rejection Practice The Experimental Technique The Feared Fantasy And more. Cody received an abundant outpouring of love, respect, and encouragement from those in attendance (LINK). We also gave Cody two "homework" assignments to complete following the group. Do at least three Rejection Practices in the mall and notify the training group members via email within 24 hours that he had completed this assignment. Complete the Positive Thoughts column of your Daily Mood Log. If you'd like to see Cody's complet4ed Daily Mood Log, you can check this LINK. If you'd like to see Cody's intimal and final Brief Mood Survey plus Evaluation of Therapy session, check this LINK. As you can see, there were dramatic changes in all of his negative feelings. However, he wanted to retain some anger toward his childhood friends who made fun of him. Here's the email we received from Cody about his homework assignment. Hello groupers, I can proudly say mission accomplished! Although it took me around 7 hours to do it, I did it. A lot of emotions came up as I kept trying and chickening out. I really feel like something has changed in me, by the last person I felt almost no anxiety and now I keep asking myself why I was ever afraid of this (I hope it sticks. I know I'll need to keep up this momentum I'm sure). Having to do this email and being held accountable to you all was what drove me to the finish line. Thanks again, see you all next week! Thanks to you, Cody. You were incredibly inspiring in group and after and the work you did will touch the hearts of many people, just as you have already touched the hearts of all the people in our group! And thank you all for listening! Cody, Rhonda, and David

Featured pic of Cody in one of the small group practice sessions in David's virtual Tuesday training group. Live Therapy with Cody, Part 1 of 2 I recently treated Cody, a young man wanting help with his fairly severe social anxiety since childhood, during one of our Tuesday evening Stanford training groups. My co-therapist for this session was Rhonda Barovsky, PsyD, the Feeling Good podcast co-host. The full session will be broadcasted in two parts, starting today and finishing next week. Part 1 T = Testing At the start of the session, Cody's depression score was only 6 out of 20, indicating minimal to mild depression, but his score on the loss of self-esteem was "a lot." His anxiety score was 11 out of 20, indicating moderate anxiety, and his anger score was only 2, minimal. However his score on the Happiness test was only 11 out of 20, which is only moderately happy, indicating a lot of room for improvement. If you like, you can review his Brief Mood Survey at this LINK. We'll of course ask him to take this test at the end of today's session so we can see what, if impact, we made on his feelings. E = Empathy Cody described his shyness like this: "I've been shy for as long as I can remember and feel introverted. It started in middle school. I felt like I never fit in or connected with people very deeply. In middle school, you really want to fit in. "I wanted my friends to like me, and one day they all started to torment me. Our seats in school were assigned, so I couldn't get away from them. I cried at recess every day for months. Then, one day, they suddenly went back to being my friends again, and I never understood why. "When they were tormenting me was the most painful moment of my life. I felt like they were judging me. "I've worked on my own and I've gotten over 90% of my social anxiety. At first, I was afraid of answering the phone or even ordering a pizza, so I got a job where I was required to answer the phone and got over it. "Now I'd like to date, but this has been a problem for me. Also, when I'm treating someone, and this topic of social anxiety comes up, I get uncomfortable. I think if I could overcome the rest of my shyness, it would boost my confidence. "The podcast you and Rhonda did with Cai on Rejection Practice (LINK) inspired me tremendously, and I managed to do one Rejection Practice. By now I'm chickening out again. I go to the mall determined to do it, but I just keep putting it off. Asking women to reject me seems incredibly frightening, and I'm afraid people will judge me or see me as a predator. I love in a small town, and most people know each other. "When I was thinking about the session all day today, I felt nervous and my stomach tightened up. Cody brought a partially completed Daily Mood Log to the session, which you can review at this LINK. As you can see, the Upsetting Event was thoughts of approaching someone at the mall for Rejection Practice. His negative feelings included the entire anxiety cluster, shame, the entire inadequacy cluster, unwanted, humiliated, embarrassed, the entire hopelessness cluster, frustrated, annoyed, and anger with himself. These feelings ranged from a low of 35% for shame to a high of 100% for foolish and humiliated and 90% for the hopelessness cluster. And as you can see, many of his negative thoughts focused on the theme of being judged by others who might see him and think he was strange, or a disrespectful jerk, and so on. He was also convinced that women would be annoyed by him, and that the word would spread so that he'd lose the respect of people he cared about. A = Assessment of Resistance Cody's goal for the session was to feel motivated to do the Rejection Practice he'd been avoiding, and to get rid of the negative thoughts that were holding him back. He said he'd be reluctant, though, to press the Magic Button and make all of his negative thoughts and feelings disappear, so we listed what his fears might actually say about him and his core values that was positive and awesome. Here's the list we came up with: Positives My anxiety My anxiety shows that I care about peoples' comfort. My anxiety protects me from rejection or doing something foolish. My fears of being seen as a predator show that I want to fit in with the social norms and not be weird or threatening to women. My fears show that I want to be respectful towards women. My fears of being judged show that I care about friends and family. My anxiety shows that I care about my reputation. My feelings of inadequacy show that I'm aware that I have things I want to work on. Those feelings also show that I'm humble. My feelings show that I really care about connecting with others, which is one of the most important things in life! My negative thoughts and feelings motivate me to work hard on changing. They also show that I have high standards. My hopelessness shows that I've tried to do Rejection Practice six times and have always chickened out. So I'm being realistic. My hopelessn

Curing YOUR Social Anxiety— The Ridiculously Cheap and Awesome Shame-Attacking Marathon Jacob Towery, MD Michael Luo Today, we are joined by Dr. Jacob Towery and Michael Luo to promote their upcoming, two-day Social Anxiety Marathon. Jacob Towery, MD is an adolescent and adult psychiatrist and therapist in private practice in Palo Alto, California. Michael Luo is a fourth year medical student at the Chicago Medical School. More on them at the end of the show notes, but here's the scoop. Jacob and Michael will be offering a mind-blowing, two-day marathon for anyone who struggles with social anxiety, which includes shyness, public speaking anxiety, and performance anxiety. They will both be present, along with more than ten experts in TEAM-CBT, coaching participants in the latest tools for quickly overcoming all social anxiety. And here's the amazing thing. You can come and attend, and transform your life, for only a $20 donation to one of their four listed amazing charities. For information / registration, click here How cool is that? Don't pass this up. It will be an in-person, hands-on training experience designed to free you from the fears that narrow your life. You will learn and participate in cognitive therapy exercises, identifying and smashing the distorted thoughts that trigger social anxiety, as well as the Self-Defeating Beliefs that trigger social anxiety like the Spotlight and Brushfire Fallacies, the Approval Addiction, and more. They will also illustrate and lead you in a wide variety of Interpersonal Exposure Techniques, including Smile and Hello Practice, Self-Disclosure (which Michael demonstrates in real time on today's show), Rejection Practice, Flirting Training, Shame Attacking Exercises, and more. David claims that Jacob is likely the world's top expert in Shame Attacking Exercises, and we illustrate several on the podcast. Rhonda described a Shame Attacking Exercise that I challenged her with. It was incredibly terrifying, but turned out really well! David also described the impact of self-disclosure on a wealthy and powerful businessman he treated who was so insecure that he was even terrified to be around his wife and children. People who are socially anxious nearly always try hard to hide their negative feelings out of a sense of shame, so others, even friends and family and colleagues, typically aren't aware of how they feel inside. Michael courageously discloses his own negative thoughts that triggered feelings of social anxiety at being around Jacob, his mentor. Maybe I'll make a mistake. I might be wasting Jacob's time. Then he might not want to mentor me. These thoughts caused feelings of loneliness and shame. I felt much closer to Michael when he disclose these feelings. Jacob added that he was totally unaware that Michael had been struggling with these thoughts and feelings. The treatment of social anxiety is profoundly serious, because we are involved in changing the lives of people who are suffering and lonely and inhibited, but the treatment can also be fun, hilarious and of course, enlightening. Michael wraps up the show by describing the transformation this training has had on his own life. If you wish to attend, act rapidly because space is limited and will be given out on a first-come, first-serve basis. I hope you can attend, and make sure you let Rhonda and David know about your experiences! Thanks for listening today! Rhonda, Jacob, Michael, and David

Secrets of Overcoming Romantic Rejection Part 2 of 2 In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more! 6. Do you have any tips for moving on and realizing that maybe your ex isn't as great as you think they are? David 20 qualities I'm looking for in an ideal mate. Rhonda Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different. Fill out the form: "20 Qualities in An Ideal Mate" and review how many of these qualities your ex had. 7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who's been cheated on in trying to get their confidence back? David YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average. Kyle Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you've been cheated on? Practice talking back to those. 8. How can we boost our confidence back up after a breakup in general even if we haven't been cheated on? David SAME ANSWER. Rhonda Do things you love to do with people who love you: go dancing, go to the beach, go hear music, read, etc. Daily Mood Log on the thoughts that lead to your lack of confidence. 9. Do you guys believe in the notion that you are capable of "healing completely from your ex (aka completely being over them and all the pain the breakup brought you)" or do you believe that it's not possible. David I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU'LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU! Rhonda You may never be exactly the same, why would you want to be? Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds). Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships. Relationship Journal to see how you have contributed to the relationship problems. Maybe do Reattribution to see what you contributed to the relationship problems and what they did. 10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations? David I DON'T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT'S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT "SEES." Rhonda I can't add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain. 11. Do you guys feel that you shouldn't date for a while after getting your heart broken? David THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED. Rhonda This is a very personal decision. Have you had time to heal before getting into a new relationship? Have you had time to examine your role so you can make changes if you choose, so you won't repeat the same mistakes in the next relationship? 12. Do you have to move on from your ex to go back out into the dating world again and to possibly be in a relationship again? Do you guys feel that "jumping" from relationship to relationship can be a bad thing? Why or why not? David THESE THINGS ARE ALWAYS ON AN INDIVIDUAL BASIS. I THINK IT CAN BE HEALTHY TO DATE A VARIETY OF PEOPLE AND NOT GLOM ONTO THE FIRST PERSON WHO EXPRESSES AN INTEREST IN YOU. THAT WAY, YOU CAN COMPARE A VARIETY OF RELATIONSHIPS AND IN ADDITION, YOUR DATING SKILLS WILL IMPROVE. THE "20 THINGS I'M LOOKING FOR IN AN IDEAL MATE" CAN BE VALUABLE. Rhonda "Jumping from relationship to relationship" sounds so judgmental. Are you finding yourself in relationships where you have similar complaints from your last relationship, repeating patterns that you dislike? Then I would pause and take time to heal and learn before starting another one. Kyle What does be "moved on" really mean here? Would you have to never have a thought about your ex again before dating? That might be impossible! I don't think there's anythin

Secrets of Overcoming Romantic Rejection Part 1 of 2 In today's podcast we are proud to interview Dr. Kyle Jones from the Feeling Good Institute in Mountain View, California. Kyle Jones, PhD is a clinical psychology postdoctoral fellow affiliated with Feeling Good Institute in Mountain View, California where he provides individual psychotherapy in a private practice. He co-leads a monthly consultation group with Maggie Holtam, PhD where therapists can get help with exposure methods for anxiety. He has recently become an Adjunct Professor of Psychology at Palo Alto University - teaching Clinical Interviewing in the clinical psychology PhD program. Kyle wrote: "Here are some questions from patients of mine for our podcast today - we don't have to go through all of these bust just some talking points!" We will publish part of the questions in today's podcast, and several more next week. There are even more questions, so let us know if you would want a Part 3 on this topic at some time in the future. Below you will find the list of questions with some responses by David and Rhonda BEFORE the podcast. To get the true scoop, listen to the podcast, as most of the comments below were simply ideas that popped into our heads prior to the podcast. Although we focus on romantic rejection in these two podcasts, the idea really pertain to rejection in all segments of our lives. 1. Why do you think it's so hard for us humans to handle rejection/why do you think we are so afraid of it? David THE LOVE ADDICTION SDB. LOOKING TO EXTERNAL SOURCES FOR FEELINGS OF SELF-WORTH AND HAPPINESS. THE CBA IS CRUCIAL, SINCE PEOPLE MAY NOT WANT TO STOP LINKING SELF WORTH WITH LOVE. Rhonda Plus, it hurts. And our brain is wired to experience pain when rejected. We are wired that way. Evolutionary psychologists believe it all started when we were hunter gatherers who lived in clans. Since we could not survive alone, being ostracized from our clan was basically a death sentence. As a result, we developed an early warning system to alert us when we were at risk of being rejected by our tribemates. People who experienced rejection as more painful were more likely to change their behavior, remain in the clan, and pass along their genes. Kyle Getting dumped sucks! We aren't really taught how to handle rejection very well in our culture. 2. Are we capable of overcoming the fear of rejection and how do we accomplish that? David You can face your fear with REJECTION PRACTICE. The FIRST SECTION OF INTIMATE CONNECTIONS IS ON OVERCOMING THE FEAR OF BEING ALONE. Rhonda Is part of the fear of rejection also a fear of being alone? You can use the "What If" technique to uncover more about those fears. Then put the thoughts in a Daily Mood Log, and challenge them with a variety of techniques you can select for a Recovery Circle. You can also face your fears with Rejection Practice and/or Exposure. 3. When it comes to getting dumped do you guys believe there is a good way to approach it communicating wise? David YOU CAN USE FIVE SECRETS TO FIND OUT WHY THE OTHER PERSON IS REJECTING YOU. OR, PERHAPS BETTER, YOU CAN TURN THE TABLES ON THE REJECTOR, SINCE IT IS PART OF A CHASE GAME. Rhonda If you want to know more about why you were "dumped," will you trust the other person to be honest with you? Will you believe them when they respond? You might want to do a Cost Benefit Analysis to decide whether or not you even want to ask them to explain why you were "dumped." Kyle It depends on the situation. If you have gone through a divorce and have children, you may still need to talk with you ex-partner. Generally, I don't think it's a good idea to stay in touch and keep chatting with an ex who dumped you! 4. If we are caught off guard with the breakup and don't see it coming and all of a sudden one day our partner decides to end the relationship, how do we not let our emotions get the best of us in that moment in that very moment? David WHEN YOU SAY, "GET THE BEST OF US" IT SOUNDS LIKE YOU'RE NOT ACCEPTING YOUR FEELINGS. IS IT OKAY TO FEEL FEELINGS? THIS QUESTION SOUNDS LIKE EMOTOPHOBIA. Rhonda It's perfectly reasonable to be sad, to cry, to be shocked and angry. Why not have those feelings? You also don't have to expect to respond with a "perfect 5-Secrets." Maybe you need to take a break from each other, breathe, walk, calm down, and then meet again to talk talk, if that is what you want to do. Kyle If you get blindsided by a breakup it can really be shocking and overwhelming. It's okay to feel how you feel in that moment I would think. 5. When it comes to recovery after being broken up with, how do you fight the urge to go back to your ex? David THIS URGE IS DUE TO THE BURNS RULE: WE ONLY WHAT WE CAN'T GET, AND NEVER WANT WHAT WE CAN GET. ALSO, CAN DO A CBA ON CHASING. Rhonda Also, look at the thoughts that are leading you to want to get back together. What do they say about you that is awesome? Then examine them for Cognitive Distortions, and talk back to them w

How Skillful is your Shrink! Now you can find out! The Exciting Recovery Coefficient-- and the FEAR the grips the hearts of the therapists who are afraid to use it! People often wonder how skillful or effective their therapist is, but until now, there was no very valid or precise way to know. But now there is, and it has fantastic implications for psychotherapy. Today, we feature an interview with Kevin Cornelius, a therapist at the Feeling Good Institute in Mountain View, California. Kevin Cornelius is a Licensed Marriage and Family Therapist in private practice at Feeling Good Institute, with in-person counseling for teens .Kevin is a Certified Level 4 Advanced TEAM-CBT Therapist and Trainer. I asked Kevin to write a brief description of his evolution from a career in acting to his career as a shrink. Here's what he wrote: After many years of working as an actor I was ready for a change. After some painful personal events, I saw a therapist who was quite helpful to me. She helped me see that changing to a career as a therapist could be a great thing for me. I went to school and got my Master's in Marriage and Family Therapy. Just before I began applying for internships to complete licensure, I learned that the children's theatre group I had grown up in was looking for a new supervisor to lead the group following the death of its beloved founder and leader. This was a wonderful opportunity for me to use my theatre skills and my desire to help young people in their growth and development. I was very fortunate to be hired and worked as the director of the children's theatre group for 19 years. Towards the end of my years with the children's theatre, I was ready for a change and thought it might be time for me to finish getting my therapy license. It had been 15 years since I had worked with a patient in a therapy session, so I had a lot to learn! I was so lucky to discover David Burns and his amazing TEAM-CBT. The testing element of TEAM enabled me to see right away where I needed to improve so I could focus my efforts on improving specific skills. Being able to study with David in his Tuesday group at Stanford was a golden opportunity. Here was a framework designed to make therapy as effective as possible being taught (for free!) by one of the world's greatest therapists. I'm so happy I followed David's advice to get involved at Feeling Good Institute while I was still pre-licensed. Learning TEAM while I was completing the process to earn my license as a therapist enabled me to start my career in private practice with confidence and a stable foundation. Now, I get to continue learning from mentors at Feeling Good Institute, from the wonderful Feeling Good Podcast, and the valuable lessons I get from my patients. I'll sum up my good fortune with a theatre reference and quote the Gershwins: "Who could ask for anything more?" Kevin recently made the courageous decision to find out exactly how he was doing as a therapist. And the results surprised him tremendously. Background Information for today's podcast Outcome studies with competing schools of psychotherapy in the treatment of depression have been disappointing. They all seem to come out about the same, slightly better than placebos, but not much. For example, in the British CoBalT study of 469 depressed patients treated with antidepressants vs antidepressants plus CBT, only 44% of the patients treated with antidepressants plus CBT experienced a 50% improvement in depression after six months of treatment, and the multi-year follow-up results weren't any better. This was better than the patients treated with antidepressants alone, (only 22% experienced a 50% improvement), but still—to my way of thinking—very poor. We see more improvement than that in just one day in patients using the Feeling Good App. Here are just two of many online references to that landmark study: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00495-2/fulltext https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(15)00495-2.pdf Because of the disappointing results of research on the so-called "schools" of psychotherapy, the focus is switching, to some extent, to the effects of individual therapists, since even within a school of therapy, there can be huge differences in therapists' effectiveness. Some therapists seem to have the proverbial "green thumb," with many patients improving rapidly, while others seem much less effective. Is there a way to measure this? Now there is! And do patients have a right to know how effective their shrinks are? That's what I'm proposing! For at least twenty years or more, I've been trying to sell therapists on my Brief Mood Survey with every patient at every session. That's because you can see exactly and immediately how depressed, anxious, or angry, etc. your patient was at the start and end of today's session. This allows therapists to see, for the first time, exactly how much the patient improved in various dimensions withi

Yikes! Do I REALLY have to share my feelings? Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD, a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel. Today, we feature the exciting conclusion of that session, with follow-up. If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment. Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother. I want to protect her because it may be hard and upsetting to her. I'm not used to being vulnerable with my parents. I don't want to rock the boat or change the status quo. I'm not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won't want to get "close." Jill tried to finesse around this by suggesting Keren might aim for a more "honest" relationship instead of a "closer" relationship. There are things about me that they've rejected, like the fact that I don't really want children. And I'm not so sure I want to make myself vulnerable and get rejected again! I'm afraid I'll get swallowed up and enmeshed. We asked Keren what kinds of feelings she was hiding from her mother. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she's not taking care of herself. I have feelings of anger and resentment about the fact that I'm not the kind of daughter they wanted. I'm sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don't really belong. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren's Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren's BMS and EOTS (Patient's Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she's had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she's had the chance to do her "homework" following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here's what she like "the least" about the session: "Nothing. This has been a powerful experience." Here's what she like "the best" about the session: "This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to

When the Hidden Emotion isn't Hidden! Today's podcast will feature a live therapy session on September 13, 2022 with Keren Shemesh, PhD, a licensed clinical psychologist and certified TEAM-CBT therapist. The entire session was recorded and will be presented in two consecutive podcasts. The two co-therapists are Jill Levitt, PhD, a clinical psychologist, and Director of Clinical Training at the FeelingGoodInsititute.com. Part 1 of the Keren session I will summarize the work that Dr. Jill Levitt and I did with Keren according to the familiar sequence of a TEAM-CBT Session: T = Testing, E = Empathy, A = Assessment of Resistance (formerly Paradoxical Agenda Setting), and M = Methods, with a final round of T = end-of-session Testing. In today's podcast, we will include the T, E, and A. In Part 2, we will include M = Methods and the final T = Testing. T = Testing Just before the start of the session, Keren completed the Brief Mood Survey (BMS) which you can review at this link: Keren's Pre-Session BMS As you can see, her depression score was only 3 out of 20, indicating minimal to mild depression. There were no suicidal thoughts, and her anxiety score was 10 out of 20, indicating moderate anxiety. She was also moderately angry (7 out of 20) and her happiness score was 10 out of 20, indicating very little happiness. Her relationship satisfaction level with her mother was 19 out of 30, indicating lots of room for improvement. However, she rated "degree of affection and caring" at 6 for "very satisfied," which is the highest rating on this important item. We will ask her to take the BMS again at the end of the session, along with the Evaluation of Therapy Session, so we can see what the impact of the session was on her symptoms, as well as how empathic and helpful we were during the session. These ratings will be important, because the perceptions of therapists can be way off base, but the perceptions of our patients will nearly always be spot-on. Keren also brought a partially completed Daily Mood Log, which you can see at this link: Keren's Daily Mood Log (DML) at the start of the session As you can see, the upsetting event was her mother's visit from Israel. She had moderately to severely elevated negative feelings in nine categories, along with 17 negative thoughts, along with her rather strong beliefs in all of them. Most of her thoughts were of a self-critical nature, with lots of Hidden Should Statements as well. E = Empathy At the start of our session, which took place in front of our Tuesday evening training group at Stanford, Keren described her struggles like this: On Wednesday I woke up at 3 AM with panic attacks, one after another, and no way of getting back to sleep. I get somatic symptoms, I felt weak, nauseated, with no strength, almost paralyzed, and emotionally unstable. This was four days after my mother arrived form Israel. In the last 20 years, she and my dad visited me only once, on my graduation. I always had to visit them in Israel every year and was frustrated they none came to visit me in the Bat Area. On my last visit in May, I expressed my frustration about them not visiting me. They took it to heart and made plans to come for the Jewish high Holidays. My mom arrived first a few days ago and It's my first time alone with her. She's a Jewish mom and she stresses me out. Of course, I was really excited when she first arrived, but after four days I feel overwhelmed. This is SO MUCH WORK! I feel sad. I'm afraid I won't be able to function. I just cannot seem to enjoy my time with her. I feel fragile, but I'm hiding it. She's 73, and the signs of aging are obvious now. She needs more care, and it's tough to see her aging. Dad has always been super athletic, and he's in great shape, but she doesn't exercise or take care of herself. She's frustrated about aging and is angry with us for not accepting her as she is. I don't want to seem unhappy. I'm overwhelmed and just feel bad! David and Jill empathized, and Jill emphasized how much her parents must love her, coming from such a great distance to be with her, but also acknowledged how hard it must be for them and for Keren to be living at such a great distance. Jill pointed out that one of the issues Keren may be struggling with is the belief that their time together should be fun and conflict-free, since the time is so precious. Keren continued: My biggest problem is that I feel I cannot be me when I'm around them . . . . They want me to be a different version of myself. . . . They want me to be a mother, and they want grandchildren. But I'm in the 5% of women who don't have any interest in having children. I'm 46 years old now, and I guess I could see myself adopting, but having a family is a big job, and I've never had the passion. So, I feel like I'm a disappointment to them. But we never talk about it. I sometimes feel invisible and unseen when I'm around them. They'd be so much prouder of me if I had children they could brag about. Keren al

Ask David: Featuring Matt May, MD Can hypnosis be used for evil? Can you fall out of love? Why does cheerleading fail? In today's podcast, we discuss three intriguing questions from listeners like you: Can hypnosis be used for evil? Matt says no, David mainly agrees, but isn't entirely convinced. Is it possible to fall out of love? This can and will happen. What can we do about it? Empathy vs. Cheerleading: What's the difference between cheerleading and genuine empathy with someone who's upset? Can hypnosis be used for evil? David and Matt describe their experiences, both as kids and later as shrinks, with hypnosis. David and Matt both used hypnosis early in their careers, especially in David's one-session treatment for smoking cessation, which Matt also used. But as their TEAM-CBT skills have grown, both of them use it much less frequently. It can be used for many purposes. In a recent podcast # (link) with Dr. Jeffrey Lazarus, we learned that it can be used for warts as well as a wide range of psychosomatic problems, like Irritable Bowel Syndrome and tics, as well as bedwetting, school phobia, performance anxiety, and more. Matt strongly believes that agenda setting (also called Assessment of Resistance) is just as important in hypnosis as in TEAM-CBT. You have to first bring the patient's subconscious resistance to conscious awareness and melt it away using paradoxical techniques in order to optimize the chances of success with hypnosis. Matt pointed out that hypnotic states can be quite powerful, and can even be used for surgery, but emphasizes that people will never td what they genuinely don't want to do when hypnotized. He says that hypnosis is really a form of willful collaboration between the hypnotist and the hypnotic subject. Although stage hypnotists seem to have some kind of "Svengali" power over the volunteers who come up to the stage to be hypnotized, these people are actually subconsciously volunteering to act silly and have fun in front of the audience. This doesn't mean they are faking it, but it does put these shows into a slightly different perspective. David described many goofy things he did as a teenager after he purchased a book called "25 Ways to Hypnotize Your Friends" at a magic store in Phoenix for 25 cents, and found that the techniques actually worked with many of his friends. He sometimes had a lot of fun giving post-hypnotic suggestions, and that he and his friends found hypnosis to be incredibly exciting and fascinating. Once he hypnotized a friend named Jerry and told Jerry that after he woke up, every time he heard the word, "TV," he would shout out "Boing" in a loud voice without realizing it. In addition, his subconscious mind would keep track of how many "TVs" he heard, and then he'd should Boing that exact number of times. David explains: Then we went to the local Dairy Queen a few blocks away all ordered at the window, one by one. When it was Jerry's turn to order, and the lady asked him what he wanted, we all started saying "TV, TV, TV" as fast as we could, and Jerry would shout out "boing, boing, boing" in a loud, confident voice! She said, "I didn't quite get what you want to order," and when Jerry tried to order, we did it again. It seemed incredibly funny, and fun, but in retrospect I WAS using hypnosis to kind of take advantage of someone, so you might say it CAN be used for evil, perhaps. However, Jerry didn't seem to mind, and we all thought it was a pretty exciting adventure. When I was a senior in high school, one of my teachers said that hypnosis was dangerous and told me to stop hypnotizing my friends, so I got scared and gave it up until I became a psychiatrist years later. Like anything, hypnosis is just a tool, and it can be helpful for suggestible individuals, but we have more than 100 techniques in TEAM-CBT, because no one tool has the answer for everybody and every problem. David and Matt both agree with anxiety, depression, and anger are very much like self-induced trances, since you are giving yourself and believing messages (hypnotic suggestions) that aren't actually true. For example: The depression trance: "I'm no good. I'll be depressed forever." The anxiety trance: "Something awful is about to happen. I'm in incredible danger." The anger trance: "You're no good!" Psychotherapy can be seen as an attempt to get each patient to "wake up" from the trance that has trapped them. In David's opinion, politicians sometimes put their followers in trance-like states, getting them to believe repeated suggestions that are blatantly untrue. We saw this in WWII, where Hitler essentially "hypnotized" an entire nation to believe some horrific lies and to spur them to unspeakably horrific actions. Of course, as Matt has pointed out, you have to WANT to be hypnotized, so possibly the German people wanted to see themselves as superior human beings who had been victimized unfairly by evil forces that needed to be eradicated. So, killing and the abuse of him beings

Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Last week, we presented Part 1 of the session with Meina, a young woman struggling enormously because of her feelings about the new Iranian revolution. Today, we present the exciting and unexpected conclusion and follow up of the incredible session with Meina. Part 2: The Conclusion When Meina returned, her mood scores were very similar to what they'd been at the start of the previous session. This indicated that empathy alone was not sufficient to trigger any meaningful changes in how she felt. She said that she'd had some fears about what listeners might think, since, as we mentioned, Meina rarely, if ever, opens up about how she's feeling inside, so talking openly on the podcast definitely means facing her fears and venturing into some radically new territory. The ineffectiveness of Empathy alone is important, because she graded our Empathy as an A+. Many therapists wrongly believe that empathy is the most healing tool we have in therapy. This is idealistic, but wrong. Empathy is definitely important, but without the A and the M of TEAM-CBT, very little, if anything, will change. And, in most instances, patients appreciate good listening, that's for sure, but they want more. They want tangible changes in how the feel and interact with others. Today, Meina showed more emotion. She mentioned that she'd been a Michael Jackson fan, and liked his song about how our (inner) voices don't get out. She was feeling tearful, and angry, and said that in her work, her voice was not coming out, and this was a matter of great distress. She also mentioned that after she cried and expressed her rage about the young woman who was murdered by the morality police, an annoying "eye twitch" that she'd had for six months suddenly disappeared. Meina has also had many experiences in the past of experiencing health anxiety symptoms whenever she's upset about something and hides or suppresses her negative feelings, like anger. She had participated in many of David's Sunday hikes before the pandemic, and sometimes had weird somatic sensations, fearing she had some neurologic disorder, only to have her symptoms instantly vanish when she finally expressed her anger. Many of you will recognize this as David's "Hidden Emotion Technique." She also said she's afraid she'll be seen and stereotyped as an "angry woman" if she shows her anger, and said she may even have an Anger Phobia, thinking that anger shows that you're a "violent person." She said that she's always been quick to get angry, and wanted to focus the session on anger. Her goal for the session had shifted in the two days since we did Part 1, and she now wanted to learn how to express her anger more effectively. M = Methods In the rest of the session, we used the TEAM interpersonal model to deal with an intense conflict Meina had recently when she was trying to get her colleagues to issue a statement on behalf of her institution supporting the women in Iran who were protesting, and had partially complete the Relationship Journal in preparation for today's session. As you may recall, when you use the RJ, you will discover—and this can be quite shocking—that you are actually causing the very relationship problems that you are complaining about. And this came as a huge surprise to Meina. The remainder of the session was incredibly inspiring, and Mina did some magical work. I'll let you listen to the rest of the session to see how the work unfolded. If you'd like to review Meina's RJ, you can click this LINK. End of Session T = Testing If you'd like to see Meina's end-of-session mood ratings, along with her Evaluation of Therapy Session, you can check this LINK. If you'd like to refresh yourself on the Five Secrets of Effective Communication, you can click this LINK. I was incredibly proud of the brilliant and inspiring work that Meina did during this session. She experienced the "Great Death" of her "self," along with the "Great Rebirth," or the "waking up" of the "non-self." At the start of this podcast, we asked the question of whether TEAM-CBT could be of help when people are struggling because of events that are both real and horrific. Now perhaps you see my answer: a resounding and unexpected YES. However, there are a couple of disclaimers. First, the person has to be asking for help, and Meina definitely was. Having an agenda that makes sense to the patient is always, in fact, one of the most important keys to successful therapy. Second, the therapy will usually be totally unexpected, and the work we do with each person will be highly individual. We're not in the business of creating simple formulas to deal with this or that problem. Instead, TEAM emphasizes a step-by-step process which will be unique and totally different for every person you work with. And finally, we have to thank our old friend, Epictetus, for once again reminding us that our feelings do not result from what's happening, but ra

Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Today, we see lots of horrific events, and violence and hatred seem to be on the upswing. There are the repeated and horrible mass shootings in the US, the horrific war in the Ukraine, and the extensive protests that are rocking Iran. Those problems are real, and terrible in reality. So, maybe the TEAM-CBT model, with its emphasis on our interpretations of reality, and our relationships with others, might seem like irrelevant and useless tools. Or are they? Let's check it out. Sometimes, as you'll see, things can a take sudden and unexpected change in direction in TEAM-CBT if you follow the energy. There is no "formula" for treating anything. We treat humans, not diagnoses or problems. But we do go through the T, E, A, M model in a systematic way so we can find out what, if anything, each patient wants help with, and then design an individualized plan to make that happen, if possible. Part 1 T = Testing Today's guest, whom we'll call Meina for protection, migrated to the United States from her mother country, Iran, as a young woman, and she's definitely upset. In fact, her mood scores are among the most severe that I've seen recently. Her depression score of 15 out of 20 indicates severe depression, and her anxiety and anger scores of 19 and 20 out of 20 indicates extreme anxiety and anger. You can see Meina's Daily Mood Log at the start of the session as well, with nine categories—depression, anxiety, guilt, loneliness, humiliation, hopelessness, frustration and hatred all estimated between 90 and 100 out of 100, again confirming the most extreme upset a human being can experience. As you might expect, her happiness score was 0 out of 20, indicating no happiness at all, and her Relationship Satisfaction Scale score, thinking of her husband, was only 19 out of 30, indicating considerable marital distress. What's causing those feelings? Well, let's take a look at her negative thoughts and how strongly she believes them: I'll always suffer because of being born in Iran: 90% My heart will stop from feeling so much hatred. 80% There's nothing I can do to help (the women who are protesting.) 100% It is pathetic that I can't stop feeling so angry. 90% I'm going to get sick because of these feelings. 90% Many young women will be tortured and killed. 100% I'm going to lose all my friends because I'm so angry. 70% My marriage will also be negatively impacted. 100% E = Empathy In the empathy phase of the session, Rhonda and David simply listened, as Meina described terrifying memories of the being a child during the Iran Iraq war, and being left alone to care for her younger sister when her parents were away every day, and bombs were coming down all over the city. She said that on many occasions she was so scared that she wanted to commit suicide by jumping out of the window of their apartment in Iran. And now, all those terrifying memories have come flooding her mind again, triggered by the events in Iran, as well as her fears and run-ins with the "morality police" when she was a young woman. She expressed profound connection with the young women who are now fighting the intense suppression of human rights in Iran, all in the name of religion! Once their car was stopped, and a policeman put a gun to her mother's head because she had not covered her hair properly. She also described the attempts always to separate the girls and the boys to prevent any type of dating or romantic behavior, and the constant fear of being imprisoned if you did the wrong thing. Meina tells us: I saw friends who were beaten up, and was humiliated for eating an apple. I was arrested for wanting to go to parties to listen to music. I lived in constant fear of being tortured and had panic attacks by night and by day. . . I left Iran when I was 22 and have never gone back, for fear of ending up in prison. . . Then, when I finally escaped to the United States, I never fit in. The young people were interested in the latest music, and did not seem interested in my story, in my experiences. I never felt like I fit in. I think I've felt lonely my entire life. Now I feel embarrassed, being from Iran, because it's such a violent country. . . And I have panic attacks every night. I cope by imagining that I'm in Iran, visiting and counseling girls who have been imprisoned, and giving them tips on how to use the Five Secrets of Effective Communication so they won't be tortured, raped, and murdered. Meina said she still feels alone, since few people, including her husband, are really interested in her story, including her horrific memories of growing up in Iran, or how she feels now. She said she also feels intensely guilty, since she still has friends and one relative in Iran who are facing desperate circumstances, while she enjoys comfort and safety here in California. She rated us as an A+ on empathy, so that brought us to A = Assessment of Resistance. She added that she alway

Audrey Kodye Sunny Choi Diversity: Trauma and Training featuring Sunny Choi and Audrey Kodye Rhonda and I are proud to feature Audrey Kodye, a psychologist with a private practice in Canada, and Sunny Choi, LCSW, who specializes in the treatment of underserved populations in the San Francisco Bay Area. In today's podcast, these beloved TEAM-CBT therapists bring us an important discussion on the impact of racial, gender, religious and sexual bias, including tips on how to incorporate relevant questions into our initial evaluations of all new patients, as well as illuminating ideas on how to maximize treatment effectiveness with TEAM-CBT. Both Audrey, who was born in Mauritius, and Sunny, who was born in Hong Kong, describe their experiences with bias and violence, both when growing up, and as adults, and how these experiences shaped core feelings of not being "good enough." Sunny explained that how he incorporated the negative messages that were triggered by his traumatic experiences: I grew up in a privileged family in Hong Kong, and was favored as a male child. When we came to the United States, I was 12 years old and undocumented. I got beaten up because I had slanted eyes, and I was hated because I was gay. I worked super hard, getting a degree in engineering from UCLA and a master's in management from Stanford, and became successful, but got more and more depressed due to my belief that I "wasn't good enough." Now I work with marginalized populations, the poor, people of color, LGBTQ, immigrants, and abused women. Audrey said: I've also felt like I wasn't good enough. . . . I'm a light-skinned black woman from Africa, from a lower-class family in Mauritius. . . . My ancestors had to be very resilient due to prejudice, and I'm very proud of them. I've also struggled with social anxiety and depression due to the racial trauma I've experienced. Sunny and Audrey have both been helped by TEAM-CBT, and feel it has a great dealt to offer and have appreciated that diversity is celebrated in the personal work so many people do in David and Jill's Tuesday training group. They say that "TEAM has helped us and our patients as well!." They gave some valuable tips on how to incorporate diversity awareness in to treatment with TEAM, but the same tips would be helpful to anyone interacting with a friend or colleague who may have been the victim of abuse. Sunny added: "I got scared and anxious when thinking about this topic prior to today's podcast. What I've been through has definitely shaped my behavior, my thinking, and my feelings, and the hatred is still happening today." He tearfully described the experience of his cousin who has a Chinese restaurant in Oakland, and someone threw a rock through the window to act out on their hatred for Asian Americans. Audre said: "I also felt sad and anxious while preparing for the podcast. It's not easy to talk about racism and discrimination, and I felt a lot of self-doubt about my own experiences with racism and discrimination before the podcast, because they have so often been invalidated. People get defensive and are often incredulous. They don't believe it. So you run into conflict and opposition and defensiveness when you try to speak out." David agreed and emphasized how sensitive and defensive people can be when our "blind spots" are confronted, especially when we've been in a state of denial, thinking of ourselves as totally innocent when we're not! They discussed three keys in thinking about racism and discrimination: Systemic racism: the Five Secrets of Effective Communication can be helpful. For example, it is important to acknowledge the anger your patients may feel because of the injustices they experience. Micro-aggression: These are subtle put-downs that may sound like compliments, and might even be intended as such, but are really hurtful. For example, when learning that Sunny is gay, someone may say, "Well, Sunny, you certainly don't act gay!" This statement, which might sound innocent, actually implies that you're "less than" or "less of a man" if you're gay! Internalized oppression: This is when the person who is being targeted turns against himself or herself, and internalizes the message that "I'm not good enough," or "I'm defective." David points out that this is similar to Freud's model of depression, which he thought of as "anger turned inwards." Although Aaron Beck railed against this construct, I have to admit that the negative thoughts of people who are depressed nearly always do have a hostile, bullying tone. David also compares racial discrimination and hatred to the three components of "Abuse Contract" he often explains in his work with abuse victims. There are three parts to the contract: I get to abuse you, physically, psychologically, sexually, or financially for my please. We have to keep it secret. If you ever tell on me, or even imply that I'm doing something wrong, I'll REALLY hurt you. It's all your fault. You're the dirty bad one, and you

TEAM-CBT with children and teens, featuring Jeffrey Lazarus, MD Tics, Irritable Bowel Syndrome, Chronic Pain, Bedwetting, Fears, Phobias, Performance Anxiety, and more In TEAM, we usually conceptualize four categories of problems: depression, anxiety disorders, relationship problems, and habits and addictions. Although there are similarities in the treatment of each of these targets, there are also important differences. Today's guest, Jeffrey Lazarus, MD, is a pediatrician who specializes in a fifth category, somatic complaints, which can include physical symptoms like chronic pain, dizziness and fatigue without any known medical cause. This category also includes as irritable bowel syndrome, headaches, tics with and without Tourette syndrome, bed wetting, and a wide range of other problems which are common in kids and sometimes in adults as well. Dr. Lazarus also works with anxiety disorders, such as test anxiety, sports performance anxiety, public speaking anxiety, school phobia and more. Although Dr. Lazarus worked as a general pediatrician for the first 27 years of his career, he switched to hypnotherapy when the painful plantar warts on his feet were unexpectedly cured following a single hypnotherapy session from a colleague. Dr. Lazarus was so impressed that he began studying hypnosis and incorporating it into his work with children, teens, and adults. He now works from a TEAM perspective, incorporating Testing, Empathy, Paradoxical Agenda Setting (also called Assessment of Resistance), and a variety of cognitive methods, along with hypnosis. He began today's podcast with a case of a young man he was treating for persistent bed wetting, and was surprised when his patient slammed him in the written feedback on the Evaluation of Therapy Session form following the session, labeling Dr. Lazarus as a bit "narcissistic." At the start of the next session, Dr. Lazarus responded non-defensively with the Five Secrets of Effective Communication. This won the boy over, leading to a successful outcome. Jeff said that the Evaluation of Therapy Session form and the Five Secrets have "saved him" on several occasions with disgruntled patients. Jeff then presented several fascinating cases where motivational factors and resistance played a major role in the treatment, and emphasized that treatment failure would probably have been inevitable if these factors had not been brought to conscious awareness. For example, a teenager who frequently had to go home from school because of somatic symptoms listed, at Dr. Lazarus' suggested, the many advantages of his symptoms, such as "I don't have to go to school," "I get extra attention this way," and more. After this intervention, the boy decided that it just wasn't worth it, because there were lots of fun things he was missing out on at school, and his symptoms rapidly subsided. In another case of bed-wetting, Jeff discovered that a 10-year old knew that he wouldn't be permitted to go on sleep overs at his cousin's house until he outgrew his bed-wetting problem. But when he "listened" and encouraged the boy to talk about his distress, the boy explained that his cousin had a "creepy dog" that frightened him, so he actually didn't want to go on sleepovers. Jeff encouraged the boy to tell his parents what was really going on, and when his mother said he wouldn't have to go on any sleepovers unless he wanted to, his bed-wetting suddenly disappeared. He described many additional cases where motivational factors dominated his patient's problems, including a promising teenage tennis star who suddenly developed a fear of flying which made it impossible to go with her parents to important weekend tournaments. But with Dr. Lazarus' support, she confessed that her life was dominated by school, study, and going to tennis tournaments, with no free time to be a "normal teenager." She finally confided that she was just "tennissed out" and wanted to have more fun in life, to have dates, and so forth. By subconsciously developed a flying phobia, she was subtly going on strike, and saying "I don't want to do this anymore." But by developing a symptom, she could continue to be nice and say "I can't do this," rather than saying "I don't want to do this anymore." These subconscious maneuvers are not manipulative, but automatic. When brought to conscious awareness, the patient finds himself or herself in control, and can decide to go in a different direction. This patient mustered up the courage to tell her parents and her coach, who were understanding, and her fear of flying suddenly disappeared as mysteriously as it had first appeared. Dr. Lazarus emphasized that the child's complaints are real—they're not making up the symptoms, and they need empathy and support, and the chance to tell their story. Parents are nearly always focused on "pushing" and "helping," efforts that just make the problem worse because the child pushes back. Although parents do this out of love, their misguided efforts to "

Ask David: Featuring Matt May, MD 1. Roy asks: How can I challenge my core belief that there is something wrong with me? 2. Lynn asks: Do you have any recommendations for someone with health anxiety? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Roy asks: How can I challenge my core belief that there is something wrong with me? Hello Dr .Burns, Regarding podcast 294, I had a few quick questions/suggestions on acceptance. Is it possible to do a podcast with you and Matt and Rhonda on one specific core belief? The belief: There is Something Wrong With Me Let me explain. I have dated and had relationships with some very physically attractive women in the past. In the last year I have not been able to duplicate these past successes and I suspect it's because I am at least 10 years or more older than these women ( 23-28). Let's say I NEVER EVER date or have a relationship with my specific type EVER again? This has caused a ton of frustration and some depression ( low) but has been a bit to my self image and self esteem Thoughts? Thanks Dr. Burns Roy David: At my request, Roy provides more information on his Core Belief: There is something wrong with me. Why believe it? 1. My parent said "What's wrong with you?" whenever I got in trouble in school ( infers there IS something wrong with me) 2. It feels like there is something wrong with me 3. I make mistakes and am not perfect so there MUST be something wrong with me I believe this Core Belief to be 100 % True David: I asked Roy to provide a Daily Mood Log. DML Activating Event: 3 specific events A) My ex girlfriend dumped me and ended our relationship B) A woman I suspect is a super model said No to my request to go out on a date C) I have recently struck out with the last 5 women I REALLY want to date. They ALL rejected me Feelings: Depressed/Down/Unhappy (70%) Worthless/Inadequate/Defective (80%) Unloved/Rejected (95%) Hopeless/Discouraged (99%) Frustrated/Defeated (99%) Resentful/Irritated/Upset (99%) Negative Thoughts 1.There is something wrong with me (100%) 2. I must get this specific woman's love and approval to feel good about myself (80%) 3. If I am a sexy charming guy then this woman would find me attractive. I must not be very attractive (100%) 4. If I played in the NBA or NFL then this woman would be attracted to me (100%) 5. The sex would be amazing if I were to be intimate with this woman (100%) 6. I would be so much happier if I was to have a relationship with this woman (100%) 7. Women like her with incredibly sexy attractive bodies only go for high status millionaires. I am not a millionaire. It's awful I am not a millionaire (100%) 8. I am 10 years older than these women and therefore my age turns them off (100%) David wrote back, suggesting that Roy list the benefits of his belief that "there's something wrong with me." Positives of believing There is Something Wrong With Me Very easy explanation why these specific types of women reject me I don't have to make any changes about myself ( clothes) or behaviors ( more charming) Familiar feeling and comfort in familiarity I can feel sorry for myself and have a pity party Gives me something to complain about with my friends lol My fantasy ( sexual and relationship) of these specific women remains unchallenged and is a great distraction when bored Shows I accept I am not perfect and defective I accept responsibility for my failings Don't have to get angry or upset about my mother's poor parenting skills Incredibly easy cop out whenever I fail to achieve any type of goal Can quit working towards a goal when face adversity Next, Roy identified some distortions in this belief. Distortions in believing There is Something Wrong with Me -emotional reasoning -self blame -overgeneralization Why? Feels like there is something wrong with me. I am assuming 100% blame. I am not focused on any positive things done in my life I am stuck because my mother said what's wrong with you when I was a kid. I concluded there must be something wrong with me. Whenever I get rejected this core belief surfaces. Is this what you had in mind? All the Best and THANKS Roy David's response Hi Roy, Thanks for the email. Everything about you and me could be improved. Is that all you mean when you say "there's something wrong with me?" Or are you saying you have a "self" that is somehow damaged.? If so, was your "self" always damaged, from the time of birth? Or did it "become damaged" at some point? If the answer is yes, at what point did your "self" become "damaged?" To me, conversations about "selves" have no meaning. Conversations about specific flaws or problems do have meaning. You are kind of kicking your dating problem up into the clouds of abstraction, to my way of thinking, when you obsess about a "damaged self." Lots of colleagues who used to come to my Sunday hikes had dating problems, in your age range, and m

313: People who "yes-butt" you. People who resist exposure. Does God exist? Does the "self" exist? How to you justify Ellis? "Should" we care about Putin's war on Ukraine? " 1. Rhonda asks: How can you respond to someone who yes-butts you? 2. Thomas asks: Do we have a self? Does God exist? 3. Thomas also asks: Ellis said we should upset ourselves over someone else's problems, but how about Putin, and Russia? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Rhonda asks: How can you respond to someone who yes-butts you? David's Reply Thanks, Rhonda. We can demonstrate this with Matt on the podcast recording later today! Matt's Reply: The answer is to fall back to Empathy and try to see how we are creating the problem. For example, when we are giving advice, we may have fallen into a trap, in which we are getting ahead of their resistance and would want to get behind it. As often happens, the question, and its answer, went in an unexpected direction. Rhonda, like many therapists, noticed that one of her social anxiety patients was subtly resisting exposure—facing her fears. Matt and Rhonda model how to respond to patients who keep putting off the exposure. This answer illustrates how therapists and the general public alike can improve your use of the Five Secrets of Effective Communication (LINK) with the use of "Deliberate Practice," with role reversals and immediate feedback on your technique. Rhonda starts with a low grade, and then rapidly achieves an A grade! Click here for the Five Secrets of Effective Communication 2. Thomas asks: Do we have a self? Does God exist? Thank you for giving me your time and attention. I appreciate it, even if we don't agree. I have talked about whether or not God and the self exist. David Hume made the argument about not having a self, only perception. Of course, questions arise if we don't have a "self." Thomas Thomas also comments on Nathaniel Brandon: Why do we use the words who? Him? Her? He she they.?? I certainly don't believe Nathaniel Brandon's horseshit. He talks about a teenage self, a father self, and a child self And all that is just horseshit. But do we have any self? David's response: Hi Thomas, Thanks for your question! You ask, "But do we have any self?" You ask about God, too. People have been asking for my chapter on the "Death of the Self," and my efforts to debunk the idea of a "self." I have not had the time and motivation to bring that chapter back to life, since it is so hard for people to "get" what I've been trying to say, which is exactly what Wittgenstein and the Buddha were trying to say. But I will try to share one idea with you, in the hopes that it might make sense. As I have previously suggested, these questions about some "self" or "God" have no meaning. For example, how about this question: 'What would it look like if someone had no 'self?' What, exactly, are we talking about? I know what this question means: "So you think Henry is too high on himself." This means that we think some person named Henry is arrogant or narcissistic, something like that, and we want to know if someone agrees with us. I understand this question, it makes sense. There is a distinct difference between people who are quite humble and folks who are overly impressed with themselves. So, we are talking and using words in a way that has meaning and makes sense. However, I cannot answer the following question because it does not make any sense to me: "Does Henry have a 'self'?" So, this question, to me, is language that is out of gear, like a car in neutral gear. No matter how hard you press on the accelerator, it will not move forward or backward. If you cannot "see" or "grasp" the difference between my examples of a meaningful question and a nonsensical non-question, that's okay. In my experience, few people can grasp or "get" this. But to me, the difference is quite obvious. Is it okay if I use your email as a somewhat edited "Ask David?" I can change your name if you prefer. I don't think people will "get" my answer, but hope springs eternal! David Matt's Response Many brilliant minds have addressed this question in more eloquent and thorough ways than I could, including the Stanford-trained neurologist and philosopher, Sam Harris, in his book, 'Free Will' and Jay Garfield in his book, 'Losing Ourselves' There's very little I can say, about this topic, that hasn't been said more eloquently by individuals like these and many others. Meanwhile, I'm glad that this question has arisen on the podcast because I see clinical utility in the implications of this question, including in the treatment of depression, anxiety, anger, narcissistic pride and relationship problems. For example, I might be thinking, 'I'm so mad at my (bad) self for eating all those cookies'. Or, I'm so proud of myself for making a million dollars'. I might start to think I deserve more, bec