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

Podcast #280: A Beloved and Brilliant Voice from the Past: Dr. Stirling Moorey! Rhonda and I are thrilled to welcome Dr. Stirling Moorey, from London, England, to today's podcast. Stirling was one of my first students, and he sat in with me my on all my sessions as a co-therapist for a month for two summers in the late 1970s. I wrote about Stirling in my first book, Feeling Good: The New Mood Therapy, which was published in 1980. One of the miracles of the internet, and zoom, is the chance to reunite with friends and colleagues from the past. Needless to say, Rhonda and I were SO EXCITED when Stirling accepted the invitation to join us! Rhonda starts the podcast by saying that "Dr. Stirling Moorey had the good fortune to be trained and supervised by two pioneers in the field of cognitive therapy, Drs. Aaron Beck and David Burns. In 1979, when Stirling was still in medical school in London, he did an elective with Dr. Aaron Beck at the Centre for Cognitive Therapy in Philadelphia." I (David) might put it a bit differently. I would say that during the early days of cognitive therapy, I had the fantastic opportunity to do co-therapy together with Stirling with many patients. I learned a tremendous amount from Stirling, even though I was, in theory, the "expert" and he, in theory, was a totally untrained and green novice. But he was phenomenal right out of the gates, and those months were among the happiest of my life. What I learned by observing Stirling's superb interactions with my patients eventually morphed into my Five Secrets of Effective Communication and my first book, Feeling Good Together! Rhonda continues: "Stirling was one of the first British therapists to study CBT when that discipline was in its infancy. David described their fantastic collaborative work with Stirling in Feeling Good, and has described Stirling's brilliant empathy skills in dozens of workshops. Stirling is currently a Consultant Psychiatrist in Cognitive Behaviour Therapy, and was the Professional Head of Psychotherapy for the South London and Maudsley Trust from 2005-2013. He has been a Visiting Senior Lecturer at the Institute of Psychiatry, Psychology & Neuroscience in London." Stirling is a highly regarded therapist, trainer / supervisor / teacher and workshop leader. His main research interest is in the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and has contributed to five randomized controlled trials in both early and late stage cancer. Stirling is also co-author with Steven Greer of The Oxford Guide to CBT for People with Cancer, and has co-edited a book entitled The Therapeutic Relationship in Cognitive Behavioural Therapy, published by SAGE (Moorey & Lavender, eds.) During today's podcast, Stirling reminds us that one of the aims of cognitive therapy is encouraging patients to examine their distorted negative thoughts and self-defeating beliefs in a way that is not threatening. If patients don't feel validated, they may feel attacked and become defensive, which, of course, can undermine the therapist's effectiveness. He also reminded us that the grandfather of cognitive therapy, the late Dr. Albert Ellis from New York, often attacked the beliefs of his patients in a somewhat aggressive manner, and that this can frequently trigger therapeutic resistance. In fact, an overly aggressive therapeutic style can split patients and colleagues into two camps: those who love you, and those who may stubbornly resist and oppose you. During the podcast, we reminisced a bit on shared memories, and Stirling said that "David took me under his wing with such willingness to share his knowledge and experience . . . and I was just an ordinary medical student. We had many great moments!" Although Stirling was tempted to relocate to America, he decided to remain in England, and has never regretted that decision. For one thing, he met and married his beloved Magda. My own wife, Melanie, and I were honored to take our two kids to England to attend their marriage. We all loved England and had a ball! Magda, Stirling's wife We discussed some of Stirling's amazing work with the patients we saw together in Philadelphia, as well as his visit one summer when we were in California visiting with Melanie's parents in Los Altos, where we now live. Stirling recalled that when we were out shopping one day, my wife and I tried to persuade him to purchase a large Stetson hat, but he resisted! Stirling described the three ways in which he encourages people to change their negative thoughts using the Socratic Technique of gentle questioning: he asks if the negative thoughts are realistic, if they are helpful, and if an alternative perspective can be taken. The reality testing approach focuses on the important differences between healthy negative feelings, like healthy sadness or grief, which don't usually need any treatment, and unhealthy negative feelings like depressi

Podcast 279: Dr. Leigh Harrington on Goal Setting for Habits and Addictions or Using Habits to Feel Better Today, we are joined by a very special member of the TEAM-CBT family, psychiatrist Leigh Harrington, MD, who will teach us how to set goals that work when battling habits and addictions. Leigh Harrington, MD, MPH, MHSA, is a psychiatrist, TEAM-CBT Therapist and Trainer. Originally from Michigan, where she completed medical school and graduate school, she had the good fortune to meet Dr. David Burns in 2004 during her psychiatry residency at Stanford University when she joined his original group of Tuesday night students. She specializes is helping therapists and individuals reach their goals especially in the areas of Interpersonal Exposure, Relationships, and Habits. She lives in Davis, California with her two beloved daughters. Leigh begins by saying that there are many parts of the TEAM-CBT model than help when battling unwanted habits and addictions. Our habits definitely result from how we think, and the stories we tell ourselves, and treatment can sometimes be more than just treatment, but a transformational experience. She explains that "I gained 20 pounds following my last pregnancy, so I began to set three kinds of goals: Mental goals Physical goals Relationship goals" Mental goals She continues: "I focused on reducing the many Should Statements I was battering myself with, like "I should have done this or that," or "I should do this or that." These kinds of statements sounded demanding and triggered feelings of guilt and frustration that actually made it harder to achieve my goals. "So, I decided, instead, to notice my thoughts, and focus instead on appreciating things. This was just one of many approaches to rewiring my brain. "For example, I realized I had been letting my brain run itself each morning. When I woke up my mind would start to tell me all the things I needed to (should) do that day. . . Sometimes I would wake up feeling "okay," but I was definitely not in a state of bliss, gratitude or joy. "Sometimes it seemed as if my mind would look to find reasons I might not be feeling top-of-the-world: 'Well there is this issue… or this… and also this…' "Which told me a story of my unhappiness, or simply a lack of joy. Of course, my mind was well-intentioned, trying to help me out, but it didn't end in greater joy, but in the weight of 'shoulds' and reasons to feel crummy. It had become a habit--a thinking habit. "I was struck by the idea that I didn't have to let my mind think whatever it wanted and wondered if I could break this thinking habit. In habit work, we determine the new habit we want, check our motivation, plan solutions to any problems, and commit to the new habit. "I thought I would keep my new habit simple, believable, and incorporate gratitude, as that can sometimes be helpful, too. "My new habit was to catch myself while I was still in bed, as soon as I recognized I was having thoughts, and say to myself something I believed that, was non-controversial. When I caught myself thinking any shoulds or telling myself any unhappy stories, I said to myself, 'I love my bed. I love my house. I love my lamp.' "This might seem simple, trivial, or silly. But the point of the new habit was not to be profound and brilliant. The point was to change my thinking in the smallest of ways and to prove to myself I could create a new thinking habit. "This simple thought habit has allowed me to start my day on a better note and has allowed me to prove to myself I can change my thinking habits." Physical goals Leigh explains: "Here's how I lost the 20 pounds I had gained. Instead of focusing on one strategy – like, "I will only eat vegetables," or "I will exercise 2 hours per day," I focused on achieving the goal by any means. I used the experimental technique and went through a series of habit experiments. "First I tried just thinking I'd like to lose the weight. I. This may seem crazy, but there have been times in my life when I've seemed to effortlessly loose weigh, so that seemed like an easy first go. "As you might imagine, it didn't work as well in my 40's as it did in my 20's. As long as I kept giving in to my urges to have a sugary treat in the afternoon as a pick-me-up, and refusing to be in deprivation, nothing at all happened with my weight. "I also allowed myself to eat as much as I wanted to, just as I had when I was pregnant and nursing my daughter. "Since that didn't work,. I experimented with some green juice in place of sugary snacks. I felt healthier, but there was no change in my weight. "Then I decided on a multi-pronged approach. I would keep drinking my fruit-smoothies in the morning, along with a protein shake mid-morning, and a normal lunch, plus a normal dinner – just one serving at lunch and dinner, and no more than one dessert per week, Whenever else I was hungry I would drink a protein drink and lots of water. I also committed to walking every day for 30-60 minutes an

#278: Buddhist Strategies for Financial Abundance, Featuring Zeina Halim Jan 24, 2022 Today, we feature the work of Zeina Halim, a beloved member and small group leader in our Tuesday training group at Stanford, who specializes in the treatment of anxiety. This is Zeina's third appearance on our podcast. Previously she helped us with a fabulous program on family conflicts at the start of the pandemic (Corona Cast 3, 4-06-2020) and later did live some personal work on one of the Self-Defeating Beliefs, the Achievement Addiction (Podcasts 211, 10-12-2020, and 212, 10-19-2020). Today Zeina brings us something radically different: Buddhist Strategies for Financial Abundance. What in the world does that mean, and why should you care? She starts by describing her study of Buddhist practices, and cites some books that have inspired her, including The Diamond Cutter: The Buddha on Managing Your Business and Your Life, by Geshe Michael Roach. Zeina explains the quasi-mystical concept of "Karma," which is the idea that you get what you give. In other words, the energy and spirit you convey to others, and to the universe, will come back to you. For example, when clients who are not a good fit for her practice contact her, Zeina goes out of her way to help those clients find a great fit with another therapist. This "Karmic practice," she explains, has paradoxically caused many patients to suddenly seem to show up, asking for treatment. In other words, when she meets the needs of others, the universe meets her needs. She says that she doesn't need to do very much at all of the kinds of traditional marketing that most other therapists do in an attempt to build their practices. This "karmic practice" has been mostly sufficient and far more effective than traditional marketing methods. This is a theme that I (David) resonated with, since I also give away almost everything for free, and have received an abundance of positive and loving gifts from the universe in return. Zeina cautions that this, and all Buddhist practices, must be done with balance and thoughtfulness: "When I started, I gave too much, and this can actually cause self-harm." She said that some people have raised the question: "But isn't this an inherently selfish practice, since you are hoping for abundance for yourself?" Her response to this is that when you receive financial abundance, you can give even more to others for free. She also described another book of Geshe Michael Roach's, The Karma of Love, where you try to give to the other person and meet their needs instead of worrying about whether they're loving you enough or meeting your needs. In a previous relationship, this led to inner peace and, paradoxically, she felt much more loved, although nothing observable had changed in the way her partner treated her. The change in her feeling loved all came from changes SHE made, not her partner. This aligns very closely with the TEAM-CBT approach to relationships, as well as the teachings of most religions. We also discussed group TEAM-CBT vs. individual therapy. I described my phenomenal experiences in Philadelphia creating a large intensive group therapy program at my hospital, which was in a rough, inner city neighborhood. Most of our patients had few resources, and many could not read or write. Some were homeless. The program was more or less free to all of them, and our patients and their families gave us so much in return. I was absolutely thrilled that Zeina also loves doing therapy in groups. Many patients and therapists alike think of group therapy as a kind of inferior approach, but my experience has been the opposite. If given the choice, I'd treat everyone in groups. Zeina will be starting a TEAM-CBT anxiety group within a week of this podcast. The group will focus on all the anxiety disorders, such as chronic worrying, shyness, phobias, OCD, PTSD, and more. There will be one group for adults and one for young adults, aged 18-24. If you're interested, feel free to text Zeina at 1-408-412-5678, email her at [email protected] or visit her website at ZeinaHalimTherapy.com As an aside, we'll find out if Zeina's Buddhist Karmic Marketing works. She did not ask me to promote her group. I just decided to promote it a little bit because I'm so excited about what she's doing, and I hope her practice grows and prospers to the max! Thanks for joining us today! If you like what we're doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing. This year, we'll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen! Rhonda, Zeina and David

Rejection Practice: A Love Story, Featuring Dr. Cai Chen Jan 17, 2022 Rhonda starts today's podcast by reading two wonderful recent endorsements from listeners. A therapist from San Jose, Ca was moved and inspired by the two podcasts (Episodes 268 & 269, published 11-15-2021 and 11-22-2021) with Dr. Carly on the tragic loss of her baby via ectopic pregnancy, and another listener described TEAM-CBT as "revolutionary" due to the emphasis on reducing resistance. She compared the approach to the indirect hypnotic approach developed by the late Milton Erikson. Dr. Cai Chen recently completed his psychiatric residency in Texas, and then moved to California to join the TEAM-CBT community and unite with the love of his life, who happens to be a member of our Tuesday group. Cai attributes much of his dating success to one of the techniques he read about in my book, Intimate Connections, called "Rejection Practice," because he practiced that technique to successfully defeat his negative thoughts about all the awful things that might happen if he tried to talk or flirt with an attractive woman. He would tell himself things like: She'll think I'm being too forward. She'll be offended and might call the police. People who see me trying to flirt will be offended. I'll be rejected. He described what happened when he forced himself to get 20 rejections in a mall in order to overcome his fears. His stories about what happened are both funny and inspiring. Cai also describes his initial intense resistance to using this technique, giving himself messages like, "I shouldn't have to learn to flirt because it's beneath me!" I heard excuses like that all the time when I was in clinical practice, working with shy, lonely men! Rejection Practice is a powerful and potentially super-effective technique you might want to try if you're also struggling with social anxiety or if you treat patients with this problem. We also illustrated the hilarious Feared Fantasy Technique on the podcast, where Cai enters an Alice-in-Wonderland Nightmare World, and meets the "woman from hell" who represents all of his worst fears, and verbalizes things like this to him: You're assaulting me and I'm going to call the police. You're the last person I'd ever date! You're forgettable! you You're too forward. I can see that you're very insecure! In addition, he meets the "observer from hell" who verbalizes things like this to Cai: I'm terribly offended that you tried to talk to that woman. It's highly inappropriate to flirt like that in broad daylight. You shouldn't be doing that. I condemn and reject you! Cai was surprised to discover that the monster has no teeth and experienced some enlightenment and freedom from his fears. Rhonda, Cai, and I had a lot of fun with these techniques, and hope you enjoy them, too. Again, if you're a therapist, you might consider including these techniques if you work with shy individuals. We also discuss the idea of "Physician, heal thyself," a quotation from the New Testament (Luke 4:23). We are all convinced that doing your own personal work can vastly increase your skills and depth as a clinician, because you can tell your patients, "I know what you're going through, because I've been there myself. And what a joy it's going to be to show you how to overcome your shyness and develop greater confidence, and more loving relationships with others." And that's exactly what happened to Cai. He found the love of his life. You'll hear all about it if you listen to this heart-warming podcast! Dr. Cai is just starting his TEAM-CBT practice at the Feeling Good Institute in Mountain View, California. However, since he is a trained physician and psychiatrist, he can also prescribe medications if patients need them in addition to the therapy. Dr. Cai Chen is a warm and brilliant young psychiatrist. If you would like to contact him, you can contact him at [email protected], or call him directly at 1-916-877-4749. Thanks for joining us today! If you like what we're doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing, since I have refused to monetize the podcasts. So our budget is meager at best. Still, this year, we'll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen! Warmly, Rhonda, Cai and David

Here are the questions for today's Ask David, featuring special guest, back by popular demand, the extraordinary Dr. Matt May, and of course, our super-special hostess, Dr. Rhonda Barovsky! Why is my dad the way he is? Why are people the way they are? What can you do about positive distortions? More Should Statements! How can you talk to someone who refuses to talk to you? Why is my dad the way he is? Why are people the way they are? Hi Dr. Burns and Dr. Barovsky! I love your show. Keep up the good work! I'd deeply appreciate your time and insight. My dad is 70, my mom is 67, and I'm 38. Throughout my life my dad has done things like he did earlier tonight. I was at my parent's house and my mom was telling me how Thanksgiving was going to be at my parent's cabin with the whole family like we have in years past at which my point my dad firmly said "No." My mom asked "Why?" and he just shook his head and shortly after walked out of the room to go to the bathroom, shut the door, and said "no" angrily three times in the other room to himself but loud enough for she could hear. He'll seemingly randomly act extremely possessive by angrily forbidding family get togethers, or my mom from doing things, or family to borrow things. He'll just say "No" without further explanation. Always, always, upon asking "Why?" to his "no." He'll either say angrily, "Because I said so!", say nothing, or just repeat "No" further. My mom says sometimes "Can you just gave me a reason?" and it's the same "No", silence, or "because I said so." I don't jump into the aforementioned back and fourth communication because I know such a person can't be changed and don't want to make an argumentative mess. He's never displayed any comfort with expressing the slightest vulnerability. He's very, very silent. All of my life he has displayed bullying type tendencies. Whenever I visit my parents he always shows tremendous eagerness to want to scowl and berate people for the tiniest mistakes (even people he doesn't know in public, like cashiers.) I think even the most skilled of five secrets practitioners might be outmatched. My mom tonight, and all my life, has asked me why is he like this? I've been haunted to try understand this question all my whole life too. So, I'm putting the question to you Dr. Burns and Dr. Barovsky: Why is someone like this? You must've heard of similar situations and have insight? I want to feel compassion and understanding for him. I don't want to live with baggage. And mainly, mainly I just want to relieve myself from anger thinking should, labeling, and overgeneralizing thoughts like "He shouldn't act like this", "He shouldn't be such a bully", "He's being a jerk." Thank you, Mark David's Reply Thanks, Mark, I can certainly understand your sadness, frustration, and anger, as well as your love and concern for your mom. Scientists don't yet know why people are the way they are. My focus is on helping people at specific moments of interaction when they want help. You have not asked for help in this email. I do make this type of statement in practically every Ask David episode, but have not had much luck in getting people to listen, because the general questions that have no answers keep rolling in. You say that your dad cannot change. To my ear, this statement is both blaming and untrue. People change at every moment of every day. The real question I always have is this, and it might not interest you. Do YOU want to change the way you interact with him? You and your mom probably both do things that trigger him, like silence, or asking WHY when it is abundantly clear that this response has a 100% guarantee of triggering him. I apologize if this is not the answer you were looking for! David What can you do about positive distortions? How much information is there in the book (or a particular podcast) on how we address positive distortions most effectively? It is mentioned briefly that these can be more difficult to overcome, because of the more positively perceived "benefits", which may also be re-enforced externally (such as "yes, he is such a nice person, nobody wants him to express any frustration or anger occasionally - not even he himself want to do this!"). It affects motivation to any change, or, at least, creates ambivalence. Some more on this would be great, please. Thanks, Tillerich David's Reply Hi Tillerich, Good question, and I will schedule it for an Ask David. As you point out, there usually isn't much motivation for change when it comes to positive distortions. Positive distortions trigger habits and addictions, violence, mania, marital conflicts, and narcissism, to name just a few areas. Each is handled differently, but dealing with motivation / resistance is key in every area. David More Should Statements Johnny asks: Can you help me disprove my negative thoughts? I manage to disprove them, but they return after a few hours. "A loser is someone who lives at home with his parents after he turns 18." "I shou

Hi everyone! This special podcast features one of our favorite people, Professor Mark Noble from the University of Rochester in New York. Professor Noble is a world-renowned neuroscientist and cancer researcher, one of the pioneers in stem cell research, and all-around good guy. He contributed a brilliant chapter on how TEAM-CBT interacts with the brain for my book, Feeling Great. For the past two years he has been a very beloved member of the Wednesday TEAM-CBT Training group, adding his wisdom and clarity to the teachings. Rhonda and my co-teachers, Leigh Harrington and Richard Lam, and all of our students feel very honored to have him in our midst. This is our third podcast with Dr. Noble, and the first podcast to usher in the new year. We're excited to speak with him again today. He will update us on his latest thinking on how the molecular biology of stress and learning are totally consistent with the rapid mood changes we see in TEAM-CBT. He also describes his latest writing project, tentatively entitled, The Brain User's Guide to TEAM-CBT, and you can download it for FREE if you click here! (LINK) In this booklet Professor Noble presents the "brainological perspective" on TEAM-CBT. He emphasizes that this booklet is written at the 9th grade level so as not to intimidate anyone. If you're curious, take a look, and feel free to share it with others who might be interested. Professor Noble explains that his new booklet was inspired by patients who ask how TEAM differs from traditional (aka "normal") talk therapy. Of course, the differences are many and profound, but one of the questions new patients and therapists ask is whether the rapid recoveries we observe during TEAM-CBT treatment are just superficial and temporary, or even fake. Mark asserts that nothing could be further from the truth, and that the thing that makes TEAM-CBT so special is how closely it is aligned with how the human brain actually works. He explains that there are ten essential steps in TEAM, starting with Empathy. He defines Empathy as "being in a safe place, where you can share feelings without being judged." Empathy allows the patient to access the networks in the brain where the patient's pain may be stored as memories. The spoken and written language exercises used in TEAM actively and rapidly modify the networks that generate the feelings of depression, anxiety, shame, inadequacy and hopelessness. Dr. Noble places a great importance on the written Daily Mood Log, which he describes as arguably the "greatest development in the history of psychology." He says that when you describe the horrible and traumatic things that happened to you, and you record your Negative Thoughts on paper in a systematic, step-by-step way, you can look at your thoughts, feelings, and painful memories as separate from your "self" and gain some distance from them. Then, when you pinpoint the many cognitive distortions in your negative thoughts, and substitute more realistic interpretations, you gain freedom and relief because you are actually re-wiring your brain. He said that most of our human thinking is called Fast Thinking. This is the automatic thinking that we do 98% of the time as we go through our daily lives. Fast thinking is great, but growth, learning and change can only result from Slow Thinking, where we reflect and analyze things. Slow thinking takes concentration and effort because you are changing actual networks in your brain when you challenge and crush your negative thoughts with powerful techniques like the Externalization of Voices. He says that we are not just telling people to "Stop it!" or "Get over it!" Quite to the contrary, we are teaching specific, powerful techniques that give you the chance to pinpoint and modify the exact brain networks that cause your negative feelings. He explains that "language is a powerful tool for figuring out exactly how we see the world when we're feeling down, and TEAM gives us many tools in TEAM to modify the errors in our perceptions that cause so much suffering. Mark laments on the excessive misuse of medications for individuals, including children, who are struggling with behavioral and emotional problems. He wishes more people would simply sit down with the person who is upset and ask, "What's going on? How are you feeling? What are you thinking and telling yourself?" I have had the same thought when thinking about how therapists not familiar with TEAM or Cognitive Therapy use and promote dozens of presumably therapeutic approaches without simply asking patients, "What thoughts go through your mind when you are feeling depressed, anxious, ashamed, inadequate, or hopeless?" The answers to this question provide direct and immediate access to the brain networks that need re-wiring! Mark concludes today's podcast by saying, "I went into medical research on cancer and other serious problems because I wanted to help people who are suffering. I'm convinced that TEAM-CBT, and the powerful Daily Moo

The Sara Session—Total Blow Away! (Part 2 of 2) Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session. If you click here, you can see Sara's Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on "Empathy" and "Helpfulness" were excellent. If you click here, you can see Sara's Daily Mood Log at the end of the session. By the end of the session, all of Sara's negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she'd been procrastinating for years at promoting and developing her private practice. I don't like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn't focused on this emotion at all during the session. You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot! There were quite a few teaching points, including but not limited to these: Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success. Several days after the session, Sara sent this beautiful note to the Tuesday group. Hello, Tuesday Group! I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second). 😝 Anyway, I will try to make this email short because I tend to go overboard and write too much, and I know everyone is busy. I will just share a few things that have happened since my personal work two weeks ago. I am also forwarding the email I sent David and Jill Tuesday evening after the magical evening. First of all, THANK YOU all for your awesome support and empathy during that beautiful evening. At that time, I did not realize how much this is the story of many of us in the group (the learning disability and being bullied, humiliated and teased because of it.) I felt very connected to you and felt your love and deep compassion and understanding. Thank you! So, I was not kidding when I wrote that I am dancing away. You see, during the last two weeks when I have been at a grocery or department store, I have been dancing away to the music playing in the store. For some reason my body just gets moving and doesn't want to stop no matter what song is playing. As you can imaging, this is not typical of me. As a matter of fact, I am not a music person let alone a dancer. I prefer to listen to NPR or a Feeling Good podcast when I'm in the car and don't play any music at home. Anyway, when I have been at a store these last few days, I have let loose. It was really funny when a lady at the end of the aisle noticed me dancing, and said to me, 'You go girl!" We both giggled and I kept dancing even after the song was over. I am NO longer inhibited and have allowed my body to do what it needs to do, and I really don't care what anyone thinks or says. What a liberating feeling this is! My husband also thought it was funny that I have made silly sounds, especially during meals, and we would just burst into laughter. Needless to say, a lot has gone on since my personal work. I am definitely more relaxed, and therefore, less serious and more playful. Enjoying life!!! The main shift has been my thought that has been ingrained in me my whole life: "Que van a pensar?" which translates to "What are they going to think?" I used to care and believe this !00% but now I don't believe it (0%) and it does not matter to me what people think. My new thought now is more powerful and I believe it 100%: "I don't care

The Sara Session—Total Blow Away! (Part 1 of 2) In one of my recent Tuesday psychotherapy training groups at Stanford, we reviewed the Interpersonal Downward Arrow Technique. This is a high-speed technique I created that allows you to rapidly identify the roles that you play in your relationships with others so you can pinpoint the patterns that create tension and unhappiness for yourself as well as the people you care about. The Interpersonal Downward Arrow Technique is similar to what psychoanalysts try to do with free association on the couch, except it only takes five to ten minutes, as opposed to five to ten years. In addition, I have also developed fairly rapid ways to change and modify those dysfunctional patterns—IF this is what you want to do. Some of the psychoanalysts call these hidden patterns "core conflicts." The late Dr. Lester Luborsky (https://en.wikipedia.org/wiki/Lester_Luborsky), a prominent psychotherapy researcher at the University of Pennsylvania School of Medicine, has written about core conflicts extensively. He gave as an example of a core conflict, a person who might have the belief that "my needs will never be met in my personal relationships." Beliefs like this not only create unhappiness, but they can also function as self-fulfilling prophecies. In addition, most people re not aware of these "core conflicts," and do not realize they are just beliefs. Most people just believe that "this is just the way the world is," and think they have a profound insight into the reality of human nature. But we actually create our own interpersonal realities at every moment of every day. Since we usually cannot "see" what we're doing, we may wrongly conclude that we're victims of the "badness" of others. And, of course, there is always a grain of truth in that belief as well! During the training group, we had group members identify some of their own "core conflicts," using the Interpersonal Downward Arrow Technique, and this hit one of our members, Sara Shane, like a ton of bricks. She discovered that she sees herself as "an outsider" and has always believed she is stupid and inferior to others. And this intense belief has caused tremendous suffering for Sara for decades, including her participation in the Tuesday training group, where she is usually totally silent. Sara traced this pattern to her childhood, growing up in a village in Mexico, where she was bullied and put down because she was short and overweight, and had the darkest skin of any of her many siblings. In addition, she struggled with a learning problem and was frequently put down and labeled as stupid. Sara's sudden decent into emotional hell was fueled by the fact that she was planning the wedding of her niece at a town in Mexico which was only two hours from the town where she grew up. And the thought of showing her daughter that town filled her with feelings of shame and terror, fearing she would run into the people she grew up with, including the people who cruelly put her down. Here's what she wrote prior to doing personal work on this problem in a subsequent Tuesday group: Hello Jill and David, Where to begin…all day yesterday it was very painful as I thought about emailing you... As I'm writing this, I am in tears and I know it is going to take me a while to write everything I want to say. But first let me say that it has taken me a long time to even sit in front of the computer because this has been very difficult for me. I had earlier said I would email you yesterday morning but I know now why I could not. I procrastinating mainly because this hurts a lot, beyond what I had earlier experienced. Right now, I am not even paying any attention to proper writing because I just want to write this without worry about correctness and just express my feelings. Let me describe what I have been feeling physically all week long since Tuesday. I have been feeling sick to my stomach especially when I was working on the DML. I felt a hole in the pit of my stomach. I felt anxiety all over my body and felt overwhelmed. At times I could not even go one. I had to push myself to complete the Cognitive Distortions on the DML. I just wanted to run away from it all. It was that painful. But I also knew this was a good thing because I was getting down to something very important that I wanted and needed to face. So the Interpersonal Downward Arrow has been very enlightening, but also, extremely painful. And David, you are absolutely right, there is no doubt in my mind (not that there ever was), that all of our problems are encapsulated in one brief moment in time and that we create our own interpersonal reality at every minute of every day. Let me explain what transpired on Tuesday that motivated me to be a volunteer during small group practice. After postponing it for more than a year due to COVID, my niece is having her destination wedding in Mexico in November. My husband and I along with our daughter are attending the wedding. While there,

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More! Here are the questions for today's Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky! How can I turn off my Shoulds!? Is there a downside to treating people for free? What's the difference between Feeling Great vs Feeling Good? Isn't it important to blame the other person when that person really IS to blame? How can I turn off my Shoulds!? Nice podcast! (Maurice is referring to Part 2 of "I want to be a mother.") It's refreshing to see that we sometimes mix our needs with wants. I also have a huge problem with regret and shame, saying to myself "I should be far more ahead in life." "I should have dated more." "I should have used my energy to create art and being productive." I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn't deal with depression. I tried the semantic method to soften my thoughts regarding my should statements but telling myself "I wish I did xyz," is carrying the same weight of regret as when I "should" myself. These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought. I often ask myself: "Am I really a failure?" Maurice David's Reply Thanks, Maurice You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting. I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed. For example, we could use "Let's Define Terms," as one of 15 or 20 potentially helpful techniques. It might go like this: Is "a failure" someone who fails all the time, or someone who fails some of the time. If you say, "some the time," then we're all "failures," so we don't need to worry about it. If you say, "all the time," then no one is a "failure," so we don't need to worry about it. If that technique is not effective, we'd have tons more to try. You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts. Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise. david Is there a downside to treating people for free? Dear David and Rhonda, I live in England, and I'm close friends with a team CBT therapist in Bristol (Andy Perrson), and I've been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people. I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I'd also like to use your methodology at a later date. In the meantime, I have a question for you. I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people. But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don't do homework. I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge. David comment: I think the word "therapist" in the line above was supposed to be "patient." I hope that makes sense. Thank you again to you and Rhonda for all your hard work. Kind regards Brad Askew (Bristol, England) David's Reply We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free. What's the difference between Feeling Great vs Feeling Good? Dear Dr Burns, First of all, thanks for the great work that you do and also all the podcasts you did, I am planning to order a copy of Feeling Great, your

Today's podcast features Dr. Peter Spurrier, a British physician who has founded TEAM-UK. Peter describes how he spent most of his career as a physician in general practice, but was forced to see patients for only ten minutes due to the British health system. He didn't like the "quick fix" approach to patients with emotional struggles, and at the age of 55, five years before he retired from General Practice, he decided that he wanted to do something more meaningful, so he began to get training in CBT which "helped me listen better." However, CBT seemed stilted, and the outcomes weren't very good, either. Then he attended a two-day "Scared Stiff" workshop I presented in London several years ago. The workshop was sponsored by my friend and colleague, Jack Hirose, from Vancouver, Canada. I was not aware that Peter was in the audience, but was really happy to hear that he like the workshop. I had been pretty disappointed in it, since the attendance was light and I ran into quite a bit of resistance from the audience. This was a huge surprise, since I thought they'd be eager to hear about all the improvements we'd made in traditional "Beckian" CBT. At the workshop, Peter purchased my Therapist's Toolkit, but said "it just laid on my shelf for two or three years. Then, he began using it and decided to focus on TEAM-CBT full time. He began listening to the Feeling Good Podcasts, starting from #1 and eventually caught up. He says that "along the way, I learned by practicing the techniques I was hearing about." He says he has always been a critical thinker, and initially was dubious about the T = Testing part of the TEAM treatment model. As a GP, he was required to use questionnaires for patients with anxiety and depression, but for some time he thought it wasn't very accurate data. When he started using the Brief Mood Survey, he was shocked as he began to realize that this WAS good data, and that his reading of how his patients felt was frequently off-base. This, of course, is the foundation of the TEAM-CBT model, which is entirely and intensely data-driven. Then he attended one of my four-day summer intensives at the South San Francisco Conference Center, and loved the warm and encouraging atmosphere, commenting on the friendliness and encouragement of Rhonda, whom he met, and Dr. Angela Krumm, from the Feeling Good Institute in Mountain View, California. They both reached out to him. He said it was actually great to get the chance to work with people, and he was delighted by a demonstration I did on public speaking anxiety and social anxiety, which captivated the audience. After the intensive, Peter returned to London and founded TEAM-UK. He also looked up Dr. Stirling Moorey, who I'd mentioned in my first book, Feeling Good. I have also mentioned Stirling in numerous workshops, especially when teaching therapeutic empathy. Although Stirling was my student, I learned a great deal from him, especially in the area of empathy. Peter described an outstanding chapter on empathy, written by Stirling in a book he has co-edited with Anna Lavender entitled The Therapeutic Relationship in Cognitive Behavior Therapy. I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. His particular interest has been the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and is co-author, with Steven Greer, of The Oxford Guide to CBT for People with Cancer. I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. Peter wrote an article on TEAM-CBT for the newsletter of the British CBT group entitled "CBT Today." He got zero response for several months, and then heard from Derek Reilly who uses TEAM-CBT in the treatment of pain patients. And, slowly, others began to join Peter's TEAM.CBT.UK group, and now there are 25 to 30 members. Click here if you'd like to see the current edition of the Feeling Good UK newsletter! Peter also talked about the visit that Rhonda recently paid to the UK and TEAM UK's first in-person meeting, at Oxford University. "It was such a great pleasure to meet and spend time with Rhonda. She formed strong connections with the group, which we hope will endure for years to come". Rhonda on her visit to the UK TEAM group at Oxford University. We discussed the resistance to change that we sometimes run into among mental health practitioners. Peter said, "It's often quite hard to get people to change their ways, and organizations are not always that flexible, either." One of the things that drew Peter to TEAM-CBT was the fact that it offered a way to embrace the best from various approaches to CBT. This is a phenome

Today's podcast features an esteemed colleague and beloved friend, Dr. Angela Krumm, who will describe her personal victory over a recent weight gain. We will illuminate the TEAM-CBT techniques she used so that you can use them yourself if you'd like to lose some weight. But I have to warn you that you have to do these techniques using paper and pencil. If you try to learn and use them just from listening, they will not be effective. As an aside, if you go to my website, www.feelinggood.com, you'll find a free chapter offer at the very bottom of my home page. If you click on it, you'll receive two unpublished chapters from my most recent book, Feeling Great, with crystal clear instructions on the methods you'll learn about in today's podcast. Angela's biosketch goes next, including how she joined David's Tuesday training group when she was a post-doctoral fellow in clinical psychology and how she ultimately developed the TEAM-CBT certification program at the FeelingGoodInstitute.com. Hopefully Angela can help with this paragraph! As the podcast begins, Angela explains how she's always viewed herself as a very fit, health-conscious woman who actually completed some marathons in the past. But during 2021, her life has been complicated by a number of tragedies and traumas, including: Angela's father was sadly diagnosed with terminal cancer and died within four months. Angela had many personal injuries that impacted her capacity to exercise, including a laceration of her retina and a fractured toe. In addition, she fell backwards over a ledge in her backyard and plunged eight feet. She sustained a concussion and experienced many lingering symptoms for 6 to 8 weeks including dizziness, brain fog, and sensitivity to light. She described what happened next like this: All this time my weight kept creeping up. I stopped caring about exercise, and during the COVID crisis, food become a joy and an escape. Then, I had a wake-up call, an ah-ha moment when everything suddenly changed. Angela described attending a wedding, and her husband was the photographer. When she saw herself in the photos, she was shocked that she no longer recognized herself because of the weight she'd gained. She also noticed that the day of the wedding, she'd eaten six huge but delicious chocolate chip cookies that her niece had baked. She says, It hit me, and I didn't have to think twice. There's a history of diabetes in my family, and I didn't want to keep gaining weight and struggle with all the medical complications of type 2 diabetes. I want to be healthy and fit so I can live to an old age and enjoy my children and grandchildren! She used behavioral and TEAM-CBT skills to tackle the problem, starting with setting specific goals for herself. She said that lots of her patients who are overweight have vague goals, like "I want to lose some weight" or "I want to get in shape," but general goals won't be effective. In TEAM, you always focus on something specific. Angela explained the critical difference between Outcome Goals and Process Goals. An example of an Outcome Goal would be telling yourself that you want to lose ten pounds or whatever your goal might be. There's a big problem with Outcome Goals. You might go on an extreme, like fasting or eating very little, so you can lose weight fairly quickly. Then you will feel happy and tell yourself that you're done when you've achieved your goal. The big problem is that you haven't modified your eating habits, and that's exactly why you will quickly gain back all that weight you temporarily lost. Process Goals are different. Instead, you focus on the number of calories you can eat each day in order to lose weight, and then you make wise food choices within your calorie limit. In addition, you start out with a gentle but consistent exercise regimen, and then you slowly build up to more exercise. Angela started with two workouts per week and built up to four weekly workouts over time. She also set modest and realistic goals for weight loss, setting a calorie limit that would allow her two lose weight slowly, at the rate of just ½ pound per week. This plan has allowed her to lose 21 pounds, and she was looking terrific today! She has been using a free app called Lose It which provides her with all the information she needs for tracking calories bd weight, along with her BMI (Body Mass Index). She's now on a maintenance diet of 1800 calories per day and she's really pleased with it. We also illustrated several powerful motivational TEAM-CBT techniques, including: The Triple Paradox. You divide a piece of paper into three vertical columns where you list Advantages of your habit / addiction: First, you list all the GOOD reasons to continue with the status quo of unlimited eating and little or no exercise. Disadvantages off change: Next, you list all the negatives and hassles associated with dieting and exercise. Core values: Finally, you list what your overeating and slacking on exercise shows about you

The featured photo shows Dr. Carly Zankman at the Big Sur with her 8 month old nephew, Micah October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and last week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies. This will be the second of two podcasts featuring a live therapy session with Dr. Carly Zankman, a courageous young psychologist. Dr. Zankman has been struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother. Last week, we featured the first half of her session with Dr. Jill Levitt and me at one of our Tuesday Stanford training groups. If you have not yet heard part one, you can link to it (podcast #268) at the list of Feeling Good Podcasts on my website. In this podcast, you will hear the conclusion of our work with Carly. We are also delighted that Carly could join us in person today to tell us what has transpired since the end of her session some months ago. You can see Carly's Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session as well as her Brief Mood Survey and Evaluation of Therapy Session at the end of her session. You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought. There were a number of teaching points in Carly's session: Depression nearly always results from telling yourself, and believing, that you have lost, or don't have, something you believe you "need" in order to feel happy and fulfilled. It could be something internal, like greater intelligence or talent, or something external, like a baby, or a family, or greater wealth or status. There is a difference between a high-level and a low-level solution to most depression. In a low-level solution, you find happiness by getting what you want. For example, you learn that you are pregnant, or that you got an important promotion at work, or that someone you're attracted to has accepted a date with you. In a high level solution, you discover that you can feel happy and fulfilled without the thing you were so certain that you "needed." Although therapeutic empathy alone has limited healing powers, it can be absolutely precious and essential. Sometimes, people have a desperate need to be heard and given the space to express their feelings and to be accepted. In addition, people who have experienced a traumatic event or series of events often need the time to describe their experiences in detail. This can function like exposure, allowing the anxiety to diminish. Therapy without a meaningful agenda is highly likely to fail. And sometimes, a therapist has to "sit with open hands," even when the patient's agenda may be a bit different, or even radically different, from you own. Our task is not to force the patient to conform to our standards and expectations, but to help the patient find happiness on their own terms, pursuing their own goals. The Downward Arrow Technique was helpful and revealing during the Empathy phase of the session. This technique allowed us to pinpoint Carly's core belief, which was also a Negative Thought on her DML: "I'm never going to feel fulfilled in life without children." It is okay for therapists to struggle with, and discuss, moments of confusion or uncertainty during a session. This type of dialogue can involve the patient and can often help you find your path forward. There were some additional steps that could have been taken but we were limited by time. For example, we could have explored the interpersonal dimension of how to enhance the communication of feelings between Carly and her husband, as well as between Carly and other family members. She sometimes feels ignored and hurt. This problem is exceptionally common and can be addressed with tools like the Relationship Journal, the Interpersonal Downward Arrow, and the Five Secrets of Effective Communication. However, this can take some time, and also requires an agenda for the patient to be willing to examine his / her role in the problem and practice some new communication skills. Our negative feelings always result from our thoughts and beliefs, and not from the actual events in our lives. However, sometimes patients can be extremely fixated on certain beliefs that trigger their pain and may even put up a powerful wall to protect those beliefs. This is human nature, and part of what makes the job of therapy incredibly challenging, fascinating, and rewarding. We are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. You can find her Bri

The featured photo shows Dr. Carly Zankman at the Big Sur with her 8 month old nephew, Micah Podcast #268 : An Ectopic Pregnancy (Part 1 of 2) October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and next week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies. This will be the first of two podcasts featuring a live therapy session with Dr. Carly Zankman. Dr. Zankman, a 27 year-old clinical psychologist in our Tuesday training group at Stanford, is facing a serious crisis involving motherhood. She is struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother. The featured photo for this podcast is Dr. Zankman at the Big Sur with her 8 month old nephew, Micah. You can see the love and joy in her face, and her intense desire to become a mother herself. The session took place at my Tuesday training group at Stanford, and my co-therapist was Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California. You can see Carly's Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session The DML reflected her feelings several weeks before, when she felt that her chances for pregnancy were greatly diminished, and the BMS reflects how she was feeling at the beginning of our session. As you can see, she was still moderately depressed and anxious, and her happiness and marital satisfaction scores were quite low, indicating that she was unhappy and somewhat dissatisfied with her relationship with her husband. Carly was also anxious about being on the podcast, due to these additional negative thoughts: I'm not going to be able to describe what I've been through. She believed this 70%. There's a potential to be judged by people. She believed this 100%. In today's podcast, you will hear the T = Testing and E = Empathy portions of the session, and in next week's podcast you will hear the A = Assessment of Resistance and M = Methods portion of the session, and hopefully Carly will be able to join us for a follow-up to see how she's been doing since the session. The show notes for next week's podcast will include eight teaching points. Rhonda Jill and I are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. Thank you for listening, David, Rhonda, Jill & Carly

Hi everyone! This podcast offers specific help to LGBTQ individuals who are under attack from loved ones who might judge them and criticize their sexual orientation or gender identity. Plus, we all get slammed at times by people who judge us for all sorts of reasons, which can be immensely painful, so most of today's discussion will apply to people more broadly. I recently received a great email from Heather Donnenwirth, a therapist in Ohio who works with LGBTQ individuals. She mentioned that some of her patients struggle with how to respond to critical or judgmental statements from loved ones, including parents, and provided several examples: "Being Gay is wrong/a sin" "If someone doesn't know if they are a man or woman, then something is messed up in their head." "We are worried that you are going to go to Hell for your lifestyle." "We don't want your partner at our house, and we don't want to see any displays of affection." Heather wanted to know how one might use the Five Secrets of Effective Communication to respond to these kinds of criticisms. I invited her to join us in the podcast, and she wrote: I was excited about this topic. Thanks so much for including me. David's work has improved my life in so many ways and Rhonda's Wednesday TEAM training group has been a wonderful way to practice my TEAM skills and improve the kind of care I can offer patients. I appreciate and admire you both so much!! Also, I can't wait to meet Kyle!! I also invited the brilliant and wonderful Kyle Jones to join us. Kyle is a TEAM therapist who joined my training group in 2016 before ever seeing a patient! He is completing his PhD in clinical psychology at Palo Alto University and his dissertation research focuses on psychologists who provide mental health treatment to LGBTQ people. Kyle joined us in 2018 for a FB Live TV program on dating and flirting strategies (https://feelinggood.com/2018/06/17/dating-strategies-today-on-fb-live-sunday-june-17-2018-at-3-pm-pst/) and in 2019 for Podcast 151 on treating LBBTQ individuals with TEAM (https://feelinggood.com/2019/07/29/151-working-with-lgbtq-patients-whats-the-team-cbt-approach/). During today's podcast, we used the excellent statements that Heather provided in role-playing exercises with the Five Secrets of Effective Communication. We used the Intimacy Drill that I developed, which is by far the best way to master the Five Secrets. We also discussed the issue of the inner dialogue that always accompanies the outer dialogue with the person you're in conflict with. If you get anxious, depressed, and angry when criticized, it will be much more difficult to use the Five Secrets skillfully, because you may feel defensive and resentful and inadequate. So some work with the Daily Mood Log may also be invaluable before trying to use the Five Secrets. Finally, we discussed the question of "Outcome Resistance." This means asking yourself if you WANT to develop a more loving relationship with a loved one who is being highly critical of you because of your sexual orientation, or for any other reason. We decided it is perfectly acceptable to decide NOT to try to develop a more loving relationship, if that feels better to you. It may even be in your best interest or help keep you safe from harm if you're an LGBTQ person facing discrimination and persecution because of your sexual orientation or gender identity. I explained my own anger toward my father who was a successful Lutheran minister. However, when he retired from his ministry at the Shepherd of the Valley Lutheran Church in Phoenix, Arizona, he began working with gay individuals at the Arizona State University, trying to convert them to a heterosexual orientation. This was profoundly disturbing to me, I felt a great deal of shame and anger, and it ultimately led to a sad rupture of our relationship. Rhonda, Heather, Kyle and David

266: Ask Matt, Rhonda, and David: Can we solve the pain in the world? How can we deal with someone who might weaponize our vulnerability? What can I do about my emotional eating? And more! Today's podcast features awesome questions from viewers like you, with answers from Rhonda, David, and our brilliant guest expert, Dr. Matthew May. Here's the list of questions, followed by partial answers (prepared prior to the podcast) from David. Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world? Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies? Telia asks: Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life. Daniele asks: What "upsetting event" should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression? Anca asks: Should I work on a different upsetting event every day and do a Daily Mood Log? What about the days when I don't have any distorted negative thoughts? Oliver asks: Dear Dr. Burns, How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)? What is overkill when doing Positive Reframing? Sarah asks: Hi Doctor Burns! Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage.(By way of explanation, Sarah is referring to an episode on the Five Secrets where the wife was blaming her husband for saying, "You never listen" for 25 years, and was shocked to discover that she was causing the very problem she was complaining about.) * * * Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world? Thanks, Ezgi, I will read and answer this on an upcoming Ask David. I have committed my life to helping people who ask for help with depression, anxiety, and other problems. I do not evangelize or reach out, trying to convert people to some new way of thinking and feeling. Also, I only work with people one to one, (or in groups), and I think healing must begin with yourself. There are tons of free resources on my website, plus my books, like Feeling Good, and others, can be invaluable, including on the topic of suicide. You can get used copies inexpensively on Amazon, too! All the best, david * * * After Hearing Podcast 14 on the Five Secrets Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies? Thank you, I appreciate you and all you do to make the world a kinder and gentler place. David's Response Hi Megan, Please provide a specific example. What did the other person say, and what, exactly, did you say next. One exchange is enough. Then we can do something amazing, and not just BS on an abstract level that will be useless. You see yourself, based on your note, as the sweet innocent victim of the other person's "badness." Once we have a specific example of an interaction that did not go well, and you focus on your own role, things will suddenly fall into a shockingly different perspective. david Will include this in an Ask David. * * * Telia asks: Hi David, Thank you so much for your free information and podcast #155 on emotional eating. Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life. I listened to episode 155 but I need more help like actual questions to ask myself or tools to use in the moment. I have suffered with this my entire life, and I know with your help I can be free from it. Thank you Telia from Australia David's Response Hi Telia, Check out the free chapter(s) offer on bottom of my website home page. Full instructions are right there. Feel free to contact me if any questions after following the guidelines there, and doing the exercises on paper. d * * * Daniele asks: What "upsetting event" should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression? Hello Dr. Burns, i am reading your second book, Feeling Great. The first one, the new mood couldn't help me or i couldn't get it done right. And now i am trying Feeling Great. I like the book and your thoughts. I have struggled with anxiety and depression since 2014 - on and off. Lately more on.... My biggest problem with the exercise is that

Podcast 265: An Extreme Leech Phobia: Once Bitten, Twice Shy! Today's podcast features the treatment of an extreme leech phobia in real time, using live leeches. Dr. Danielle Kamis, a clinical psychiatrist practicing in Los Altos, California, is our courageous patient, and Dr. Matthew May, a frequent guest on the Feeling Good Podcast, conducts the treatment, while David and Rhonda observe and comment. If you ever saw the famous Humphrey Bogart movie, "African Queen," you know how terrifying leeches can be. But why in the world would anyone working in downtown Los Altos, California, need or want treatment for a leech phobia? Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world (Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world. She has had a keen interest in global health work and has spent a significant amount of time doing research with indigenous population in the pre-Andes mountains of Argentina. She has also spent time living with tribes deep in the Amazon forest as well as the jungles of Sumatra. These experiences have transported her back in time to better understand the core components of humans in our most natural state. She described a terrifying experience while exploring in a jungle in Sumatra, where the leeches not only invade the water, but can also drop onto you from trees. After hiking through the beautiful, lush landscape for some time, Danielle began screaming and sobbing in terror when she noticed that her foot was bleeding because of a leech that had just detached itself. This was understandably embarrassing, and she realized that she needed to overcome this fear before going on another jungle adventure. In today's therapy session live leeches will be placed on Danielle's skin, and she will be encouraged to surrender to the anxiety and make it as intense as possible, rather than running away or trying to control or avoid it. This is an extreme form of exposure called "flooding." It can be incredibly effective, and often works quickly, but requires great courage on the part of the patient and therapist, as well as a high degree of therapist skill. To prepare for today's exposure session, Danielle obtained four live leeches, which she kept at her apartment. She said that even looking at the leeches slithering around in the water and thinking about them biting her made her fear instantly jump to 9.5 on a scale from 0 (not at all) to 10 (the most intense anxiety). She asked Matt if he'd be willing to do the leech exposure first. Matt agreed, since we never ask our patients to do anything that we wouldn't do, ourselves. This modeling by a trusted friend or therapist can be a useful tool in the treatment of anxiety. Danielle carefully removed one of the leeches with a spoon and placed it on Matt's forearm. After crawling around for a minute or so, the leech attached itself and begin to engorge itself on Matt's blood. Danielle watched in fascination and fear, and then it was her turn. She bravely placed a second leech on her forearm. She was afraid it was going to be extremely painful, but was surprised when it was just a mild feeling of sandpaper on her skin. Over a period of about ten or fifteen minutes, with episodes of nausea and profuse sweating, Danielle's anxiety gradually dropped from 9.5 at the start all the way to 1, and she felt triumphant. You can see some photos and videos of the session here, including our lunch prior to the session at the Phoa Cabin in downtown Los Altos. It is a favorite local spot that features tremendously tasty Vietnamese food. (LINK) Teaching points in today's TEAM-CBT session include the following: Avoidance is one of the major causes of all forms of anxiety. When you avoid or try to escape from your fears, they will always intensify. Exposure is a powerful treatment tool for anxiety, but is not a treatment per se, and there are many additional tools with powerful anti-anxiety effects. I (David) use at least 40 tools in the treatment of anxiety, but exposure must always be included in the mix. It is probably impossible to cure any form of anxiety without exposure. All patients and most therapists resist and fear exposure. Patients fear exposure because of the intense anxiety they must endure and their belief that something terrible will happen if they don't avoid their fear, and most therapists are also afraid that the patient is too fragile, or the procedure is too extreme, and something terrible will happen. However, I (David) have never had a bad outcome when using exposure. I am convinced that poor therapy skills, and not exposure, cause negative outcomes in the treatment of anxiety. Excellent empathy is extremely important in treatment of Anxiety. Danielle mentioned the importance of her trust in Matt, and in his modeling of the exposure in the treatment. I (David) strongly agree with this, as I have ha

How to Get Laid! (With a Little Help from the Five Secrets of Effective Communication) One of our top TEAM-CBT teachers and therapists, Thai-An Truong, LPC, LADC from Oklahoma City, is featured in today's podcast. Thai-An is the owner of Lasting Change Therapy, LLC, a TEAM-CBT group practice in Oklahoma that focuses on using TEAM-CBT to help women overcome depression, anxiety, and relationship problems, so they can live happier lives and have more satisfying relationships. She is passionate about working with postpartum women after overcoming her own personal struggles with postpartum depression and anxiety. She is also passionate about spreading TEAM-CBT and training therapists in this awesome treatment approach. Thai-An suggested a podcast on how one could use the Five Secrets of Effective Communication to deal with critical comments from your spouse or partner during marital conflicts. She submitted specific examples from several troubled couples she has worked with, and Rhonda submitted an example as well. Wife continues to bring up things that needs to be addressed, e.g., baby's medical needs, how he needs to set boundaries with his mom, precautions to take because of the pandemic. Husband says: "All you do is talk about stressful things. You don't even care about being romantic anymore." Wife's typical response: "How can I be romantic with you when you aren't doing what you need to for our family?" Sex often comes up with every couple, and the criticism is typically from the husband, as in the first couple and this second couple as well. Husband says: "You never want to have sex. It's like we're roommates instead of husband and wife." Wife's typical response: "I'm tired, and I can't just get in the mood when you haven't been nice to me all day." This couple had been trying unsuccessfully to have a baby. The wife was very critical of her husband and said: "If it wasn't for you, I'd have a baby. I should have married someone else." Husband's response: He said nothing and walked away. Infidelity: In this couple, the wife had an affair three years ago and the husband continues to bring it up when they get into arguments. Husband says: "Oh, you say I'm so bad because I did x. How about you cheating on me? You're the one who did the worst possible thing, and I can never trust you again." Her typical response: "It's been 3 years, why can't you just let it go so we can move on with our lives? I'm tired of you throwing this shit in my face all the time." During the podcast, we critiqued the responses to the criticisms in these four cases, using the EAR algorithm. It was easy to point out that the responses of the partner who was criticized typically failed in all three categories: No effective E = Empathy. No effective A = Assertiveness. No effective R = Respect. We also spelled out the consequences of these responses to criticism, and showed how the respondents were actually forcing their spouses to treat them in exactly the way they were complaining about. Then we used the "Intimacy Exercise" to practice more effective responses, based on the Five Secrets. This is, by far, the best way to learn the Five Secrets. Your Turn to Practice Now, here's another example that Thai-An provided, and you, the listener, can practice with it. This wife was talking about how her friend had hurt her feelings. The husband typically goes into the advice-giving and problem-solving mode. Her criticism: "You suck at listening. I don't need you to fix it." His typical response: "I'm just trying to help." First, see if you can explain why the husband's response was ineffective, using the EAR acronym. Ask yourself: Did he use E = Empathy and acknowledge how she was thinking and feeling? Did he use A = Assertiveness and express how he was feeling at that moment? Did he use R = Respect to convey some warmth, respect, or love during the heat of battle? Next, ask yourself about the consequences of his response. What will his wife think? What will she conclude? How will she feel? How will she likely respond to his defensiveness? Finally, put yourself in his shoes and see if you can write out a more effective response, using the Five Secrets of Effective Communication Thanks! Rhonda, Thai-An, and David

Photo features Taylor and her husband, Gregg, who is an ER / ICU physician in NYC. 263: OCD in Kids, Featuring Dr. Taylor Chesney Rhonda starts this podcast by reading two incredible endorsements from fans like you. Thanks so much for the many kind and thoughtful emails we receive daily! Today's podcast features Dr. Taylor Chesney, the founder and director of the Feeling Good Institute of New York City. Taylor was a member of my Tuesday training group at Stanford for several years during her doctoral training in psychology. Then she and her husband, Gregg, who is an ICU / intensive care unit doctor, returned home to NYC where she opened her clinical practice. We have featured Taylor on a number of two previous podcasts: Corona Cast 4 (published 4-09-202) and Corona Cast 6 (published 4-30-2020). We always benefit greatly from Taylor's wisdom, warmth, and superb teaching. Taylor specializes in TEAM-CBT for children and teens, and tells us today about the upsurge in OCD (Obsessive-Compulsive Disorder) in young people, and how she approaches this problem using TEAM-CBT along with some family therapy. Taylor describes OCD as a pattern of intrusive thoughts, fears, and images that trigger feelings of anxiety. In addition, the patient engages in a series of repetitious, supposititious behaviors in an effort to avoid the fear. Sometimes the parents may get caught up in the child's fears as well and engage in the compulsive rituals as well. The fears Taylor sees in children are similar to the fears reported by adults with OCD, such as the fear of contamination, and the compulsive habit of repeated handwashing, and more. But especially common in kids are fears that loved ones, like parents, won't come home or will be hurt. Common OCD rituals in children include wanting things to be a certain way; for example, organizing your desk meticulously, arranging your pencils, and so forth. The patient often feels that he or she can't stop or something terrible will happen. Another common fear is getting sick, and needing repeated reassurance that the food the child is eating is safe. David asked about the Hidden Emotion Model that is common and often helpful in adults with OCD, or any anxiety disorder. For example, if a child fears that a parent will be hurt, might this suggest that the child has repressed angry feelings toward the parent? Taylor confirmed that this dynamic was, in fact, common in children as well as adults with OCD. She emphasized the need for an alliance with the parents as a part of the treatment team. This might include urging the child to express his or her anger, wants, and so forth. Taylor speculated that the increase she's seen in OCD may be the result of the COVID pandemic, and the uncertainty we all feel. Children have a great need for love, empathy, structure, and certainty, and OCD is just one pattern that the increase in anxiety can take. At the start of treatment, Taylor does an initial intake session with the parents, followed by two sessions with the child, and in both cases attempts to empathize and form an alliance via the Five Secrets of Effective Communication. She also wants to find out who the "patient" really is. Who is asking for help? Is it the child? Or the parents? She also wants to know who will do the work of the therapy. If the child doesn't see the OCD symptoms as a problem, she will work with the parents. Sometimes there's a mismatch as to what the problem is. The parents might want the child to get help with procrastination on schoolwork or household chores, but the child might want help with shyness and relationships with other kids. She describes how she uses TEAM to show the child that his or her symptoms reflect his or her core values, but that they can turn down the intensity of the fears using the Magic Dial. She emphasized a role for psychoeducation in the treatment as well, explaining the evolutionary and protective role of anxiety. It's just that sometimes the volume gets turned up to unnecessary levels. She said that the parents are a huge part of the treatment, since the problem "lives in the house," and the parents may fear what might happen if the child does not engage in the rituals. And, of course, Exposure and Response Prevention are important keys to successful treatment, just as they are in adults. Taylor described a compelling example of a teenager with an intense fear of vomiting in the middle of the night, who had resorted to a variety of rituals including avoiding dinner, secretly sleeping in his bathroom just in case. and more. Together, she guided him in the creation of a hierarchy of exposures as well as Positive Reframing of his symptoms. He successfully completed his treated in just six sessions. Taylor offers a 12-week introductory course on TEAM-CBT with children and adolescents, and is a superb and highly esteemed teacher. For more information, you can contact [email protected] or look for her on the website of the www,FeelingGoodIns

A Country Doctor, Part 2 of 2 A = Assessment of Resistance At the end of the moving and tearful empathy phase, we asked Jillian about her goals for the session, which included the ability to enjoy my work to give away all of my certificates set limits with my patients feel happy with what I do not have to fear my work anymore! After Jillian said she would be willing to press the Magic Button to achieve all these goals instantly if we had one, we suggested Positive Reframing first. to see what might be lost of she suddenly achieved all these goals. You can creview the Positive Reframing that we did together. Here's Jillian's Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering while still allowing you to preserve all the awesome things about you! Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, blue, down, unhappy 80 15 Embarrassed, foolish, humiliated, self-conscious 50 10 Anxious, nervous 90 20 Hopeless, discouraged, pessimistic, despairing 100 0 Bad 70 0 Frustrated, stuck, thwarted, defeated 90 5 Inferior, inadequate, incompetent 95 5 Angry, mad, resentful, annoyed, irritated, upset, furious 100 10 Jillian said that the Positive Reframing really opened her up, especially when we read the list of positives out loud. It kind of shocked her in a good way so see that her negative feelings were not really problems, defects, or symptoms of one or more "mental disorders," but the expression of what was most beautiful and awesome about her as a human being, and as a physician. This Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, rather than pressing the Magic Button that makes them disappear, it paradoxically eliminates or drastically reduces the resistance to change, and opens the door to the possibility of ultra-rapid recovery. M = Methods We asked Jillian what Negative Thought she wanted to work on first, and she chose #9: "I'm not having a big enough impact." She believed this thought 100%. First, we asked Jillian to identify and explain the cognitive distortions in this thought, and she focused on these: Should Statement; Self-Blame, All-or-Nothing Thinking, Mental Filtering, and Discounting the Positive. In retrospect, I think I spotted two additional distortions: Emotional Reading (I feel I'm not having a positive impact, so I must not be having a positive impact) and Mind-Reading (my patients expect me to have the answers to all their problems and judge me when I don't have all the answers.) Then we challenged the Negative Thought, and Jillian she was able, with a little help and a role reversal, to crush it, as you can see here. Usually, crushing one Negative Thought is about all you really have to do, because once the patient blows one Negative Thought out of the water, there is usually a kind of "cognitive click," and the brain suddenly changes, and all the positive circuits suddenly get fired up. It's amazing to behold, and you will hear it for yourself! The damn did suddenly break, and Jillian could clobber the rest of her Negative Thoughts fairly easily, using a combination of Self-Defense, Self-Acceptance, and a lot of the CAT technique. She suddenly appeared to be a radically and delightfully different person during the Externalization of Voices. You can see her final Daily Mood Log here. You can see her feelings on the Emotions table at the end of the session. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, blue, down, unhappy 80 15 0 Embarrassed, foolish, humiliated, self-conscious 50 10 0 Anxious, nervous 90 20 0 Hopeless, discouraged, pessimistic, despairing 100 0 0 Bad 70 0 0 Frustrated, stuck, thwarted, defeated 90 5 0 Inferior, inadequate, incompetent 95 5 0 Angry, mad, resentful, annoyed, irritated, upset, furious 100 10 0 Jillian's scores on my Happiness Test on the Brief Mood Survey also soared to 100% and her ratings of Jill and David on Empathy and Helpfulness tests were also perfect. After the workshop, Jillian sent this email. Hi Jill and David, As I drove home tonight from my office, I actually felt like my heart had been opened. My chest didn't feel as tight and locked-up like it normally does. It felt so relaxed. I put my baseball cap on, rolled the windows down, and listened to 90's country music (my favorite) on my drive and sang loudly. I have spent the last hour checking my new superpowers. There have been negative thoughts, but telling them to "shut the heck up. I am not listening to you" has been quite liberating. I even was greeted by my 4 year old when I got out of the car. I knelt down and hugged her without the worry of being a rotten mom, but rather one of feeling like I am the perfect mom for her, flaws and all. Thank you for this opportunity. I took a chance to email you in the first place after listening to a podcas

A Country Doctor, Part 1 of 2: "Nothing I do makes a difference!" This is the first of two podcasts on one of the live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16th, 2021. I think you will find the session interesting and incredibly inspiring! Our patient is a physician in a small town in the mid-west. I want to thank Dr. Scherer for her tremendous courage in sharing this very personal experience with all of us. Dr. Levitt practices at the Feeling Good Institute in Mountain View, California, where she also serves as Director of Clinical Training. She also teaches at our weekly TEAM-CBT training group as Stanford. I am thrilled to share the audio of Jillian's live session as a two-part podcast, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. But this gives all of you the chance to hear what you missed, and I think you will NOT be disappointed! When Jill and I asked for volunteers for the live demonstrations in the workshop, Jillian was the first to respond with an offer to volunteer. This was her email, describing her situation.. Hi Dr. Burns, I am writing to you offering to be a volunteer for the live demonstrations in the workshop on 5/16, if you need one. I am learning TEAM CBT, and have been enjoying it personally as well as trying to do more of it professionally. I am a family medicine physician, but I have my own direct primary care clinic. This means that I can spend 1-2 hours with a patient if needed. I have been slowly offering this to patients who want to do the work to improve their mood or anxiety. As for why I am writing, my anxiety and need to please people is huge and disruptive to my enjoyment of life. I keep striving and achieving things likely to get the attention of others. I fear not knowing the answer and making a mistake with my patients. This had caused me to develop anxiety and insomnia at my last job. I sought counseling and physician coaching, but ultimately I wound up leaving that job, moving to another state [due to intense stress and demands of that job], and starting my own practice. My current practice is going well, but I am annoyed when patients come in or call with questions I don't know the answer to. I constantly worry that I will not be able to figure something out by myself and that the patients will leave me. In addition, I continually strive for [yet another] training certificate. As you know, I did medical school, residency, and fellowship, but I also have a lactation consultant certificate, training in lifestyle medicine, and now a Level 1 TEAM-CBT certificate with enough hours for Level 2, and most recently I started a 3-year program to become a pastor for our church. And I realize that I will not have the time to sustain all of these. It is as if I love the journey of getting the certificates, but I am not great at implementing them, so I move on to something else. As for the rest of life, I have a great life, but I am melancholy most of the time. My husband is terrific, sensitive, understanding, loving, and yet, I am constantly reading marriage books because I think it could be better. My 2 children, aged 8 and 4, are smart and funny, but I live constantly thinking I am going to screw them up and so I read even more parenting books. My family medicine practice is thriving and offers me part-time work at great pay with autonomy, yet I dread Monday mornings. Overall, my life should be an A+ and enjoyable, but somehow I make it seem like everything is going wrong all the time. I have sought counseling and even TEAM-CBT earlier this year via teletherapy from FGI. I continue to do a Daily Mood Log about 3-4 times a week. I feel like we got so far, but not to complete recovery. My FGI therapist was the eighth therapist I have been to, but the others were mainly talk therapists. I just thought I would reach out in the hope that maybe you need a volunteer, and maybe I would have the opportunity to work with you live. It would be nice if my anxiety and faulty core beliefs didn't steal my joy. Sincerely, Jillian As you can see, Jillian is an incredibly dedicated physician, but feels like she is never doing enough for her patients. At the start of her session, she described her incredibly stressful previous job, when she was often on call for 72 hours at a time, often going long hours without sleep. She said, "I used to walk to work, hoping I'd get hit by a car." Although, as you saw in her email, she finally quit, and set up her own practice in another state, she continued to struggle with depression and the belief that she wasn't doing enough. Her constant self-criticisms robbed her of happiness, in spite of the fact that she had a fabulous practice, superb medical and human skills, and a wonderful husband and children. Her unhappiness confir

Podcast 260 TEAM-CBT Games, featuring Amy, Heather, and Brandon In today's podcast, three of our most creative TEAM therapists describe a number of innovative games they've created to facilitate learning key TEAM-CBT techniques in group settings. Our guests are: Amy Specter: Amy is a Level 3 certified TEAM therapist, licensed marriage and family therapist and credentialed school counselor. She works with at-risk youth in schools and has an online private practice specializing in shyness and breakup recovery. She can be reached at [email protected]. For a free copy of Flirty Dice or to purchase Tune In, Tune Up head over to https://www.feelinggreattherapycenter.com/ Amy Spector Brandon Vance, MD: Brandon is a Level 4 certified TEAM trainer and therapist for individuals, couples and groups. His most recent TEAM related project is an international book club to support people in reading Feeling Great. He can be reached at: [email protected] Brandon Vance, MD Heather Clague, MD Heather Clague, MD is a Level 4 certified TEAM therapist and psychiatrist who works in private practice and at Highland General Hospital in Oakland. In addition to teaching and writing about TEAM CBT, she runs Berkeley Improv that holds in-person and online improv classes for all levels. You can reach Heather at: heatherclaguemd.com Tune In / Tune Up, a card game which features spontaneous speaking situations using the Five Secrets of Effective Communication. Heather, Brandon, and Amy guided us while we played and explained each of the following games during the podcast: Love Feast, where you make fake, over the top introductions of other people in the group Flirty Dice, where you have to flirt with some using a specified facial expression, a specified type of question, and a specific affect. Future Projection, where you talk back to a Negative Thought from the perspective of your wiser, happier self from the future. The group also discussed how these types of games can help individuals with social anxiety develop greater courage, spontaneity, and interpersonal skills. We also did a group Shame Attacking exercise and briefly described the use of this tool in the treatment of social anxiety. You can also reach Heather, Brandon, and Amy at the Feeling Great Therapy Center, where you'll find links to Tune In / Tune Up, Flirty Dice and more Improv Games. Thanks! Rhonda and David

Podcast 259 TEAM-CBT for Eating Disorders, featuring Donna Fish In today's podcast, Rhonda and David are delighted to welcome Donna Fish, LCSW, a New York mental health professional who's doing pioneering work applying TEAM-CBT to eating disorders such as overeating / obesity, binging and vomiting (bulimia), and anorexia nervosa (starving oneself in combination with excessive exercising). These problems appear to be more prevalent in modern society, perhaps because of the emphasis on physical beauty as well as the availability of fattening foods and the financial resources to purchase them. Donna is an LCSW and Level 4 TEAM-CBT therapist. She is a guest lecturer on eating disorders at Columbia University and Harvard University, and author of Take the Fight Out of Food. She has been a popular guest on many radio and television shows, writes for Psychology Today magazine, and more. Donna began the interview on a personal note, reflecting on one of Dr. Burns' workshops in 2014. She volunteered for a role-play with David illustrating the Externalization of Voices, a powerful cognitive therapy technique David developed during the mid-1970s. That experience pointed Donna in the direction of learning more TEAM-CBT. Here's how she described her experience at the workshop: It blew my mind! I don't easily follow any one particular 'school of therapy, but I joined a TEAM-CBT training group that Dr. Taylor Chesney had just begun in NYC and then continued my online training until this day! I am thrilled to combine my eating disorder training and experience with the TEAM approach, and have been training therapists at Elise Munoz's Feeling Good Center in NYC, so that they can use TEAM with the common problem of Binge/Restricting. Donna started her career as a professional dancer, and struggled with her own eating and body image issues. She saw these problems in her many peers and colleagues working as performers as well. She said: I was always on a diet, and saw foods as "good" or "bad." I would restrict (fasting) during the week and then binge on all the "bad" foods on weekends. My life was a yo-yo of binging and restricting. Later, I taught myself how to eat in a healthy way, and how to say, "Yes, I can have that food and I can have it right now if I want it (which I do). But do I really need it right now?" This simple change in how I talked to myself freed me and cured me! When I became more accepting and less rigid in my "eating rules," I paradoxically began to feel happier and more in control. I saw so many actors and dancers who used up tremendous amounts of emotional energy struggling with body image issues and problems with eating. That's why I did a 3-year training program in working with eating disorders. When some of my patients who had recovered became pregnant, they worried about giving their own children an eating disorder. That's why I wrote my book incorporating the methods that had been so helpful to them. This included a 4 Step Program to help them to give their kids a healthier relationship for life. These are the four steps: Step One: Talk To Your Kids About Nutrition Step Two: Reboot the Connection Between the Belly and the Head Step Three: Separate Hunger and Fullness from Other Feelings Step Four: Teach Your Child Skills and Develop Confidence in Decision Making I incorporated many of the ideas and techniques in TEAM-CBT, including Dr. Burns' Decision-Making Tool, as well as his "Addiction and Habit Log." (link to the free chapters on these tools available on the home page of my website). Donna emphasized the role of restricting in the maintenance of eating disorders. She explained that restricting and fasting actually cause and perpetuate the problem because the cognitions become 'Tempting Thoughts' to binge such as: "I will definitely re start my diet tomorrow, and I won't eat that cake that I shouldn't have had, so I may as well eat more now since I've already blown it." She explained: If you commit to having a piece of that cake tomorrow as well, and in fact every single day, you are less vulnerable to the Tempting Thought of "I won't have that 'bad food' tomorrow' which tempts you to eat the cake, and then every other food that you 'won't eat tomorrow or again', since you've already had a piece. In fact, learning how to eat a piece of cake, or whatever food you deem 'bad,' is imperative to learning how to eat well and balanced in order to modulate your weight. The Tempting Thought that you will Restrict Tomorrow, seduces you to binge. The Focus needs to be on Reducing the Tempting Thoughts to Restrict! A Method like 'Examine the Evidence' can be used to see if Thoughts like: "I won't eat tomorrow or have that food again," evolve into Tempting Thoughts that promote the 'binge' in that moment of temptation, and it becomes a circular game of 'Restrict/Binge'. Donna described some of the dangerous medical consequences of restricting and severe weight loss that you see in young people with anorexia,

Podcast 258: Doctor, I know you're secretly sexually attracted to me! / How to Agree with Criticisms that are Just Plain Wrong! Today's podcast features the incredibly brilliant and kindly Dr. Matthew May, who has become a semi-regular on the Feeling Good Podcast. Our show was the result of an email from Ana Teresa Silva, who is running a new and totally free weekly practice group for the Five Secrets of Effective Communication. If you want to learn those invaluable techniques, contact her immediately before they fill up at ana silva [email protected]. Her question had to do with the incredibly important Disarming Technique, which means finding the truth in a criticism, even when the criticism seems absolutely incorrect. I've posted her letter and my response at the end of these show notes. Today we tackled two kinds of incredibly difficult attacks, with lots of role-playing and (hopefully) useful feedback and teaching. One was the one listed in Ana's email, where you are accused of stealing money, but you didn't actually steal any money. So how can you agree with that? The other was perhaps even harder—what do you do when a patient accuses you of being sexually and secretly attracted to him / her? Matt, Rhonda and David illustrate a variety of strategies for responding with the Disarming Technique as well as the rest of the Five Secrets. The role-playing is challenging and immensely interesting! David emphasizes that if you want to learn the Five Secrets, three things are mandatory: An intense desire to learn. Humility. Tons of practice. David also emphasized the intense resistance nearly all humans have to all three components of EAR: E = Empathy A = Assertiveness R = Respect. I have attached a document listening 12 GOOD Reasons NOT to Listen, Not to Share Your Feelings, and NOT to treat the other person with respect. If you want to master the Five Secrets, my book, Feeling Good Together, will be an invaluable resource. If you read it, you MUST do the written exercises while reading to get any deep understanding of this approach. Simply reading will not "do it!" I want to thank Dr. May once again for hanging out with us today. In our next podcast with Dr. May, he will describe his work with a young professional woman who loved fly fishing but had an intense fear of leeches. Make sure you tune in, it will be extremely interesting, and his patient will join us, too! If you want to contact Dr. May, you can reach him at: Here's Ana's email: Hi, David. Hope you are recovering well!! I got stuck with the Disarming Technique. Last week, in the Five Secret Practice Group meeting, something came up and I didn`t know how to answer. How do we "disarm" someone who blames us for a very specific behaviour that is not true? For example: "Why did you steal my money from the drawer?" I thought we could try to find some truth in the attack noticing some reasons why the person could be mad at us or doesn`t trust us, or maybe we could ask if we did something to offend or upset her, but, at some point, we have to say that we didn't steal the money, right? And we`ll be defending ourselves. Can you help me with this? Thank you! I appreciate it. ana silva Ana Here's my response: Hi Ana, We'll do some practice on this on today's show. You might say, "I'm afraid I'll have to plead guilty to your criticism. Although I didn't and would never steal money from you, I clearly have done a terrible job of winning your trust and providing genuine warmth and support. "It's painful for me to hear how I've failed, and I feel ashamed, especially since I like you so much and value our friendship. I wouldn't be surprised if you're feeling angry, frustrated, and disappointed, and perhaps alone, too, and perhaps even anxious. "Can you tell me more about what happened, and how you feel, and all the ways I've let you down and come across as untrustworthy?" This is just a try, and the details will be different depending on who the person is and what the situation is. Hope this helps! Also, Podcast 161 might also be helpful. It's all about "hearing the music behind the words" (https://feelinggood.com/2019/10/07/161-listening-to-a-different-kind-of-music/) david Rhonda, Matt, and David (without Dr. Rutherford Knows) Rhonda and I are convinced that Dr. May is one of the greatest therapists on the planet earth. If you have a question or would like to contact Dr. May, please check out his website at: (www.matthewmaymd.com) Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working via Zoom, and can be reached at [email protected]. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com. You can reach Dr. Burns at [email protected].

Podcast 257: What's an Intensive? Today's podcast features Dr. Lorraine Wong and Richard Lam who describe the intensive TEAM-CBT treatment program at the Feeling Good Institute in Mountain View, California. Dr. Wong is a board certified clinical psychologist and the Clinical Director of The Feeling Good Institute in Mountain View. Richard Lam is TEAM Certified Therapist, Trainer and Certification Program Manager at the Feeling Good Institute. An intensive is a departure from the conventional weekly 50-minute session and compresses an entire course of therapy into a brief period of time. David describes how he created this treatment approach accidentally at his hospital in Philadelphia when one of the world's most famous and beloved actors, a man who was a great fan of Dr. Burns first book, Feeling Good: The New Mood Therapy, contacted him and asked for treatment. However, there was a catch. He only had two days available, and asked if he could fly from Hollywood to Philadelphia and book all of my sessions for two days. I was delighted to do that, and scheduled 17 back-to-back 45-minute sessions on a Thursday and Friday. He came in a disguise, and explained that fans and the paparazzi were constantly hounding him, and that he felt like a hunted animal. I asked if the disguise was effective, and he said it wasn't working at all. People still hounded him and asked why he was wearing the disguise and asked for autographs. Because he was a powerful actor, the roleplaying techniques I have developed, like Externalization of Voices, were tremendously effective, and he actually made a complete recovery within a couple hours. Later on, I developed an intensive program for the patients in our inner-city neighborhood, with the help of the president of our hospital, and it was also incredibly effective for our patients who had few resources. However, they loved cognitive therapy! Richard and Lorraine explain how they are implementing the intensive concept at the FGI, working with people from around the United States and the world who come to Mountain View for several days for the treatment. They describe their work with a severely and chronically depressed man who came from Europe who seemed incredibly challenging at first. He was super skeptical and said that that he'd had tons of failed therapy but nothing and no one had ever helped him. He was telling himself things like this: Life isn't worth living. I'm a special case and no one will be able to help me. Life shouldn't be so hard. I should be able to enjoy life more. However, once they blew away his resistance using Paradoxical Agenda Setting, Richard explains that "it was a breeze to blow all of his negative thoughts out of the water." The treatment is costly in the short-term, but can be extremely cost-effective in reality because recovery often happens rapidly. It is my impression, too, that in the hands of a skillful therapist, extended sessions and intensive treatment with TEAM-CBT can often be amazingly effective. If you would like to contact them, you can go to the FGI website (www.feelinggoodinstitute.com) or email them: [email protected] or [email protected]. Thanks for listening, and thanks to Richard and Lorraine for being especially fun and gracious guests on today's podcast! Rhonda and David Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients via Zoom, and in her office. She can be reached at [email protected]. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com. You can reach Dr. Burns at [email protected].

Intense Performance / Public Speaking Anxiety, Part 2 of 2 Last week we presented the first half of the session with Michelle Wharton at the Live Therapy workshop on May 16, 2021. Michelle had been struggling with years of intense public speaking anxiety, especially in professional settings. So far, we've commented on the T = Testing and E = Empathy portions of the session. Today, we present the exciting and inspiring conclusion of that session. A = Assessment of Resistance At the end of the moving and tearful empathy phase, we asked Michelle about her goals for the session, which included Not to have to feel this terror at full volume. Not to be stopped from volunteering for things that require public speaking and teaching, and to be able to feel some excitement in my career! After Michelle said she would be willing to press the Magic Button to achieve all these goals instantly, with no effort, we suggested a round of Positive Reframing so we could see what might be lost of she suddenly achieved all these goals. You can click here to review the Positive Reframing that we did together, as well as Michelle's Emotions table at the end of the Positive Reframing. You can see her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you! The Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, the Positive Reframing typically eliminates or drastically reduces the patient's resistance to change, and opens the door to the possibility of rapid recovery. This will be true even if the patient has been struggling with a problem unsuccessfully for years or even decades, as was the case with Michelle. M = Methods We asked Michelle what Negative Thought she wanted to work on first, and she chose #5: "People will think you are selfish and self-preoccupied." She believed this thought 100%. First, we asked Michelle to identify and explain the cognitive distortions in this thought. As you can see on her Daily Mood Log (LINK), she found all ten distortions. Of course, the most prominent distortion in this thought is Mind-Reading. That's because Michelle thinks she knows how other people will be thinking and feeling about her when they find out about her intense public speaking anxiety. This distortion is nearly always present in any form of social anxiety. I know this from my clinical work and personal experience, since I have personally suffered from at least five forms of social anxiety, including extremely public speaking anxiety, when I was young. You feel absolutely certain that you're flawed and that people will judge you! Then we challenged the Negative Thought, and Michele she was able, with a little help and a couple of role reversal, to crush it. Take a look. (LINK) Here were Michelle's reflections on that portion of the session. First we used the Double Standard and I think that's when I said this to the imaginary friend with the exact same problem: "I think you're being kind of brave." Then it evolved into Externalization of Voices. Both David and Jill played the negative Michelle and I had a little difficulty talking back to my Negative Self. I connected on a logical level, but didn't yet have the ammunition or determination I need to blow my Negative Thoughts out of the water. David spotted my ambivalence immediately, and suggested that maybe it wasn't something we should work on. Before he made that comment, I didn't even realize that I had mixed feelings about giving up my intensely self-critical thoughts. At that point, I found myself making the decision to fight back and felt myself getting stronger. The next time David (as the Negative Michelle) asked if he could talk to me for a minute I told him he had only 30 seconds to make his point because it was time to back off. I had some hesitation about only using the Counter Attack to defeat the thought but David said he liked the feisty response. Then David and Jill both told me of all the positive feedback that was coming through the chat, and I was given the opportunity to use the Survey Method with a couple of audience members. I think I asked two or three people if they thought I was using up valuable time, since that was one of my painful Negative Thoughts. The both commented that they found the session incredibly helpful and that they could relate to these feelings of anxiety and shame, and that they weren't judging me harshly at all! Here you can see how Michelle challenged thought #9. As you can see, her belief in this thought fell from 100 to 50, and then to 0. Negative Thoughts % Now % After Distortions Positive Thoughts % Belief 5. people will think that you're selfish and self-preoccupied. 100 50 0 AON OG MF DP MAG/MIN ER LABE SS SB In fact, I'm being kind of brave!! 100 My anxiety is very real, and it's good to ask for help. 100

Intense Performance / Public Speaking Anxiety, Part 1 of 2 This Is podcast features the first of the two live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16th, 2021. I hope you enjoy this dramatic and inspiring session! Jill and I believe that doing your own personal work is vitally important to the growth and credibility of a mental health professional for many reasons. First, when you're in the patient role, you can see things from a radically different perspective, including a far greater, first-hand appreciation of the errors that shrinks make as well as what is especially helpful. Second, if you are successful in your own work, you can tell your patients, "I know what you're going through, and how intensely painful it is, because I've been there myself, and I can show you how the way out of the woods as well!" This is a message that most patients welcome. And finally, the personal work you do with TEAM-CBT is a fantastic way of comprehending how this new approach really works. Our "patient" today is Michelle Wharton, a forensic and clinical psychologist from Australia. I want to thank Michelle for her tremendous courage in sharing a very personal experience with all of us. I also want to thank Dr. Levitt, who practices at the Feeling Good Institute in Mountain View, California, where she serves as Director of Clinical Training. Jill is also a co-leader at my TEAM-CBT training group at Stanford. I am especially thrilled to share Michelle's live session with you, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. By way of compensation, this podcast will give all of you the chance to hear what you missed, and I think you will NOT be disappointed! When Jill and I asked for volunteers for the live demonstrations in the workshop, Michelle sent us this email, describing her situation. Hi Jil and David, I've just seen your email on the listserv asking for volunteers for the live therapy training on 16 May and thought I'd put up my hand. I'm an Australian clinical and forensic psychologist with Level 2 TEAM-CBT certification based in Adelaide, South Australia. I had been thinking about volunteering to do some work on social anxiety and feelings of inadequacy. I know this has impacted me at different points in my life like holding back my career contributing to perfectionism, and causing high anxiety in social settings. My anxiety is probably more work-related but does impact personal relationships where I just assume I'm not particularly important. After reading your post, it just kept playing thru my mind that I wouldn't be a very good volunteer. This thought was keeping me awake, which paradoxically also made me think I might actually be a good volunteer. Also, from the fractal perspective, the anxiety triggered by just thinking about volunteering is probably reflective of all of my inadequacy concerns. So, I've attached a Daily Mood Log (DML)/ If you think it might be useful let me know. Since I'm in Australia, the workshop will be from 1am-8am in my part of the world. We scheduled Michelle at the start of the workshop, due to the tremendous time difference, but it still required enormous commitment on her part to work with us in the middle of the night! That kind of motivation is extremely helpful and often predicts rapid changes, but it's no guarantee and we'll have to see what happens in the session. This will be a two-part podcast. In today's podcast, you will hear the first portion of Michelle's session (T = Testing and E = Empathy). Next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.) I hope you enjoy the session as much as we did. Again, a big hug and thanks to Michelle, the superstar of the podcast! T = Testing To get started, take a look at the Daily Mood Log (LINK) that Michelle shared with us at the start of her session. As you can see, most of Michelle's negative feelings were intense, especially the anxiety and embarrassment, which she rated at 100%. You would not have known how overwhelming her suffering was if you had met her in daily life because she comes across as warm, bright, personable, and likeable. But inside, a part of her is dying, and that's the part she's been hiding and fighting desperately to change. Her actions today—opening up and become completely vulnerable in front of a large live audience of mental health professionals—required incredible courage and was a fantastic gift to all of us. That's one of the really important reasons for Testing. You can see exactly what you're dealing with, in terms of the type and severity of negative feelings. Of course, we'll ask Michelle to rate her feelings again at the end of the session. That way, we'll know how effective—or ineffective—the session was. This information

#254, Ask Matt, Rhonda, and David (with the famed Dr. Rutherford Knows) Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions! Here are the questions we will address on today's podcast. Karine asks: How can I help my daughter with anorexia? Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication? Guy asks: Are there any Five Secrets practice groups I could join? * * * Karine asks: How do I help my daughter with anorexia? Hello Dr. Burns, I am trying to help my daughter who is starting to have anorexia with your book as the consultations are not working and we are waiting on a list for a specialist which can take months or even year here in Quebec. I have read both of your last books and i am getting good to use it for social anxiety. However. i can't see exactly how to apply it for eating disorder. I asked her to list the benefits she gained from not eating and i am trying to help her see the cognitive disorder in it but it is much harder (ex: i loose weight quickly...which will do ... ) i may help her see the cognitive disorder in the « which will do ... » but not in the « i will lose weight » statement ). Could you help me see the pattern i should follow please as i really think your technique can help her faster and better than the traditional psychologist conversation. Regards Karine * * * Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication. Hello David and others, I have been convinced how important using the Five Secrets of Effective Communication are. I do have a question about living with a person who is emotionally abusive. He uses his criticisms of others to manipulate and control them. How do you accept the criticism of such a person who is taking advantage of you accepting the criticism. My soul wants to rebel against these criticisms and against the person who is trying to manipulate me. How do you navigate such a relationship when the abuser will never acknowledge that they are abusing others. He lives in a fantasy world of excuse making and blaming others. Also, how do I acknowledge my weakness and allow the "death" of my ego to happen? Thanks for your consideration and help. Shirley We reviewed this problem and describe how we treat relationship conflicts using TEAM-CBT. This involves giving up blame and examining your own role in the problem. You will discover--and this might be disturbing, or enlightening, or both--that you are contributing in a BIG way to the very problem you're complaining about. You can review Shirley's partially completed Relationship Journal if you link here. * * * Guy asks: Are there any Five Secrets practice groups I could join? David, Please consider asking one of your skilled therapists to create a Five Secrets of Effective Communication "Practice Group." Possibly the group could be run weekly (virtually) and it would be an opportunity to repeatedly practice each of the secrets. I practice on my own, but I know that learning is often strongest when working with others. Guy Marshall David's Response Hi Guy, Ana Teresa Silva has a five secrets zoom practice group. Check with her! They are just getting started. [email protected] We have an exciting podcast scheduled the next time Matt visits. We will address the many controversies around exposure therapy, and will be joined by a patient Matt recently treated with the fear of leaches! We will also address some of the hundreds of questions submitted by the more than 6,000 fans who registered for my free 90-minute presentation on rapid Recovery from Anxiety which was sponsored by PESI. All the best, Rhonda, Matt, and David (plus Rutherford) If you would like to contact Dr. May, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting. Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working mostly via Zoom, and can be reached at [email protected]. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

#253: Sadness as Celebration, Part 2 In today's podcast, Rhonda and David present Part 2 of their work with a young woman named Rose who has been struggling with profound feelings of grief since learning of a discouraging update on her father's struggles with multiple forms of cancer. A = Assessment of Resistance At the end of the moving and tearful empathy phase, Rhonda asked Rose if she felt ready to do some work, or needed more time to talk and share her thoughts and feelings. She said she was ready to do some work, and described her goals for the session: I know I cannot change the facts, and I would not want to eliminate the grieving, but I would like to dial down the intensity of some of my emotions, particularly when I'm triggered. Next, we did some Positive Reframing to highlight what was positive about Rose's feelings. You can click here review the list of positives that we generated. Rose's Positive Reframing Table* Thought or Feeling List your negative thoughts or feelings, one by one, in this column. Advantages and Core Values--Ask yourself What are some advantages of this thought or feeling? How might it help, protect, or benefit me? What does this negative thought or feeling show about me that is positive and awesome? How does it reflect my core values? Sadness, depression Shows my deep love for my dad and honors the contribution and impact he's made in my life Shows the strength of our relationship Anxiety The anxiety is warranted in this situation, shows that I'm being realistic with the situation It shows my love for my dad, being worried is a way of showing care and concern It shows that I don't want him to suffer It motivates me to connect with him and to make every moment count It makes me vigilant so I explore every possible treatment option It motivates us to think about moving to be closer to him It has motivated us to schedule another visit again in July Guilt Shows my connection to our family Drives us to visit as much as possible Shows that I don't want to live with regret Feeling defective Shows that I'm honest about my flaws Shows I feel that I'm not doing a good job supporting others, so it means I have high standards in my relationships Shows that I'm vulnerable Lonely Shows my love for my dad and the important role he plays in my children's life Shows how strongly that I value relationships Motivates me Hopelessness Shows I am being realistic Prevents me from getting my hopes up too high Prepares me for the inevitable Makes me value and make each moment count Might decide to discontinue the chemo if it causes problems and isn't helpful Makes me more vigilant Frustration Shows I haven't given up or thrown in the towel Anger I will fight and contest this! Now you can review Rose's Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you! Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, down, unhappy 100 50-60 Lonely, alone 80 10 Anxious, worried, frightened 100 30 Hopeless, discouraged, pessimistic, despairing 90 10 Guilty 80 15 Defeated 70 20 Defective 70 10 Angry 80 25 As you can see, she wanted to dial all of her feelings down to low levels, with the exception of her sadness, which was an expression of her love for her dad. M = Methods We used Explain the Distortions, the Double Standard Technique, and the Externalization of Voices, including the CAT (Counter-Attack Technique). Here's how Rose challenged Negative Thought #1. 1. He's going to die; we're running out of time. 100 50 No distortions We're all going to die, but I can be present on those moments when we are together. 100 David discussed healthy vs unhealthy grief, and shared some stories of love and loss. He also talked about the concept of sadness as celebration. In this case, a celebration of Rose's love for her Dad. The impending loss, of course, is tragic, but the wonderful father daughter relationship is beautiful and perhaps somewhat scarce, as so many people have not had such a beautiful relationship with their parents. At the end, Rose said the session was "incredible and special" You can take a look at her end of session scores on the Daily Mood Log (link). After the session, Rose sent the following email: Hello David and Rhonda, Thank you so much for that amazing session today. I am feeling so much more contentment and gratitude after talking with you both. I even feel lighter and more hopeful. The key insight for me was realizing how special and precious this relationship is that I have, and rather than focusing on what I won't have. It sounds like a cliché, but it is true for me and seems to have freed up a weight. I will definitely do my homework, and will can send you the completed DML after listening to the session as that may help. And as for sharing with my dad,

#252: Sadness as Celebration, Part 1 In today's podcast, Rhonda and David present Part 1 of their work with a young woman named Rose. Rose is a 38-year-old mother of two boys aged 2 and 5. She works as a Therapist at an outpatient clinic, the East Bay Center for Anxiety Relief, and is a member of our Tuesday training group at Stanford. Rose sought help because of her profound grief after talking to her mother about her father's recent visit to his oncologist. Her father has had many severe health problems in the past several years. He's been a survivor, but suddenly the outlook seems bleak, and Rose feels tremendous sadness and fear, because of her deep love for her father. In most cases, grief does not need treatment. Clearly, grieving is healthy and even necessary when you lose someone you love. However, it can be helpful to distinguish healthy from unhealthy grief. From a cognitive therapy perspective, all feelings, including grief over the loss or impending loss of someone you love, result from your thoughts. Healthy grief results from negative thoughts that are not distorted. For example, if a loved one dies, you may think of all the things you loved about that person and the experiences you will no longer be able to share. Your sadness is actually an expression of your love. Healthy grief, in contrast, results from distorted thoughts. For example, in my book, Feeling Good, I described a young physician who became suicidal when her brother committed suicide because she told herself; "I should have known he was suicidal that day. His death was my fault, and so I, too, deserve to die." This thought triggered intense guilt, and it contains many of the familiar cognitive distortions, including Self-Blame, Emotional Reasoning, Should Statements, and Discounting the Positive, and Fortune-Telling, to name just a few. With my help, she was able to challenge and crush her distorted thoughts, and her depression disappeared. Then she was then able to grieve his tragic death. Paradoxically, the distorted thoughts that triggered the unhealthy grief had actually prevented her from grieving in a healthy way. Today's podcast is illuminating because Rose is experiencing a combination of healthy and unhealthy grief resulting from a mix of undistorted and distorted thoughts. The work that Rose did is incredibly inspiring, and sad. Today we will publish the first half of the session, including T = Testing and E = Empathy. Next week, we will publish the second half of the session, starting with the question, "What do we have to offer our patients once we've empathized?" Then you will hear the A = Assessment of Resistance and M = Methods portion of our work with Rose. T = Testing Take a look at the Daily Mood Log (LINK) that Rose shared with us at the start of her session. You will see that she had very elevated scores in 8 different categories of negative feelings, suggesting she was in pretty intense distress. We will ask her to rate these feelings again at the end of the session so we can see if she experienced any changes during the session. I'm a firm believer that all therapists should use testing at every session, and many are now doing this, but lots of therapists still refuse for a variety of reasons. I was going to say "bogus reasons," but didn't want to sound harsh or dogmatic! To me, the refusal of psychotherapists or psychiatrists to measure symptoms at every session is the "unforgiveable sin!" I don't believe it is possible to do good therapy, much less world class therapy, without Testing, for a wide variety of reasons: Therapists perceptions of how patients feel, and patients feel about them, are not accurate. Measuring suicidal urges at the start and end of every session can save lives. Seeing how effective. or ineffective, you were at every session allows you to fine tune the therapy and abandon strategies and methods that aren't working in favor of better techniques. This turns your patients into the greatest teachers you've ever had—IF you can take the heat! You will see, for the first time, how your patients rate your Empathy and Helpfulness at every session. At first, this information can be incredibly shocking, but if you process it with your patient at the next session in the spirit of humility, warmth, and curiosity, the experience can be transformative. E = Empathy Rose explained that she was feeling acute grief because of her father's health problems. He had extensive surgery to remove a cancerous kidney in 2014, but the surgeons found additional unusual growths around his spleen. Her dad has also had open heart surgery, surgery to remove a bone tumor, and many other serious medical problems. She said, "he's like a cat with nine lives, but we're concerned that now he's near the end." He experienced GI distress and vomiting in September of 2020, and was hospitalized again in February of 2021, but they found nothing. In March, he was again hospitalized, and the doctor found an aggressive cancerous l

#251, Ask Matt, Rhonda, and David (with the famed Dr. Rutherford Knows) Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions! Today's questions were submitted by the more than 6,000 people who registered for my free talk on July 8, 2021 on the Rapid Treatment of Anxiety Disorders which was sponsored by PESI. I was very grateful to PESI for organizing this event, since it was open to shrinks as well as the general public, and that is the same audience that Rhonda and I are trying to reach with our Feeling Good Podcast. By the way, thank you for your ongoing support of the Feeling Good podcasts. Our four millionth download should happen in August! Please keep telling friends about the podcast if you think they might be interested. The very shy but erudite Dr. Knows may again join us and make an occasional comment. Let us know if you like his input and want to hear more from him in future podcasts. If you don't like him, we can quietly sweep him to the sidelines. Here are the questions we'll answer today: Hello Dr Burns, excited to be here at your talk today. Could you tell us more about dependency on anti-anxiety medications (benzodiazepines like Valium, Librium Ativan, Xanax, and so forth) and how to inform the client about the dangers of addiction? If this treatment you describe for anxiety disorders is 'rapid' does it linger? Is this rapid response you describe in your treatment of anxiety disorders merely first-aid? Am I right in assuming that the sustained work of psychodynamic therapy, body work, and so forth will still be required? Can you discuss any published or ongoing empirical research on the efficacy of TEAM-CBT compared to other therapy techniques? How does Rational Emotive Behavior Therapy (REBT), developed in New York by the late Dr. Albert Ellis in the 1950s, fit into the picture? How does the cognitive distortion, Fortune Telling, apply to specific phobias? Rhonda, Matt, Rutherford, and I thank you for joining us today, and hope you enjoyed the dialogue! Rhonda, Matt, and David (plus Rutherford)

#250: How to Tell Someone, "You Suck!" Featuring special guests, Dr. Matthew May and the always exciting but pedantic Dr. Rutherford Knows, plus our podcast regulars, Rhonda and David Rhonda begins the podcast with a wonderful email from a woman who asked how you might use the Five Secrets of Effective Communication when you have to deliver give negative feedback to someone. Hi David and Rhonda, I'm an avid listener of the podcast and reader of Dr. Burns' material. I've been working my way backwards listening to all the podcasts, and I now own all of Dr. Burns' books and am working my way through those, too! I've especially found the live therapy on the podcast and role-play using the Five Secrets incredibly useful. The Five Secrets of Effective Communication are like a cheat code for life. As I've been applying it in my own life, every conflict has had a phenomenal outcome and I end up closer with the other person. It's incredible. You've given many useful examples of using the Five Secrets on the podcast to respond to someone, for example, who is attacking you and you use the disarming technique and inquiry to hear more about how it's been for them. My question is, how would you use the Five Secrets to initiate a conversation where you have to be the one to bring up something that the other person doesn't want to hear, or that it may be painful for them to hear? I started to think about this when consulting for a CEO who needed to fire someone, but needed to keep the relationship amicable, as well as consulting with another business owner whose employee had been deceitful and she needed to have a "come-to-Jesus" talk with him. Similarly, I've always struggled to bring up something that's bothering me to a spouse or loved one, because I didn't know how to initiate the conversation, and keep it from devolving into an argument (my greatest fear!). Could you perhaps do a role play on the podcast to demonstrate using the Five Secrets of Effective Communication to initiate a difficult conversation, such as: Firing or correcting an employee? Telling a spouse (or loved one) when you've felt hurt or angry because of something they did? Obviously you would still use all the same techniques (Stroking, I Feel statements, Inquiry, etc.), but I would love to hear an example. I find the role plays especially useful and would love to hear your expert wording for how you would approach this. Thank you to both of you for all your tremendous work! Rosemary We loved this request, and model how to deliver the bad news to someone using the Five Secrets. David mentioned that when he was in clinical practice, several women he treated were reluctant to give clear negative signals to men who were chasing them, for fear of hurting their feelings. So, out of excessive "niceness," they ended up leading the man on, sometimes for months, and hurting him even more. It is probably far more merciful and caring to be honest with someone in a kindly way, so he or she can let go and move forward with his or her life. Rhonda, Matt, and David illustrate David's "Intimacy Drill." In this exercise, the person delivering the bad news is Person A, and the person receiving the bad news is Person B. The drill involves four steps. First, Person A delivers the bad news to Person B, trying to use the Five Secrets of Effective Communication (link). The bad news might be telling Person B that she or he has been fired, or that you're angry with Person B, for example. Then Person A gives himself or herself a letter grade on how well she or he did. Was it an A, B, C, D, or an F? Then Person B and the observers give a letter grades to Person A as well.. Next, everyone points out what Person A did that was effective, and what was ineffective, using Five Secrets terms. For example, you might say that the Feeling Empathy and Stroking were great, but there was no "I Feel" Statement or Inquiry at the end. Then you can do a role-reversal, and try to model an improved response. This is, by far, the best way to learn the Five Secrets of Effective Communication. However, it requires non-defensiveness on the part of all who participate, and the philosophy of "joyous failure." This means that you view your errors as opportunities for learning and growth instead of shame and defensiveness! If you want to master the Five Secrets for use in ANY situation, the "Intimacy Exercise" is a fantastic way to practice. However, remember to check your ego at the door, because you'll probably gets some low grades and make plenty of errors, especially if you're a beginner. But if you work at it, and keep practicing—which very few people do—you can develop some fantastic communication skills that can help you in personal and professional relationships. Today, we also introduced, in a small way, the very shy and erudite, and somewhat pompous, Dr. Rutherford Knows, who makes an occasional comment. He may agree to participate in future podcasts as well. Dr. Knows could be a really great

Podcast 249 Update on the Amazing Feeling Great Book Clubs! July 5, 2021 Today we report on the first two Feeling Great Book Clubs, with Dr. Brandon Vance and Sunny Choi, LCSW. Brandon explained that more than 200 people signed up for the groups, and that he 100 people on the waiting list for a future book club. The first two clubs have been a tremendous success. Brandon explained why he started the Book Clubs: It's because these are tools in the book that people who are struggling with depression and anxiety can use to get better. Roughly 10% of the people in the world have significant mental health problems causing functional problems in their lives. That's eight hundred million people! I have asked myself how we can spread these tools to people around the world. Since I finished my psychiatric residency in 2003, I've been mostly working with individuals, but seeing factors influencing their mental health, like oppression, inequality, injustice, lack of safety, prejudice and othering, and environmental destruction with ensuing lack of resources. This has inspired my activism towards changing these things. I feel like we need to take action on those levels as a society. At the same time, we have powerful and empowering skills people can learn on an individual level, and these skills can be taught in group settings to relieve suffering. I think we actually need an "owner's manual" for the mind, and could teach mental health to children, right along with the basics of reading, writing, and arithmetic, as well as adults. Some people have more access to these tools in psychotherapy, but many people in the world may not. I would love to make these tools like those in Feeling Great more accessible to people worldwide. The book, Feeling Great, does that, and I created the Feeling Great Book Clubs, as a way to reinforce those concepts, so people can come together in groups during this period of isolation, and learn these techniques, get support, and have their questions answered. Rhonda asked several questions, including Where do the book club members come from? Who helps them? What happens during the hour. The participants come from all over the world, including North and South America, Europe, Asia, Oceania, Africa, and the Middle East. Most are lay people, but 15% are therapists. A number of certified TEAM-CBT therapists help out voluntarily, including: Phillip Lolonis Katie Dashtban Sunny Choi Heather Clague Brandon described the breakout groups: The typical group starts with music, followed by meditation, and a general check-in on how people are feeling. This is followed by answers to questions members have submitted concerning the assigned reading for the week, and reviews of the chapters. Then everyone joins their breakout groups, which are the same each week. This facilitates the development of trust and bonding among the members in each group. There are specific instructions for the breakout groups that relate to the material in the chapters that were assigned for the week. They may discuss questions related to the chapters, or work on a skill presented in Feeling Great. For example, they may work on identifying the cognitive distortions in their thoughts. Then they may use the "Straightforward Technique" or other techniques to challenge their thoughts with "Positive Thoughts." Last week while reading the chapters on Fortune Telling and Anxiety, we had a check-in circle, where one member describes a mildly embarrassing experience and shares some feelings she or he had. Then the other members practice responding with a couple of the Five Secrets of Communication. For example, they may use "Thought Empathy" to repeat a bit of what the person said along with an "I Feel" Statement and say, "I'm feeling sad to hear that." In future weeks, we will use this same format but add more of the 5 secrets, including Feeling Empathy, the Disarming Technique, Stroking, and Inquiry. Sunny mentioned that it is neat to see people from the most remote corners of the globe connecting and developing friendships. He said that Brandon's genius is in how he has created a safe environment to open up and has made the groups really fun, with singing and sharing that have made the groups a powerful and unique personal experience. Sunny explained that when he grew up in Hong Kong, he had anxiety and panic attacks, but you don't always need a therapist to feel better. One of the most powerful groups was when Sunny shared his grief about a painful personal experience in the group, when his cousin's restaurant was targeted and vandalized in an act of anti-Asian violence. Working with Sunny in front of the group as if he were a patient, Brandon demonstrated the Feared Fantasy Technique that they'd read about in Feeling Great that week. Brandon said Sunny's vulnerability opened people up and made it easier for them to share their feelings and experiences. Sunny explained that many Asian people have an anti-therapist bias, but they are very

Podcast 248 Ask David and Rhonda! In today's podcast, Rhonda and David answer some fascinating questions submitted by listeners like you! We both thank you for your interest in our show, and for your kind comments and terrific questions! The Questions Kati asks: I notice that in your therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way? Kati also asks: Do you believe that empathy can be 'taught'? Yiftah asks: How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? Yiftah also asks: From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective? Esther asks: You say there is no convincing or consistent evidence to support most psychodynamic claims about the causes of things. What you said resonates, but aren't you also just making claims? I have a psychodynamic supervisor, and am struggling to choose between empirically validated treatments and traditional psychodynamic approaches. Sean asks: Burns, what can you do when you are using the disarming technique and the person keeps interrupting you? Ben asks: Since exercise improves the mood of some people who are feeling down, doesn't this prove that physiologic changes can improve mood, as opposed to changing negative thoughts? The Answers Note: The answers below were based on David's email exchanges with the people who asked the questions and were created before today's podcast. Therefore, the podcast may contain new and different information from these show notes. Hopefully, both the show and the notes will be helpful to you. Rhonda and David Kati asks I notice that in your live therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way. David responds Hi Kati, thank you for the kind comments! It is great to get negative feelings to zero and experience enlightenment and joy. However, no one can be happy all the time, so you will have plenty of opportunities to "learn" from negative feelings again. In addition, there is a difference between healthy and unhealthy negative feelings. Healthy sadness is not the same as clinical depression, healthy fear is not the same as a phobia or panic attack, healthy and unhealthy anger are quite different, and so forth. There will bumps in the road of life for all of us at times. * * * Kati also asks Do you believe empathy can be "taught?" As a mum (of a 15 and a 10 year old girls) and a (HS) teacher I notice some people seem to have it more 'innately' than others but would also love to think it is an aspect that can be intentionally developed in others in some way. If you think like me, I would love to hear your thoughts on how that could be done (i.e. what practices or strategies would be most helpful to use with young people in particular). I am still in awe that we can have a sort of conversation with such a brilliant and creative mind and I humbly hope you can address these two questions either in one of your podcasts or by responding to this message. In admiration, Kati David responds Thanks again, Kati, With regard to empathy, it is something that can be learned, but it takes commitment and practice. A good first step is the book I wrote on this topic called Feeling Good together. In addition, there is, as you say, an "aptitude" that people have for this or any skill, with a tremendous variability in the population. But regardless of your natural aptitude or lack of it, you can learn and grow tremendously. I started out with very poor listening skills. You can also search for Five Secrets of Effective Communication on the website, using the search function, and you'll find lots of podcasts teaching these skills. david * * * Yiftah asks How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? Dear Dr. Burns, I love your podcast and books. They have completely changed my practice and had helped my personally. In particular it was great to hear you working with Dr. Levitt with cognitive exposure, and your discussion about it. I have two questions regarding cognitive exposure with PTSD (for the podcast. First, how could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? David responds Hi Yiftah, I try to deal with the Outcome and Process Resistance issues prior to agreeing to help any patient with anxiety. I might say something like this: "Jim, I'd really love to help you with your fears of X (whatever it is), and I'm pretty convinced that if we work together, you can make some great progress in overcoming your fears. I have more than 30 great tools to help you overcome anxiety

The Night My Childhood Ended, Part 2 In today's podcast, we present the second half of the therapy session with Todd, who did personal work focused on the impact of a traumatic event that ended his childhood when he was eight. Last week, we presented the T = Testing and E = Empathy phase of the session. Today we present the A = Assessment of Resistance, M = Methods, final testing, and teaching points. A = Assessment of Resistance Todd's goal was to be able to feel more vulnerability by the end of the session. During the Positive Reframing, we listed the positives that were embedded in Todd's negative thoughts and feelings. My sadness shows my humanity. My sadness shows my commitment to family. I put others before me and value the time people are taking by listening to this session. I challenge myself to work on myself. My negative thoughts and feelings make me a more loving husband and parent, and a more committed and effective therapist. I love my mom and want to protect her. I have high standards. Although I feel like I was and still am "a frickin' coward," sharing this shows tremendous courage. As you listen, you'll see that it was incredibly difficult for Todd to see anything positive in the fact that he was that calling himself a coward. He kept thinking that he "should" have gone in earlier to try to help and save his mother, and that this might have changed the entire trajectory of his life. At the same time, he conceded that he was just a little guy, and that his father was an incredibly frightening and intimidating figure. You can see Todd's Daily Mood Log at the end of A = Assessment of Resistance (link). As you can see, he wanted to reduce all of his negative feelings quite dramatically, but he wanted his sadness to remain at 100%, because he wanted to be able to feel this emotion and grieve. M = Methods Jill and I tried a variety of techniques during the Methods phase of the session, including a new version of the Double Standard Technique. I played the role of the 8-year old Todd, and he played the role of himself. I verbalized all of his Negative Thoughts, "But isn't it true that I rally was a frickin' coward?" and challenged him to crush them. This helped Todd get in touch with his compassionate and realistic self. You can see his final Daily Mood Log. As you can see, there was a dramatic reduction in all of his negative thoughts except sadness, which fell to 80%. You will recall that his goal for sadness was 100%. There were lots of positive messages for Todd throughout the session in the chat box. There were many outpourings of love and admiration for Todd's courage and vulnerability. We sent those messages to him after the end of the session, and that was when the tears finally came. Here's an email we received from him after the session. What an evening! I just saw the video again and I was so blown away from the amazing love and support I felt from all of you last night. I also was able to tear up a bit when I was reading all of the heart felt chats that Alex had shared with me. I would give all of you an A+ on empathy for sure. Finally, I'm so grateful to JIll and David for their compassion, and for helping me reconnect with little Todd and feel much closer to all of you. What an awesome night and group! Brandon Vance MD sent a link to a song one of his students created, and Todd responded to it: Last night, it was so awesome to listen to the musical recording that your student so beautifully shared with us. I'm not one to cry very easily, but I was so moved by the lyrics and the emotions in that song. I've been so amazed at how you continuously evolve TEAM in so many wonderful and creative ways. Kudos! Here's the link to the song if you'd like to listen! I also found it moving and beautiful. Cassie Kellogg is the performer and songwriter, and her song is called Double Standard, which is the method that proved so helpful for Todd. Some interesting information about Brandon and Cassie, as well as the words to her song, appear at the bottom of the show notes. There were also tons of positive comments about the session in the teaching evaluation at the end of the session, with overwhelming outpourings of love and appreciation for Todd. Time after time, the personal work we sometimes do while teaching seems to make the most positive emotional impact on our students. And, of course, the teaching value can be tremendous. Teaching Points 1. T = Testing is crucial. If you met Todd, you would have no idea how he feels inside, and if you were his therapist, and you did not use the Brief Mood Survey at the start and end of every session, and the Evaluation of Therapy Session at the end of every session, you would also be partially "blind" to how Todd was feeling, and how dramatically his feelings changed at the end of the session. Most therapists still are not using session by session assessment, and they are at a severe disadvantage that they are not even aware of. I am convinced that it is impos

The Night My Childhood Ended, Part 1 In today's podcast, we present the first half of a therapy session with Todd, who describes a traumatic event that ended his childhood when he was eight. Next week, you will hear the exciting and inspiring last half of Todd's session. My co-therapist is Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, CA, and one of the co-leaders of my weekly training group at Stanford. We are deeply indebted to Jill and Todd for making this incredible and extremely personal podcast possible. Todd hopes, and we all hope, that it will be helpful to many people around the world who are suffering, and perhaps hiding the scars from your own traumatic experiences. As we always do in TEAM, Jill and I went through T, E, A, M in consecutive order, and I will give an overview of each phase of the session. T = Testing and E = Empathy Todd started by saying: I'm uncomfortable with all the attention I'm getting right now, and I'm worried about derailing the group, since our plan was to have teaching on exposure tonight. I'm going to describe one of the worst nights of my life, when I was 8 years old. It was the last night our family lived together, and my childhood essentially ended. But I'm not looking for a pity party. When I think about that night, I feel 100% sad and shitty. My life isn't shitty. but when I think about that night, it's incredibly discouraging. Here's what I'm telling myself right now: I'm more screwed up than anyone else in this group. 100% I worse than all of the others. 100% My parents got married very young, when they were 18. I was raised in the 1970's, which wasn't the child-centered world like it is today. My parents drank all the time. and they've both had lifelong challenge with addictions and mental health. In fact, my mom got arrested for a DUI just last week. I have one older brother, and we were on our own most of the time. My parents had a horrible fight one night. It was the last night our family was together. They were both drunk and screaming at each other. They began physically fighting in their bedroom, and I thought my dad was going to kill my mom. My brother and I were scared, and we hid in the bedroom and created a fort with our bunk beds. Then things got quiet, so we decided to see what had happened, and went into their bedroom. Mom was badly beaten up, her face was all bruised, and dad seem horribly embarrassed and ashamed. It was devastating, because I told myself that I should have done something to help her, to save her, and I felt, and still feel, like a frickin' coward. I believe that 100%, and have felt ashamed every time I think about it. I feel all alone. I'm here, but I'm not here. That was the end of my childhood. I don't like to think about it. My father moved out, and my brother lived with him. I lived with our mom. The idea at home was always, "don't speak unless you're spoken to." Dad was very angry and controlling. He was angry at my mom for not taking better care of my brother and me. He was angry at life, and I'm also angry and disappointed in her for not taking better care of us. I want to be able to get in touch with my vulnerability and my emotions. Then I stop myself and say, "I'm not allowed to have these feelings." I want to be consoled, comforted, and not be so hard on myself. Maybe I want people to feel closer to me. You can see Todd's Daily Mood Lot at the start of the session (link). As you can see, he was incredibly upset, and had eight Negative Thoughts, and his belief in all of them was strong, with most at 100%. Next week, you will hear the dramatic conclusion of Todd's personal work, including the A and M of TEAM! If you would like to contact Todd, you can reach him at: [email protected] david and rhonda

Ask Rhonda, Matt, and David! Tips for Joy and more! In today's Ask David, we are honored to feature Matthew May, MD, a former student of David's during his psychiatric residency training, and now esteemed colleague. Rhonda and David are thrilled that Matt can join us, not only because he is a dear and loved colleague, but also because he is one of the greatest therapists on planet earth! Plus, he's an incredibly gentle and compassionate man. Rhonda Asks: What is the most effective way to help a suicidal patient? Rhonda Asks: How would you teach, the technique, Thinking in Shades of Grey to therapists or patients? Brian Asks: Any tips for joy? ThisLife asks: "Could you possibly explain why Albert Elis thinks the three valid uses of shoulds are valid, and provide the source where he explain this point, if convenient?" Mark Asks: Why is trying to change a person or help fix a person's emotional problems insulting? And how can I stop this habit? Along the same lines, EJG asks, "What's the best way to help people who don't want any help?" Rhonda and David

The Paradoxical Nature of TEAM In today's podcast, we are honored to feature Matthew May, MD, a brilliant and beloved colleague of Rhonda and David. Rhonda suggested the topic for today's podcast on the Paradoxical Nature of TEAM, and Matt and I were more than excited to dive into this cool topic! We reviewed the paradoxical nature of the four components of TEAM. As you will see, each paradox requires one of the four "great deaths" of the therapist's "self," or "ego." The Paradoxes in T = Testing TEAM therapists assess how the patient is feeling "right now" in at least six dimensions just before the start and just after the end of every therapy session using brief, extremely accurate scales for negative feelings like depression, suicidal urges, anxiety, and anger, as well as happiness and marital / relationship satisfaction. These scales are like an emotional X-ray machine so therapists can see, for the first time, exactly how effective or ineffective they are in every single therapy session. You can also see exactly what happens to the patient's feelings between therapy sessions. Therapists may make several potentially disturbing discoveries during Testing. His or her perception of how the patient feels are frequently wildly inaccurate. The therapist's perceptions of the degree of improvement in his patients may be shocking, since the therapist will often discover that patients have not improved, and may even feel worse. These "disturbing" discoveries can be celebrated, because the therapist, if humble and open, can accept the fact that his or her therapeutic strategies are not sufficient, and that meaningful change has not yet happened. The therapist can search for and try different treatment methods that may be more helpful for each patient. Paradoxically, the therapist's failures become golden opportunities for learning and growth every day, and your patients will become the greatest teachers you've ever had. This involves the first of four "great deaths" for the TEAM therapist—the death of the "self" that has expert understanding of how patients actually feel. You will discover that your perceptions are very inaccurate in many or even most situations. This discovery can transform the way you practice if you have the courage and humility to try something new! The Paradoxes in E = Empathy At the start of the session, the therapist attempts to listen and provide an empathic, compassionate connection with the patient, reflecting back how the patient is thinking and feeling and convey acceptance and warmth. But here's what happens in TEAM. When assessing empathy with the "What's My Grade Technique" during the session, the therapist will often / nearly always discover that you didn't really "get" the patient. When you review your scores on the Empathy and Helpfulness Scales that patients complete at the end of every session, most therapists are shocked to see that they get failing grades from most or nearly all patients after most or nearly all therapy sessions. Paradoxically, this is a big plus because it allows the therapist to explore his / her failures with the patient in a spirit of humility and curiosity at the start of the next session. If done skillfully, this can lead to therapeutic breakthroughs as well as a significant deepening of the therapeutic alliance. But this also requires a second "great death" of the therapist's ego, because patients' criticisms on the feedback forms will nearly always be accurate, and often biting. If you have the courage and skill to acknowledge that truth, the therapeutic relationship can be instantly transformed. Learning skillful empathy skills, using the Five Secrets of Effective Communication, requires tremendous commitment and practice, and the "beginner's mindset." The Paradoxes in A = Assessment of Resistance (formerly called Paradoxical Agenda Setting) During this phase, the therapist brings the patient's subconscious resistance to conscious awareness, and melts the resistance away using approximately 20 "resistance melting" techniques, such as Positive Reframing, the Paradoxical Invitation, the Acid Test, the Gentle Ultimatum, the Externalization of Resistance, Sitting with Open Hands, and more. During this phase, the therapist, paradoxically, does NOT try to "help" the patient, but instead assumes the voice of the patient's subconscious resistance, helping the patient suddenly "see" why she or he actually should NOT change. Paradoxically, the moment the patient "gets it," there will be an illumination, and the patient will suddenly lose his or her resistance and become way more open and collaborative. This what makes the rapid recovery in TEAM-CBT possible. The patient also discovers, paradoxically, that his or her symptoms, like depression, hopelessness, and feelings of worthlessness, anxiety, or rage, are NOT the expression of what is wrong with him or her, like a "mental disorder" or "chemical imbalance in the brain--but the manifestation of what is right

Ask Rhonda, Matt and David! Ask David #243 May 24, 2021 David and Ronda answer your questions about the role of hope, treating court-ordered patients, suicide threats, being a virgin, and moral scrupulosity. Guest expert, Dr. Matthew May, joins us for this fascinating podcast featuring questions from fans like you! V3A asks: What is the role of hope? EdG asks: How would you deal with a patient who doesn't like you or doesn't want to come for treatment, but has been required by either an employer or the courts? Preetika asks: Recently, a client said she felt suicidal and that made me feel suicidal about anything untoward happening on my watch! I was 'scared stiff!' Please do a podcast if possible on therapist fears and dilemmas. Dale asks: How would you do Positive Reframing with someone who is suicidal? Miho writes: From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Robyn writes: I would very much like to hear about how you treat patients suffering OCD with moral/religious scrupulosity. * * * V3A asks: What is the role of hope? Hi David, how do you fit the cultivation of hope into TEAM-CBT? Being such an important aspect of recovery, it seems to be most needed in those that most need help, creating a seemingly unwinnable situation for those people. If someone has enough hope to seek treatment, is that enough to make a recovery? * * * EdG asks: Just listened to Podcast 025 on how to relate to a patient you dislike, Very useful! What about the opposite situation? How do you deal with a patient who may have a hidden agenda, like coming to you in order to avoid a legal problem or because s/he was ordered by an employer or the courts? Thanks, EdG. That's sometimes fairly easy, and might make this an Ask David. I once told such a patient that if he wanted to work with me he'd have to have an agenda of something he really wanted to change, and he would also have to do tremendous amounts of psychotherapy homework, and that this was non-negotiable, and that he or she might prefer going to another therapist who would be more of a pushover! In my limited experience, this was very effective, and seemed to motivate the man who came to me. He did, in fact, work tremendously hard! david PS We can get Rhonda's take on it, as she does forensic work. * * * Preetika asks: Recently, a client said she felt suicidal and that made me feel suicidal about how anything untoward happening on my watch! I was 'scared stiff!' Please do a podcast if possible on therapist fears and dilemmas. Dear Dr Burns, Thanks for sharing your wonderful podcasts, they are of immense value. I have been using your brief mood surveys and though I found it tiresome initially, I realized its value when I I uncovered suicidal thoughts in a patient that came forth only because of repeating the mood survey each session. Further, do you think a brief behavior survey at the start of a session is beneficial to record sleep, eating, and self harm patterns is needed to assess how clients are doing in between sessions? Does it have value? Recently, a client said she felt suicidal and that made me feel suicidal about how anything untoward happening on my watch! I was 'scared stiff!' Please do a podcast if possible on therapist fears and dilemmas. Thanks for so many continuing insights and for making therapy feel real, Preetika Hi Preetika, Perhaps you can search on website using search function and find the podcast on suicide prevention. Then let know what you think. When you use the Brief Mood Survey and Evaluation of Therapy Session, you said it was tiresome at first. What were your scores on the Empathy Scale? Scores below 20 are failing grades. Most of my colleagues, and myself, find this anything but "tiresome," but rather dynamic and fantastically challenging. Also, what percent reduction do you see in patient's depression scores within sessions? This shows your level of skill and effectiveness. 25% to 35% reduction within a session is a fairly good benchmark of sorts. This is called the Recovery Coefficient. Have you looked at that? I find it pretty exciting, and also challenging, especially when the scores don't change, and also when they do1 Thanks for the great question. David * * * Dale asks: How would you do Positive Reframing with someone who is suicidal? Would you suggest that it says that they have a strong self-awareness of the severity of their hopelessness that protects them from more disappointments? Or perhaps a wake-up call message from there awaren

Professor Yehuda's TEAM-CBT Israeli Initiative! Today's podcast is the latest in a series Rhonda has created featuring people who are doing interesting and creative things with TEAM-CBT. In today's episode, we feature Yehuda Bar-Shalom, D.H.L, TEAM CBT level 4 trainer and therapist, who will teach us all about the use of TEAM in the school system. Yehuda, who is an associate professor appointed by the Council of higher education in Israel, is the first person we know to teach TEAM to school counselors in a practical way. (We also refer you to our podcast episode 152 where we interviewed Amy Spector, MFT, who is a TEAM therapist providing TEAM therapy to "at-risk" teen-agers at a high school in the San Francisco Bay Area.) Yehuda is an educator, psychotherapist and researcher. He has served as president of Hebraica University in Mexico City, the only Jewish University in Latin America which is open to students of all religious faiths. When he became the president of Hebraica University, he adapted the psychology and wellbeing department so that it became a training program for TEAM therapists. When he returned to Israel in 2020, Yehuda's former student Victoria Chicurel, and several others, continued the Mexico TEAM training program. Yehuda has authored seven books and almost 70 academic articles on education and society, with a focus on Jewish education, social entrepreneurship and consulting in psycho-educational settings, mostly from a CBT perspective. He has been the Vice President of the David Yellin College in Jerusalem, and the Dean of Education at the Ono Academic College. His book, Educating Israel: Educational Entrepreneurship in Israel's Multicultural Society was published in 2006. Yehuda is married to Amira Bar Shalom, and has three children. Yehuda, who in his professional life is both a therapist, educator, and researcher, earned his doctorate in education in 1997, conducting research on applying Bion's theory in group work with adolescents. When he was teaching school counselors, he realized he wanted to become a counselor, so, 20 years after earning his research doctorate, he went back to school and earned a Master's degree in school counseling, and later another Master degree in the treatment of addictions. He also studied for a two-year certificate in cognitive behavioral therapy at the Psagot Institute, where he met Maor Katz, MD, Director of the Feeling Good Institute, and one of the Psagot instructors who taught TEAM therapy. Yehuda also learned about TEAM therapy by listening to the Feeling Good Podcasts. When he started listening, he thought TEAM therapy was "like a miracle." Yehuda then attended several of David's TEAM training workshops, as well as on-line trainings sponsored by the Feeling Good Institute (FGI). He has also studied one-on-one with Level 5 TEAM therapist, Daniel Minte. Yehuda currently teaches at a master's level training program for school counselors at the Ramat Gan College in Israel. He is committed to teaching TEAM to school counselors for many reasons. One is that using TEAM provides school counselors with an immediate way to create a fast connection to students. In addition, TEAM can more quickly help students who are struggling with their moods, behaviors, relationships, or habits and addictions. Yehuda emphasizes the importance of T = Testing for the school counselors, and teaches them how it helps create empathy. For example, the school counselor might say this to a new student, "Oh, I see your score on anger is such and such. Tell me about that." Yehuda explained that school counselors are like primary care physicians. They have the immediate pulse on the student's needs and feelings. He is training the school counselors to speak with their students using the Five Secrets of Effective Communication. He also shows the counselors how to teach the Five Secrets, so their students can use this tool in their lives. He gave an example of how a school counselor might use the Disarming Technique when interacting with a child who feels angry and wants to escape. The counselor might say, "Wow, I can see that you're feeling really angry about being sent to me for counseling and that you want to escape! I want to escape, too!" Then the child feels understood and opens up. Yehuda is also teaching the school counselors how to identify their own distorted negative thoughts, and how to positively reframe and challenge them. Once the counselors learn these skills for themselves, they can teach them to their students so that the students can learn to challenge their own distorted thoughts. The school counselors are also learning the use of paradox, so prominent in TEAM therapy, in order to help them understand their students' motivations about why they feel and act the way they do, and how their understanding of their students' motivations can lead to the change. The school counselors Yehuda trains are often quite skeptical and don't believe him or David, which is understandab

Live Work with Elizabeth, Part 2 (of 2) "I'm tired of being terrified. I want to be at peace!" Last week, we brought you Part 1 of a session with a women who's been struggling with anxiety and the fear of poverty every since she was 13 years old. that included T = Testing and E = Empathy, including an empathy error that David and Jill corrected. Today, we bring you the conclusion of that amazing session! After the empathy correction, Elizabeth suddenly said: "I don't talk about this stuff very much as an adult. I'm feeling overwhelmed in a good way right now. A sense of peace is opening up." You can review the partially completed Daily Mood Log Elizabeth gave us at the start of the sess if you click here. Her goal for the session was to get some relief from the constant pressure she put herself under to function and to keep her practice full. A = Assessment of Resistance Together, we did Positive Reframing with her negative thoughts and feelings, asking: What does this thought or feeling show about you and your core values that's positive and awesome? What are some benefits, or advantages, of this thought or feeling? Together, we came up with this list of the positives. They keep me moving. They are very familiar. They show I've got a good work ethic. They show I'm a responsible human being. They show I care deeply about my family and my business. They show I'm determined to change the family history of failure and deprivation. The anxiety protects me from failure. It has kept me alive. It has paid the bills. Keeps me independent and self-supportive. Shows I'm strong and confident. Shows my love for my daughter. You can see Elizabeth's Daily Mood Log with her goals for each negative feeling cluster if you click here. M = Methods Next we helped Elizabeth challenge her negative thoughts using Identify the Distortions, Explain the Distortions, and Externalization of Voices, starting with her seventh Negative Thought, "I need the pressure to function," which she initially believed 100%. She identified the following cognitive distortions in this thought: All-or-Nothing Thinking, Jumping to Conclusions (Fortune Telling), Emotional Reasoning, and Magnification / Minimization. She decided to challenge the Negative Thought with this Positive Thought: I do not need pressure to function. I have functioned many times without pressure just fine. She believed this thought 100%, and this reduced her belief in the Negative Thought to 10%. Then we did Externalization of Voices with this thought and many others. Then David suggested Cognitive Flooding. The idea is to flood yourself with anxiety by imagining whatever it is that terrifies you the most. Every minute or two you record the time, your anxiety (0 to 100), and any fantasies you are having. The goal is to make yourself as anxious as possible for as long as possible. Over time, your anxiety falls, and eventually disappears. This can be frightening, and requires some courage on the part of the therapist and patient, but it can be extremely helpful and often works rapidly. Cognitive Flooding Flow Sheet Time Anxiety Fantasy Comment 6:34 100 I am looking at my appointment schedule, which is only half full, and the phone is not ringing with new patients 6:35 100 Only two patients are scheduled, no one is calling to inquire about therapy 6:36 110 My throat is getting tight, and I'm telling myself that other clinicians in our practice rely on me, and I'm letting them down. 6:37 Eliz can fill in anxiety ratings, perhaps I'm asking myself, "What will we do? What's going to happen?" 6:38 Eliz can fill in anxiety ratings, perhaps My schedule is drying up. My associates don't have any patients. Jill begins with the What-If Technique. What's the worst that could happen? 6:39 Eliz can fill in anxiety ratings, perhaps The economy is crashing. I have to let go of my associates. This is devastating. And then what? What's the worst that could happen? 6:40 Eliz can fill in anxiety ratings, perhaps I'm standing in my office by myself. Everyone is gone. I'm alone. No one is calling for training or treatment. And then what? What's the worst that could happen? 6:42 50 I have to keep working alone in a dark office until I'm 80 years old. And then what? What's the worst that could happen? 6:43 30 Now I'm 85 years old, still trying to make things worse. My husband has a heart attack and Parkinson's Disease. Now I have to treat people for free. At this point something unexpected happened. Elizabeth burst into tears, and said: "I'm angry because this is what I've always wanted to do. . . I don't want to have to charge people for therapy. I just want to treat people for free. She said the flooding was powerful, and melted the conflict she'd been experiencing: "I want to embrace therapy, and do something for free. I love doing therapy. And my biggest fear is that I cannot do that!" David suggested doing the cognitive flooding whenever she felt a pang of anxiety about her practice. You can see Eliz

"I'm tired of being terrified. I want to be at peace!" Live Work with Elizabeth, Part 1 (of 2) This podcast features Elizabeth Dandenell, LMFT, who runs a successful treatment clinic in Alameda, California for anxiety disorders, The East Bay Center for Anxiety Relief (www.eastbayanxiety.com.). She is a certified Level 4 TEAM therapist and trainer, and also helps teach mental health professionals at our Tuesday psychotherapy training group at Stanford. We are deeply indebted to Elizabeth for allowing us to publish the very personal, dramatic and inspiring work she did that evening. I also want to thank Jill Levitt, PhD, who was my co-therapist in the work with Elizabeth. Jill practices at the Feeling Good Institute in Mt. View, California (link) where she is Director of Clinical Training, and teaches with me at Stanford. Like most mental health professionals, Elizabeth occasionally struggles with feelings of anxiety, stress, and self-doubt, and wanted to do some personal work in a recent Stanford Tuesday group. The personal work takes courage, but is crucial to the training and personal growth of all therapists. She was hoping for help with fears that have haunted her since her father died when she was just 13 years old. She explains: I started working when I was 13 years old and that is when the pressure to make money began because my father was an unsuccessful businessman. We were all just scraping by. I started working because my father was unable to pay basic bills at times like phone and electric. Or our car didn't always run. He was not good at running his own business and money flow was very inconsistent. I discovered when I started working that I could have some control with financial stability if I had my own money and would help out paying the phone bill occasionally. This is when the anxiety of not having enough to survive kicked in and developed the" pressure" I discussed in the podcast and in my daily mood log.. This pressure to survive has has fueled my anxiety for years. My father died from Parkinson's Disease in a nursing home when he was 77. He wa on Medicaid because he had lost everything. I was 50 when he died. You will hear many techniques that Jill and I used during the session, including Cognitive Flooding. This is, to the best of my knowledge, one of the first times that we have captured this type of Exposure live on a Feeling Good Podcast. Combining Cognitive Flooding with the What-If Technique (pioneered by Dr. Albert Ellis) makes the confrontation with your deepest fears especially powerful. Listening to that portion of the session will be illuminating for many therapists and patients alike, especially if you are not familiar with, or confident in, the use of exposure in the treatment of anxiety. Elizabeth's anxiety was triggered by an exercise we did called "No Practice" in one of the David and Jill workshops for mental health professionals. Essentially, you practice saying "no" to someone who is pressuring you and making unreasonable demands on you. But in Elizabeth's case, and perhaps for you, too, those demands are internally generated. If you click here, you can see the partially completed Daily Mood Log that Elizabeth brought to the session. T = Testing We began our session by reviewing Elizabeth's scores pre-session scores on the Brief Mood Survey. The scores indicated only mild anxiety and minimal anger, but these scores probably do not reflect the intensity of the anxiety and terror she often feels. We then went on to: E = Empathy Elizabeth said, "That workshop exercise ("No Practice") got me thinking about an unresolved issue I've been struggling with my entire life." She explained that I'm doing too much in my life. I complain and then I take too much on and get overwhelmed. I fill my plate too much, and I tell myself that my patients need me, so I'm always taking on new patients to keep my schedule full . . . At times I get really anxious and don't feel competent or confident. Who I am today is due to constant pushing, pushing, pushing, and never letting up. She explained that the problem started when she was 13: We didn't have much money, and my father died penniless, in poverty in a skilled nursing facility. I'm always pushing for fear of meeting the same fate, telling myself that if I slow down I might not have enough money for my daughter's college education, or for our retirement. I work so hard I was once even treated for adrenal fatigue. But my husband and I are not in any financial danger now, and things are fine, and I'd love to have time for more walks, for more meditation. But I'm terrified of slowing down. We did the What-If Technique to explore Elizabeth's fear of slowing down. What was at the root of her fears? David: What would happen if you slowed down? What are you the most afraid of? Elizabeth: We might not have enough for my daughter's college and for our retirement. David: And then what? Elizabeth: Our daughter would have to take out student loans. Da

239: Ten Days to Self-Esteem, Featuring Dawn O'Meally Dawn O'Meally is a licensed mental health professional from Westminster, Maryland who purchased my book, Ten Days to Self-Esteem workbook (link) as well as the Ten Days to Self-Esteem Leader's Manual for at a workshop she attended in 2002. This is a 10-class self-esteem training program for patients and the general public. The groups can be led by a therapist or lay person. This book was the basis of a large and successful treatment program at the hospital where I practiced in Philadelphia. Dawn described reading the books and telling herself, "I can do this!" Since that time, she has conducted roughly four Ten Days groups per year. The improvement in her patients has been phenomenal, due, in large part, to her spark, creativity, and gift for teaching and inspiring individuals struggling with depression, anxiety, and low self-esteem. In the podcasts she takes us through the first seven steps of the ten-step program, and reads testimonials from patients like Julie who wrote: "I had many WOW moments. This book is my bible!" If you are interested in setting up a similar program in your area, feel free to contact Dawn at [email protected]. I think it is fair to say that today's podcast is electrifying, and filled with the same excitement that Dawn brings to her patients! Dawn describes herself as a little like Miss Frizzle with her Magic Schoolbus. I'm not personally familiar with Miss Frizzle but it does sound like fun, exciting, and creative, three strong characteristics of Dawn. She describes how she makes patients accountable, requiring a $50 deposit they can earn back by coming to groups on time and doing their homework (HW). As a group, they also do a Cost-Benefit Analysis (CBA) on the Advantages and Disadvantages of doing the HW, and review the list of really GOOD reasons for NOT doing the HW in the book, with each member ticking off the ones that resonate with their own thinking. She said some of the most popular ones are: I'm afraid of what might happen if I DO change. I believe that others are to blame for my problems, so why should I have to change? I don't trust Dr. Burns! I'm not convinced the exercises in this book will really make a difference in my life. Dawn described several of the "steps" in the group, including the exciting steps on "You FEEL the Way You THINK" and "You can CHANGE the Way You Feel." She said that members found the lesson on healthy vs unhealthy negative feelings illuminating, and the lesson on the Acceptance Paradox was mind-blowing. The group trains participants in 15 techniques for crushing distorted thoughts, and some of the popular ones include the CBA, Examine the Evidence, the Double Standard Technique, and the Acceptance Paradox. She described the feared and famous "Mirror Method," where patients pass a mirror around the group and each one has to look into it and verbalize his or her negative thoughts, like "I'm a failure," and "I'm the worst mother on the planet." Then they have to talk back to that thought, using the second person, "You," as they talk to themselves in a more realistic and compassionate manner. She also does the T = Testing at each group session, tracking changes in depression, anxiety, and relationship satisfaction and sees significant reductions in scores on the mood tests by the end of the program. She also gives each participant a "report card" at the end of the program so they can see how much they progressed. Participants FEEL so much better! At the start of the group she tells participants, "If you attend the groups and do the exercises in the book, you WILL change. This material can't not have a huge impact on your life." She said that at the end of the ten sessions, the participants see that this really did happen. She emphasized that she greatly prefers treating people in groups, but calls them "classes" due to the stigma of "group therapy." I, David, strongly agree, as this has been my experience as well. With a skillful group leader, and great material, magic becomes possible! Dawn has done much more, creating follow-up groups for interested patients, as well as a new program based on my new book, Feeling Great (link), so we hope to have an encore appearance from this bubbly and brilliant woman! Rhonda and David

238: Feeling Great Book Club Featuring Drs. Sharon Batista and Robert Schacter In today's podcast, Drs. Sharon Batista and Robert Schacter describe their visionary 16-week Feeling Great Book Club for mental health professionals that we mentioned in a podcast several months ago. The group was a great success, and I am super thankful to them for creating it! Sharon described how the group came into being. She'd been looking forward to Feeling Great and ordered the hardbound and the audio version as well. But she found, like so many mental health professionals, that it is difficult to keep up with career and family, and sent out a post to colleagues suggesting a possible book group to make the process of learning easier. Bob wrote back and said, "What a brilliant idea! Let's do it!" Sharon and Bob reported that the more than 40 therapists signed up for the Book Club, which consisted of 90-minute sessions every other week. The participants ranged in experience from Level 1 to Level 4 certification in TEAM-CBT. Sharon explained that "People liked learning the parts of TEAM piece by piece. Being assigned to read 1 chapter per week gave them enough time to read and digest the material in small chunks. And people had a myriad of questions at every group." Sharon and Bob graciously said that "a highlight for the group was the time David attended and generously gave us over two hours for Q and A." For me (David) it was also a peak experience. Due, in part, to my narcissism, I just love answering questions, and they asked tons of really good ones! The other phenomenon they described was that "we became a group. It was comforting to see each other every two weeks with a common purpose and sense of community. People felt the group was relaxed and said they gained more understanding than from the training groups they'd been in. People were relieved to discover that they weren't the only ones who thought TEAM-CBT was very complex." Sharon added; "As therapists, we face lots of challenges and sometimes make mistakes. The participants got a lot of support and engaged in a process that involved learning and personal growth." The questions from book club members began with clarifying the descriptions of the ten Cognitive Distortions. People asked questions like these: What is the difference between Overgeneralization and Mental Filtering? Why is a Should Statement a cognitive distortion? Why do some methods work better than others for various distortions? How do we know which ones to use? What is Unconscious Resistance? Why does the therapist need to become the voice of that resistance? What do you do when nothing seems to be working? Can you explain how the Magic Button leads to the "Switch" that makes someone decide to get better. How do you show empathy to someone who is suicidal? Can you explain the Death of the Ego? (This was a big question) When you are dealing with the spiritual side, how do you take the path of acceptance? What is the path of acceptance? What is the difference between a low-level and high-level solution? How can you be happy if the negative thoughts are true? How can you do TEAM-CBT when only 50-minute sessions are possible? Tell us what Enlightenment is! A major question was: Why do some people seem to not want to get better? How do you figure out what the resistance is, and how do you work through it? We shot the breeze about some of these questions in today's podcast. If you would like to start your own Feeling Great Book Club for therapists or for lay people, and need more information, feel free to contact Sharon or Bob. Sharon M. Batista, M.D., FAPA, FACLP, FAMWA Medical Director, Balanced Psychiatry of New York (212) 869-0515 [email protected] Rhonda and I want to thank both of them and send them a big virtual hug!

Podcast 237: The Gentle Ultimatum: Can We Make Our Patients Accountable? April 12, 2021 At the top of the podcast, Rhonda reads several beautiful and thoughtful comments from listeners like you. One was an enthusiastic listener who found us on YouTube and wondered why we don't have vastly larger audiences, since the quality of what we offer is not only free, but it beats out all the other "self-help gurus" by a large margin. Thanks for that. We are not experts in market and could use all the help we can get. So if you can spread the word for us, we'd appreciate it! David announced that his next workshop with Dr. jill Levitt will be on May 16, 2021, featuring David and Dr. Jill Levitt working with two audience volunteers who are struggling with depression and anxiety. Link to Registration Information It should be dramatic, inspiring, and profoundly educational, so you can see how TEAM-CBT really works in a live and spontaneous setting with no role-playing. This will be the real thing! One of the unique features of TEAM Therapy is the Gentle Ultimatum. At the beginning of therapy, we tell patients what will be required of them, and how the therapy works, if we accept them as patients. That way, they can make an informed decision about whether or not they want to work with us. This table illustrates what they'll be asked to do. Problem What the "Gentle Ultimatum" involves Rationale Depression Psychotherapy homework David's published research indicates that psychotherapy compliance has massive causal effects on recovery from depression. Anxiety Exposure Extensive research shows that Exposure is effective in the treatment of all forms of anxiety. Clinical experience indicates that full recovery from depression is difficult, if not impossible, without exposure. A Relationship Problem Giving up blame and focusing on your own role in the problem Research and clinical experience indicate that blame is probably the main cause of troubled relationships. In the podcast, David and Rhonda discuss the rationale for the Gentle Ultimatum, as well as how to do it skillfully, and when. David describes his own reluctance to make patients accountable during the first seven or eight years of his practice, and what happened to change his mind, and how that led to the emergence of TEAM-CBT. David also describes the correct and incorrect way of presenting this to patients at the initial evaluation in a kindly, collaborative way. This requires therapist integrity, skill, and compassion. You cannot simply issue a crude "my way or the highway" demand. David also describes the Concept of Self-Help Memo that he created and began sending to patients prior to their first visit. The memo explains the rationale for requiring psychotherapy homework, briefly describes the ten most common forms of homework, and asks patients if they are willing to do homework if accepted into the clinical. The memo also asks how many days per week they'll agree to, how many minutes per day, and how many weeks she or he will keep it up. The memo concludes with a list of "35 GOOD Reasons NOT to do Psychotherapy Homework," and patients indicate how strongly they agree with each one. David illustrates how he discusses the memo, and the topic of homework, with new patients. David compares the Gentle Ultimatum with what happens when you go to the doctor with a broken leg. He or she might say you have to get an X-ray, and then we'll give you a cast. If they patient protests and says that she or he is against X-rays and casts, and wants to be treated with "talk therapy," the doctor would politely decline and explain that s/he is using a medical model of treatment, and that "talk therapy" is not offered for broken limbs. David and Rhonda explore the fairly intense resistance of many, and perhaps most therapists to making patients accountable. Rhonda describes her own inner fight about this, and how she had to terminate a patient recently because s/he refused to do homework, and opted for pure "talk therapy" from another therapist instead. The table above indicates that if the patient is struggling with anxiety, Exposure is the focus of the Gentle Ultimatum. If the patient wants effective treatment, Exposure will be required, and not an option. If, in contrast, you want help with a relationship problem, like a troubled marriage, you will have to agree to stop blaming the other person, and focus on pinpointing your own role in the problem, which can be immensely painful and humiliating. But it's also liberating, because when you change yourself, instead of blaming the other person, you can transform trouble relationships into loving ones. Rhonda points out a potential conflict of interest with TEAM-CBT and the Gentle Ultimatum. It can lead to such rapid recovery that therapists need a large flow of patients. David mentions that one of the therapists in Rhonda's FeelingGreatTherapyCenter.com, Sunny Choi, has this exact problem. His patients are getting better so fast he c

Upcoming Workshops The Cognitive Distortion Starter Kit With David Burns, MD A One-Day Workshop on May 5, 2021 Click here for more information including registration! 8:30 AM to 5:00 PM West Coast Time: 7 CE Credits Bringing TEAM-CBT to Life in Real Time Two Live Therapy Demonstrations with Drs. David Burns and Jill Levitt REGISTRATION CLOSES AT 5:30 PM PACIFIC TIME ON SATURDAY 5/15/21. NO EXCEPTIONS. Live Online Workshop with David Burns, MD and Jill Levitt, Ph.D. Click here for more information including registration! May 16, 2021 | 7 CE hours. $135 8:30 AM to 4:30 PM West Coast Time Binoy asks: How does one know that a thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling one? What is the basis? Binoy also asks: Is there something called "objective truth" that we can all agree on? Kristina asks: I have been labeled codependent in therapy. Is it a true label? . . . Do you believe in highly sensitive or empathetic people that can feel others energy? Fabrice asks: What do you think about this definition of the "self?" Don asks: Is TEAM as effective as you say? Binoy asks: I live in an Arab country and some of the things on your list of Shame-Attacking Exercises could get me arrested. Is there a better way to overcoming anxiety? * * * Binoy asks: Hi David, I just listened to podcast 079: "What's the Secret of a "Meaningful" Life? Live Therapy with Daisy." One of the questions that came across my mind is, how does one know if a negative thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling distortion? What is the basis? Hi Binoy, thanks! Excellent question I might address on a future Ask David podcast. However, I would need you to give me a specific example of a thought you want help with. Specifics typically lead to illumination, whereas abstract thoughts sometimes lead to endless pontification. Binoy also asks: "Hi David, I did listen to the podcast #20 on "The Truth About Antidepressants." I wish everyone agreed that there is something called objective truth. This is a question about truth or the existence of objective truth. Is the popular ideology that there is nothing called objective truth (everything is relative) correct? How can we talk about truth in a way that will help us be on the same page? So, I hope to hear from you again! Hi Binoy, this is also an abstract question, best answered through specific examples. For example, I can explain the concept of controlled outcome studies to test a drug against placebo, but even there you can find lots of ways to challenge any scientific study. We can also talk about distorted negative thoughts that trigger negative feelings like depression and anxiety. These thoughts are not really true. but we always focus on one specific thought at a time, and only from someone asking for help. I do not pontificate about "truth" in some abstract sense! All the best, david * * * Kristina asks: I have been labeled as codependent in therapy. Is it a true label? Hi Dr. Burns, Thank you so much for all your services and help that you offer Dr. Burns. It has been life changing and I'm just starting to help myself out of this anxiety and depression. I wanted to ask how you feel about the terms, codependency and boundaries. I have been labeled codependent in therapy and is it a true label? Do you believe in highly sensitive or empathetic people who can feel others' energy? Thanks again for all you do! Thank you, Kristina Hi Kristina, I had to look up the term. According to dictionary.com, someone who is codependent "is in a relationship in which one person is physically or psychologically addicted, as to alcohol or gambling, and the other person is psychologically dependent on the first in an unhealthy way." David and Rhonda can mention: the "codependency" and compulsion to "help" or "rescue" that often gets therapists into trouble with patients. This is a kind of addiction that therapists have, and is the main cause of therapeutic failure. that I work with specifics more than labels. For example, if a patient wanted help with "codependency," I would ask him or her to describe a specific time on a specific day when this seemed to be a problem. Then I'd figure out what was going on, and find out if it was an individual mood problem or a relationship problem. After empathizing, I would find out what, if anything, the patient wanted help with, and then I'd bring the resistance to change to conscious awareness. My research on empathy indicates that even therapists are not accurate in sensing how their patients feel. The same is true, I believe, of the general public. People vastly overestimate their capacities to understand how others are thinking and feeling, and this is super easy to demonstrate with simple experiments using rudimentary statistical analyses. David * * * Fabrice asks. What do you think about this definition of the

235: Anger in Marriage Several months ago. a professional dancer named Brian emailed me with an Ask David question on how to deal with anger in marriage using the Five Secrets of Effective Communication. I was pretty excited because anger in marriage is a problem nearly everyone can identify with, and something we all need some help with! Brian and his family Brian said that he and his wife, Michelle, have been married since 2009, and while he loves Michelle a great deal, their relationship runs hot and cold, with frequent angry clashes. I asked Brian for a specific example, including a partially filled out Relationship Journal (RJ), so I could get some details on what his wife said to him, and what, exactly, he said next, during one of their conflicts. Brian and his wife, Michelle The analysis of this exchange will provide us with a crystal clear example of the type of problem they are struggling with, along with the opportunity to pinpoint the specific errors Brian is making in responding to his wife's criticisms. In the example he sent, she said that he wasn't doing enough to help put the kids to bed one night, and he responded by saying nothing. He analyzed his response with the EAR technique from my book, Feeling Good Together. By ignoring her, it was obvious that failed on E = Empathy (he did not acknowledge how she felt), and A = Assertiveness (he did not share his feelings), and on R = Respect (he did not express any warmth, respect, or love for her.) He was able to see that this response will make the problem worse and force her to keep criticizing him. When he ignores her, she feels even more hurt, ignored, abandoned, and unloved. As a result, she'll keep criticizing him since he hasn't yet listened or "gotten it." So although he feels like an innocent victim, he's actually the secret creator of his own interpersonal reality. In other words, he forces her to do the very thing he's complaining about. That's the purpose of the Relationship Journal (RJ) —to help you see your own role in a conflict. It's an amazing but pretty painful tool that's potentially liberating. At my urging over the past several months, Brian worked really hard studying the Five Secrets of Effective Communication (LINK) and doing the written exercises in Feeling Good Together. After a rocky start, with some notable failures in his attempt to improve his interactions with his wife, he slowly began to "get it," and their relationship began to improve a lot. Brian joins us today to describe his journey, and share his excitement about my first book, Feeling Good, as well as Feeling Good Together. I am really proud of what Brian has accomplished through commitment, practice, and hard work, as well as his courageous willingness to look at his own role in the problem. This is nearly always painful, and requires the "great death" of the "self," or "ego." During today's podcast, we practiced with the "Intimacy Exercise." This exercise can help you improve your skills with the Five Secrets. Here's the way it works. To get things started, either Rhonda or David will play the role of Brian's wife, and Brian will play the role of himself. We will criticize Brian in the way his wife sometimes criticizes him, and then he will respond, using the Five Secrets. For example, she recently said: "When I was on the phone with my best friend, you were rude and selfish, and making too much noise with the video you were creating." Then he responded and we gave him a grade, and pointed out what he was doing right and what he was doing wrong that needed improvement. If you check your ego at the door, this can be a great, but challenging, way to learn! Brian gave himself a C on his response, which you'll hear in the podcast, and Rhonda agreed. She also gave him a C. I gave him a B, as I thought he did some pretty cool things while making several errors. Here's where he needed improvement. His use of the Disarming Technique needed upgrading. He didn't strongly and directly endorse the truth in his wife's criticism. For example, he might say something like this: "You're right, I was being insensitive and selfish, and I've done that to you so often over the years." His response would benefit from the inclusion of some "I Feel" Statements," since it sounded a bit mechanical. For example, he might say, "I feel really sad and ashamed to hear you say that I was selfish and insensitive, because you're absolutely right, and I love you so much." There was no Stroking, and I included one way to do this in the "I Feel" response I just described. His Thought Empathy was good, but there was no Feeling Empathy. In other words, he did not mention how sad, hurt and angry his wife might be feeling. He did not finish with a sound use of Inquiry that would invite his wife to open up even more. For example, he could end by asking her to tell him more about how she feels when he's being insensitive and selfish, and how hurt, angry, and lonely she might feel. Brian was non-def

Announcements / Upcoming Workshops March 24, 2021 Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! April 7, 2021 Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! * * * Podcast 234: How To Deal with Whiners and Complainers In today's podcast, we bring to life two of the earliest CBT techniques I developed way back before I wrote Feeling Good: The New Mood Therapy. The are: The Anti-Whiner Technique The Anti-Heckler Technique they are both based in two of the Five Secrets of Effective Communication: The Disarming Technique: You find truth in what the other person is saying Stroking: You find something positive to say to the person In addition, if appropriate you can include Feeling Empathy, especially in the Anti-Whiner Technique. This means that you acknowledge how the other person is feeling The Anti-Whiner Technique Most of us know someone who tends to whine and complain a great deal, and you might have noticed that when you try to help them, cheer them up, or give them some advice, their whining and complaining just escalates, so you end up secretly frustrated and annoyed. If you're tired of this pattern, you might want to try the Anti-Whiner Technique, which can be incredibly effective, but it's anti-intuitive. You simply agree with the person who's complaining, and give them a compliment. Rhonda and David will illustrate this with complaints like these: Nobody cares about me! I never get to do what I want to do. Nobody likes me. I never get invited anywhere. I never get to do anything fun. I've tried everything and nothing seems to help. All the doctors just seem to care about themselves. Nobody listens to me! Life is unfair. People only care about themselves I have to do everything for myself. Nobody helps. I can't hear very well, my sight is deteriorating, and I've got hemorrhoids! What can I do? Preparation H doesn't help at all! My students just don't listen. This younger generation is totally screwed up! Nothing helps! I'm depressed all the time. I've tried everything. No one every said one kind thing to me! I've got so much to do, but I just can't get started, and everything just keeps piling up! The Anti-Heckler Technique I love treating public speaking anxiety because I used to struggle with this problem myself, but now I totally love public speaking. One of the many reasons that people fear public speaking is because they're afraid someone in the audience will become critical or hostile, or ask them something they can't answer. The Anti-Heckler Technique is fairly easy to use, and works like a charm if done skillfully. It's similar to the Anti-Whiner Technique we just illustrated. Just make a list of hostile things that the audience member from hell might say during your talk, or during the Q and A period, and then respond with the Disarming Technique plus Stroking. Rhonda and I will illustrate this with these kinds of critical comments. You're full of shit and you know it! What you're saying isn't true and doesn't make sense. You're a total fraud and a fake. You're not supposed to say that. You talk too fast. You are confusing. You don't know what you're talking about. You are not following the outline you gave us. It's too cold, too hot. You're wrong about that. You are quoting outdated research that's been debunked already. I didn't like it when you made jokes. You don't know enough to teach this class. You're disorganized, incomprehensible, and boring. You always call on the same people in the audience, you play favorites. Rhonda and David also explore why it is so hard to use these techniques in our personal and professional relationships, and why we lapse into adversarial defenses when we could collaborate with others in the spirit of mutual exploration and learning. Most of it has to do with the idea that we have a "self," or "ego" to defend! As the Buddha so often said, "Selves are cheap. Selflessness is dear!"

Phillip with his brother, (Paul), his mother (Maureen) and Ladybug (Labrador). Phillip Lolonis joins us again with vital information we forgot to explore in his first podcast two weeks ago. Phillip's interest in the treatment of schizophrenia stemmed from his relationship with his brother, who suddenly and unexpectedly developed schizophrenia when he was 19 years old. and Phillip was 26, One of his motivations to become a therapist was his anger and disillusionment with the treatment his brother received that was medication focused and somewhat formulaic. Phillip thought the impact was somewhat detrimental. In today's podcast, we explore how to use the Five Secrets of Effective Communication, and especially the Disarming Technique, in interactions with individuals with schizophrenia. This can be difficult and challenging, because many of the things the patient says are delusional and can't possibly be true, like "I know you're plotting against me!" And yet, as David points out, if you listen to the "music" behind the words, you will see that the individual is saying something that's absolutely true. He or she is just expressing feelings in a symbolic manner. And if you find the truth in what the person is saying, he or she will nearly always calm down and feel heard and respected. Rhonda, Phillip and David demonstrate this in role-playing, using statements like "You're against me!" David recalls his treatment of an angry young university student with severe paranoid schizophrenia who responded beautifully to Dr. Stirling Moorey, a (then) visiting medical student from London who was doing cotherapy with David so he could learn the then-new cognitive therapy. Stirling used the Disarming Technique when the young man insisted that the police were trying to prevent him from seeing John the Baptist who had secrets about the spiritual human of the human race. When Stirling expressed interest and found truth in what the young man was saying, there were immediate and dramatic results. David described this interaction in his first book, Feeling Good. Phillip said he's experienced similar things with his brother, and that this new way of communicating has been helpful. Rhonda commented that we've had many podcasts recently on the Five Secrets of Effective Communication. These techniques are very challenging to learn, for technical and human reasons, but incredibly rewarding if you're willing to learn them and let your "ego," or "self," die. Phillip asked us to add these comments to the show notes: I'd like to add that the place that has been a godsend for my brother and our family is called the Putnam Clubhouse he regularly attends but not during covid, it's tough on everyone especially the severely mentally ill, in terms of isolation. They do have zoom meetings and come by members' homes to deliver food and goodies during covid. It's a place that provides socialization, work, gatherings with music/poetry and outings like going to a baseball game. They are part of a larger organization world wide. This is the link to the Clubhouse in Contra Costa County. and this is the link to the international Clubhouse for the severely mentally ill Rhonda asked me the question if have I ever been afraid of my brother. That was a good question, Rhonda and I didn't answer very well. Only once in the 20 years of my brother's disease have I been afraid of him. People judge my brother as potentially violent when in fact he's terrified daily because of the violent voices towards him he hears. My brother is stigmatized by the world as dangerous when the facts state that most people with schizophrenia are preyed upon, like my brother has been over the years---people taking his money, people crossing the street to avoid him, people calling the police on him, etc. When he is upset or angry, and I respond with 5-Secrets, especially a strong "I Feel" Statement, his rage softens immediately. Your question itself, "was I ever afraid?" is a misnomer. Here's a better question: Is my brother afraid? Yes, every day he's afraid of being misunderstood, stigmatized, hospitalized by the police (5150) but mostly he is afraid of the voices hurting him. And my mother and I are afraid someone will eventually hurt him, or he will take his own life because he has stated that he has done enough over the years to defeat the voices but they won't go away. So at times he feels hopeless.

Announcements: Feeling Great Book Club We're excited to announce a Feeling Great Book Club for anyone in the world, supporting people in reading and learning from David Burns' powerful and healing TEAM-CBT book Feeling Great with questions and answers, exercises and discussions in large and small groups. It will meet online for an hour at a time for 16 weeks on Wednesdays starting March 17 at 9am and 5pm Pacific Time - which should allow for fairly reasonable hours from anywhere in the world. Note that the group is intended to provide education but NOT therapy or treatment. Cost is 8$ per session paid in advance, but people will be able to pay whatever they can comfortably afford and no one will be turned away for lack of finances. The group will be primarily led by Brandon Vance, a psychiatrist who is a level 4 TEAM therapy trainer who has studied with David Burns since 2011. Please go to https://www.feelinggreattherapycenter.com/book-club to find out more and to register. Your Book Club Teacher: Brandon Vance, MD Upcoming Virtual Workshops February 28, Self-Defeating Beliefs: How to Identify and Modify Them, a one day workshop for mental health professionals. 7 CE credits. Featuring Drs. David Burns and Jill Levitt, sponsored by FGI, Mt. View Click here for more information including registration! March 24, 2021, Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! April 7, 2021, Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! Today's Questions Brian asks: Can negative thoughts lead to high blood pressure? Thank you Jim asks: I'm having panic attacks! What should I do? Adam asks: Shouldn't we get rid of the terms, "Positive Thoughts" and "Self-Defeating Beliefs?" Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions? Nandini asks: How do I get your Decision-Making Tool for help with habits and addictions? A man from France asks: After listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: "How do we do when the person, we are having a conversation with does not feel comfortable in sharing his/her feelings and thoughts, or does not know how to deal with feelings and thoughts when hearing them? Thomas asks: What would you say to a person who wants more ego strength.? * * * Brian asks: Can negative thoughts lead to high blood pressure? Thank you Thanks Brian. I don't know the answer to your excellent question. One big problem is that much, if not all, of this type of research is of pretty poor quality. When I review research articles, my focus is not on "what are the implications of these findings," but rather on "what are the flaws in this research study?" Usually, the flaws are so severe, at least to my way of thinking, that the findings are not worth interpreting. I apologize for this answer, as it is way less exciting than speculation! On minor point would be that if you believe negative thoughts, you will experience feelings like depression, anxiety, anger, and so forth. So the real question would focus on whether elevations in negative feelings are associated with increases in blood pressure. One common phenomenon is that some people get very anxious when their blood pressure is measured, and this, it appears, can lead to temporary blood pressure elevations. So, sometimes the doctor or nurse will ask the patient to sit quietly for a little while, and will then repeat the blood pressure measurement. So, it might be the case that people who are more prone to feelings of anxiety would have more fluctuations in blood pressure. But the question then might be—are these temporary fluctuations associated with generally elevated blood pressure? I don't think they are, but I'm not up on the latest thinking on this topic. david Brian adds: David Burns Last night, I was having stressful thoughts about family and I checked my blood pressure and it was way up, so I think it does. 🙂 Cool, nice research! You can also see if changing those thoughts and feelings leads to a reduction in BP! d Dr. Burns i did and my stress lowered and so did my blood pressure Way to go, Brian! Kudos! david * * * Jim asks I'm having panic attacks! What should I do? Dear Dr. Burns, I recently bought copies of Feeling Good, Feeling Great, and The Feeling Good Handbook, and studying them has been remarkably helpful so far. Thank you for writing them! I hope this is not too forward, but I am struggling with one immediate difficulty: within the past two weeks, I have had two panic attacks that brought on heart palpitations, and i

This is the first of two podcasts featuring Phillip Lolonis, LCSW, who works with Rhonda at her new FeelingGreatTherapyCenter.com. Some of you may remember my descriptions and photos of my Sunday hikes for people in our training groups for the past ten years. Here's a photo from one my last hikes before the pandemic. Phillip is the one in red in the back row. I hope to resume the Sunday hikes as soon as people are vaccinated! In today's podcast, you'll meet Phillip Lolonis who has transformed TEAM-CBT hiking therapy into a high and exciting art form on the California trails near Mt. Diablo. Phillip is a licensed clinical social worker and Level 3 TEAM therapists who is a member of Rhonda's new Feeling Great Therapy Center in the East Bay. He describes his love for "nature therapy" and pointed out that the Buddha experienced enlightenment when meditating under a tree. Phillip describes growing up on a farm and feeling at peace and profound connection with nature as he watched his father working in the fields. He said that his ancestors were all farmers in Greece for hundreds of years. Phillip first started "hiking therapy" when he was working with groups of individuals suffering from schizophrenia. One day, he decided to take his group out for a hike in the hills behind the hospital, and noticed the peacefulness and relaxation the patients experienced while hiking, and see the views of the San Francisco Bay from (describe the location at the top of the hike.) He said the patients seemed to experience much less of the internal, distracting stimuli that interfered so greatly with their attempts to connect with others. All of his patients complete David's Evaluation of Therapy Session after each session. This tools encourages patients to rate the therapist's empathy and helpfulness and describe what they liked and disliked about the session. Phillip works with a wide range of individuals, and says that whether they are 10 years old suffering from shyness, or executives from a tech companies who are facing burnout, they often say that they feel more open, honest and willing to go deeper when hiking in nature, than when they are being treated back in his office or on zoom. He pointed out that these days, a great many individuals coping with mental illness end up being "treated" in jails, which are frightening and actually intensify the symptoms of schizophrenia. Phillip has a special tenderness and compassion for individuals with schizophrenia because his younger brother struggles with this affliction. However, his "hiking" therapy is not limited to individuals with schizophrenia, but adults and families with the full range of emotional challenges, such as depression and anxiety. He explained how he integrates the four elements of TEAM: T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods while hiking with his patients / clients. He also discussed some of the ethical considerations, and how to gently create boundaries so that his patients will understand that this is a professional relationship in a natural setting. Phillip is convinced, and probably right, that a beautiful and peaceful outdoor environment actually facilitates treatment and speeds recovery. Here are some photos from his hikes. just to give you an idea of what his special "office" looks like. It's a bit different from the analyst's couch! Take a look at this incredibly cute video of "talking turkey" on one of his hikes! [videopress McaWCx7u]