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

This will be our last podcast of 2019, so we wanted to make it something special. We also want to thank all of you for your support over the past year, and wish you all the very best in 2020! Thanks to all of you, we surpassed 1.5 million downloads this year, and will likely hit 2 million in the spring of 2020. If you like the Feeling Good Podcasts, please tell your friends and family members, as word of mouth is our best marketing by far. In addition, if you are a member of any mailing lists, send them this link to the list of all the Feeling Good Podcasts. On any given day, 30% of human beings are feeling depressed and / or anxious, so you'll be doing lots of people a favor, since the podcasts, as you know, are entirely free. We are joined today by Amir Sabouri, PhD, MD, a highly esteemed neurologist from Iran with extensive medical training in the United States in addition to his PhD research in molecular immunology in Japan. Amir specializes in the treatment of horrific neuromuscular disorders such as ALS (the dreaded Lou Gehrig's Disease) at one of our local Kaiser Hospitals here in the San Francisco Bay Area. In today's riveting and inspiring interview, Amir describes how he discovered that, in spite of his extensive technical training, his strongest and most effective medicine by far is sometimes a healing dose of humility and compassion, delivered with the Five Secrets of Effective Communication. We are also joined by our wonderful host, Dr. Rhonda Barovsky, as well as my friend and neighbor, Dave Fribush, who has joined many of our podcasts recently, as well as Steve Reinhard, a certified coach and TEAM-CBT therapist who flew in from Colorado for the Sunday hike and podcasts. Steve will be the featured guest on next week podcast, along with his wife, Barbara, on the topic of "Sadness as Celebration." Back row: Amir, David, Rhonda, and Dave Fribush. Front row: Steve and Barb Amir and I have had a friendship and professional collaboration that goes back several years, when Amir first joined one my Sunday hikes, along with his wife, Dr. Sepideh Bajestan, PhD, MD, who was one of my students during her psychiatric residency at Stanford. In the past couple years, Amir has attended the Sunday hikes regularly and has worked hard to learn and master TEAM-CBT, especially the Five Secrets of Effective Communication, which have begun to play a huge role in his clinical and professional work. Amir begins with a description of the first time he did personal work on one of the Sunday hikes. At the time, Amir was struggling with feelings of sadness, guilt and inadequacy about his role as a physician and neurologist. That's because, in spite of his incredible background training and research in molecular immunology and neuromuscular pathology, the bottom line was that he had no cure to offer his many patients he had to diagnose with incurable diseases, such as ALS, and he confessed that he often felt like a failure in his attempts to help these unfortunate patients and their families. However, by looking at his own negative thoughts, and pinpointing the distortions in them, he was able to challenge and crush those thoughts, and accept the incredible value of the immense caring and compassion he brought to his work with his patients. The change he experienced on that hike was quite pronounced, and was arguably his first "enlightenment." It was a very moving experience for me, too. Next, Amir tackled the Five Secrets of Effective Communication, and worked extremely hard to practice and master these techniques, which have also been invaluable in his medical work. He describes two recent patient encounters where these skills were invaluable. One involved an angry new patient who aggressively criticized Amir from the very moment he walked in the door. The many also criticized bitterly all the other doctors he'd seen. He complained that he didn't want to be there, that nobody could help, and that nobody cared about him. Amir responded using the Five Secrets of Communication, empathizing and disarming hat the man was saying, and using "I Feel" Statements, Feeling Empathy, Stroking, and Inquiry as well. The man suddenly began to sob and share his deepest feelings throughout his entire encounter with Amir. At the end, Amir was concerned that he'd given him "nothing" other than his efforts at skillful listening using the Five Secrets, and was afraid the man might issue yet another complaint. One hour later, Amir received a touching email from the patient, filled with praise and gratitude, and he said he felt hope for the first time! We talked about the paradox of "giving nothing," just listening with compassion, without trying to help or fix. and how this is often the greatest gift of all. Amir also talked about his interaction with a young woman who suffered horrific complications from a powerful medication that Amir had prescribed for her neurologic problem, and Amir was flooded with guilt and fear, thinking that he had fa

Happy Holidays to everyone! Today's podcast is nestled between Hanukkah (on the 22nd) and Christmas Eve (on the 24th.) We send our warmest greetings to all of our listeners of all religious faiths. Today, Rhonda, Dave and David discuss three questions you have submitted: Does emotional trauma cause brain damage? Do you have to have a good cry when something traumatic happens? Why does avoidance make anxiety worse? 1. Is it true that emotional trauma affects the brain? Hi again Dr Burns, I love the 5 secrets, and have had great success in my new job by implementing them! I keep listening to all the 5 secrets podcasts over and over to keep it fresh for me and really loved the podcast on advanced techniques. My question today is about how trauma affects the brain. 'Trauma' is the new buzz word in education, and psychologists are creating presentations geared for teachers and other school professionals that claim the "trauma-affected brain" is altered and cannot learn as easily. They allege imaging technology can prove this. Do you know if PTSD/trauma actually impacts a person's ability to learn? I thought that it was the negative thoughts that interfere with attitudes toward learning, not an actual brain impairment. Another term that is used frequently is "intergenerational trauma", meaning if my parent experienced trauma, it could be passed down to me and therefore impact my ability to cope with life stressors. Any thoughts? Any credible research you are aware of? In the Ask David, could you also include your opinion on how Adverse Childhood Experiences impact people's mental health and ability to cope? There are a range of experiences cited in studies from moving around a lot in childhood to witnessing a murder to molestation. After listening to your podcast episode 147 (Garry with PTSD) I was satisfied with the effectiveness of TEAM to treat trauma rapidly. But then I remembered a documentary I had seen about 'feral children' who were extremely neglected as children, and I wondered if there are some cases where the psychology or potential of a person is forever impacted by an adverse childhood experience. Your take? All the best, Jackie Educational Consultant Mountaintop School Division Answer David finds these buzzwords and buzz-theories somewhat misleading, and sometimes even pseudo-scientific. He has treated large numbers of patients struggling with the effects of severe trauma, and has found that trauma patients are usually the easiest to treat and the quickest to learn. David like to focus on rapid healing, using TEAM-CBT, rather than sending people the message that they are impaired, damaged or defective because of some emotionally traumatic experience. In fact, nearly all humans have experienced quite a lot of traumatic events, which can range from mild to extreme. And lots of us have some degree of brain damage. My brain (David Burns) was squashed at birth, for example, and there are certain cognitive functions that I'm not very good at. For example, for some reason, I can't often find something that's right in front of me, and I have lots of trouble remembering names and faces. I just try to accept my many shortcoming and work around them. The problem is rarely our flaws or imperfections, but rather the distorted negative messages we give ourselves; messages that generate anxiety, fear, inadequacy, shame, and so forth. Of course, animals and humans with traumatic experiences at a young age, or any age, may struggle with fear and may seem, as you say, "feral." My wife and I (David) have adopted many feral cats, and have found that consistent warmth and love can lead to dramatic changes and the development of trust. We all have a history, and every person's story and suffering deserve respect and profound compassion. 2. What's displacement? Is it true that you have to have a good cry when something traumatic happens? Hi there again, I've been practicing TEAM-CBT for a year while at the same time studying Dr. Gordon Neufeld's theories on the need for "tears of futility" for true healing (including adaptation, maturation and development of resilience). He states that if we only work on the cognitive level, we risk to just displace the symptoms in our clients and they would miss out on maturation and adaptation. I'm wondering if you have ever seen a displacement of the symptom in treating your patients with TEAM-CBT? In most live sessions I've seen with you you seem to have this gift / skill to make it safe for the client to let the tears flow and that this often seem to be the moment when a breakthrough is about to happen. So I wonder if you think the client needs to shed tears or at least feel the feelings of futility or "true sadness" before we should move forward to methods (in addition to getting perfect empathy scores)? And what role you think tears play in the healing process? Would love to hear your thoughts on this! (See my last e-mail if you want more details to why I'm asking.) Thanks, Warmly

Today, Rhonda rejoins us as host after a three week hiatus! My neighbor, Dave Fribush, joins us as well, as we answer two thought-provoking questions! Is it possible to treat "burnout?" Can negative feelings can make physical pain worse? 1. Does "burnout" exist? How do you treat it? Comment: Hi! I have been listening to your podcast for a while now and it has helped, and has encouraged me and made me feel less alone. Thank for your work and sharing your podcast with us! My situation now is very much defined by my burnout syndrome (a medical diagnosis in Sweden, not sure about the US) and/or depression. From what I've learnt there is no evidence of CBT as a treatment for burnout - really nothing other than adaptations at your workplace. What triggered me to "hit the wall" was studying too hard and not giving my body and mind time to recover. Do you have any thoughts on burnout and effective treatment of it? I feel I have made huge progress in the underlying reasons to my burnout like perfectionism, performance-based self-esteem, figuring out how I want my life to be, who I am etc (although the last one is a big one!). All this with the help of CBT and other sorts of therapy. What remains is mental fatigue, on and off anxiety, not being able to focus and hardly any mental or emotional resilience. Through healthcare, you are basically treated for depression, the treatment being anti-depressants. I've been on sick leave full time for over four years now, am in my late twenties and am constantly frustrated, sad and feeling stuck. I want to get going towards this life I now know that I want but I don't seem to get any better. I eat and sleep well and exercise. I realize this could be a complete medical question but nobody REALLY seems to know anything about burnout. A long question but hey ho :) Would be grateful for any thoughts you might have, thanks again! Sincerely, Elisabeth Hi Elisabeth, I'm sorry to hear that you've been struggling for some time, but I'm glad you've been making progress, and I'm so glad you wrote to me. To my way of thinking, there is really no such "thing" as burnout. Depression, anxiety, anger, and other negative feelings do exist. Burnout is just a vague buzzword for feeling upset when something upsetting has happened. When I was in clinical practice, I saw as many as 17 depressed and anxious patients in one day, and as the day went on, I just got higher and higher and more energetic. That's because I loved what I was doing and felt I had something to offer, a lot, actually. I only got "burned out," or unhappy, if I felt I had said something that hurt someone's feelings, or if I had not done a good job for someone. Then I got really upset, but it was my thoughts, and not what I was doing, that caused my feelings. That, of course, is the cognitive model. I found it helpful to zero in on one moment when I was feeling depressed, anxious, or "burned out," and to do a Daily Mood Log focusing on that moment. I'll attach one to this email in case you are interested. I've also included a completed one so you can see how it works. This is not a similar case, just something I grabbed by way of illustration. Thanks, David (a fellow Swede) On the show, I describe one of the most stressful experiences of my career, when I appeared on a Philadelphia TV show with Maury Povich, and a patient of mine threatened to commit suicide. Fortunately, the story had a surprise ending that was very positive. So my message is one of hope. The idea is to focus on some specific thing you are upset about, as opposed to getting overly focused on a concept like "burnout." I think we all feel pretty exhausted at times, and if you've been studying or working too hard, it definitely makes sense to take a break to take care of yourself. When I transferred from my residency training program at Highland Hospital in Oakland, California, to the residency program at the University of Pennsylvania, in Philadelphia, one of my supervisors gave me this advice--he told me to make sure I set aside at least one half a day a week to stare at walls. What he meant was that I was working intensely, 24/7, during the first two years of my residency, and he wanted to make sure I gave myself a break to rest from time to time. So every Sunday afternoon I just watched football games on TV, often with a cat on my lap. This was refreshing and helpful, and my supervisor's advice helped me avoid feeling guilty for not working 24/7! 2. More on physical pain. Is it really true that negative feelings can make physical pain worse? We recently did a podcast with Dr. David Hanscom, a back surgeon who emphasized non-surgical treatments for back pain that can be surprisingly helpful. In that podcast, I described my research indicating that 50% of the pain we experience can the result of negative feelings, such as depression, anxiety, and anger. And if you can reduce or eliminate those negative feelings, your physical pain will often diminish substantially,

Today, Rhonda could not join us due to the religious holidays, so we have recorded several podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, a friend and colleague from New York. Dave, Michael and I answer two thought-provoking questions! 1. Working with Abused Women Hi David (and Rhonda!), I want to start out by stating how much I love your podcast. It has helped me understand myself, and, in turn, has made me a much more effective counselor. I'm a drug and alcohol counselor, working here in Los Angeles. I work primarily with women from 18 - 25 years old who have aged out of the foster care system. They are an endearing group of women, as I know you are aware (I've heard you speak of working with this population), and they just want to feel loved and worthy. However, their deep-seated beliefs of being unworthy of good things happening in their lives prevents them from attaining their goals of getting jobs, getting their children back, and gaining housing. These deep-seated beliefs are based on mistreatment by their families of origin, and their subsequent experiences in the social services system. Most were sexually abused or physically abused as children, taken out of their homes, then bounced around from one Foster Care family to the next. Despite my best efforts, the majority of these women go back out to the streets just shy of completing our 6- to 12-month treatment program. Once on the streets they return to drug dealing, prostitution, and crime. After which, if they are lucky, they get picked up and incarcerated. Many die on the streets of drug overdoses or murder. I'm using all of the tools I can to help them change their core beliefs, but it is challenging to say the least! My question to you is—is there a book coming out which goes into depth about T.E.A.M. therapy? I need to become the most effective counselor I can in order to help these women recover and lead normal lives. Thank you so much for your help! Keep up the good work. You are definitely saving lives!! Pennie Hi Pennie, Thank you so much for your question. I did work with this population at the Presbyterian / University of Pennsylvania Hospital in Philadelphia, and found the patients to be incredibly rewarding and hungry for help, love, and connection, as you have said. I'm sure it is heart-breaking for you to see so many fall short, continue to struggle, and even die on the streets. I found this population to be particularly easy and rewarding to work with because they seemed so grateful to be getting any kind of help at all. Many of our patients were homeless, and about a quarter of them could not read or write. We gave them more than eight hours of cognitive group therapy every day in a residential treatment setting, so they got 40 to 50 hours of therapy per week. The program was very inexpensive to run, and was more or less free to the participants, paid for by some type of medical assistance insurance, as well as by our hospital. Most patients showed dramatic changes within three or four days. The average length of stay was something like a week or ten days or so. In today's podcast, I describe a patient in one of our groups, a woman who was severely depressed. She thought of herself as "weak" and "a bad mother." She recovered from her depression in just 20 minutes or so when I used a TEAM-CBT method called "The Paradoxical Double Standard Technique. My book, Ten Days to Self-Esteem, is the program we used at my hospital in Philadelphia when working with this population. It is a simplified version of CBT, and it is a ten-step program that can be administered individually or in groups (which I prefer.) It is written using simple words for individuals with little education. We gave a copy to every patient entering our program, and found that really boosted our outcomes. The hospital purchased them in quantities of 50 or more, and got the wholesale price, which made the books cheaper than having to copy the materials for the patients. There's also a companion Ten Days to Self-Esteem, The Leader's Manual, that you can get as an eBook. It shows the group leaders how to set the groups up and what to do at each of the ten group sessions. There are many additional resources for you, if you'd like to learn more about CBT, as well as TEAM-CBT. First, my new book, Feeling Great, is now at the publisher, PESI, and should be coming out in 2020. I'll update you as more details become available. But yes, it does have all the new TEAM-CBT stuff in it. It is intended for therapists as well as the general public, and features lots of written exercises while you read, so you can really master the many new methods and concepts. My psychotherapy eBook, Tools, Not Schools, of Therapy, is for therapists, and we use it in all of our TEAM-CBT training programs. It is an interactive book that shows you how to do TEAM-CBT in a step-by-step way. this book also features many challenging interactive wri

Today's podcast features Michael Simpson, a friend and colleague of Dr Burns, who describes his personal battle with social anxiety. Dave Fribush will again be our host, since Rhonda is celebrating the important religious holiday of Yom Kippur with her family. Michael first became acquainted with David when he read David's book, When Panic Attacks, which he says was SO GOOD! But when he went to David's website, www.feelinggood.com, he was shocked to see so much terrific free content for people, but the website was not well-presented. In fact, it was pretty sucky! So, Michael sent David a brief video, pointing out all the problems, and offered to redo the website in exchange for some help with his social anxiety—and the relationship took off from there! Michael describes his own experiences with social anxiety, which amounts to slight to moderate nervousness, tension and dis-ease during interactions with people. There is no apparent pattern to his triggers: he can become anxious (or not) around friends, strangers, men, women he is attracted to, and women he is not attracted to. He experiences the anxiety physically: butterflies in his stomach, tension around his face and a general tightness in his body. He is usually unaware of his negative thoughts, which involve fears of looking weak, being judged by others because of his anxiety, and being unable to connect with others while he is feeling anxious. He usually tries to hide all of these fears. In addition, his social anxiety does not appear to inhibit him — he is a tall, handsome, articulate man, and when he confides his social anxiety to others, they are usually extremely surprised that someone who outwardly appears so confident could possibly be struggling with social anxiety. Michael describes one of his first "homework assignments" from Dr. Burns, who suggested that instead of hiding his anxiety, he should approach attractive women he encounters on the street and simply tell them that sometimes he becomes anxious when speaking to attractive women. The purpose of the exercise was to confront his fear (Exposure) and do a real-world experiment to find out if his fears of being judged are realistic. Opening up about his anxiety was very challenging for Michael, to say the least, given that he had spent most of his life trying to hide it. He describes walking around Times Square in New York City, procrastinating, and trying to muster up the courage to follow through on his assignment. So, he finally approached a woman from Brazil whom he found exceptionally attractive. He kind of had to chase after her to stop her to tell her. We can call her Adrianna. Adrianna did not judge or reject Michael, and the two of them seemed hit it off tremendously. And they talked and hung out together every day. Michael described their relationship as one of the deepest and most fulfilling relationships he'd ever experienced. He was amazed by Adrianna's warmth, compassion, and openness, and appreciated the respect and love she conveyed to everyone she met. Michael also describes visiting her and spending a week together in Brazil after she returned home. One of the take-home messages for Michael was that vulnerability, rather than trying to be cool, or trying to impress people that you have it all together, is the real key to intimacy and joy in our relationships with others. Dave Fribush and David Burns feel very indebted to Michael for his awesome work on today's podcast. Michael hopes his experiences will be helpful to any of you who have also struggled at times with social anxiety. My new website makeover will probably be launched by the time you read this, so let us know what you think! It's will be at the same address: www.feelinggood.com. If you are struggling with social anxiety, you might also enjoy my book, Intimate Connections. It's now a bit dated, but the ideas can still be tremendously helpful. Here's an unsolicited endorsement I recently received from a young professional woman: "I'd like to share a story about a book I started reading on my trip to Asheville this past weekend. On the plane, both tears and uncontrollable laughter simultaneously streamed from my face while reading the Intimate Connections book. No more peanut butter and jelly sandwiches telling myself what a loser I am!" ZR David

Happy Thanksgiving if you live in the United States! This is my favorite holiday, because it means just hanging out with the people you love, eating some wonderful food together, and doing simple things like a family hike, without the commercialism and "push" of some of the other holidays. I wish the very best to you and yours, too! Today, Rhonda could not join us due to Yom Kippur, the highest Jewish holy day. So we will record three podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, who flew out from New York to attend my Empathy workshop two days ago. He will also join the Tuesday group at Stanford tonight. Michael is doing a massive upgrade / fast lift of my website, www.feelinggood.com, which will likely be published by the time you read this. Let us know what you think about the new "look." Dave Fribush, Michael and I answer many thought-provoking questions submitted by listeners like you! 1. How can I overcome my fear of blushing? Hi David, Hopefully this reaches you well. I am dealing with Erythrophobia (the fear of blushing) and have been having issues with going out with friends, being in public, in work meetings, etc. The weird part is that I don't even get red, but the visualization in my head is so vivid sometimes (Kool-Aid man) that I believe it. Sometimes, if I think about it long enough (like an internal panic attack for 20+min), I get kind of red. . . . Currently, I am trying to just break this habit and I have been reading your book When Panic Attacks and it has been pretty good at helping me. I have been facing my fears and going out into public and hanging out with friends; I'm kind of anxious on the inside of getting red all of sudden, which puts me on edge. I look in the mirror and see that I am not red, but it's been hard to train my brain to believe it. I started reading your book five days ago and it has helped a lot already. Since then, I have been able to accept I don't mind being occasionally red or nervous and I'm fairly confident, but I struggle to accept the idea of being perpetually red? Part of me wants to accept the idea that "Eff-it! If I'm red, I'm red! That's who I am," but another part of me knows that it's not true; occasionally I might blush but it's not the norm. Please let me know if you have any advice. I think this might be a great podcast topic because I know a lot of people with Rosacea deal with anxiety and I'm sure that would help a lot of others. Best, Alex Hi Alex, I have a awesome podcast on the fear of blushing! You might find it helpful (Podcast #88, published on May 14, 2018.) I cannot do therapy through this medium, so this is just general teaching, but exposure / self-disclosure in one method you could use. You could tell 5 to 10 strangers every day something like this: "Could I speak to you for a moment? I've had the fear of blushing almost all of my life, and I've been hiding it from everybody out of shame. But today, I've decided to stop hiding and being ashamed, so I've decided to tell people, and that's why I'm telling you." You'll find tons of additional ideas in the podcast and in one of my books, like the one you're reading, When Panic Attacks, as well as The Feeling Good Handbook. Actually, blushing is NEVER a problem. The only problem is the shame. Without the shame, the blushing, like shyness, can be an asset, making you more human and more appealing. Also, on my Sunday hike yesterday, we were joined by a young Stanford dermatologist who showed us some photos and videos of a new laser treatment for rosacea, which is similar to blushing. Apparently, the treatment is quite effective. Thanks, David 2. How can you get over a broken heart? Hi David, First of all, I would like to thank you from my bottom of my heart for the wonderful jobs you are doing. I have a question regarding aftermath of divorce and searched feelinggood.com for any post but I couldn't find any. My best friend is going through divorce process and he cannot forget the good memories he had with this wife. He still loves her so much and would like to continue their relationship but she's not interested in that. They have been separated for 4 years and he tried his best to bring her back. How can I help him move forward? Those good memories are haunting him? Thanks, Didi Hi Didi, Thanks for your terrific question, as most of us were rejected by someone we loved at some point in our lives. You're in luck! We just recorded a podcast on how to help a friend or loved one who's hurting, and by the time you read this, it will have been published. It's Podcast #164 on "How to HELP, and how NOT to Help!" It was published on October 28, 2019. You can find the link on the list of all of the published podcasts on my website. I would definitely listen before trying to "help" your friend! Resources for your friend might include the book I wrote on this topic, which is called Intimate Connections. One of the themes is that rejection could

Professor Mark Noble was our special guest on the one hundredth Feeling Good Podcast. In that podcast, he described the effects of TEAM-CBT on the human brain. Many listeners were enthralled by Dr. Noble's revolutionary ideas! Today, Dr. Noble returns to discuss his illuminating ideas, and prevents an overview of his chapter entitled, "TEAM CBT and the Art of Micro-Neurosurgery: A Brain User's Guide to Feeling Great," which will appear in David's new book, Feeling Great, which will be released by PESI in 2020. Rhonda begins the podcast by asking how Dr. Noble met Dr. Burns. What brought the two of you together? Dr. Noble explains that he read about David's work on drug-free treatments for depression in the October, 2013 issue of Stanford Magazine entitled Mind Over Misery, This article became the most-read article in the history of the Stanford Magazine. Dr. Noble was particularly interested in drug-free treatments for depression because of some alarming research emerging in his laboratory on the central nervous system impact of some popular antidepressants on lysosomes in the brain. So, Dr. Noble made a trip to California so he could visit David's Tuesday training group at Stanford and participate in one of David's famous Sunday hikes. This was so much fun, and so intellectually rewarding, that he become an irregular regular at the Tuesday groups and Sunday hikes! Since that time, there have been many Sunday hikes and many Tuesday groups in the emerging friendship and professional collaboration between David and Dr. Noble. David describes some of the resistance he runs into from mental health professionals who cannot believe that the rapid recoveries David sees in TEAM-CBT can be real. Most therapists were trained to believe that depression develops slowly, over many years, and that effective treatment must also be very slow, often requiring many years, or even more than a decade of weekly sessions. But Dr. Noble argues that the amazingly rapid changes David routinely sees in TEAM-CBT are actually highly consistent with the latest neuroscience understanding of how the human brain works. David and Dr. Noble on a Sunday hike In fact, Dr. Noble presents the amazing idea that if you had to invent a form of psychotherapy that was specifically developed to capitalize on how the brain works, you would come up with something very much like TEAM-CBT. Dr. Noble discusses neuroscience in simple, everyday terms that anyone can understand. Even me (david)! Dr. Noble teaches in a kind of clear, accessible way of communicating that I (david) admire greatly. I have seen this in all of the teachers that I've admired the most in college, medical school and beyond. Dr. Noble explains that if you want to change the way you think, feel, and behave, you have to change certain specific networks in your brain. That's because networks of nerves are the biological equivalents of thoughts. But how do you do that? How can you change the networks in your brain that cause you to feel depressed, anxious, and inadequate? It's through two basic concepts of neuroscience called FTWT and WTFT! In Dr. Burns' new book, Dr. Noble writes: "One of the most famous concepts in the science of learning is called, "What Fires Together Wires Together" (FTWT). Nerve cells that frequently interact with each other become functionally connected, and the more they fire together, the stronger the connections become. This is how new networks are formed and how existing networks become stronger. "In addition, nerve cells that are Wired Together tend to Fire Together (WTFT). WTFT. This idea explains why once you've learned something it gets easier to repeat it every time you do it." Dr. Noble also views TEAM-CBT as a kind of micro-neurosurgery, because you replace highly selected negative brain circuits that send distorted signals, such as "I'm not good enough," or "I'll never recover," with new circuits that are far more accurate and positive. Dr. Noble also explains why Dr. Burns' concept of "Fractal Psychotherapy" is so complimentary to our understanding of the human brain, as are the other components of TEAM-CBT, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. David and Dr. Noble following a Sunday hike, just before the dim sum feast with the hiking group at the Joy Luck Palace in Cupertino, California, Notice the slightly bulging but happy stomachs from both doctors! Dr. Noble also explains why conventional therapy--where the patient comes in week after week to vent about his / her problems--may actually make the patient worse. This is because the neurons that Fire Together every week, actually Wire Together. So, in simple neuroscience terms, conventional therapy may actually lead patients in the wrong direction, by strengthening the negative circuits in the brain. You will love this down-to-earth discussion of TEAM-CBT and the human brain! David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

In today's podcast, David and Rhonda interview Dr. David Hanscom, a renowned and controversial spine surgeon who gave up a large and lucrative surgical practice in favor of helping and educating people struggling with back pain, directing them on the path to recovery without surgery or drugs. Dr. Hanscom describes his personal journey and recovery from panic, pain, and other disabling somatic symptoms when he read Dr. Burns' book, Feeling Good: The New Mood Therapy, and began doing the written triple column technique to challenge his own negative thoughts and overcome his own feelings of depression, panic, hopelessness, and anger. He also began to study alarming research reports indicating that many of the surgical procedures were no more effective than placebos; and even worse, he could see that back surgery often had damaging and even disabling and horrific effects on patients. And he also discovered that most of the patients seeking surgery for back pain could be helped simply through talk therapy and support, by focusing on the problems in their lives, rather than simply focusing on pain and pills. Dr. Burns supports Dr. Hanscom's premise, that even physical pain can have powerful psychological causes and cures. Dr. Burns briefly summarizes his own research on hospitalized inpatients with significant emotional problems as well as chronic pain. He wanted to answer the question of why physical pain and negative feelings so often go hand-in-hand. To find out, he studied changes in negative feelings, like depression, anxiety and anger, as well as the intensity of pain, in more than 100 patients attending a 90 minute cognitive therapy group. He saw that there were often massive shifts in negative feelings, like depression, anxiety, and anger, as well as the severity of physical pain, during the groups. He analyzed the data with sophisticated statistical modeling techniques to evaluate two competing theories about why pain and negative feelings go hand-in-hand. Physical pain could cause negative feelings, like depression, anxiety and anger. This seems plausible, since physical pain is so debilitating, and just plain awful. Negative feelings could have a causal effect on physical pain. The analyses indicated that there were causal effects in both directions, but the most powerful effect, by far, was the effect of negative emotions on physical pain. In fact, the analyses indicated that, on average, half of the physical pain these patients were experiencing, on average, was the direct result of their negative emotions. This means that if you're in pain, and you're emotionally upset, which would be totally understandable, that a great deal of the pain you are feeling is the result of a magnification of the pain by your negative emotions. There is a positive implication of this finding that supports what Dr. Hansom is saying--namely, that if you are in pain, including chronic pain, and you are willing to overcome your negative feelings and deal with the problems in your life, there is a good chance that your pain will improve substantially. Some people, as David saw in the groups, will experience a total elimination of pain--something he often observed within the group. It is also possible that you will experience a reduction of your pain, but not a complete elimination. And it is possible that your pain will not improve when your negative feelings disappear--but at least you won't have to struggle with pain and depression! So he has now devoted his life to making people, as well as his surgical colleagues, aware of the realities vs. the myths of back surgery. To learn more, visit his website, or pick up a copy of his terrific book, Back in Control. The book includes a section on your personal roadmap out of pain. Rhonda and I are incredibly grateful to Dr. Hanscom for this illuminating, challenging, and profoundly personal interview. We hope you enjoy it! And if you've been struggling with any kind of chronic or debilitating pain, we hope you will find some hope, as well as a drug-free path to recovery! David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

In today's podcast, David and Rhonda answer two questions about suicide submitted by podcast fans. Question 1. Why do shrinks kill themselves? Dear Dr Burns, Before I get to my question (which I hope you will consider addressing in your 'Ask David' segment of the podcast), I would like to extend my gratitude to you. Your book, Feeling Good, came to me at a time when I was struggling to make sense of my depression and anxiety, and it has been a vital part of my recovery journey. The exercises and the podcast have been such lifelines, and I am grateful to you for the incredible and life-changing work that you do. I know you have addressed the topic of suicide in a previous episode, but I recently was struck by a piece of news from my alma mater, the University of Pennsylvania, where a senior member of the college's counselling services (CAPS) died by suicide. Here was someone who had spent his life's work on promoting suicide prevention, and had a great deal of knowledge on resilience. How can we process/understand the decisions that someone like this might make to take his life. How can I arrive at the understanding that his decision doesn't necessarily spell doom for the rest of us? What TEAM-CBT exercises can we do to make sense of the world when it might not make much sense at first glance, during situations like these? Thank you very, very much, Sindhu Dr. David's Answer Thanks, Sindhu, this is a really great question. I'll put this in the Ask David folder. Should I use your name? Here's the short answer. It's a lot like saying that an infectious disease expert shouldn't get pneumonia, or that an orthopedic surgeon shouldn't have back pain, or a broken leg. I know of at least three mental health professionals who have committed suicide, but my knowledge based is tiny. I'm sure there are thousands of mental health professionals who have committed suicide. People can commit suicide for many reasons, and I can only mention a few here, as my knowledge, like yours, is limited. Hopelessness is one of the most common causes of suicide in depressed individuals. Hopelessness always results from cognitive distortions, and never from a valid appraisal of one's circumstances. Depressed people often turn to suicide, thinking (wrongly) that it is the only escape from their suffering. You may have done something that you are profoundly ashamed of, and fear it is about to be made public. Like the fellow in New York arrested for child abuse who hung himself just a few weeks ago. I am convinced that sometimes people commit suicide to get back at someone they are angry with, someone perhaps who rejected them. Physician-assisted suicide. I believe that physician assisted suicide is absolutely indicated and compassionate if someone is in excruciating pain from an irreversible terminal illness. The Achievement Addiction. Feelings of failure and worthlessness. In our culture, we sometimes (wrongly) base our feelings of self-esteem on our success in life, our income, or our achievements. And so, if your achievements are only "ordinary," you may feel worthless, like "a failure," and kill yourself. The Love Addiction: Many people (wrongly) tell themselves they must be loved to feel happy and worthwhile, and then kill themselves when they are rejected by someone they thought they loved and "needed." Drug and alcohol abuse: These habit, when severe, can greatly disrupt a person's life. They can also make someone more impulsive, and more likely to jump or pull the trigger when intoxicated. There are likely way more causes than just these common ones. For example, a psychotic process like schizophrenia might sometimes play a role as well. I suspect you may have a hidden "Should Statement," telling yourself that a mental health professional "should not" get depressed or have the urge to commit suicide. But to me, that would be a nonsensical claim, and it isn't even clear to me why you might think that way. In fact, most people are drawn to this profession because of their own unresolved suffering. There is, I suspect, MORE depression and anxiety in mental health professionals, but I have not seen data, so I'm not certain of this. But I've trained tens of thousands of mental health professionals, and pretty much ALL of the ones I've known personally have struggled at times, and sometimes intensely. People also ask, "Why did so and so commit suicide? S/he was so famous and loved and wealthy!" Well, famous and loved and wealthy people often suffer and commit suicide, too. Finally, I would say that suicide is both tragic and devastating—for the patient for sure, for the family and friends who typically suffer for years, and for the therapist as well. Fortunately, the family and friends can be helped, if they ask, but it is too late for the person who was depressed. And the tragedy is needless in most cases, since the patient's intense negative feelings can be treated effectively in nearly all cases. David Question 2. How can you find out

Lately, I've received numerous emails asking, in essence, "how can I help my loved one who has this or that problem?" I would say that I get several emails like that every week. For example, here's one from a man we'll call "Karl." Love you podcasts. Listen as often as I can. keep reading your books. Our son is in an unhappy marriage. Last night we talked and he mentioned that there is no love in their marriage. Just coldness. The children "feel" the chasm. There is a lack of trust in the home. Our son feels he did not protect the children in defense of their mom, even though he disagreed with her. Now the children feel their father does not have their best interests. Our daughter-in-law feels that everything is fine. She uses the passive-aggressive "silent treatment" to punish others. Our son says she is controlling and manipulative, and that the children have become that way also. There's no truth in the home. Years ago, she wanted them to go to counseling, but our son refused; now the tables are turned. Sad. We want to help but don't know how to approach it. What podcasts would be helpful to us? And to our son and daughter-in-law? We visit our grandchildren often, sometimes one-on-one. Communications are open with them and with our son. Daughter-in-law feels, and tells others, we are conspiring against her Karl Thank you Karl, for that moving email. It can be really sad and frustrating to see a couple in conflict who are at odds with each, especially when your son and grandchildren are involved. And I can imagine you might also be feeling anxious and a bit helpless, and deeply concerned! When I wrote Feeling Good forty years ago, I tried to make it clear that the cognitive therapy tools I described in that book are for people to use to help themselves. It is okay to correct your own distorted negative thoughts in order to break out of a bad mood. But it is generally NOT a good idea to try to correct someone else's distorted thoughts, because they'll just get ticked off at you! This is a very understandable error, because you may get really excited by the things I'm teaching, and how helpful they can be when you're feeling depressed, anxious, or insecure. So it just makes sense that you would want to share these tools with others. But those are generally NOT the tools to use when you're talking to your son, daughter, spouse, or friend who's feeling down in the dumps. There is a way to help someone you love who's hurting—but you'll have to use an entirely different set of tools and skills—the Five Secrets of Effective Communication—WITHOUT trying to "help." So, the short answer to your question is—skillful listening is all that's called for. Anything more runs the risk of getting you into trouble. But this may require a radical change in the way you communicate, as well as your personal philosophy. Let's talk about what TO do, and what NOT to do when patients, friends or people you care about express angst, or seem troubled, or describe problems in their lives, and they seem to be hurting a lot. DO NOT Give advice Try to help Try to cheer the person up Try to solve the problem s/he is struggling with Try to get the other person to think or act more positively Try to minimize the problem by saying it's not that bad, or things will get better. Point out ways the other person may be thinking or acting in a self-defeating manner. Before we tell you what does work, let me focus on just one of these errors, to bring it to life for you. Recently, Rhonda and I recorded a live therapy session with a man named who was upset because his mother had lost the use of her legs to due a rare neurological disorder, and needed much greater care in an assisted living facility. This required selling the house his mother was living so they could afford the assisted living facility, and it was a great loss for everyone, since Kevin was raised in that house, and his parents and grandparents had lived there, too. After Rhonda and I empathized with him for about thirty minutes, we asked the other therapists to offer empathy as well, as part of their practice and training that evening. We stressed the importance of simply summarizing what Kevin had told us (Thought Empathy) and how he was feeling (Feeling Empathy), without trying to "help." One of the therapists, who was new to the group, kind of missed the mark, She did what we call "cheerleading," telling Kevin what a wonderful and heroic person he was without acknowledging what he'd be saying and how painful it was for him. You'll hear this brief excerpt from the session in the podcast. When we asked Kevin how he felt about her comment, he had to tell her that he was embarrassed, and not helped, by what she'd said. Here's why. When you don't acknowledge someone's profound negative feelings of loss, anxiety, sadness, anger, and more, you might unintentionally convey the message that you don't want to hear about how they really feel inside. And when you cheerlead, it also conveys t

163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more Can you treat anxiety without meds? How do you interpret dreams? Are negative thoughts cyclical? How can I get over anxiety when selling? How does exposure work? Will you teach on the East Coast again? Hi! We've had tons of great questions from listeners like you. Here's the first: Question #1. TREATING ANXIETY WITHOUT MEDICATIONS Hi Dr. Burns, I would love to talk to you!!! I have been going to a wonderful counselor for several years, and he is the one who recommended your book. My question is how can you overcome anxiety without taking medicine? I have been on a very low dose medicine for years and would love to discontinue but when I try the anxiety seems to come back. Thank you. Lisa Hi Lisa, Thank you for your email! This is one of my favorite topics, since I've personally had at least 17 different anxiety disorders that I've had to overcome. That's why I love treating anxiety. Whatever you've had, I can say, "I've had that too, and I know how it sucks! And I can put you on the road to recovery, too!" Did you read When Panic Attacks, or one of the earlier books? The written exercises would be the way to go, I think. You will find more than 40 methods in that book. Write back if you have questions after reading it. Focus on one specific moment when you are anxious, and do a Daily Mood Log, as illustrated in Chapter 3. You can also listen to the free Feeling Good Podcasts on anxiety. Go to my website, FeelingGood.com, and click on the Podcast tab. There, you'll find a list of all the podcasts, with links. In the right hand panel of every page, you'll find the search function. You can type in "anxiety," or "social anxiety," and so forth, and all the relevant podcasts and blogs will pop right up. You can also sign up in that same right-hand panel of every page so you'll receive all the new podcasts, along with the show notes. In addition, withdrawal effects are pretty much inevitable when going off of benzodiazepines, if that is the type of medication you are taking. These are the drugs most often prescribed for anxiety, like Valium, Librium, Ativan, Xanax, and so forth. Typically, the withdrawal, which typically involves insomnia and increased anxiety, take several weeks to wear off. Your medical doctor can guide you in this. I cannot advise you about medications in this forum, so make sure you check with your doctor! David Question #2. How can you interpret dreams? Hello, Dr. Burns. I am terrified that this may be the most boring question you have ever received, but, I'll press on none the less. I often experience very vivid dreams after listening to your podcasts. In fact, I recently dozed off after listening to one of your podcasts on procrastination (#75) and forgot to turn off my phone. In my dream I was in my childhood house and could hear you talking away in some far corner of the house and I was really getting quite annoyed and angry. I really wanted to find you to tell you to shut up, but I couldn't get the words out. When I awoke, podcast #77 was playing, which seems to explain some of my unconscious hostility. I struggle with most of my relationships and don't really want to deal with all the hard work I have to do to improve them. So, there you have it! Thanks for listening to me and all your Herculean efforts on behalf of all those in the struggle to grow. Mike Hi Mike, I explain how dreams function, and give an example with my dream that I had a broken jaw! Question #3. Are Negative Thoughts cyclical? David, I have a question about our strong attraction or inclination to negative thoughts. Are our psychological processes cyclical? People seem to recycle the same negative thoughts for years. Even if we produce a strong alternative thought or reattribution it may not be a default choice the next time. How can we make the alternative/ positive thoughts a conscious choice? Thanks, Rajesh Hi Rajesh: Negative Thoughts are not cyclical for the most part, but are an inherent part of our human nature. The podcast on fractal psychotherapy might be useful, since the same Negative Thoughts will tend to come back over and over throughout your life. And once you have learned how to combat those thoughts, you can use the same techniques to smash the thoughts whenever they pop back into your mind. The written exercises I describe in my books, like the Daily Mood Log, are extremely helpful, even mandatory, in building new brain networks and strengthening them through repeated practice. Bipolar manic-depressive illness is a little different, and it can be quick cyclical. (David will briefly explain this.) Thanks Rajesh for yet another great question! david Question #4. I'm in sales. How do I combat my Negative Thoughts about each person I approach? Hi David, I have been struggling with anxiety for the last 18 months and recently faced up to the fact I have also been suffering from depression. And then I discove

"Yikes! I might get contaminated!" The Treatment of Sara Today we are joined by a woman named Sara, who will be featured in one of the chapters from my new book, Feeling Great. Rhonda begins today's podcast by reading two heart-warming endorsements from podcast fans. Then we did a brief overview of OCD. OCD consists of two components, obsessions and compulsions. The obsessions are intrusive, anxiety provoking thoughts, like "what if I forgot to turn off the burners on the stove." Compulsions are rituals that temporarily relieve the anxiety, such as going back into the kitchen repeatedly to make sure that the burners really are turned off. This problem can become more and more severe until the obsessive thoughts and compulsive rituals consume massive amounts of the patient's time and become crippling. You are probably aware that OCD plagued the life of the billionaire playboy, Howard Hughes, featured in the recent film, "The Aviator." During the last years of his life, he became totally consumed by concerns about germs, and ended up isolated in the penthouse suite at the top of a hotel in Las Vegas. According to a "psychological autopsy" (https://www.apa.org/monitor/julaug05/hughes) published by the American Psychological Association, Hughes lay naked in bed in darkened hotel rooms in what he considered a germ-free zone. He even wore tissue boxes on his feet to protect them, and burned his clothing if someone near him became ill. Sara, today's guest, was a victim of the same type of OCD. She describes how her intense fears of germs and contamination came on more than 20 years ago, and the devastating impact of the OCD on her as well as her relationships with friends and family. She also describes her shame about her rituals of constantly washing her hands and desperately trying to avoid contamination. Sara also describes, in vivid detail, her remarkable and inspiring five minute "cure" one evening at David's Tuesday evening training group at Stanford earlier this year. She had courageously volunteered to be the patient so David could to demonstrate TEAM-CBT with a problem generally thought to be exceptionally challenging and refractory. And although Sara's dramatic and mind-blowing recovery only took about five minutes, the treatment required a lifetime of courage! Fortunately, one of my students had his cell phone in hand, and made a brief video of the last phase of her treatment at the Tuesday group, which involved putting her hands into a slimy, dirty garbage can right outside the front door of our Behavioral Sciences Building at Stanford and then rubbing her fingers on her face. Check it out! (link) And yes, the effects DID last! Her treatment was many months ago, and she's been a totally changed person! Following the podcast, Rhonda and I got two beautiful emails from Sara: Wow! What a beautiful day! Thank you, Rhonda and David for the amazing opportunity to share my story! I feel very selfish but I enjoyed every minute of it. You both made me feel so comfortable and welcome. You two are so incredibly AWESOME! You make a superb team! :) And here is the second wonderful email: David, I hope you are feeling better and that you recover from your cold soon, very soon. I wanted to share an afterthought I had a couple of days after we recorded the podcast. I wish I had thought about it before the podcast because this was so much part of my OCD. Anyway, for years (many years) I bought sanitized hand wipes and carried them in my purse, car, briefcase, you name it—I had hand wipes everywhere. I was known for having wipes with me all the time. Not long after the magical treatment of my OCD, I was at the grocery store and proceeded to add three packets of sanitized hand wipes to my basket and I burst into laughter, even though I was by myself! I, then, put them back on the shelf, as I told myself, "I don't need these anymore!" Since then, I no longer carry them NOR NEED THEM! Funny enough, I have been approached on different occasions by family members and friends saying something like, "You always have wipes, can we have one, please?" I have to say, "Sorry, I don't carry wipes anymore since I've been cured!" What a wonderful feeling that is—not to feel dependent nor a slave to the sink and hand wipes. Not to mention, all the money I am saving by not buying wipes!!! Anyway, I thought I should share that with you and I'm sad I didn't remember it until after the recording of the podcast. Once again, thank you both for the amazing recording, all your support, and all you do for our Tuesday training group and humanity in general! With Immense Gratitude, Sara Sara Shane is a certified TEAM-CBT therapist practicing in the central valley of California (Stockton). She is multi-lingual and offers intensives—extended, single-session treatment of depression and all of the anxiety disorders. And, here's something fantastic—although Sara is a superb therapist, her fees are modest, thus bucking the current trend of charging out

Hearing the Music Behind the Words This podcast again features the music of two beloved colleagues we introduced last week, Brandon Vance, MD and Heather Clague MD. We will be listening to music again this week, but it will be, for the most part, a different kind of music—it's the music behind the words when someone criticizes you. We will be focusing on the most challenging and important of the Five Secrets of Effective Communication, the Disarming Technique. This week, Brandon and Heather will help Rhonda and David illustrate how to use this technique when you're under the fire of criticism. But in addition, Brandon and Heather will also sing one more of their extremely beautiful and fun songs, appropriately entitled, "The Five Secrets!" When you use the Disarming Technique, you find the truth in a criticism, even if the criticism seems untrue, unfair, or exaggerated. This technique is based on the Law of Opposites. The essence of the Law of Opposites is that if you genuinely and immediately agree with the criticism that seems untrue, you will put the lie to it, and the critic will stop believing the criticism. This is a remarkable phenomenon that can be enormously helpful in conflicts with patients (if you're a therapist) as well as friends, colleagues, and loved ones. However, it is challenging, because you have to be able to really listen and "hear" the music behind the other person's words. If you use the Disarming Technique, or any of the Five Secrets, in a mechanical way, it will backfire. And I (David) have noticed that even trained mental health professionals can have a tremendous difficulties learning to use the Disarming Technique. Here's an example of POOR technique. Although this is a therapy example, it is equally valid for conflicts between friends and loved ones. Let's say that you're a therapist, and your patient confronts you by saying, "This is the second week in a row that you've been late for my session." I've seen therapists respond like this: "You're right. I have had emergencies which made me late for your sessions last week and today." Is this a good example of the Disarming Technique? NO! Can you see why? It's because this therapist is agreeing with the criticism in a literal way, and not hearing the "music" behind the words. What is this patient really saying? He's probably saying that he feels a lack of caring from his therapist, and this may be one of his core conflicts, thinking that the people he cares about never care about him. So the therapist's "mechanical" answer misses the boat. Here's an improved response that addresses what the patient really said. After each sentence, I'll put the name(s) of the technique(s) I used in the sentence. "Jim, it's painful to hear you say that, because you're right. ("I Feel" Statement; Disarming Technique) I was late and I let you down, and I feel embarrassed. (Disarming; "I Feel" Statement.) I wouldn't be surprised if you're feeling hurt and annoyed, and maybe even a bit angry with me, and for good reason. (Feeling Empathy) This is particularly uncomfortable, because you've told me that everyone you care about seems to let you down. ("I Feel" Statement; Thought and Feeling Empathy) I care about you and have tremendous respect for you. (Stroking) Although I was delayed by emergencies last week and this week, the fact is, you had to wait. (Disarming) I will try to correct the problem of getting emergency calls when I'm in the clinic, which definitely is irritating and unfair to you, and I'll gladly offer a free session to compensate the fact that you had to wait. (Disarming Technique, Feeling Empathy) I want to know more about how you've been feeling, and if there have been other times when I've let you down or perhaps said things that seemed uncaring? (Inquiry)" Can you see that this response addresses the music, or feeling, or message behind the words, and not just the words? And can you see the Law of Opposites in action? When this therapist agrees that he has let the patient down, and shows some humility, the patient will probably suddenly feel very cared about. In today's podcast, Brandon, Heather, Rhonda and David play a kind of Disarming Round Robin, taking turns responding to unexpected criticisms, using the Disarming Technique as well as any other communication techniques that may be needed. For example, one of the therapists is attacked by a patient who is a person of color who calls him "one of the rich white privileged people." You will also hear the immediate grading of each response--was it an A, a B, a C, or a D--along with what worked and what didn't work, followed in some cases by a second try. If you want to learn the Five Secrets, and especially the Disarming Technique, this type of practice will be a must! You can practice with a colleague, or with a friend. But be prepared to check your ego at the door so you can learn from failure, because it will be very challenging for you at first! A neighbor who was helping with t

Introducing Brandon Vance, MD & Heather Clague, MD This podcast features the music of two beloved colleagues, Brandon Vance, MD and Heather Clague MD. Brandon and Heather are both certified TEAM-CBT psychiatrists practicing in Oakland, California. Brandon is a brilliant multi-instrumentalist and singer / song writer / performer who has transformed his vision of TEAM-CBT into music! Heather is brilliant and fun improv acting teacher and performer who is quick in her mind and on her feet! Brandon and Heather have performed at David's annual South San Francisco psychotherapy intensive for the past several years, and we are delighted to bring them to you up close and personal today! In today's podcast, they'll bring you their songs and amazing personal stories. And what is super cool is that you can follow the words for the music right here in the show notes. Song #1 Heather and Brandon begin with music about a familiar but painful theme for nearly all of us—the feeling of failure, and the belief that we are somehow defective or just "not good enough." Brandon and Heather are extremely talented and successful individuals, but they are not immune from suffering. During the podcast, they describe their own painful personal experiences with depression, anxiety, shame, and defectiveness. Most therapists, including David, were trained in the psychoanalytic tradition and told that we should NEVER disclose or reveal our own personal feelings or experiences to patients. But we believe that some personal disclosure can be very healing for patients if done with skill and compassion. Most patients want to hear this type of message from a therapist: "I've been there myself, and know how much pain you're in. And I can show you the way out of the woods, so you can experience feelings of joy and self-esteem again. And what a joy that's going to be!" So, with no further ado, Brandon and Heather perform their first song: The Feel of Failure Lyrics by Heather Clague and Brandon Vance to the tune of "The Sound of Silence" by Paul Simon Hello failure my old friend I've come to talk with you again Because my ego softly creeping Infects my thoughts while I am preaching And that vision that was planted in my brain Still remains; becomes the Feel of Failure Fool, said I, you are so lame Done something wrong to feel this shame Perfect is the way that you should be Self-blame coming like a tsunami Negative thoughts one hundred - percent on my DML I was in hell Suffered the Feel of Failure My self-esteem had turned to shit I needed the magic button hit Something told me my feelings weren't lame Began to do a positive reframe Maybe my feelings say something about me that is pretty fly I set the bar high So I have a Feel of Failure I saw that I was not alone Dared go beyond my comfort zone I took pride in my humility Welcomed my faults as my humanity And in a moment of enlightenment I cried and then I laughed I'd finally grasped The wisdom... of the Feel... of Failure Song #2 The next song is on social anxiety. Brandon explains: "I wanted to introduce this song I wrote with Amy Specter who was on your podcast on August 5th #152 a month or so ago. It's called, "Negative Thoughts Shut your Piehole Tonight." And it's about social anxiety and the idea that when you're upset, it's not the event or the other person who's "making you" feel upset, it's your own negative thoughts. "Where it gets personal for me is that I was bullied in elementary school by a group of my former friends who made up a story that I was gay - as if that's a bad thing - and then yelled things, tried to get in fights with me, etc., for really the majority of the school year. And I got really down and felt ashamed, and didn't tell my parents or anyone else about it because of that. But what they did, didn't make me down - it was my negative thoughts. I wasn't actually gay, but what was important was that I told myself that I was defective, and people didn't want to be around me. "The person who I thought was the ringleader was a blonde blue-eyed (as if those are good things) smart, handsome guy who had great social skills and apparent confidence - both seemingly more than I had. In my mind I made him into an evil person just interested in popularity. But he had many good qualities (and was a friend of mine before this). Seeing his good qualities reminds me of the concept of the disarm. "In this song, the singer is anxious about going to a party. She feels envious of Anna, a woman who's thin (as if that's a good thing) and gets a lot of attention - both because of our culture's preoccupation with women being thin and also because she has great social skills. So, she feels bad about herself. "But then realizes it's just her negative thoughts and also sees that her negative thoughts and feelings helpful to her, and represent good things about her. Then she works successfully on changing the way she thinks and feels." Negative Thoughts, Shut Your Piehole Tonight! by Amy Specte

The Secret of a Meaningful Life One of my favorite podcasts of all time, and one of the most frequently downloaded, was the live session with Daisy (podcast #79): "What's the Secret of a Meaningful Life?" You may recall that Daisy and her husband, Zane, were looking forward with dread to the possibility of childlessness, since their efforts at pregnancy had so far failed, and Daisy was asking if she could possibly have a joyful and meaningful life without children. In today's podcast we return to the same type of question from the other end of the spectrum. When we age and look back on our lives, and realize that our days are numbered, we may once again, "Have I lived a meaningful life?" Do you know how to answer this question? What, in your opinion, is the secret of a meaningful life? If the answer to this question is important to you, you might enjoy today's podcast, which features, once again, two beloved friends and colleagues, Dr. Marilyn Coffee and Dr. Matthew May. Matt and I first treated Marilyn for intense depression, anxiety, and anger two years ago at the time of her unexpected and shocking diagnosis of Stage 4 non-smoker's lung cancer. Marilyn was incredibly depressed and panicky, as you might imagine. If you are interested, you can listen to our initial treatment of Marilyn in podcast #49, "The Dark Night of the Soul." One of Marilyn's concerns at that time was that she had lost her faith in God and had begun to doubt the existence of an after-life. She was intensely self-critical and ashamed, and was also extremely angry because she began doubting her spiritual teachers and thinking of them as frauds. These doubts were all the more troubling to Marilyn, since she'd been a devout Catholic for her entire life. In fact, she even has a Master's Degree in theology, along with several additional Master's Degrees plus a PhD in clinical psychology! But now she was terrified by the prospect of her own death. During that initial treatment session, Marilyn overcome her fears, depression, and doubts, and ended up in a state of joy, and even laughter. This rapid transformation confirmed the basis of cognitive therapy, that our emotional pain results from our thoughts, and not from what is actually happening to us. And the thoughts that cause depression and anxiety will be distorted and cruel--I've often said that depression and anxiety are the world's oldest cons. Following that session, we were flooded with emails praising Marilyn. Oddly enough, many people said she was their spiritual hero. They said they were stunned and grateful her raw courage, testimony, and honesty. Now, it's two years later. Sadly, Marilyn has just learned from her doctors that she's had numerous metastases, and that her lung cancer has spread to the opposite lung, as well as to her bones, brain, liver, and lymph nodes. Marilyn is understandably paralyzed once again by overwhelming feelings of depression, anxiety, shame, hopelessness, and anger. Today's podcast is based on our most recent session with Marilyn about two weeks ago. I have to warn you that the session may be sobering, and even a bit terrifying, but hopefully you will find it to be inspirational and helpful, because sooner or later, we'll all have to share the prospect of facing our own inevitable death, and asking ourselves, "Have I had a meaningful life?" We scheduled this follow-up live therapy podcast for three reasons. First, we hoped to provide Marilyn with some relief from the devastating depression that had returned when she learned of her metastases. Second, we wanted to give you, and all of Marilyn's many fans, an update on what's happened in the past two years. And third, Marilyn wanted the chance to tell you about some of the positives in her life, since she so often mentions her failures, such as her bouts with alcoholism, and the fact that she never found a loving partner. Every TEAM session begins with T = Testing. You can see her scores on the Brief Mood Survey she filled out just before the session began. (link) All her scores reflect the most severe negative feelings a human being can experience. Marilyn has extraordinarily severe depression, anxiety, and anger, and her positive feelings are totally absent. Marilyn brought a partially completed Daily Mood Log to the session. If you take a look, you'll see all of her intensely Negative Thoughts and devastating feelings about the spread of her cancer. During the E = Empathy phase, Matt, Rhonda and I gave Marilyn the space she needed to vent and describe her despair and feelings of terror. We did not try to help or cheer her up. Marilyn cried as she described her fear of dying alone, and vividly recalled a friend who died a horrible death from lung cancer 20 years ago. Marilyn says he could barely breathe, and fears a similar horrific fate. Marilyn cries, and confesses that she has not been able to cry up until now. She says she suddenly felt a spiritual presence being around Matt, Rhonda, and David. Dur

David and Rhonda are joined again today by David's neighbor, friend, and hiking buddy, Dave Fribush. We appreciate his superb technical skills and thank Dave for his support of our podcasts! Rhonda starts the podcast by reading a question from a podcast fan named Rajesh, who wrote: I have often seen that estranged friends or family members do not talk or resolve a trivial conflict for years because one or both of them have ego issues or have fear of rejection. This problem of unfairness may even exist between a demanding parent and the child, ranging from secretly resenting to not talking at all. They might come face to face in family occasions or professional settings in case of friendship and bear the discomfort, but not attempt to reconcile. They might be suffering deep down emotionally but they refuse to accept that it matters. One or both members might feel they have been treated unfairly and expect apologies. But, both parties are scared to even make the move for the fear of being hurt again or rejected. On a personal level, I have faced such unfairness with a close friend. I see even if you forgive the other party, that element of resentment is still in their somewhere. How do you know you have truly forgiven someone and moved on? Whats the best that can be done at an individual level without involving the other party, at least till the time both are ready to talk it out, if it ever happens. Once again I thank you for all the selfless Good work you do for people through your knowledge sharing. My sincere best wishes to you and great thanks 🙏. Rajesh I appreciate this question, and it is a great introduction for our podcast on Changing the Focus, one of the three Advanced Secrets of Effective Communication. We recently introduced the three advanced secrets in podcast #126, and you can listen to it for review if you like. Changing the Focus. This technique can be tremendously helpful when there's an "elephant" in the room. Multiple Choice Empathy. This technique can be transformative when you're trying to connect with a teenager, friend or loved one who refuses to talk to you. Positive Reframing. This technique can be invaluable when you're fighting with a colleague, patient, friend or family member, and you're both feeling frustrated, angry, and upset Today we take a deeper dive into Changing the Focus. This technique can be extremely helpful when you feel tense or awkward in your relationship with someone. For example, you may be arguing endlessly, or there could be some unacknowledged feelings that no one is talking about, like shame, anger, hurt, or resentment. When you use Changing the Focus, you gently point out what's happening, and focus on your feelings, and drawing out the other person's feelings, instead of continuing in the same pattern of arguing or avoidance. Although this technique can be tremendously helpful, it is very challenging, so I have written two memos explaining the technique in greater detail, with examples. One is for therapists and one is for the general public. If you are interested in learning this technique, this would be a great starting place, and it might not hurt to read both memos. In addition, you have to be skillful with the Five Secrets of Effective Communication before trying this technique. That's a lot to ask, I know! David, Rhonda, and Dave (our new podcast co-host) model how Rajesh might use Changing the Focus with estranged friends or family members. Then Dave Fribush provides a terrific example of how he used the Five Secrets, plus Changing the Focus, in a troubled love relationship, after arguing and resisting for several years. Then I (David) provide an example with a patient I was failing with, and Rhonda provides two tremendous examples--one from her clinical practice, and one involving her sister. See what you think about our new three-person format! Since our audience consists of therapists as well as the general public, we welcome Dave with open arms and hearts, and feel lucky! David, Rhonda, and Dave :)

One Student's Experience In today's podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it's a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago. Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher. During today's interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment "packages" at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to "sell" this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well. Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient's subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient's resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT. Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help. But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist's efforts to "help." Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to "get it," and that she also resisted using the Invitation Step it at first, thinking it wasn't needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn't know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors! Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients. Finally, I asked her why she wasn't using the Invitation Step. She told me she was afraid her patients would say, "Yes, I DO want some help with problem X, Y or Z." And then she might not know how to help them solve whatever problem they had! She said, "As long as I just schmooze with my patients, I know that nothing will change, but they'll think it's good therapy!" Fortunately, after we discussed this dilemma, she began using the Invitation Step, along with many other Paradoxical Agenda Setting techniques, and her clinical work improved a ;pt. Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments. I think this is arguably an ethics violation, since therapists' perceptions of how their patients feel can be wildly inaccurate. I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments. The importance of assessment instruments in clinical work and training was underscored by my experience several days ago with a patient who gave me incredibly poor grades on empathy as well as helpfulness at the end of a free, two-hour phone session. I had sensed the session had not gone especially well, but I didn't realize just how awful it was until I s

Plus, Thomas Szaas, TV Shrinks, and more! David and Rhonda are joined today by David's neighbor, friend, and hiking buddy, Dave Fribush. He has incredible technological skills, and wisdom. We thank Dave for his support of our podcasts! We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the "Tiger Monastery" in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery. Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us! Here are the questions for today's program: Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question - I have suffered from panic attacks for years - the past 2 years I've become agoraphobic and don't want to be far away from my house. So, my phobia is now "having panic attacks." Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying. Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide. Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a "study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists' perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis." I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student's the results of your research. Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this? If a person is worthwhile but the world thinks they are not worthwhile, isn't this almost as bad as not actually being worthwhile. Don't we have to play by the world's rules, however bad, instead of our own or the Platonic rules? What do you think? Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date! I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours. Robert also asks: My other question is an idea for future podcasts and it is...How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy. Some of the Hollywood therapists people know best are: Judd Hirsch as the shrink in Ordinary People Lorraine Bracco as the shrink in The Sopranos Peter Bogdanovich as the shrink's shrink in The Sopranos Billy Crystal as the shrink in Analyze This! Robin Williams in Good Will Hunting Kelsey Grammer in Frasier I am sure there are many others. These are the ones who quickly came to mind I just found an article about this that might help make the case that what the public sees on TV and in the movies is not really reflective of the therapeutic process or good therapy. Here's the link: https://www.huffpost.com/entry/therapists-on-the-big-and_b_4263798 Thanks for tuning in! David and Rhonda References for Nathan Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012. Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients' and therapists' shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 - 643.

The Story of Lorraine and "Anna" In today's podcast, David and Rhonda interview Dr. Lorraine Wong, a board-certified clinical psychologist, and her patient, "Anna," who sought treatment recently for depression, anxiety, and self-image / self-esteem issues. But first, David and Rhonda answer a question submitted by Estafonia, a "public image consultant," who asks about the treatment of a woman who sees herself as "fat." Estafonia wrote: "Hi Dr. Burns, "I am learning TEAM, CBT and implementing your techniques to help my clients change or improve their self-perception. In most cases, your techniques have been very effective. I am very grateful to you and I will happily join your list of fans! "My question is this—What would be the best method to change someone's self-image? How can you help people change the idea that they are fat for example? "I have a patient who can't defeat the thought, 'I am fat.' We tried the method called Examine the Evidence," and she has already found 20 people who see her as thin. So, the evidence clearly did not support her belief that she is fat. But this did not help. "We also tried the method called Let's Define Terms, and we both concluded that she is not fat. But now she tells me, 'I know I am not fat, but I can't stop thinking about it.' "We also did the Downward Arrow Technique to probe her deepest fears and Self-Defeating Beliefs, but that didn't seem to help, either, and she keeps ruminating about being fat. I would greatly appreciate your guidance on how to help her overcome that thought! "Thanks in advance! Estefania" Lorraine, Rhonda, David and Anna quickly diagnose the most likely cause of Estefania's stuckness—she is trying to "help" her patient without first melting away her patient's resistance. This is the cause of practically all therapeutic failure, and you're not really doing TEAM-CBT if you don't know how to eliminate the patient's resistance. That's because most people are ambivalent about change. As the Jesuit mystic, Anthony DeMello, has said: "We yearn for change but cling to the familiar." Recognizing and modifying this inherent ambivalence is the heart of A = Paradoxical Agenda Setting, but you can also think of the A as standing for "Assessment of Resistance." How could we melt away this woman's ambivalence / reluctance to stop bombarding herself with the message, "I'm fat"? It is important to realize that this self-critical thought, and, in fact, all of her negative thoughts and feelings have huge advantages for her, and also indicate some really beautiful and awesome things about her and her core values. For example, telling herself "I'm fat" may motivate her to diet, to exercise, and to make extra sure that she doesn't get complacent and gain a tremendous amount of weight. In addition, the thought, "I'm fat," shows that she has high standards, and her high standards have probably motivated her success in many areas of her life. For example, she probably works really hard to stay in good health and in good physical condition. The thought, "I'm fat," also shows that she's humble, and on and on and on. And that's just one negative thought. But this woman probably has many negative thoughts and feelings, like anxiety, shame, inferiority and depression, and they ALL have tremendous advantages, and they ALL reveal what is beautiful and awesome about her and her core values. In addition, the thought may be protecting this patient from things she fears, like intimacy. As long as she tells herself, "I'm fat," she does have to risk trying to get close, or having sex, or risking rejection. So the thought, in a way, is a form of self-love and self-protection. Once Estafonia and her patient list all these positives, Estafonia could ask her patient, "Given all these advantages and positive qualities, maybe it wouldn't be such a good idea to stop telling yourself, 'I'm fat.' This thought seems to be working for you in a really positive way, and also reflects your core values." That's the essence of Paradoxical Agenda Setting. We try, in a genuine way, to honor the patient's resistance, rather than trying to sell the patient on change. This is very difficult for therapists to learn because of the compulsion to save, help, or rescue the patient. In addition, obsessions (recurring illogical negative thoughts like "I'm fat") frequently result from the Hidden Emotion phenomenon, and this has to be dealt with skillfully when treating any patient with anxiety. Estafonia's patient may be upset about something she's not dealing with in her life, and bringing the hidden problem or feelings to conscious awareness can often be incredibly helpful. For more information, see my book, When Panic Attacks, which you can order from my books page (link). After focusing on Estafonia's excellent question, David, Rhonda, Lorraine and Anna talk about the emotional challenges that brought Anna to treatment, including severe feelings of depression which came on when Anna returned to the Unite

Ask David Five Secrets Relationship Questions Kate asks: I love listening to your podcasts and am currently reading my way through your book, Feeling Good. I appreciate that you have written and spoken about relationship problems at length, but in what I have read and heard so far I do not see how this can apply to the current climate of casual dating and hook up culture which is fueled by apps such as Tinder. I don't know how it's possible to build relationships when the dominant mentality is that people are disposable. It feels like no matter how much I find truth in what my date says, stroke them and empathize with them, that they will disappear ('ghost') at the drop of a hat. I think this may be a significant problem for many of your listeners, and would greatly appreciate your thoughts, as well as any practical steps on how to date in today's world. * * * Eli asks: Your work has helped me tremendously over the past 2 years. However, recently I've discovered something about myself that I don't know how to change. I'd be really curious to hear your thoughts. For some reason, when it comes to sex, it seems that I have a lot of self-worth wrapped up in my sex drive. I'm realizing when my wife and I have sex I feel like I'm on top of the world afterwards. I feel so positive the following few days and I feel mentally and emotionally healthy. But it's devastatingly real that the reverse is true as well... when we don't have sex (and particularly when I reach out and she's not in the mood) and when a week or so passes that we don't have sex, I find myself feeling very insecure. I feel ugly, unlovable and generally less valuable as a person. Is there an exercise you would recommend for me to discover possible hidden thoughts/emotions that could be causing this? Is it possible to change this about myself? I want to have a close, intimate relationship with my wife (sexually and non-sexually) but I also want to feel valuable and positive whether or not we're sexually active. PS - If, by chance, you address this on the podcast, could you refer to me as "Eli" or something else anonymous as you usually do. Thank you for all you have do! * * * Susan asks: You seem like a good person to ask this question partly because you are a man. Someone I know, I won't say whom, told me he felt emasculated when I asked him to take my car to the gas station to get the wipers replaced. He said that he should be able to replace them himself but doesn't actually know how, so he would prefer if I took the car to the service station. I said that was stupid, granted not very diplomatic, and he said that's what he gets for expressing his feelings, which I frequently complain he does not do. To me "emasculated" is more of a concept or a thought. I will not get into toxic masculinity and the patriarchy, but I am curious what you think. By the way, this person and I have benefited a lot from your relationship journal exercise, thankfully we did not need it this time :-) * * * Knaidu asks: Here's a specific example which occurred whilst I was trying to use the disarming technique. It is one where I failed to use the technique. Anyway, I was meeting a friend of mine, and was a running a few min late for our lunch appointment. I couldn't send her text to let her know as I was driving. I arrived at least 5 min late. When I arrived she immediately said "I knew it all along, you really don't want to meet with me or actually have lunch with me!" I tried to explain that I was stuck in a traffic jam and couldn't text, but it didn't work. Here's what I said: "Please Mrs. X, I was stuck in a traffic jam and that's why I am late. Have I ever said I don't want to meet with you? And if I didn't why have I bothered to arrive at all, I mean I could have just not arrived if I didn't want to meet you!" After I said that she stormed off. I am afraid I could agree with her idea that I didn't really want to meet with her, because the truth was I did want to meet but couldn't help being late. I could agree with something that was not real to me and if I did try to agree, I would be lying to her. Please help me, David and Rhonda! Thanks for tuning in, and keep the great questions coming! David and Rhonda

New Ask David Questions Kelly asks: Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so "professionalized" that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate? Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this? Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind? Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I've read for hypochondriasis try to cover the writer's back by first and foremost telling you that you should get yourself checked for real causes for your concern. Eduardo also asks: I've been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It's just Detective Work, and then do something about it. Is there some newer technique to dig into what's eating you?

In today's podcast, Rhonda and I interview the incredibly brilliant, funny, and creative Amy Spector. Amy is a licensed marriage and family therapist and credentialed school counselor with over a decade of experience working with adolescents and their families. She is passionate about providing school-based mental health services and advocates for legislation to mandate universal mental health care for youth. Amy works with "at risk" teenagers at Vicente High School in Martinez, California. This is a continuation high school, as well as teens at Briones School, an independent study school. Her students are credit deficient and at risk of not graduating from high school. Nearly all have experienced significant trauma and most are severely depressed, anxious and angry when first referred to Amy, and some have suicidal thoughts or urges as well. Although you might think that this would be an exceptionally challenging, oppositional, and frustrating group to work with, Amy has had tremendous success treating these teenagers with TEAM-CBT. She measures symptom severity at the start and end of every session, just as we do with adults, and often reports a phenomenal reduction of 60% in depression and anxiety in a single, 30-minute therapy session. Although this may be hard, or even impossible, to believe, it is real, and you'll see why when you listen to this amazing interview. Amy's secret involves a combination of superb E = Empathy skills to form a meaningful relationship, along with A = Paradoxical Agenda Setting to reduce resistance, followed by truly creative applications of M = Methods. And, of course, she does T = Testing with every student at every session, and plots her effectiveness over time. Amy describes her work with a severely anxious young man with artistic skills, who drew an "Anxiety Hero" figure who saves the world by worrying constantly about every little thing, plus a "Chilled Out" figure who never worries and ends up getting hit by a bus. In other words, Amy skillfully emphasized the many BENEFITS of the young's man's constant anxiety, as well as the downside of getting cured. This paradoxically boosted his motivation, and he improved rapidly. This is prototypical TEAM, which is difficult for many therapists to learn, because therapists are so used to, and addicted to, "helping." Amy has developed expertise in aligning with the resistance of her students. paradoxically, she ends up on the same page, and this allows some awesome TEAMwork to emerge. Amy, Rhonda and David talk about the idea of teaching TEAM through creative innovations, with many examples of games Amy has created. For example, she created a game with another one of our fabulous TEAM-CBT therapists, Brandon Vance, MD, which can be played with teens and adults, called "Tune In / Tune Up." This game provides a really fun way to learn the 5-Secrets of Effective Communication. If you're interested, you can check it out at www.gamefulmind.com. Amy and her students have also created a podcast that you might want check out. Although I (David) have been primarily an adult shrink, I have really enjoyed working with teenagers as well. A few years back, I tested hundreds of juveniles who had been arrested in California, many for violent crimes, including murder, at the request of the probation department, using my Brief Mood Survey to find out how depressed, anxious, suicidal, and angry the kids were. Toward the end of the podcast, I describe what happened when I was invited to visit two groups of incarcerated gang members at the Juvenile Hall in San Mateo, California to find out how they felt about the tests I administered, and to get their take on the causes of so much teen violence. I think you'll find this episode to be fun, funny, and inspiring! Amy is a strong advocate for including mental health training in high schools, and her experience illustrates the enormous potential for rapid and profound mental health growth and learning in teens. If you would like to contact Amy, she can be reached at [email protected].

Are there some special techniques therapists need to use when working with LGBTQ patients? Does the therapeutic approach have to be different? In today's podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David's training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today's program is based on Kyle's doctoral research on the treatment of LGBTQ patients. To get the interview started, Kyle defines LGBTQ: L = lesbian G = gay B = bisexual T = transsexual Q = questioning, or queer. Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle's research reveal about the important factors in the treatment of gay individuals? Kyle emphasizes that most important factor is the therapist's attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient's gayness, while some tend to sweep this "uncomfortable" issue under the rug. Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with? In other words, there is no special "agenda" that the therapist should impose on the treatment simply because the patient is gay. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some "correct" way one should treat gay people, or some "correct" set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow "different" or special. In TEAM, we do NOT treat disorders, diagnoses, or "types" of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient's problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction. Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias. David talks about his father's work, trying to convert gay students at the University of Arizona after he retired from his work as a Lutheran Minister in Phoenix, and how much shame and anger David felt about this. David described his positive bias toward LGBTQ individuals, because of the suffering most have had to endure due to hatred and prejudice. David asks whether gays therapists are obligated to announce their sexual orientation to their patients, and Rhonda and Kyle come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question all therapists face, and that the goal of self-disclosure in therapy should be on how best to help the patient, not the therapist. Again, this question of the hows, whens and ifs of self-disclosure is a general therapy issue, and not something specific to gay therapists. Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he'd just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother. The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept himself or herself. In fact, acceptance seems to be the path to recovery and enlightenment for all of us, whether gay or straight! David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (

What can you do when you can't identify your negative thoughts? Is it really true that our feelings always result from negative thoughts? How can I get over my public speaking anxiety? Rubens, a faithful and enthusiastic Feeling Good Podcast fan, sent me an email with a terrific question that has both practical and theoretical implications. He wrote: Dear Mr. David, I've read "Feeling Good" and I'm reading "When Panic Attacks" now. Both have and are helping me immensely. However, the one thing I have never understood is that my anxieties and worries often don't come as a thought. For instance, I have an academic presentation tomorrow, and I'm suffering from much anxiety because of that. But the symptoms did not appear because I thought in my mind the sentence "you are going to fail!". In my case, it is usually silent. I just remember that I have a presentation tomorrow, then I immediately feel worried. My chest hurts before any thought. How do I counter-argument my thoughts, if I have none? Thank you for replying, Mr. David! In today's podcast, Rhonda and I address this question and explain what to do when you can't pinpoint your negative thoughts. There are two really good methods. We will also demonstrate how to deal with some of the negative thoughts that typically trigger public speaking anxiety. The cure involves changing the way you think, and changing the way you communicate with the people in your audience. If you've ever struggled with public speaking anxiety, this podcast may be helpful for you! Thank you again, Rubens, for your excellent question! David D. Burns, MD / Rhonda Barovsky, PsyD

I recently published the results of a survey of Feeling Good Podcast fans like yourself. The findings were overwhelmingly positive and illuminating. However, there were a few criticisms as well, like the excellent and thoughtful comments Rhonda and I will address in this podcast. I appreciate negative feedback, as this provides the greatest opportunities for growth and learning. However, like most people, I sometimes find criticisms emotionally challenging and want to lash out, defending myself! Do you sometimes feel that way, too? When I feel defensive, its because I think I have a "self" or some cherished "territory" that's under attack. When I let go of this "self," it can be incredibly liberating to find truth in a criticism and discover that the feedback is really coming from a trusted colleague or friend, rather than some enemy who is trying to destroy or defeat you! Here's what s/he wrote: Dr. Burns, you seem to disregard healing modalities outside of CBT. CBT is wonderful and nobody teachers it better than Dr Burns—I believe that it is a foundational practice to well-being. However, working with difficult emotions is very important and not always well addressed through CBT alone. Thinking CBT is the answer for most issues is loaded with cognitive distortions. Example--Discounting the Positive in other practices, All or Nothing Thinking, Magical Thinking, and seeing CBT as a "cure all." In my personal healing journey CBT has been absolutely essential--as has self compassion, learning to let things go, inner child work, mindfulness, somatic awareness and more. I have noticed there has repeatedly been a dismissive tone for other valuable practices. Obviously. the Feeling Good Podcast is about CBT and sticking to your expertise is essential. However, I would be careful not to disregard other healing practices that could potentially help someone out. I have such respect for Dr Burns and his team-but your words carry weight- please be thoughtful about discounting other methods that could be helping someone. Thank you, whoever you are, for this thought-provoking feedback. And you are SO RIGHT. Cognitive Therapy has value for some problems, but it is definitely NOT a panacea. In fact, no treatment is! The belief that you have THE ANSWER for everything is incredibly misguided but unfortunately, way too common in our field. I have no doubt that many people have shared your concerns. Let us know what you think after you hear today's podcast! David and Rhonda

How would you overcome the fear of aging? Can you use TEAM for sports psychology? Describe your typical day, David-- do you ever get down or anxious? Hi Listeners: Thanks for your many and awesome questions. I love to answer them! And there will be more to come in future podcasts. Your questions are GREAT! Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey) Guy: What's a nervous breakdown? Rob: How would you treat a field goal kicker who's afraid of missing the winning field goal? Would you use positive visualizations? Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age. Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover? Brittany: I had an idea that I think would benefit a lot of us. I'd like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log? Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that! David and Rhonda PS Here's a great question we did not get to today. We'll do it in a future Ask David, as it's really important. Rubens: What can you do when you can't identify your negative thoughts? I get anxious, but don't seem to have any negative thoughts. Is it really true that our feelings always result from negative thoughts?

Is it REALLY Possible? And Can the Effects Last? Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne's Lace that were in blossom. He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary's classmate. The bus driver said, "Don't look!" But Garry watched as his friend, who was trapped under the dead horse, "bled out" and died. Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry's session with David, it constantly intruded into Garry's every interaction for the next year and a half. Garry says, "I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking." Garry tearfully describes what he experienced during his TEAM-CBT session with David, including his dissociation at one point during the session, and the profound changes he experienced by the end of the session. Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work? You'll find out when you listen to this amazing and inspiring interview! We are incredibly indebted to Garry for his courage and openness to share this experience with all of you!

Hi Listeners: Most people do not do a very good at helping loved ones, colleagues, or friends who are upset and complaining. Have you ever noticed that when you try to help or give advice they just keep complaining? This can be very frustrating--fortunately there's a fabulous solution to this universal problem. This special podcast features our guest, Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute. Jill is also one of the teachers at David's Tuesday evening psychotherapy training group at Stanford, as is our esteemed podcast host, Dr. Rhonda. Jill describes the "helping" errors she made when her son became despondent after some painful foot surgery. Following the surgery, he was in a cast for weeks, and when the cast was removed, he discovered that he could not move or feel his toes. This is common, and results from muscle atrophy when you are in a cast, and is not dangerous. However, Jill's son was very discouraged and frustrated, and told his mom that he didn't feel like going to school and thought he wasn't ever going to get better. Jill felt exhausted from all the demands on her that day, trying to get him off to school, and trying to get to work on time, and so forth, and gave in to the urge to say things like, "You're going to be fine," which were totally ineffective. Jill describes a similar error that she made when her mother also complained about foot problems and the need for surgery. Her mother loves to hike and was upset that she'd be unable to hike for some time. Jill, perhaps feeling a little impatient with her mom, suggested other forms of exercise, like swimming, and this simply increased her mother's complaints. I'll bet you've experienced this same thing when you tried to "help" someone who was complaining. Even therapists make this type of error all the time. Rhonda, Jill, and I discussed the most common errors we all make when we lose patience with someone who's complaining, and illustrated the techniques that are effective. As usual, they involve the Five Secrets of Effective Communication, especially Disarming, Stroking, and Feeling Empathy, along with some compassionate I Feel Statements. We also discussed the phenomenon of drifting in and out of Enlightenment, a concept first described by the Buddha. It is easy to drift out of enlightenment when we are rushing around, trying to get breakfast on the table, lunches made, kids to school, and ourselves off to work. It's so easy to feel overwhelmed and frustrated at those moments. Part of the process may include forgiving ourselves when we make mistakes, and using the 5-Secrets to repair relationships with our loved ones when we do. In fact, this can even lead to deeper and more loving relationships. We also discussed a closely related and possibly controversial theme--is it okay to use the Five Secrets just to get someone to stop complaining, especially if you're angry with that person and they tend to complain most or all of the time? Do you always have to use the Five Secrets in a totally sincere manner? I want to thank Dr. Levitt for joining us in this inspiring and illuminating podcast. Whenever Jill teaches, the heavens open up, and this podcast is no exception. Jill is simply a fabulous therapist, teacher, and human being! Click here if you are interested in some online training with Jill! David and Rhonda

Hi Listeners: Many of our podcasts are inspired by listeners like you who send us really cool emails with show ideas. Sometimes the emails are from people wanting self-help with emotional or relationship conflicts. And sometimes, they are from therapists wanting more training and information about TEAM. Rhonda and I love your emails! Yesterday, I got the following email from Dipti Joshi, one of our listeners and TEAM-CBT therapists from India. Dipti flew all the way from India to Canada with her lovely daughter last summer for my Intensive in Whistler, Canada. I am hopeful that Dipti will one day create the first TEAM Treatment and Training Center in India. How cool would that be! Here's the email that Dipti sent me: Dear David, I am really enjoying all the educational materials available on your website. Thank you! I will soon be taking my Level 3 TEAM certification exam, and am seeking your kind blessings for the same! Also, I have a special request for you. Is it possible to have a workshop or podcast on "paradoxical techniques?" I feel this is a very challenging area, and that a lot of skill is needed. Perhaps you can also talk about why paradoxical techniques can be so effective. Meanwhile can you suggest me something to read or listen to for this? Regards, Dipti Thanks, Dipit! Today's podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview. When my new book, Feeling Great, comes out, I am hoping to do a series of workshops on a variety of powerful paradoxical techniques. And of course, the new book will have a great deal of instruction on paradoxical techniques as well. These are the four key components of TEAM: T = Testing E = Empathy A = (Paradoxical) Agenda Setting M = Methods In today's podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient's symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren't helping your patient much, if at all. You may also discover that your perxceptions of how the patient feels, and how the patients feels about you, are off-base, and sometimes alarmingly so. This can be very disturbing, especially if you're not use to this kind of information. However, in TEAM, we are actually hoping for failure, and welcome that kind of "disturbing" information. Why is this? Isn't therapy all about recovery and making positive changes? Why in the world would the therapist want to know that he or she is not helping? It's because many of the most important breakthroughs in therapy come from the therapist's discovery that he or she is failing. We WANT to fail! Why? David illustrates this paradox by describing his discovery that he was not actually helping a patient he thought he'd helped enormously. David explains how and why this shocking information led to a tremendous breakthrough. When you review how your patient rated you at the end of the session, you may discover that your patient gives you failing grades on the E = Empathy scale. The patient's ratings may indicate that he or she didn't experience you as sufficiently warm and caring, or completely trustworthy, and that you didn't really "get" how she or he was feeling inside. Once again, as TEAM therapists we welcome failing grades on the Empathy Scale. Why? It's because your worst therapeutic failure will nearly always be your greatest success in disguise. How can this be? It seems absurd, or impossible. Karl Rogers told us that empathy is the necessary and sufficient condition for personality change. So why would a TEAM therapist hope to discover that he or she is failing in this category? You'll discover the explanation for this paradox on today's podcast. When the patient asks for help during the A = Agenda Setting phase of the session, the TEAM therapist doesn't jump in and offer to help, using this or that therapy method. In fact, the TEAM therapist will often assume the role of the patient subconscious resistance and argue for the status quo, sincerely encouraging the patient to cling to the feelings of depression, anxiety, shame, worthlessness, hopelessness, and anger. The therapist will bring out all the reasons why the patient should RESIST change. Why in the world would a therapist want to do that? It sounds crazy! You'll find out on this podcast. And finally, during the M = Methods phase of the session, the TEAM therapist will be working with the patient on his or her negative thoughts, like, "I'm worthless," or "I'm not as good as I should be," or "I'm hopelessly damaged because of the abuse I experienced as a child." And the TEAM therapist's goal is not success, but rather failing as fast as you can, trying technique after technique that DOESN'T work and the patient's belief in the Negative Thought is still 100%. Why would a therapist

My wife claims that I never listen! How can I possibly agree with her? My wife left me! How can I correct the distortions in her criticisms? How can you deal with people who constantly wallow in self-pity? And more! Hi podcast fans, Today we've got some terrific Five Secrets questions that you have submitted. Mike #1: I love your Five Secrets of Effective Communication. Why does secret #4, "I Feel" Statements, not include Thought Empathy? Mike #2: I have seen communication models that include expressing and listening for needs. Aren't needs and wants important and important to express? Al: How can I help my wife recognize her many cognitive distortions, like All-or-Nothing Thinking? It seems hopeless! Guy: If a loved one says, "You never listen," how could I possibly find the truth in this statement? How could you genuinely agree with an All-or-Nothing statement such as, "You never …."? Both Sonja and Eileen asked: How can you deal with someone who constantly wallows in self-pity and plays the role of victim. It's exhausting! Thanks for tuning in, and keep the great questions coming! David and Rhonda

Session with Rhonda, Part 2 Last week we published the first half of the session with Rhonda, who was struggling with severe performance anxiety about her work as the new host of the Feeling Good Podcast host. We did the initial T = Testing, which indicated many intense negative feelings, as well as E = Empathy phase of TEAM therapy session. This week, we include the conclusion of the session, with A = Paradoxical Agenda Setting and M = Methods, plus final T = Testing to see how effective, or ineffective the session was. As a reminder of the first podcast, plus the work done on this podcast, you can review Rhonda's Daily Mood Log here. When you listen, you will see that the changes Rhonda experienced were amazing,. But were these changes real? It almost seem too easy, and too fast, especially for a problem that started in childhood and persisted right up to the present moment. Was the session just a publicity stunt, perhaps, or some kind of superficial quick fix? David asks Rhonda about this, as well as this question: 'If the changes were real, what caused the changes? David and Rhonda used many TEAM-CBT techniques they during the session, including these: David Empathized with the Five Secrets of Effective Communication at the start of the session during the E = Empathy phase. Of course, good empathy is necessary throughout a therapy session. David melted away Rhonda's resistance during the A = Paradoxical Agenda Setting. These techniques included: Straightforward Invitation Miracle Cure Question Magic Button Positive Reframing Pivot Question Magic Dial The M = Methods that were helpful in this session included included: The Individual Downward Arrow to identify the Self-Defeating Beliefs that triggered Rhonda's feelings of inadequacy.Rhonda enjoyed this exercise and felt it was on target. We identified many beliefs, including: Perfectionism Perceived Perfectionism Achievement Addiction Approval Addiction Love Addiction Fear of Rejection Submissiveness Inadequacy schema Spotlight Fantasy Brushfire Fallacy Superwoman The Interpersonal Downward Arrow to illuminate how Rhonda saw her relationship with her father, with David, and with some other people, including the podcast listeners. This is kind of like Psychoanalysis at warp speed. Rhonda said this felt uncomfortable, perhaps because it cast David somewhat as a dangerous ogre! David and Rhonda smashed several of Rhonda's Self-Defeating Beliefs with the Feared Fantasy Technique Identify the Distortions Paradoxical Double Standard Technique Externalization of Voices Acceptance Paradox / Self-Defense Paradigm Self-Disclosure / Exposure The Experimental Technique Thinking in Shades of Gray Finally, if the changes were real, will they last? Or will Rhonda just slip back into more performance anxiety and self-doubt? You can click on this link if you'd like to review the evolution of Rhonda's Daily Mood Log during the session, and see her ratings on the Brief Mood Survey before and after the session at this link. You can also review her ratings of David on the Empathy and Helpfulness scales at the end of the session. You can also review her interesting comments on what she liked the least, and what she liked the most about her session with David. I want to thank Rhonda, my esteemed colleague, friend, and wonderful podcast host, for giving all of this incredible gift of her humanness. And I, Rhonda, want to thank the most marvelous, compassionate and incredible David Burns, for the gift of healing and facilitating me experiencing enlightenment and peace from these difficult feelings and negative thoughts that were devastating me. I feel so much gratitude, for all of our work together, for you trusting me enough to invite me to be the host of these podcasts, and for the gift of your friendship. Words can't express the full depth of my love for you and for everything you have given me both personally and professionally! Did you like the personal work we did? Was it helpful for you personally? Rhonda took a chance and was courageous to share intensely personal experience with you. Let us know if you liked this! If you are a therapist, or an interested patient, let us know if this was it a good learning experience. Would you like to hear more podcasts with live personal work? We are here to serve you, so share your thoughts and feelings with us, as well as your wish list for future podcasts! David and Rhonda

"I sound stupid! . . . Ouch!" Have you every struggled with performance anxiety, thinking you might fail or not be good enough? I think it is fair to say that every therapist in my Tuesday training group at Stanford has struggled with fairly intense feelings of anxiety and self-doubt, and perhaps you have, too, thinking you should be smarter or better than you are, and fearing that others would judge you if they saw your "true self." In fact, I would suspect that most of our podcast fans have struggled with these feelings at some time during your life, and maybe even recently or now. Well, today, we've got a wonderful program in store for you. Our own Dr. Rhonda Barovsky asked me for personal help with her own anxieties about being the new podcast host. I asked if she wanted to do it live, on a podcast, and she generously agreed! In this heart-warming and very human session, Rhonda shares the negative thoughts and feelings she had when she listened to herself on several podcasts and begin noticing this or that error she made. She felt intensely down, anxious, ashamed, inadequate, rejected, embarrassed, discouraged, frustrated, and angry, to name just a few of her negative feelings, and her mind was flooded with negative thoughts like these: I sound stupid and inarticulate, and some of my comments were inaccurate, like when I said psychiatric diagnoses are meaningless labels. I've had feelings of insecurity ever since I was a child, and should be over this by now! David is going to regret having me as the podcast host! Everyone will know I'm a fraud, and no one will like or respect me. People will judge and reject me, and I'll end up ostracized and alone. She believed these thoughts at 100%. You might recall that the Necessary and Sufficient Conditions for emotional distress are: You have one or more negative thoughts. You believe the negative thoughts. In today's podcast, you will hear the first half of the session, which included T = Testing as well as E = Empathy. During the Empathy phase, David also included two Uncovering Techniques, the individual Downward Arrow Technique and the Interpersonal Downward Arrow Technique, so that he and Rhonda could identify the Self-Defeating Beliefs under the surface, like Perfectionism, Perceived Perfectionism, the Approval Addiction, Superwoman, and more. This is because there are two goals in TEAM-CBT. The first goal is to crush the negative thoughts in the here and now, so that you'll feel relief. The second goal is to modify the Self-Defeating Beliefs so you'll be less prone to similar thoughts and feelings in the future. In next week's podcast, you will hear the second half of the session, which included A = (Paradoxical) Agenda Setting and M = Methods. You'll also hear the final T = Testing to find out how effective the session was, and how Rhonda rated David on Empathy and Helpfulness. I think you'll find that both sessions are incredibly inspiring and wonderful sources of learning as well. I want to give a shout out to Rhonda for being so courageous and vulnerable and real, and for making this live therapy session possible! After you've heard Part 2 next week, let us know what you think! You've all responded very positively to the live therapy we've done on the Feeling Good Podcasts, and you've asked for more. Rhonda and I are committed to making that happen for you, and we are both so grateful for your support, which means a lot to both of us. Thank you! David and Rhonda

Are the rapid changes real? And do they last? In the Spring of 2017, we published our first live TEAM therapy session so our listeners could peak behind closed doors to see an actual TEAM therapy session. Although the session lasted about two hours, we broke it up into seven consecutive podcasts including expert commentary on each segment of the session. If you have not yet heard them, they were Feeling Good Podcast #29, published on April 10, 2017 through Podcast #35, on May 1, 2017 which was exactly two years from the time today's podcast was recorded. My co-therapist for this session was Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Our patient was a physician named Mark who'd had two goals for his life when he was growing up. The first goal was to become an outstanding doctor. The second goal was to have a large and loving family. At the start of the session, Mark confessed that although he'd achieved his first goal, he'd failed to achieve his second goal because he wasn't able to get close to his sons, especially his oldest son. At the start of the session he rated his relationship with his son on the Relationship Satisfaction Scale as only 2 out of 30, an extraordinarily low score. In addition, his scores on the Daily Mood Log indicated he felt very sad, unhappy, guilty, and ashamed. He also felt very inadequate, lonely, self-conscious, discouraged and defeated, frustrated, and somewhat resentful and upset, too. He confessed that he'd felt this way for years. By the end of the session, these feelings had largely disappeared, and Mark was in a state of joy. In fact, we all felt elated—but will it last? Many people complain that the rapid and dramatic change I experienced when I do TEAM therapy cannot be real, and cannot last, and that it has to be superficial or fake. They insist that real change can only unfold slowly, over years, or even after a decade or more of talk therapy. I respect critical thinking, and if you'd told me that such rapid and dramatic changes were possible ten years ago, before TEAM had emerged with all the new technology, I would have thought you were a con artist too! Of course, others have argued the other side of the coin, pointing out that TEAM is research-based and genuinely appears to represent a significant, or even amazing breakthrough in psychotherapy for depression and anxiety, and that the changes ARE real. They have also argued that rapid change should be the goal of treatment, rather than just nursing people along for prolonged periods of time without tangible and measurable changes. Rhonda and I had the wonderful opportunity of sitting down to interview Mark this last Sunday, following one of my Sunday hikes, so we could try to get some answers to these questions. We asked Mark whether he now felt that the changes were real, and how he'd been doing in the two years since the session. Did the changes last? The interview with Mark was pretty mind-blowing. He confessed that at the start of the session he, too, was very skeptical that years and years of negative feelings could be reversed in a single therapy session. Then he summarized the session he'd had with Dr. Levitt and me in May of 2017, and his tears flowed once again, as he recalled his feelings of failure at being unable to connect with his sons. Rhonda asked Mark what happened after the session. Did he just relapse back into the same way he'd been feeling? Mark said that right after his session, there was an amazing and almost instantaneous transformation of his relationships with all of his sons. He used the Five Secrets of Effective Communication for the first time in his interactions with his sons, and they opened up immediately. He has felt extremely happy, over joyed, really, and reported that: The changes were VERY real! The changes DID last. His relationships with his children and grandchildren are now fantastic. Rhonda and I are incredibly indebted to Mark for giving us such a transformative and inspiring interview! It probably won't quiet all of the critics, but this information may be illuminating and inspiring for those who are intrigued by the many new developments in TEAM-CBT. And my message to those who are still critical of TEAM, or critical of me—please continue to use your critical thinking and skepticism when you evaluate TEAM or any other approach. It was my own skepticism about the things I learned during my residency training and clinical work that actually led to the emergence of TEAM therapy. I don't want to quiet my critics, I want to praise all of you! David and Rhonda Coming Up Soon Follow-Up with Gary: Rhonda and David interview Gary, a veteran who David treated for PTSD several years ago at a trauma workshop. Gary describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne's Lace that were in blossom, and what he experienced during his TEAM-CBT session wit

Do I have ADHD? Is it a real disorder? Hi podcast fans, Today we've got some terrific questions that you have submitted. General Questions Jose and Bri both asked: How would you treat hypochondria? Christian: How would you treat an abuse survivor? I've heard that talk therapy is inadequate for healing trauma! Ted: Is there such a thing as healthy euphoria? Hillary: Would you do a podcast covering the treatment of mania? Jim: I think I have ADHD, but some doctors claim it's not a true diagnosis. What do you think? Dan: What your thoughts are on LSD in the treatment of depression and anxiety? I could not get to all of your excellent questions in the time provided. The next time we do Ask David with general questions, we will include these: Guy: What's a nervous breakdown? Rob: How would you treat a field goal kicker who's afraid of missing the winning field goal? Would you use positive visualizations? Michael: How would you treat someone with the fear of aging? I turn 60 in a few months! Hidem: How fast is fast? You seem to get super-fast recoveries from your patients most of the time. How about other therapists? How rapidly does the average patient recover> Rubens: What you can do when you're upset but can't identify any negtaive thoughts? Next week, our Ask David will focus on questions about relationship conflicts and problems. Rhonda and I have lots of other cool programs planned in upcoming weeks. Thanks for tuning in today, and over the past months. We will hit one million downloads in a week or two (this is April, 2019). Rhonda, Fabrice, and I deeply appreciate your support! David and Rhonda

What's Bibliotherapy? Hi podcast fans,David and Rhonda discuss and old controversy: Can a self-help book can really help? Or will you need psychotherapy and / or an antidepressant if you are seriously depressed? [gallery ids="60,357,58,54,51,50,42" type="rectangular"] I (DB) wrote up the following overview of bibliotherapy research prior to today's recording with Rhonda. I hope you find it interesting! I have to admit that I've never had much respect for self-help books. Many of them seem to be written by narcissistic individuals with pretty superficial ideas who mainly want to promote themselves, and this has been my strong bias as well. When I pick one up in a bookstore, I nearly always get immediately turned off. And I get a flood of them in the mail as well, from authors asking for an endorsement. I have a policy of not doing book or product endorsements—it's the easiest way to say no. And I never thought of my book, Feeling Good: The new Mood Therapy, as a self-help book. My idea was that people receiving cognitive therapy could read it between sessions as a way of speeding up their recovery, so that the therapist could do the individual work and not have to do so much teaching about the basic concepts, like my list of ten cognitive distortions. But at the same time, shortly after the book was released, I began getting letters, and later on emails, from individuals who said they book had actually caused them to recover from pretty severe depression. In fact, over the years, I would guess I've received more than ten thousand letters or emails like that, and probably way more than that, maybe even fifty thousand. Still, it had not occurred to me that it might actually be a self-help book, in spite of the fact that lots of the people who wrote me said the book had helped them much more than the treatments they'd received over the years. One day a colleague asked if I'd seen the article about my book in the New York Times. Apparently, Dr. Forrest Scogin, a research psychologist from the University of Alabama Medical Center, had studied the effects of reading a self-help book on patients seeking treatment for moderate to severe depression. In a nutshell, their studies indicated that simply reading Feeling Good may help some patients overcome depression and may help to prevent future relapses as well. This finding was a shock, but was not entirely unexpected due to all the testimonials I'd been received from people who'd read the book. In their first study, Dr. Forest Scogin and his colleagues told patients seeking treatment for depression that they'd be placed on a four-week waiting list before beginning treatment. Half of the patients were given a copy of either my Feeling Good or a self-help book on depression by Dr. Peter Lewinsohn called Up from Depression. The researchers suggested that the patients could read their book while they were waiting for their first appointment with the psychiatrist. The other half of the patients who were placed on the four-week waiting list did not receive a copy a self-help book. Both groups of patients were contacted each week by a research assistant who administered a test to assess the severity of depression. The goal of course was to find out if there were any changes in depression in any of the patients. The results of the study were interesting. Approximately two-thirds of the patients who received one of the self-help books improved or recovered from depression during the four weeks, even though they received no other treatment with drugs or psychotherapy. In fact, they improved to such an extent that most of them did not even need any further treatment. In contrast, the patients who did not receive one of the books failed to improve during the four-week waiting period. As far as I know, this was the first time that the anti-depressant effects of a self-help book had ever been documented in carefully controlled research study published in a scientific journal. Then the researchers did a number of additional experiments. First, they gave a copy of one of the two self-help books to the patients in the second group who had not improved. They asked them to wait four more weeks before beginning treatment, but suggested they read the book during their wait. Two-thirds of them also improved and did not need further treatment. This study was published in the medical journal, Gerontologist. Some critics challenged the study, arguing that the improvement in the patients who received the self-help book might have simply been a placebo effect. In other words, maybe it was just the reading, and the expectation of recovery, that helped, as opposed to the ideas and techniques described in the books. To test this, the investigators studied a new group of patients who were asked to read a "placebo" book while waiting for treatment. The researchers chose a classic book by Victor Frankl called Man's Search for Meaning. If these patients also improved, it would confirm that the effect

This is the second of two podcasts on the Story of Sherrie, who experienced some of the symptoms of PTSD after a traumatic event involving her husband. In the first podcast, we played the T, E, and A portions of the session. In this podcast, we will play the M = methods as well as the conclusion of this amazing session. Dr. Rhonda and I will make some teaching comments on the session as well. If you'd like to see Sherrie's end-of-session Daily Mood Log, click here. After the session, Sherrie received some notes from others in the audience. Sherrie, I think what stood out for me in that session was your authenticity. No mask, no defenses. I fell like we can't really appreciate what our clients are doing when they open themselves up to face their fears until we do it honestly ourselves, and you did--in front of all of us! I feel it was a gift you gave us and I thank you! Candice Here's another note for Sherrie: Sherrie, You Rock--I love you--and never met you before tonight. :) You cried. You laughed. You said No. You said Yes. You woke up! You're a Brave Woman! What a lucky husband you've got! Thank you. A sister, a colleague, Rita And another. To Sherrie Your session--that was brave! Shows strong commitment to yourself and to the people you work with. You will be more effective stronger, real, fee, and go even deeper with your clients. Mary If you want to send a message to Sherrie, use the comment feature below, and I will be sure to forward your thoughts to her! When people learn about the incredibly rapid recoveries that I am so often seeing with TEAM, they always ask about whether the effects last,or whether the dramatic changes are just a flash in the pan. Of course, Relapse Prevention Training is critical, as negative thoughts and feelings will tend to come back over and over for all of us. That's just part of the human experience. And if you know how to deal with these occasional "relapses," you don't have to worry about them, because you'll know how to crush the negative thoughts and feelings pretty fast. At any rate, Sherrie's session was more than three years ago, and here's an email I got from her a couple weeks ago: Hi David. I always enjoy hearing from you! I agree for you to show the video at the summer intensives, I am actually quite proud of it all so have nothing to hide! You can also do it as a podcast, whatever is workable. I have looked at the podcasts you sent and they look wonderful so will certainly listen to what I can over time! Okay, so for an update and thank you for asking. The year after my cancer, my husband had his heart attack, so that was four years ago. He is, thank G-d, wonderfully healthy. There is no heart damage and he can do everything he wants to do. And he is even getting better at taking his pills, so I don't have to remind him so much. I have a question for you as what you do is not what I can or want to do. I think you said you were 75 when we met in the training. So what I don't get is how do you have the energy to see clients, write books, do podcasts, travel all over and do workshops etc? How do you fit all that in? You must want to! All the best and enjoy spring! Sherrie Thanks for listening! David and Rhonda Oh, my secret is that I am almost always doing what I want to do. Teaching and treating colleagues with TEAM give me tremendous energy, except when I screw up, which is fairly often! But I'm used to making errors by now, and I really love what I do, so I don't think of it as "work," but more like having fun hanging out with friends. It is a bit like when you were a kid and got to go out and play after dinner! That was THE BEST!

Hi Podcast Fans, There have been many requests for more podcasts on how we would treat trauma, using the TEAM-CBT model. I have done at least 25 workshops on the treatment of trauma in the past several years, and always do a live therapy demonstration at the end of day 1, so people can see with their own eyes how TEAM-CBT actually works. About three years ago, I did a live demonstration with a wonderful woman named Sherrie who was extremely anxious about a traumatic event involving her husband a year earlier. Sherrie kindly and courageous gave me permission to share the audio tract with you. I think you'll really enjoy the session! I want to thank Sherrie for giving us this gift! I also want to thank my co-therapist during the session, Mike Christensen, who is Canada's top expert in TEAM-CBT. Here's our photo at the workshop: While you are listening, you may want to take a look at Sherrie's Daily Mood Log, which describes the trauma, along with her negative thoughts and feelings. We will publish the first half of the session in this podcast, and the end of the session in the next podcast. We'll also include a live, three-year follow-up with Sherrie that we recorded recently. Dr. Rhonda and I will make some teaching comments on the session as well. David and Rhonda

Rhonda, Fabrice and I received a number of thoughtful emails following our recent podcast on mindfulness meditation, which seems to be quite popular these days, but there some push-back from listeners who all did not agree that mindfulness is an effective way of combating negative thoughts and feelings. Email from Jeremy Hi David, I listened to the Feeling Good Podcast on meditation this morning and had some thoughts I wanted to share. For context I've been meditating daily for about 3 months. First - I personally think that if someone is struggling with depression or anxiety, TEAM-CBT is a dramatically faster acting and more powerful tool than mindfulness. I've never seen or heard about someone having a dramatic recovering in just a few hours due to mindfulness. I've never seen the idea of resistance explored in any kind of mindfulness book or article. I also don't really think much of mindfulness as a "method" in the TEAM model, because compared to the other methods for removing negative thoughts it's extremely weak. I imagine that with hundreds of hours of mindfulness practice you might reach a point where it's easier to let go of negative thoughts. (There are a lot of reports like that/) However, it's a very slow way of dealing with negative thoughts compared to externalization of voices etc. I think for a therapist who knows TEAM to suggest mindfulness as a key practice to their patient is almost negligent, since TEAM is so much more effective. That said, I've sensed a few benefits of mindfulness which is why I've been investing my time in it: - I think you can view meditation as concentration practice, and I've found that meditation increases my ability to concentrate - You can reach a very calm and relaxed state in meditation where you cease to have thoughts, and this state is extremely pleasurable - I've noticed that mindfulness increase my ability to enjoy experiences, including experiences I might enjoy less if I was having even positive or neutral thoughts. As an example, after about 30 minutes of meditation the other day I went for a walk in the woods and stop for about 10 minutes to look at a ridge. My visual experience was completely immersive and I even started to feel like the trees were breathing with me. It was one of the high points of my week. I suspect that even someone who had no negative thoughts might be flooded with positive but irrelevant thoughts (like a yummy meal they might be headed to eat later) would have enjoyed this scene much less. I've also run an experiment using the PAS and CBT to remove the motivation to have distracting thoughts. (ie write down the advantages to having distracting thoughts and disadvantages of focusing on the breath, and then talk back to those) I would classify it as a highly successful experiment, after talking back to all the good reasons to think about something besides my breath my focus got dramatically better. I wonder if this technique could be used to either improve meditation or even supplant the need for it. (because it gets rid of distracting thoughts directly, while meditation is basically practice for having fewer distracting thoughts) Anyway, just thought I would share some thoughts and ideas with you. Best, Jeremy Email from Paul Hey, Dr. Burns! I am with you in terms of the skepticism of mindfulness as a panacea. I also am not sure how particularly effective it is even as a tool in the fight against negative thoughts. I personally cannot seem to get anything out of it, but I am trying to make sense out of how so many people can find it useful. Perhaps you could put it like this: Mindfulness is not a specific technique for specific problems, but a general method for psychological health. If you have a specific medical condition, you'll want to get a specific treatment. Sometimes specific conditions can be alleviated by taking care of your health generally (eating healthier, sleeping better, etc.) Still, depending upon the disease, in order to get rid of it, you'll need a specific treatment. However, even when you're not dealing with a specific disease, generally good health practices can lower your chances of getting any diseases and lessen the severity when they do arise. In sum, perhaps the goals of mindfulness and CBT are different. I think that might respect what both you and Fabrice are getting at. I think this goes to answer partly a question I've had about TEAM. To what extent is alleviation of anxiety, depression, etc the final goal? Are there religious, spiritual, or psychological problems that are positive goals beyond relief? In Feeling Good, it sounded like you thought that happiness was just the absence of depression. Is that all there is to say about human flourishing? Or do you methodologically stick within the parameters of your client's value system, asking only "what can I help you with" because you're a psychologist and not a priest, for example? Paul David and Rhonda discuss several important points raised by these

How to Overcome Shyness In a recent podcast, David and Rhonda emphasized the importance of specificity--selecting one specific moment when you want help. This is very true in the treatment of shyness. Jason, who we introduced in the last podcast, wanted to work on the intense anxiety he felt in the locate grocery store. He thought the woman checking groceries was attractive, but he was terrified about talking to her, or trying to flirt. So he said nothing, and left the store feeling like a failure. After this humiliating experience, he filled out a Daily Mood Log and listed all the Negative Thoughts and feelings he'd had while waiting to check his groceries. After doing Positive Reframing, he decided on the Negative Though he wanted to work on first: "People will think I'm a self-centered jerk if I try to flirt with her." David and Jason put this thought in the Recovery Circle and selected more than 20 techniques Jason could use to challenge thought. On the podcast, David and Rhonda illustrate how to challenge that thought using many of the methods listed on the Recovery Circle, including: Identify the Distortions. They found all ten distortions in this thought. The Straightforward Technique. This technique was not effective, since the Positive Thought Jason came up with was not valid, and it did not reduce his belief in the Negative Thought. However, this technique did reveal something important about Jason—he seems to see the world in an adversarial way, and imagines he is in competition with others who will try to put him down. The Cost-Benefit Analysis. What the are Advantages and Disadvantages of Jason's Negative Thought? Jason did a remarkable job with this technique, and found it helpful and illuminating. The Individual Downward Arrow Technique. David and Rhonda illustrated how this works, using role-playing. They were able to identify five of Jason's Self-Defeating Beliefs that are extremely common in Social Anxiety, including: Perfectionism Perceived Perfectionism The Approval Addiction The Spotlight Fallacy The Brushfire Fallacy The Paradoxical Double Standard Technique. What would Jason say to a dear friend who was also struggling with severe shyness? Would he say, "People will think you're a self-centered jerk if you try to flirt with her." If not, why not? What would Jason say to a friend? And would he be willing to talk to himself in the same compassionate way? This technique was also very helpful to Jason. Examine the Evidence. What's the evidence that people will think he's a self-centered jerk if he tries to flirt with a young lady he's attracted to? Survey Technique. Have his friends ever struggled with anxiety when they were starting to date? Would they think of him as a "self-centered jerk" if he was more outgoing and flirtatious? This was a homework assignment, to ask his friends. The information he got was a huge surprise. Thinking in Shades of Gray. He thinks he has to sweep her off her feet or he'll get totally rejected and ostracized by the human race. Is there some easier goal he could shoot for? He's telling himself that if she shoots him down, it will prove that he's a "loser." Are there other reasons why a grocery checker might not respond favorably to a young man who is trying to flirt with her? Feared Fantasy / Acceptance Paradox. David and Rhonda illustrate this amazing technique, with role-reversals. This technique will help Jason crush the Self-Defeating Beliefs that cause his shyness in the first place, like the Approval Addiction. These techniques were extremely helpful to Jason, and all of his negative feelings went down dramatically by the end of his first therapy session. However, he will have to do more work outside the office for homework, using Interpersonal Exposure Techniques to confront his fears of rejection, including: Smile and Hello practice Flirting Training Talk show Host Rejection Practice Self-Disclosure Shame Attacking Exercises These assignments terrified Jason, but he courageously agreed and followed through. He had his share of rejections, as we all do, but had some successes, too, and soon was dating a lot and enjoying it, and his shyness became a thing of the past. The treatment only required four sessions.

How to Overcome Shyness David and Rhonda begin with two emails (among many) from listeners asking for more help on the problem of social anxiety. Email from "Margaret:" Hi David, How do you distinguish a personality disorder - say, for example, Avoidant Personality Disorder, from "just" (and I don't mean that in a derogatory way) being depressed and anxious? I ask because I have a strong suspicion that I may be suffering from Avoidant Personality Disorder, and I think if you knew my history you would probably agree that there are strong signs (I have been having problems from my early childhood until now, and I am 30 years old now). Also, a further question – is it possible to have severe anxiety without feeling like the confrontation with the thing you're afraid of means you're going to die? I have isolated myself completely, and I have no social life in any sense of the word – my only real contact with the outside world is through my job, because it is a necessity for living. But it's not because I think I'm going to die if I hang around people – I just very strongly dislike it and 'shut down' or 'freeze' due to all the thoughts in my head about being negatively judged and watched, so I prefer to avoid contact with people, and in situations where I'm forced to endure it, I'll usually find ways to 'avoid' or escape the situation. There are many ways I do this – since I was very young I've had the habit of purposely looking annoyed, so that people would not approach me, even though I secretly wish they would (oh, the paradox..), and at work I will often be listening to music with earphones – both because the music calms my anxiety, and because it makes me appear less 'available' to other people. In situations where I cannot escape crowds – say, in the canteen during my lunch break - I'll sit by myself, as far away from everyone else as I can, and leave as soon as I have taken the last bite of my food. In college I would often hide in the bathroom by myself during breaks, or I would avoid interpersonal contact in some other way. And so on and so forth. These are just a few examples – I could give you a million others. I am aware of my own behavioral patterns but still feel powerless to change them. It's like being an observer, observing yourself committing the same mistakes over and over, but with an anxiety so strong that rationality alone is not enough to change the behavior. After 30 years of this, it's getting old. I have never felt any other way, so I cannot fathom what it means to lead a normal life. I have never had a friend in any usual sense of the term, and I literally never spend time with anyone in my spare time except for my parents. As a consequence, I have never learned or understood how to make friends, and I have never been in an intimate relationship, or taken part in any of the social activities that are normal to other people (parties, school dances, etc.) The simplest things are rocket science to me. So, I'm interested to know when a person crosses over from "simply" being depressed or anxious into having a personality disorder. If you use any of this for a future episode I am fine with that - you can even quote me directly. But I only ask that you please don't use my real name as to not jeopardize my job and so on. Thank you. 🙂 Kind regards, Margaret David explains that there is no such thing as "Avoidant Personality Disorder." It is just an imaginary concept created by the American Psychiatric Association, and is applied to individuals with shyness that is so severe that it causes significant problems in their lives. And yes, you can definitely deal with mild, moderate, or even extremely severe problems with the TEAM-CBT as well as exercises in my books, such as The Feeling Good Handbook, When Panic Attacks, and Intimate Connections. They also read an email from "Abdul," a podcast fan who's been struggling with shyness. I'm from Pakistan. Please make podcasts on shyness and public speaking and other anxiety issues. I have anxiety shyness. My father has also anxiety. I know he is not happy. I also sometime feel exactly like him. And one of my cousins is very much depressed. He is a cleaner in a garments shop. He always use to pack clothes all the time even if they are kept properly. Dr burns please guide us. It would be very very helpful. Sorry if I wrote anything unprofessional. Thank you. Several days later, David received an additional email from "Abdul:" My social anxiety has returned back. In my office I feel very lonely. Here my negative thoughts: I should say something impressive. I'm good looking so I should not be anxious. I should talk to girls. I should say hi to people. I should mix with people. Today and next week, David and Rhonda will describe how to treat / overcome shyness using TEAM-CBT. David explains that this is probably his favorite problem to treat, since he himself has struggled with every conceivable form of social anxiety, so he really knows how to defeat this

Mission Accomplished! Dear Feeling Good Podcast fans, I am profoundly sad to say goodbye to my beloved friend and terrific podcast host, Dr. Fabrice Nye, who is leaving the podcast to start his own show this spring. I wish him well on his new podcast he'll be releasing soon. I'll share the specifics when they become available so loyal fans can tune in and follow him! What a joyous experience it has been working with Fabrice for the last three years. He proposed the idea of a weekly podcast in the fall of 2016 and we produced episode #001 on October 27 of that year. Together we have been able to share TEAM-CBT with many enthusiastic listeners, and just exceeded more than 70,000 downloads monthly. Please join me in wishing him well! My feelings of profound loss are comforted by welcoming another dear friend and colleague, Dr. Rhonda Barovsky, our new host. Rhonda and I look forward to creating many more fabulous podcasts for all of you. Rhonda received her doctoral degree in Forensic Psychology from the Eisner Institute for Professional Studies in 2013. Throughout her career, she has been a champion of women's rights and defender of the victims of childhood sexual abuse. Rhonda is the founder of the San Francisco Juvenile Sex Offender Treatment Program and has served as Director of San Francisco Family Court Services. She has also worked at the San Francisco Rape Treatment Center, providing crisis and short-term counseling for adult survivors of sexual assault and their families. Rhonda is a certified TEAM-CBT therapist and esteemed teacher. In her clinical practice, she focuses on TEAM-CBT for adults struggling with depression, anxiety disorders, and relationship problems. She brings warmth, enthusiasm and brilliance to her new role as host of the Feeling Good Podcasts: "I am extremely honored to be invited to host the Feeling Good Podcast with Dr. David Burns. Fabrice Nye has been a visionary, and his shoes will be impossible to fill. I hope to add to the joy and excitement of learning and teaching TEAM-CBT along with David and having lively and productive discussions." Dr. Rhonda Barovsky Rhonda and I will be posting two surveys shortly on my website, www.FeelingGood.com, to find out more about you. I want to find out if you are a therapist or non-therapist, and what kinds of topics might interest you the most. And unlike some tech giants, we promise to keep your information totally confidential. We don't sell information; we just want to do the best job we can for therapists and non-therapists alike, for free. If you are a "patient," we want to accelerate your learning and your recovery as well. If you are a "therapist," we want to help you improve you skills and your joy in your clinical work. I put the words, "patient" and "therapist" in quotes, because the line between the two is very narrow indeed! As "therapists," most of us struggle at times with the same human dilemmas that our patients face. And as we do our own personal work, as therapists, we bring far more healing and compassion to our work with our "patients!" On the show, Fabrice and David share fondest memories of the show, and Rhonda talks about new directions as she becomes the host of the Feeling Good Podcast. Fabrice also gives some hints about his new show, which will be broadcast in French and English. Fabrice will describe and translate new developments in psychology research and relate the findings to our daily lives. Thank you so much for your awesome support over the past 2 ½ years!

Today's Ask David questions. Do depression and anxiety result from medical illnesses, like thyroid problems? Do we REALLY create our own interpersonal reality? What if you're being raped? Are you saying that's your fault? How can that be? I struggle with anxiety. Why is it a mistake to try to "calm down?" How do you deal with entitlement? I think my patients should do what I tell them to do! After all, I'm a highly trained professional! How do you deal with racism, sexism, and other societal barriers? What if the injustice is real and it isn't "all in your head?" And here are the longer versions. Fabrice and I hope you enjoy these thoughtful questions submitted by listeners like you! 1. Barbara asks: 1) How are hypothyroidism, depression, anxiety, and bipolar disorder related, and (2) how are heart disease, depression, and anxiety related? 2. Mark asks: I'm one of your most avid listeners to your podcasts. I've listened to most of Feeling Good Podcasts as well as the recordings of your Facebook live broadcasts with Jill. I absolutely love your content and extremely grateful for your insights and the material you put out for free. I've heard you say numerous times how in interpersonal relationship problems we create the poor behavior we see in the other. At what point though, is a threshold crossed and you acknowledge the other in the relationship is creating problems? For example, if your client is being raped by their partner and is being threatened with violence if they dare leave, you wouldn't say to your client you're creating that kind of treatment from your partner. Obviously the above is a very extreme example, but what if its scaled back in terms of severity of abuse, stopping short of physical attacks and threats? Where does a line in the sand get drawn where you acknowledge the client is not creating the problems themselves? I'd deeply appreciate your reply! 3. Angela asks: I was intrigued by your comment in your podcast #88 on Role-Playing Techniques that "trying to calm down is a big mistake. . . then your emotions become your enemies," but then you said, "that's a good topic for another podcast." I hope you do a podcast on that topic!!! I'm eagerly waiting to hear more about that! 4. Julio asks: I'd like to share my experience. I am a therapist and I suffered from, and am still working on, feeling inadequate. I frequently questioned "am I good enough to be a therapist?" "How can I help others if I have issues of my own?" After reading Feeling Good I realized I frequently jump to conclusions, engage in mind reading, and labeling whenever there is some uncertainty with my clients. At times I might even have blamed them when things didn't go the way I thought they should go. I believe I do that to protect my ego, and I might have developed some cognitive distortions related to entitlement such as "I'm a therapist, people are supposed to do what I say" "I worked too hard and too long and potential employers better give me what I deserve" "Because I practice evidence-based therapy, I'm better than 99% of all therapists." These entitled thoughts led me to become irate whenever someone didn't act according to my expectations. I would vacillate between feeling angry and feeling depressed. I guess when I initially emailed Fabrice I was confused as to how my entitlement develops, but now I'm realizing that it comes from the same distortions that can cause depression. I didn't know that distortions could produce depression and entitlement. I'm curious what you and Fabrice think about this. I thoroughly what you and Fabrice think about this. I thoroughly enjoy your podcast and often find myself re-listening to earlier episodes. 5. Holly asks: " Burns: I have found tremendous value in your books and podcast. I have noticed that you discuss some emails/letters/etc. on your podcast and I have one I'd like to hear you discuss. What are your thoughts on dealing with racism, sexism, and other societal barriers? For example, it is not uncommon for people with dominant identities (white, male, physically able) to tell women, people of color, or those with physical challenges that their issues are all in their minds and that if they thought differently, then they would have different outcomes. I am an African-American woman and I don't believe this (the statistics on access to education, employment, and justice all suggest otherwise). What are you saying (if anything) in your writing, practice about thoughts related to injustice? Best, Holly So there you have it! Great questions, and keep them coming! Thanks, David and Fabrice

Debbie asks: Can you use TEAM-CBT to help people with medical disorders, such as Parkinsonism or Cancer? Here is the promised link to Stirling Moorey's book on Cognitive Therapy for cancer patients. Here is the link the first episode of live therapy with Marilyn, a woman who was diagnosed with Stage 4 lung cancer a couple days before her session with David and Dr. Matthew May. You may also want to listen to podcasts 50 to 52 and 59, which also feature David and Matt working with Marilyn. Marilyn described these inspiring podcasts as mind-blowing! Mark asks: How can I help a depressed family member or friend who is passive and doesn't want to do anything? Paul asks: How can I get over death anxiety? Sune asks: If you're super-shy, does this mean you have "Avoidant Personality Disorder?" What's the difference between garden variety shyness and a personality disorder? Sly asks: "Do you believe in the big five personality traits model? And will your therapy tools change these big five traits? I got a score of 67 on neuroticism, which means I am more prone to anger, depression, anxiety, and vulnerability, and tend to think about things in a pessimistic way. If I do the exercises in your books, and develop a more realistic outlook on myself and others, does it follow that my "personality traits" will get more or less changed?" According to Wikipedia, the "Big Five" are O = Openness to experience, C = Conscientiousness, E = Extraversion, A = Agreeableness, and N = Neuroticism, often represented by the acronym, OCEAN. Here's an important point I forgot to make on the podcast. According to Wikipedia, here's the definition of "Neuroticism:" People with high neuroticism indexes are at risk for the development and onset of common mental disorders. . . such as mood disorders, anxiety disorders, and substance use disorder, symptoms of which had traditionally been called neuroses." Can you see that this is a tautology? In other words, they ask you if you tend to have these kinds of symptoms, then they tell you this is "due to" some "trait" you have called "neuroticism." But they are defining "neuroticism" as people who tend to have more of these kinds of symptoms! It's circular reasoning. I hope you can "see" this! The reason I mention this is they make it sound like they discovered some "trait" you have which causes you to have depression, or anxiety, and so forth. But they haven't! It's just a word game. In fact, scientists don't yet know the causes of any of these problems, and "traits" do not actually "exist." Haike asks: What if you've battled your negative thoughts and self-defeating beliefs and still don't feel happy? An absence of depression and anxiety does not necessarily mean more joy in life. How can you help people find out where they want to go in life, who they want to be, and what it is that brings them happiness?"

If you're my patient, and you want help, I will ask you what specific problem you want help with. These are the four most common problems I see: depression, anxiety, relationship conflicts, or habits and addictions. Then I'll ask you to zero in on one specific moment when you were struggling with that problem. For example, if you want help with depression and low self-esteem, I'll ask you to describe one moment when you were feeling down. It could be any moment at all—it might even be right now, sitting in my office (or reading this text). Then I'd ask you to tell me exactly what you were thinking and feeling at that moment. You might be telling yourself, "I'm no good. I shouldn't have screwed up! I'm always doing that! I'll feel like this forever." These thoughts actually cause the feelings of depression, shame, inferiority, and hopelessness. In contrast, if you want help with anxiety, I will ask you to identify one specific moment when you were feeling anxious, worried, nervous, frightened or panicky. For example, you might have been feeling shy and insecure at a party, or terrified just before you had to take a test or give a talk at work. Or it might have been a moment when you were having a panic attack and feeling like you were on the verge of passing out or losing control and going crazy. If you've been having trouble getting along with a friend or family member, I would ask you to describe one brief interaction you've had with the person you're at odds with, and I'd ask you to write down one specific thing they said to you, end exactly what you said next. For example, a podcast fan told me that his wife said, "You never listen." He responded by saying, "That's not true! I'm listening to you right now." He was puzzled when she got even more upset and then the argument escalated! I recently did a one-day workshop on the treatment of unwanted habits and addictions, like procrastination, overeating, excessive cell phone use, or drinking too much. I encouraged the audience members to focus on one specific moment when they felt tempted to procrastinate, binge, or have a drink, or give in to their habit / addiction, and to write down all the Tempting Thoughts that were going through their minds, like: Oh, that beer looks SO GOOD! I've had a hard day, I deserve it. I'll just take one little sip. That can't hurt! There's a good basketball game on TV. It will be way more fun to watch if I enjoy a few beers! In each case—of depression, anxiety, a relationship problem, or a habit / addiction—I focus on one brief and specific moment when my patient was upset and having that problem. There are two reason for this concept of Specificity: When we understand what was happening at that one brief moment, we will understand everything of importance about that problem. As it turns out, all of your suffering will be encapsulated in that one brief example. So, when you understand why you were feeling depressed or panicky or whatever at that specific moment, you will understand everything you need to know about why you get depressed, or panicky, or whatever at any moment of your life. In addition, the moment you learn how to change the way you were thinking, feeling at that one brief moment, you will become enlightened, and you will suddenly grasp the solution to all of your problems. That's because that one specific problem will simply repeat itself over and over, in slightly different disguises, every time you are depressed, or anxious, or arguing with a friend or family member, or struggling with temptations. So, once you understand the solution to that problem at one specific moment, you will understand the solution to that type of problem at any time in your life. For example, if you were having a conflict with a loved one, you will not only learn how to resolve that conflict at that specific moment, but you will learn how to resolve any conflict you have with that person, or with practically anybody. Fabrice and David link this Specificity concept to the amazing insights of the new branch of "fractal geometry." Fractal geometry is a revolutionary form of mathematics in which a very simple formula, or shape, gets reproduced an infinite number of times. In the process, it morphs from a simple geometric shape and suddenly becomes a complex picture. For example, it may turn into a stunning green fern, or a gorgeous, multi-colored parrot, or a breathtaking landscape. But if you zero in on the tiniest piece of the picture, it will always look exactly the same—the same simple design that started the process. Similarly, in "fractal psychotherapy," we zero in on one very brief moment of your life, but the formula—or error—that caused you to become upset at that moment will always be the very same error you make every time you feet inferior or anxious or angry or tempted. And once you've changed at that one brief moment, you really will experience enlightenment! And your entire universe will become enlightened as well! Fabrice

In this role-reversal of the traditional Feeling Good Podcast, Dr. David Burns and his special guest, Dr. Rhonda Barovsky, interview Dr. Fabrice Nye, your beloved podcast host, on the topic of Mindfulness and Meditation, which are currently popular with the therapeutic community. Fabrice answers questions like these: What's mindfulness? How does it differ from meditation? What's the history of mindfulness as well as meditation? Did it originate with the Buddha, or did it date back even earlier? What are some of the goals and potential benefits of mindfulness? Why specific exercises can you do to develop greater mindfulness ? Why is mindfulness helpful? How does it work? Some people meditate in silence for prolonged times, like ten days, for example. What is the goal here? Are there any dangers of meditation? How does mindfulness differ from yoga, relaxation training, and self-hypnosis? Some people seem to love and benefit from meditation, and others find it uninteresting or even annoying. Why is this? What's the difference in these two groups of people? Is it okay not to be interested in meditation, or is something that everyone "should" do? The goal of mindfulness seems to be learning to deal more effectively with stressful thought and feelings. Does it deal with motivation and the resistance to change? TEAM-CBT makes us aware of the incredible importance of resistance, and provides many methods for reducing or eliminating resistance before you try any Method to "help" the patient. Does Mindfulness Meditation deal with resistance, or would it best be viewed as a method that can help individuals who are already strongly motivated to invest time and effort in their personal growth?

You CAN Defeat Shyness! Lately, I've gotten lots of emails from podcast fans who struggle with shyness, which is categorized in DSM5 (The Diagnostic and Statistical Manual of Mental Disorders) as "Social Anxiety Disorder." This is one of my favorite things to treat, since I struggled with practically EVERY type of social anxiety early in my life, so I really know how it feels and how to defeat it. It's incredibly common. In fact, when I give workshops for mental health professionals, I sometimes ask how many of them have struggled with shyness or public speaking anxiety, and nearly all the hands go up. This podcast will be the first of several on this topic, because it's so common and relatively easy to overcome--IF you have the courage! Here the are several different "flavors" of social anxiety recognized by the American Psychiatric Association, including: Shyness Public Speaking Anxiety Performance Anxiety (such as intense anxiety during a musical or athletic performance) Shy Bladder (or Bowel) Syndrome. This is the fear of peeing or pooing in a public restroom, for fear you'll freeze up or make too much noise and others will notice. Test Anxiety One common theme is the fear that others will notice your anxiety or poor performance and judge you. Another common source of suffering is shame of feeling like you are inherently flawed and will be seen as defective or even as insane by others. Sometimes, these fears become so extreme that they can significantly interfere with relationships and leisure-time activities as well as work. Dan is a podcast fan who courageously immigrated to the United States from Iran as a young man. When he arrived in America, he had little education and almost no knowledge of English. He also suffered from an extreme case of acne, which eventually cleared up, but left him with severe social anxiety. In spite of these problems, Dan worked hard, learned English, and became a top student in college and in graduate school as well, and went on to develop an excellent career. But in certain performance situations, such as public speaking or interacting with strangers, he panics and trembles and his heart races; his mouth twitches and his voice gets shaky, and he has thoughts like these: I'm about to lose control over myself. Others will see my symptoms and think I'm mentally insane. In spite of making Herculean efforts to control these symptoms, I have failed. I will never overcome this. I am defective for life. I will lose my job. David and Fabrice remind listeners that they cannot treat anyone through a podcast, and that there are large numbers of treatment techniques that can be extremely helpful in the context of a compassionate and skillful therapeutic relationship. Since Dan is seeing an excellent therapist, they suggest and illustrate five powerful Interpersonal Exposure Techniques that Dan might want to do under the supervision of his therapist, including: The Survey Technique Self-Disclosure The Experimental Technique Shame Attacking Exercises The Feared Fantasy Technique David and Fabrice also discuss how to address patient and therapist fears of using powerful exposure techniques, and how the avoidance of exposure can sabotage the treatment. They describe four techniques David as developed to help therapists with this, including: Dangling the Carrot The Gentle Ultimatum Sitting with Open Hands Fallback Position David describes "Reverse Hypnosis." This is where the patient hypnotizes the therapist into giving up on exposure thinking that it is "too dangerous," or that the patient isn't "ready" or is "too fragile." And speaking of anxiety, listeners might want to consider the upcoming workshop by David and his colleague, Dr. Jill Levitt, on the treatment of anxiety disorders on May 19, 2019. Check it out below! Also, I promised to post my list of 100 Shame Attacking Exercises, so here it is! It's not perfect, so please have low expectations. It does have some value.

Can the Five Secrets of Effective Communication Help Us in this Era of Intensely Polarized Politics? Clearly, the nation is intensely divided, and passions on both sides of the political divide are characterized by hostility, frustration, and mistrust. Can the Five Secrets of Effective Communication help us communicate with colleagues, friends and loved ones who may have radically different political beliefs? Find out on this edition of the Feeling Good Podcast, as the David and Fabrice respond to Eileen, a podcast fan who kindly allowed us to share her intensely painful conflict with her mother with all of you. Eileen's mother is an ardent Trump fan, and Eileen is an equally ardent anti-Trumper, and there have been plenty of tears on both sides of the aisle! Eileen wrote: "How can you talk to someone with whom you fundamentally disagree? My Mom is a big fan of the current regime (Trump) and I'm horrified by what's happened in the past two years and what's coming. It's hard for me to get past my rage at her. . . intensely distorted and not-reality based beliefs, fed by right-wing media. To be clear, she thinks exactly the same about my beliefs and information sources. I feel so stuck. . . and I would love to repair this relationship with her before she dies." Can you identify with similar conflicts in your own family or circle of friends? I know that I can, and it's quite painful. Fabrice and I will give you our take on a new approach to this widespread problem this Sunday! While you're listening, you can take a look at Eileen's Relationship Journal. You may also want to review the Five Secrets of Effective Communication as well as the three advanced communication techniques we discussed in last week's podcast. Let us know what you think after you've listened to the podcast!

Learning to use the Five Secrets skillfully requires strong motivation and lots of practice, but the benefits can be tremendous. The Five Secrets have transformed my clinical work as well as my personal and professional relationships. And they've also had a huge impact on my teaching. But there are even more communication techniques that can be immensely helpful. In this podcast, we discuss three advanced techniques: Changing the Focus. This technique can be tremendously helpful when there's an "elephant" in the room. Multiple Choice Empathy. This technique can be transformative when you're trying to connect with a teenager, friend or loved one who refuses to talk to you. Positive Reframing. This technique can be invaluable when you're fighting with a colleague, patient, friend or family member, and you're both feeling frustrated, angry, and upset. David emphasizes that these techniques may look easy, but they are actually difficult to learn and require lots of practice as well as the mindset of humility, as well as a strong desire to develop a more loving relationships with the person you're not getting along with. People who are serious about learning can read Feeling Good Together and do the written exercises while you read!

More Great Questions from Listeners Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself "booster shots?" Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do? Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good? Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, "My Mom thinks I should come to see you." When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do? Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this "Do-Nothingism," which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can't do the psychotherapy homework, either! It's a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve! Jim asks another related question: How about doing a podcast on psychotherapy homework? "What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks."

I hope you've enjoyed these episode on Common Therapist Errors, and I apologize in advance if any of the ideas I'm proposing in today's podcast seem "over the top" or simply off base. I teach with great passion, but I'm not always right! Fortunately, my esteemed host, Dr. Fabrice Nye, challenges me quite a bit, and he is almost always right. Hopefully, you will enjoy our dialogue and the chance to think a bit more critically about psychotherapy. And when you find I've made an error, or said something offensive to you, I hope you will put it in perspective. I'm kind of a mixed bag, to be honest. I believe I have a lot to offer, but I've got tons of flaws, too! I fight my flaws, but not always with success. For better or worse, here are today's therapist errors! 1. Confusing psychoeducation with psychotherapy. Pyschoeducation can be helpful, but it's rarely curative. Effective psychotherapy requires much more. Here are some examples of helpful psychoeducation: Teaching people about the list of ten common cognitive distortions from David's book, Feeling Good: The New Mood Therapy Teaching people how to pinpoint their negative feelings at any moment in time using David's Daily Mood Log Teaching people that your thoughts, and not external events, create all of your positive and negative feelings Explaining the Five Secrets of Effective Communication etc. etc. etc. Psychotherapy means helping people CHANGE the way they think and feel, or helping people develop more loving and satisfying personal relationships. That requires a great deal of therapeutic skill and hard work on the part of the patient--during sessions and between sessions. it also requires a warm and trusting therapeutic alliance. 2. Belief in Gurus. Believing that the individuals who start schools of therapy are nice and well-balanced individuals! David describes conversations with the late Albert Ellis, PhD, who argued that many, and arguably most, are incredibly narcissistic and manipulative. Sometimes, individuals who appear incredibly charming and brilliant and inspiring have a dark underbellies they are keeping hidden! David argues that it might be more desirable to have a science-based, data driven, systematic approach to psychotherapy, as opposed to a field dominated by therapeutic schools, which sometimes function almost like competing cults. 3. Reverse / "backward" statistical reasoning. Most therapists who work with patients with Borderline Personality Disorder as well as Multiple Personality Disorder, as well as patients who are prone to violence, believe that childhood trauma, deprivation, or abuse is the main cause of these problems. They believe this because patients with those diagnoses frequently describe traumatic experiences in their past, so they assume those experiences caused the patient's disorder. This is a statistical and conceptual error, because most individuals who experienced traumas when growing up never developed Borderline Personality Disorder or Multiple Personality Disorder. This is not to say that traumas are unimportant—traumatic experiences at any phase of life can be very damaging. What this DOES mean is that most psychiatric problems have other causes. What are those other causes? They are not known, for the most part. This information is not easy for many people to accept. For example, I just found this statement on WebMd: "As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9)." Here's another web comment: "Several studies have shown that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders [7, 8], with a range between 30 and 90% in BPD patients [7, 9]." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/ The same source also stated that: ". . . Widom and collaborators [12] followed 500 children who had suffered physical and sexual abuse and neglect and 396 matched controls, and they observed that . . . the presence of a risk factor, such as adverse childhood events, was not necessary or sufficient to explain the reason why some individuals developed BPD symptoms in adulthood, whereas others did not." If you are interested, you can find the references to these studies at the end of this blog. Here is one way of understanding this error. Childhood sexual abuse is far more common in the population (typically estimated in the range of 15% of men and 25% of women), and if you add childhood trauma or neglect, these percentages in crease even more. AT the same time, the incidence of Borderline Personality Disorder or Dissociative Identity Disorder are typically estimated around 1%. That means that most individuals who have experienced childhood sexual abuse, neglect or trauma do not develop these disorders. I do not in any way mean to minimize the importance of trauma, sexual abuse o