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

I was concerned that our recent "Ten Most Common Therapist Errors" show might antagonize people, but we got quite a lot of positive and encouraging feedback from listeners, which was surprising to me. As a result, Fabrice and I decided to take a chance and publish two more shows on common therapist errors this week and next week. We hope you like these shows! Make sure you let us know what you think, and let me apologize in advance if I come across as annoying or overly cynical. All of the errors I describe are correctable; the goal is to improve the treatment of individuals struggling with depression, anxiety, troubled relationships, or habits and addictions. Thanks! Here are the five errors discussed in today's show. 1. Failure to hold patients accountable. Example, the therapist may let the depressed patient slip by without doing psychotherapy homework, since the patient insists he or she doesn't have enough time or motivation to do the homework; or the therapist may agree to treatment an anxious patient without using exposure, since the patient may resist exposure; or a patient may treat someone with a relationship conflict without exploring the patient's role in the problem, and so forth. David argues that this rarely or never leads to significant change, much less recovery. However, many therapists, and perhaps most, get seduced into this error for a variety of reasons. 2, The "corrective emotional experience." This is the belief that the patient's long-term relationship with the therapist will be sufficient for growth and recovery, without having to do any psychotherapy homework or be accountable. Therapist may imagine himself or herself as the loving and nurturing parent the patient never had. David argues that this caters to the therapist's ego and feeds into what the patient wants as well—a long-term relationship built on schmoozing. But does it lead to recovery? Here's David's short answer: Nope! Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. Your patient may think you're the most wonderful and supportive listener in the world, but that will rarely or never lead to recovery from depression, an anxiety disorder, or an addiction, and it will not lead to the skills to heal troubled relationships, either. 3. Responding defensively to patient criticisms. David argues that therapists almost always react defensively to criticisms by patients, such "you don't' get me," or "you aren't helping," or "you don't really care about me." He describes an interesting five-year study of psychoanalysts in Atlanta, Georgia, sponsored by the National Institute of Mental Health (NIMH), to find out how the analysts responded to patient criticisms. You may find the results surprising! He gives an example of defensive responding during a workshop he conducted at a hospital in Pennsylvania. Therapists can learn to correct this error with lots of practice with the Five Secrets of Effective Communication, but this requires several things: Using the Patient's Evaluation of Therapy Session after each session so can quickly pinpoint empathy / relationship failures. Lots of practice with the Five Secrets. Humility, and the willingness to see the world through the eyes of the patient. This requires the "Great Death" of the therapist's ego! 4. Joining a school of therapy and treating everything with the same method or approach. Can you imagine what it would be like if medicine was organized like this, with "schools of therapy," like the "penicillin school"? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders. Let us know what YOU think! 5. Confirmation paradox. I (David) majored in the philosophy of science in college, and this was one of the first topics, and it definitely applies to our thinking about the causes of emotional problems. I'll try to make it really simple and understandable. Here's the essence of this error. If I have a theory that predicts the patient's behavior you may conclude that your theory is correct. But this logic can be very misleading. Here's a general science example Your theory: the sun circles around the earth. Your prediction: if my theory is true, the sun will come up in the east each morning and set in the west each evening. Your observation: the sun DOES come up in the east and set in the west, exactly as predicted. Your erroneous conclusion: the sun circles around the earth. Now let's consider a psychotherapy example. Many therapists believe that perfectionism and insecurity result from growing up with parents who emphasized hard work and high standards as a precondition for being loved. Now let's assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn't good enough when growing up. So, you conclude that the patient's

Do you have trouble saying "no"? Lots of people do—and it can sometimes get you into trouble. In spite of many best-selling books on assertiveness, like Manuel J. Smith's classic book, "When I Say No I Feel Guilty," many people still have trouble saying no. For example, you may have led someone on in a romantic relationship because you were afraid of saying no and breaking the other person's heart. Or, you feel burned out, because you're always giving, giving, giving because you can't—or won't—say no. Or, you may end up hopelessly over committed at work, putting in long hours and feeling secretly used and resentful, because you don't know how to say no. Sound familiar? In this Podcast, Fabrice and David interview Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Jill confesses that she sometimes has trouble saying no—to new referrals when her practice is full, to her family, who she loves tremendously, as well as colleagues who request this or that. David admits he sometimes has similar problems. There are lots of reasons why you may have trouble saying no. Some are negative, but some are actually positive, including: Conflict phobia. You are afraid that if you say no, the other person will get angry and annoyed with you. Fear of disapproval or rejection. You are afraid that if you say no, the other person will judge you, disapprove of you, or reject you. Perceived narcissism. You believe that other people will lash out if you don't give in to their demands. Submissiveness. You believe that your role in relationships is to make others happy, even at the expense of your own needs and feelings. Joy / Love. Jill confesses that she often says yes to this or that request because she feels it will be fun, or because she doesn't want to let the other person down. One example would be baking brownies for her sons when she's exhausted. One consequences would be giving in, but resenting the person she's saying yes to. Guilt. You may feel that if you say no, it means that you are somehow "bad," and that it's your duty to please other people. Achievement addiction. You say yes to almost everything because you think this or that activity will make you more productive and successful. Fabrice, Jill and David discuss many strategies for overcoming this problem, including: Empathy--as a therapist, you always want to start with empathy, without trying to "help." Motivational strategies such as the Paradoxical Cost-Benefit Analysis, Positive Reframing, or even the Straightforward Cost-Benefit Analysis. This is crucial to find out if patients really want to change before using methods to help them become more assertive. Punting. This is a delay strategy that David uses to get himself off the hook when feeling ambivalent about a request. For example, you can say, "I'm really pleased and honored that you've invited me to do X. I'm going to check with my schedule and see what might be possible, and I'll get back to you." Then, he has a day or two to work up the courage to say "no" in a kindly way. Write down your Negative Thoughts. when you're feeling compelled to say yes because you're feeling anxious or guilty, Ask yourself, "What am I telling myself?" Those thoughts will nearly always be distorted. Then ask yourself how you could challenge and talk back to those thoughts. Fabrice, Jill and David also discuss how to say no effectively and demonstrate this skill in a role-play with Jill that is surprisingly challenging! They also demonstrate the Feared Fantasy, a powerful technique to help patients say no, using Jill's example. Her worst fear is that if she says no to colleagues, they will: Feel disappointed. Become angry and demanding. Will say they won't work with her in the future if she says no. Will say they'll get someone else to do whatever it is, and that Jill will miss out on all the fun. David and Fabrice play the role of colleagues from hell who put demands on Jill to do another podcast and then get upset when she tries to say no. The dialogue is quite entertaining and dynamic, and Jill finds it helpful, though anxiety-provoking. They also describe the importance of giving patients homework to actually say no between sessions to requests that are excessive or inappropriate.

Answers to Great Questions from Listeners Like YOU! Dylan asks: Do you believe in Freud's "secondary gain," in which patients resist change because they benefit from their symptoms? Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing? Ismail asks: Should I use the Daily Mood Log just when I'm upset, or at the end of the day, or when? Do I have to stop what I'm doing when I get negative thoughts so I can write them down and work on them? Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas. Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife? Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?

This is David and Fabrice's top ten list for the worst errors therapists make. 1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists' perceptions of how their patients feel, or feel about them, are not accurate. TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist's ego, but has revolutionized clinical practice. In addition, TEAM therapists assess the patient's perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance. 2. Trying to help, "save," "rescue" or "reassure" patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be "sold" on anything. When patients are hurting, they want to be heard, not saved. In TEAM we do Paradoxical Agenda Setting before trying to "help." We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient's symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that's positive and awesome, Then we raise the question: "Given all those positives, why in the world would you want to change?" This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago. 3. Reverse Hypnosis. Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy. Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure. Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person's bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy. 4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change. With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session. 5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today! I've never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they'll still be just as angry, panicky, and they'll still feel worthless! There is at least one notable exception to this rule. Most anxious patients are exceptionally "nice" and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety. 6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst's feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst's feelings are the complete creation of the analyst's thoughts! And those thoughts will often be distorted and completely misleading. Therapist's perceptions of how their

How can you get rid of Self-Defeating Beliefs? Although any of the 100 + TEAM-CBT methods can be used to modify an SDB, four methods will be highlighted in today's show. Cost-Benefit Analysis Semantic Method Experimental Technique Feared Fantasy For more information on how to change SDBs, you might want to watch the extremely popular David and Jill FB Live show on Overcoming Perfectionism (recorded on November 11, 2018). What research has been done on SDBs? This topic was not discussed in the show, but individuals with an interest in research might want to read David's study with Dr. Jackie Persons on the causal connections between depression and SDBs about dependency (attachment) as well as achievement (perfectionism) in several hundred patients in Philadelphia during the first 12 weeks of their treatment at David's clinic. The study confirmed That both types of SBS were significantly correlated with depression severity at intake and at the 12-week evaluation. In addition, changes in depression were correlated with changes in SDBs. However, a sophisticated statistical analysis with structural equation modeling techniques did not confirm that SDBs had causal effects on depression, or that depression had causal effects on SDBs. Instead, SDBs and feelings of depression appeared to share an unknown common cause. Persons, J. B., Burns, D. D., Perloff, J. M., & Miranda, J. (1993). Relationships between symptoms of depression and anxiety and dysfunctional beliefs about achievement and attachment. Journal of Abnormal Psychology, 101(4): 518 - 524.

Rajesh asked: Is it possible to change an SDB? Does the mere knowledge of an SDB change it? How long does it take to change an SDB? How do you change SDBs? Nikola asked: Aaron Beck said the SDBs never really go away. They just get activated and deactivated and activated again. Does this mean that depression is an incurable disease that will keep coming back over and over again? What's the point in battling against a core belief if it cannot be changed? Fabrice and I appreciate your questions--they often give us ideas for shows! In today's Podcast you'll learn the answers to several questions about Self-Defeating Beliefs. What's the difference between Self-Defeating Beliefs (SDBs) vs. Cognitive Distortions? The thoughts that contain cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Discounting the Positive, and Self-Blame are distortions of reality, they are the cons that trigger depression and anxiety. When you're upset, these thoughts will flood your mind. These thoughts can be show to be false, and when you crush a distorted negative thought, you'll immediately feel better. Self-Defeating Beliefs are stipulations, values that you've set up for your self. For example, you may base your self-esteem on your accomplishments due to your belief that people who accomplish more are more worthwhile as human beings. SDBs like this cannot actually be shown to be false--they are simply your personal, subjective values, and they are thought to be with you all the time, and not just when you're depressed, anxious, or angry. The question with an SDB is this: What are the advantages and disadvantages of having this value system? How will it help me--what are the benefits--and how might it hurt me? What's the downside? Why are Self-Defeating Beliefs thought to be important? When you challenge and defeat a distorted thought, you feel better in the here-and-now. When you challenge and change an SDB, you change your value system at a deep level. This is thought to make you less vulnerable to painful mood swings and relationship conflicts in the future. What are the different kinds of SDBs? David's list of 23 Common SDBs is attached. This list is not comprehensive, as there are many more, but the ones on the list are very common. There are several categories of SDBs. Individual SDBs are often "Self-Esteem Equations" Perfectionism Perceived Perfectionism Achievement Addiction Approval Addiction Love Addiction Interpersonal SDBs are expectations of what will happen in certain kinds of relationships, or relationships in general What's your understanding of the other person's role in your relationship? What adjectives describe him or her? What's your understanding of your person's role in the relationship? What adjectives describe you? How would that kind of relationship feel? What rules connect the two roles? Other kinds of SDBs Anger / conflict cluster Entitlement Truth Blame Anxiety cluster Niceness Conflict Phobia Anger Phobia Emotophobia Submissiveness Spotlight Fallacy Brushfire Fallacy How can you identify your own, or a patient's, Self-Defeating Beliefs? Look at the list of 23 individual SDBs (easiest). You might want to do that right now. Review the list, and you'll probably find many of your own beliefs! Individual Downward Arrow Interpersonal Downward Arrow

I recently did two terrific interviews (Podcasts #92 and #111) with Stephanie James on her superb radio show and podcast, The Spark. Today, Fabrice and I are bringing you my third and final interview with Stephanie, as we describe how to convert conflicted relationships into loving, rewarding ones. Stephanie said it was her favorite interview, although all three were really fun for me. Today you will once again hear how dynamic, warm and positive she is! My first interview with Stephanie was on the amazing inner power we all have to change our thoughts, feelings, actions, and lives. We talked about how to transform your automatic negative thoughts and create a more joyful present and a more fulfilling future. My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. We highlighted the amazing new motivation-busting techniques that can lead to extraordinarily rapid recovery. Stephanie also recently interviewed our beloved colleague, Dr. Matthew May, a psychiatrist who is a phenomenal TEAM therapist. Click here if you'd like to take a look and listen. Matt has worked with Fabrice and me on our podcasts--you may remember the amazing and inspiring podcasts featuring live therapy with Marilyn. Stephanie is a outstanding therapist and radio personality from Colorado. It was an honor to be on her show on three occasions. Stephanie is co-authoring a book on how to live a "spark-filled life." It should be completed soon, so you'll likely be hearing much more from Stephanie during 2019!

This dynamic interview covers the integration of TEAM-CBT with Christianity as well as Judaism, Buddhism, Hinduism, the Muslim faith, and more. Mike, Fabrice and I describe many areas of overlap, as well as some potential conflicts, between the teachings and methods of TEAM-CBT and religious beliefs. Mike and I suggest that religion and TEAM-CBT are, in fact, attempting to do the exact same things using slightly different language and symbolism. We strongly agree that at the moment of recovery, a person's religious beliefs are nearly always strengthened and deepened, and never challenged or belittled. Mike, Fabrice and I also discuss topics like religious scrupulosity, religious obsessions, cognitive distortions (John 8:32: "The truth will set you free"), and the so-called "dark night of the soul" described by Christian and Buddhist mystics. We also talk about the spiritual and psychological aspects of enlightenment (e.g. salvation), Should Statements, the Disarming Technique, forgiveness, repentance, the death of the ego, pride vs. humility, and more. If you have an interest in religious or philosophical topics, you will love this podcast! You might also enjoy the podcasts with Marilyn on what to do when you've lost your belief in God and find yourself in darkness and intense suffering! Mike Christensen treats individuals throughout Canada via teletherapy and also offers online training for mental health professionals throughout the world. If you have a question for Mike, or wish to contact him, you can find him at www.FeelingGoodInstitute.com.

Fabrice and I were thrilled to interview our dear friend and colleague, Stephen Pfleiderer, who is the first therapist in the world using TEAM-CBT techniques in the treatment of habits and addictions, including life threatening addictions, like intravenous heroin or meth marijuana alcohol binge eating procrastination smoking internet porn and more Stephen begins with his personal story of excessive beer drinking starting in high school through his junior year in college when he hit a personal crisis, telling himself, "My life sucks. I can't live like this. I'm a loser." He decided to enter a 12-step recovery program, which helped tremendously, and eventually joined David's weekly TEAM training group at Stanford because of his dream of becoming a professional addiction therapist and interventionist.

Rebroadcast of a fabulous interview David did recently for "The Upgrade" Podcast (sponsored by the popular Life Hacker website with hosts Melissa Kirsch and Alice Bradley on a range of topics, including: Why did you write Feeling Good: The New Mood Therapy? Is depression caused by a chemical imbalance in the brain? What's your experience with electro-convulsive therapy (ECT)? Why did you give up your research career in biological psychiatry? How can you tease out your negative thoughts when you know you're depressed but you just can't think of any thoughts? How does TEAM-CBT differ from conventional CBT? Can you use TEAM-CBT with severe problems, or is it only for individuals with mild mood disturbances?

1. Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What's the best degree? Should you go to school to become a psychologist, clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning! 2. Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies. 3. Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called "somatic" symptoms of depression, like insomnia or changes in appetite. For example, some "experts" would argue that the following are all symptoms of clinical depression: insomnia or the opposite—sleeping too much; increased appetite or the opposite--decreased appetite; loss of interest in sex, or the opposite, sex addiction; loss of interest in work, or the opposite, being a workaholic. How can opposite symptoms be symptoms of depression? Does this make sense? Are these really the symptoms of depression, or simply non-specific symptoms? What are the five key symptoms of real depression? 4. Kevin is a therapist with a simple question: How do I get over my desire to help? 5. Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn't making any progress in the therapy.

One of the goals for our Feeling Good Podcasts is to bring the TEAM-CBT techniques to life for mental health professionals, patients, and the general public as well. I (David Burns) use more than 50 Techniques when I'm working with individuals with depression, anxiety disorders, relationship problems, or habits / addictions. Today we will compare and contrast the four Truth-Based Techniques, including: Examine the Evidence The Experimental Technique The Survey Technique Reattribution These were among the first cognitive therapy techniques ever developed, and they were based on the work of Dr. Aaron Beck, from Philadelphia, as well as Dr. Albert Ellis, from New York. Dr. Ellis is the Grandfather of Cognitive Therapy, and he described many of these techniques in the 1950s. He called his treatment Rational Emotive Therapy, and it's still popular today. During the 1960s, Beck, who is considered the Father of Cognitive Therapy adapted the ideas of Dr. Ellis to the treatment of depression, and called his version of the treatment Cognitive Therapy. Beck emphasized that depression results from a negative view of the self, the world, and the future. In other words, the patient may think: I'm a loser. (negative view of the self) Nothing i do will be successful or rewarding. (negative view of the world) Things will never change. I'm hopeless. (negative view of the future) Beck claimed that the negative thoughts of the depressed individual are the actual cause of the depression. He also emphasized that the disturbing negative thoughts of depressed patients are nearly always distorted and illogical; however, depressed individuals don't realize that they're fooling themselves, so they think their negative thoughts are absolutely valid. Beck also claimed that depression could be treated without drugs in many cases, and focused his treatment on challenging the patient's distorted negative thoughts. Beck often compared depressed patients to scientists who have a theory about the world that simply isn't true. That's why scientists learn to test their theories by examining evidence and performing experiments. Beck suggested that depressed patients could also test the validity of their negative thoughts and beliefs by examining the evidence for and against what they're telling themselves, as well as by doing actual experiments to test their thoughts and beliefs. David and Fabrice bring the four basic truth-based techniques to life with actual patient examples. They answer the question, "What's the difference between Examine the Evidence and the Experimental Technique?" And "How does the Survey Technique work?" They emphasize the tremendous importance of warmth and empathy, as well as melting away patient resistance, before trying to implement any of these techniques. They also emphasize that these techniques, like all of the techniques, are powerful, and must be used with skill and compassion, or else they can backfire.

This is the second of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Stephanie is an experienced therapist and dynamic radio personality from Colorado. She is co-authoring a book on how to live a "spark-filled life." This interview with Stephanie focused, in part, on the evolution of the new TEAM-CBT from traditional Cognitive Behavioral Therapy (CBT). Stephanie asks Dr. Burns questions on a wide range of topics, including: How would you treat a case of social anxiety? What is "therapeutic whitewashing" and how can therapists get over it? What should therapists do instead? How would you work with violent incarcerated teenagers, such as gang members? Why is it so important for therapists who are learning TEAM-CBT to check their egos at the door? After you published your first book, Feeling Good, and the first research study on CBT was published, cognitive therapy swept the world. After your initial euphoria, your enthusiasm dimmed somewhat. Why? And what new direction did your research lead? What are the most common errors that therapists make in thinking about the causes of therapeutic resistance? How can you overcome a patient's resistance to change? Can TEAM-CBT work rapidly for someone with horrific abuse and decades of failed therapy? How can you prevent relapses following the patient's initial recovery? Dr. Burns' third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.

Fabrice and David address several challenging questions submitted by individuals who listen to the Feeling Good Podcasts. Richard: Do you have to get along with everybody? How do you deal with a sociopath? Dave: Positive distortions can trigger mania, addictions, narcissism, and violence--but how can you get rid of them? Julia: What can you do if you've been depressed all of your life and wake up every morning with your mind flooded with negative thoughts? I spend two hours trying to dispute them, but they just keep coming back the next day. Omhur: How would you treat "Reading OCD?" I feel compelled to read every sentence and paragraph carefully and repeatedly so I won't miss anything! Unnamed fan (who left a negative review on iTunes): Isn't your concept of the death of the ego potentially dangerous to people with low self-esteem who are being abused? Thank you for your terrific questions, your frequent praise, and your occasional criticisms and challenges. They keep us on our toes, and we deeply appreciate all of you. So keep your comments coming, as well as your suggestions for shows and topics you want to hear more about! We are receiving more than 50,000 downloads a month. Please tell your friends about us so we can continue to build our audience. Thanks! We really enjoy doing these shows for you.

A podcast listener asked about what techniques David is the most proud of. We briefly discuss each one on today's podcast. So here they are! The list of Ten Cognitive Distortions The Disarming Technique and Law of Opposites The Externalization of Voices plus Acceptance Paradox The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow The Feared Fantasy and Acceptance Paradox The Experimental Technique for extremely rapid treatment of patients with Panic Attacks My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain Brief Mood Survey Positive Reframing The use of extended, two-hour therapy sessions

David emphasizes that there are two issues. First, can your "self" be validly judged as not good enough, as inferior or even worthless? Or, can your "self" be validly judged as more worthwhile, or even superior? And is it really true that some people are more worthwhile, or less worthwhile, than others? Do more worthwhile, or less worthwhile human beings exist? Second, do we even have a "self?" Fabrice talks about the history of the concept of ego. For example, Freud divided the human mind into three parts: the id, ego and superego. Do these really exist as "things," or are they just concepts, or metaphors for talking about the mind? When you try to think about the "ego" or the "self" as a thing, that's when you get in trouble. David argues that if you believe that someone people are "more worthwhile" or "less worthwhile," you'd have to define what a of worthwhile human being is.

Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns' Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.

This is the second podcast on relationship problems. with Dr. Helen Yeni-Komshian. In today's podcast, we address four questions from listeners like you: Our marriage lacks intimacy. What can I do? A podcast fan named David explains that his relationship with his wife is no longer intimate; he complains that they only talk about day to day things on a superficial level. David wants to know if he needs to inject some conflict into the relationship to make it more meaningful or exciting. Why is my wife so critical of me? David wants to know why his wife constantly peppers him and batters him with critical questions, and what he can about it. Why is my friend so critical and dogmatic? Rajesh describes a friend who argues endlessly and accuses Rajesh of being irritating. His friend says, "Anyone would be upset when they try to talk to you!" What's up? Why is this happening? Who's really to blame? Adarah feels lonely and tells her husband what he can do to make her feel loved--but it just doesn't seem to work! Why? And what CAN she do to improve her marriage? I think you will enjoy the lively dialogue between Fabrice, Helen and myself and see us struggling and making some mistakes, too, when we try to model more effective responses based on the Five Secrets of Effective Communication! We also stress, once again, the importance of Interpersonal Decision-Making any time you run into a conflict with a friend, colleague, or loved one. For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.

We have invited Dr. Helen Yeni-Komshian to join Fabrice and me for two consecutive podcasts on questions listeners have asked about troubled relationships. In today's podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to "keep the peace," it just gets worse. His complaints escalate! This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What's the secret of dealing with a whiner or a complainer? Is it even possible. Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You'll LOVE this lively dialogue!

David describes research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain? And what can we do to help patients with physical pain and intense negative emotions? In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?

Today we answer six questions submitted by listeners like you: Harald: How can I find the Show Notes for the Feeling Good Podcasts? Kristin: How do you help patients who obsess about past traumatic events, with intrusive thoughts about a cruel ex-lover or bullying by classmates? These thoughts can feed into the idea that their life is miserable and they can't move forward because they feel blocked by these harmful memories. Valentina: How are cognitive distortions, self-defeating beliefs, and feelings of depression transmitted? What you describe in your books seems to describe my mother's behaviors when I was growing up? Could it be that depression is transmitted by the family? Alicia: How would you treat someone with cyclothymic disorder who cycles between euphoria and suicidal depression? He's happy now, so how do I get him to fill out the Daily Mood Log? Kathy: I'm a big fan, and I have a question about "bibliotherapy." What's the best way to use your books and other materials to help yourself? Matthew: Do you ever use drugs in the treatment of depression? Are medications sometimes necessary or helpful?

Suicidal thoughts and urges are very common among depressed patients. The vast majority of depressed individuals have thoughts of suicide from time to time, and some struggle with serious suicidal urges. The experts tell us that 10% to 15% of chronically depressed individuals do eventually commit suicide, even if they are receiving treatment for depression. It is hard for me to believe that suicide is that common, but even if it is only 2% or 3%, that's still very significant, especially if you have a large clinical practice and you treat lots of depressed individuals. Suicide attempts are shocking and devastating for the patient, for the family, and for the therapist as well. The loss of a patient through suicide is the dark side of our profession. The loss of life is a horrible and unnecessary tragedy, since the feelings of hopelessness that trigger suicidal urges are always the result of cognitive distortions; the belief that you are hopeless and cannot improve is never valid. Yet, the depressed patient does not realize this, and sometimes turns to suicide as the only way out of the suffering. Sadly, clinicians' capacity to assess suicidal urges in patients they are treating is very poor, and not significantly different from zero. In this podcast, I describe how you can solve this problem with the use of the EASY Diagnostic System and suicide interview at the initial evaluation, and the use of the Brief Mood Survey at all subsequent sessions, with no exceptions. In this podcast, I focus on two things. First, how can the clinician identify and evaluate a new (or old) patient who is struggling with suicidal thoughts and fantasies and determine if the patient is at risk for a suicide attempt? Second, how can the therapist make the patient accountable and guarantee that the patient will not now, or ever, make a suicide attempt? The "defensive psychotherapy" I recommend will sound unfamiliar to many therapists but can save lives and make your practice far more peaceful and rewarding! The approach to the suicidal patient involves Paradoxical Agenda Setting techniques, including the Gentle Ultimatum and Sitting with Open Hands.

The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest! Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the "inner universe" Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time. The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon. Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective. Dr. Noble also discusses David's "fractal" theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the "homeostasis" of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse. This is because neurons that "fire together wire together." In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together. Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well. Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right. Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!

Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about David's path into the mental health field the difficulties and rejections David faced getting his first book, Feeling Good, published David's advice to listeners interested in therapy how he approaches perfectionism, depression, and anxiety with patients the joys of a life free from the need to be special— and much more! Lisa's show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa's most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.

David and Jill do M = Methods, and show Lee how to respond to his wife more skillfully, using the Five Secrets of Effective Communication (link). Like everyone who is trying to learn the Five Secrets, Lee struggles with several blind spots: "I Feel" Statements. Lee has tremendous difficulties sharing his feelings openly, in a respectful manner. He seems indoctrinated with the cultural idea that men should not be vulnerable and express feelings. Lee makes the common error of "problem solving" instead of asking his wife to share more of her feelings. Lee makes another common error of apologizing and using the trite phrase "I'm sorry" instead of encouraging his wife to open up. David discusses the different between dysfunctional and effective apologies. David and Jill do lots of role-play practice with Lee and give him a homework assignment. T = Testing. After the session is over, Lee completes the Brief Mood Survey again. His scores indicated that his feelings of anxiety and anger have completely disappeared, and he also has a perfect score Positive Feelings Survey and the Relationship Satisfaction Scale. He also gave David and Jill perfect scores on the Empathy and Helpfulness scales and wrote what he liked the best about the session: "My epiphany came at the moment I realized I had been afraid of emasculating myself and realizing that my vision of what a "man" should be was completely inaccurate." At the end, Jill reads an emotional email from Lee describing how he relapsed and started arguing with his wife, and then remember to empathize use the Five Secrets instead, with an amazing result!

David and Jill do A = (Paradoxical) Agenda Setting with Lee, starting with the Invitation: Jill asks Lee if he wants help with the relationship conflict, and if this would be a good time to roll up our sleeves and get to work. Lee indicates that he does want help. They review the first two steps of his Relationship Journal, where Lee had recorded one specific thing his wife said to him, and exactly what he said next. Here's what he wrote down: Step 1 – She said: Write down exactly what the other person said. Be brief: I was trying to convince my 18-month-old daughter to put her pajamas on. I was calm. Eventually, I raised my voice an octave or two and in a stern voice I told my daughter to put her pajamas on. Afterwards, Liza said, "I don't think you need to use that tone with a small child." Step 2 – I said: Write down exactly what you said next. Be brief: I said, "I don't think there was anything wrong with what I did. You can be stern without losing your shit*. There are times when she needs to know I am serious and not messing about anymore." It then devolved into a debate over a clash of values on how to raise our daughter. * Transcribed as-is from Lee's Relationship Journal. Lee also circled all the emotions he thought she was having, along with all of the emotions he was having. He thought she was feeling: Sad and unhappy Anxious and worried Rejected and alone Discouraged, pessimistic, and despairing Frustrated and stuck Angry, annoyed, irritated and upset Other feelings: troubled, defensive, dismayed, downhearted, and disconnected Here's how he was feeling: Unhappy Anxious and worried Guilty, remorseful, bad and ashamed Inferior, inadequate, defective and incompetent Embarrassed, foolish and self-conscious Hopeless, discouraged and despairing Frustrated Angry, mad, resentful, annoyed, irritated, upset and furious Other feelings: hostile, loud, critical, agitated, defensive, stubborn, exasperated, sarcastic, powerless, diminished, low, resistant, confused, judgmental, vulnerable, inept Step 3. Good vs. Bad Communication. When David and Jill ask Lee to examine his response to his wife, he had to admit that his response in Step 2 had all the characteristics of bad communication—he did not acknowledge any of her feelings, he did not share his own, and he did not convey love and respect. This was disturbing and surprising to Lee. Step 4. Consequences. When David and Jill asked Lee to examine the impact of what he said to his wife, they suddenly ran into a wall of resistance, which is almost universal in relationship work. The Relationship Journal is an incredibly powerful tool, and it can be extremely painful because you have to stop blaming the other person and examine your own role in the relationship. Lee suddenly and painfully discovered the answer to his question of why his wife was so controlling and critical of him—it was NOT because of the influence of her mother, but rather because he was forcing her to treat him like that almost every time he interacted with her. This insight cannot be denied when you do the Relationship Journal, and it's potentially incredibly empowering, but it can be incredibly painful at the same time. You will also hear a masterful and paradoxical response by Dr. Levitt when Lee resists—and as a result, his resistance suddenly disappears, and he jumps on board!

For the past couple months, Fabrice has asked me to set up a live therapy session to illustrate how to treat troubled relationships using TEAM-CBT. I was fortunate to get an email request from a colleague named Lee who wanted help with his marriage. He explained that his wife was very controlling and critical of him and attributed this to the fact that she had a controlling mother. This is very typical in troubled relationships, most of us are convinced that the problem is the other person's fault. Of course, Lee told us that his wife, in turn, blames back and feels that Lee is the one who needs to change. Lee initially thought we'd do couples therapy, but in TEAM-CBT we actually prefer to treat just one person in a troubled relationship. Two weeks ago, Jill and I sat down with Lee on a Saturday morning, linking to each other on the internet since he lives abroad, for a three-hour treatment session. The session has been broken down into three separate podcasts plus commentary from Fabrice, Jill and David on each of the three segments. By way of disclaimers, Lee is a colleague who does coaching for individuals with alcohol addiction problems. We are not entering into a formal treatment relationship with Lee. Instead, he has offered to help us illustrate a therapy technique, using a real person problem, as part of his training and personal growth. We are deeply grateful to Lee for letting us share his intensely personal "session" with you! Today, you will hear the first segment on T = Testing and E = Empathy. Lee will tell his story. Jill and I will listen without trying to "help" or "rescue" Lee. On the Brief Mood Survey, he indicated no depression or suicidal urges. He was mildly anxious and slightly angry. His Positive Feelings Survey indicated that he was quite happy except in two areas: He felt only moderately close to people and only slightly connected to others. You will also hear him say that he felt like one of the loneliest people we would ever meet toward the end of the empathy phase of the session.

How to select the techniques that will be most helpful for various kinds of problems, and how to individualize the treatment for each patient.

For a long time, Fabrice has wanted to do a show on my list of "Fifty Ways to Untwist Your Thinking" called "Fifty Ways in Fifty Minutes." So we finally did it, and it was fun! If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable." Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades. And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them. That's why I've developed more than fifty methods to help you crush the negative thoughts at the heart of your suffering. So today, you'll take a look at the landscape!

For a long time, Fabrice has wanted to do a show on my list of "Fifty Ways to Untwist Your Thinking" called "Fifty Ways in Fifty Minutes." So we finally did it, and it was fun! If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable." Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades. And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them. That's why I've developed more than fifty methods to help you crush the negative thoughts at the heart of your suffering. So today, you'll take a look at the landscape!

I recently did the first of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Here's how Stephanie described the interview (with minor changes): We have amazing power within us to change our thoughts, our feelings, our actions, and our lives. This episode is an inspirational way to take control of your automatic negative thoughts today and transform them in order to create a more joyful present and a more fulling future. Join us as we talk with the legendary Dr. David Burns about how we can break through the old thinking habits that bind us and begin to live a more happy, harmonious life where we can feel good now. Stephanie is a superb therapist and dynamic radio personality from Colorado. It was an honor to be on her show. She is co-authoring a book on how to live a "spark-filled life." It should be completed soon, so you'll likely be hearing from Stephanie a lot next year! Following the interview, Stephanie visited my Tuesday training group at Stanford and participated in one of our Feeling Good Podcasts with some students in the group. She suggested we might want to broadcast the Tuesday group live so that therapists from all over the world could join us. We are thinking about that, but will have to check with the powers that be to see if we could get permission to broadcast from Stanford, as well as our Tuesday group members who may have mixed feelings, due to the intensely personal nature of the training. Let me know what you think about this idea! My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. Fabrice and I will publish it for you shortly. My third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.

I had a magical fantasies of what would happen once I was an "author." The reality was quite the opposite and quite painful, with almost endless rejections accompanied by feelings of self-pity and defeat. For example, soon after publication, I learned my book was at the top of my publisher's "loser list." Then I discovered that magazines, newspapers, and TV and radio shows had no interest in it whatsoever. I hope you enjoy the story. It's all about the celebration of failure and the conversion of failure into success.

I was recently interviewed by author, professor, and documentary filmmaker Roy Germano for his outstanding Other Side Podcast. Fabrice and I thought you might enjoy this interview, and Roy graciously gave us permission to share it with you. You will get some personal glimpses into the early days of my career, including why I left academics to pursue a full-time private practice, along with some of controversies about antidepressants. You will also hear a story of what happened when I was trying, rather unsuccessfully, to get my first book, Feeling Good, published. It wasn't easy, and it almost didn't happen! Roy is terrific and his podcasts cover a wide range of topics. You can find his podcasts on iTunes.

David and Fabrice answer five intriguing questions submitted by listeners: Joshua: How can I cope with panic attacks during job interviews? Dan: I feel traumatized by criticisms from my boss at work. what can I do? Susan: How fast can you taper off of anti-anxiety drugs and antidepressants? Ross: What if a patient who's been the victim of trauma or abuse asks for a male therapist? Isn't this a form of avoidance? Should patients be matched to therapists based on gender? Isn't it best to avoid the situations that trigger you? Sumit: I think I have "endogenous depression." Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression? If you have a question, make sure you email david and we will try to answer your question on an upcoming Ask David Podcast!

The Devil's Advocate Technique is another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as: Drug or alcohol abuse Overeating / binge eating Shopping addiction Internet addiction And procrastination, which is our problem for today. David and Fabrice are joined by Sara Shane, a member of David's Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.

David describes watching Dr. Maxy Maultsby do a demonstration of the Double Standard Technique when he was a psychiatric resident in the 1970s at the University of Pennsylvania medical school. He was quite surprised when the patient, who was severely depressed and suicidal following a break-up with her boyfriend, improved dramatically within an hour. David modified the technique in several ways, and tonight will present what is probably the most powerful way to use this technique. The technique is based on the idea that most of us operate on a double-standard. When we are upset about some failure, mistake, or inadequacy, we tend to beat up on ourselves mercilessly. But if we were talking to a dear friend with the exact same problem, we'd be far more compassionate and realistic. Once you make the patient aware of this double-standard, you ask if he or she would be willing to talk to himself or herself in the same way he or she would talk to a dear friend. But the unique feature of the way David does it, is that you, the therapist, "become" a dear friend of the patient, kind of like a long-list identical twin who is actually virtually identical to the patient, but a different person. Then the therapist (playing the role of the friend) describe the problem the patient is struggling as if it is your own problem.

David's explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique--while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT. Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and "Sarah," one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.

This interview was first published on Neil Sattin's highly regarded Relationship Alive Podcast. Although some of the material may be familiar, there's much that's new, and you will enjoy the chemistry between Neil and David as they discuss each of the ten cognitive distortions and raise many challenging questions, such as: Is it really true that only our thoughts--and NOT external events--can change the way we feel? If someone has the belief, "I'm unlovable," isn't that type of thought immutable? How could you possibly change or modify a thought that may be rooted in traumatic experiences and so deeply embedded in a patient's psyche? Should we try to change other people's cognitive distortions, or just our own? How can we challenge each of the ten cognitive distortions? And much more! David's first interview with Neil received more than 25,000 downloads in the first month, and this riveting interview promises to be every bit as popular. If you want to download a transcript of this exciting interview, you can do so at www.neilsattin.com.

In this podcast, David and Fabrice answer five challenging questions submitted by listeners: Galina asks whether we always have to face our fears? Isn't it okay to be anxious sometimes? Courtney asks how to find the supplemental written materials, tests, and diagrams if you have purchased the eBook or audio-book copy of Feeling Good: The New Mood Therapy. Carlos asks about the best treatment for smoking cessation. During the discussion, Fabrice asks if Paradoxical Agenda Setting is important for therapists using hypnotherapy. Avi asks whether humans have a dark side, with dark negative motives that sometimes compete with positive, loving motives. And if so, how do therapists help patients deal with their own negative motives? Ben asks what to do if you're very anxious but simply can't pinpoint your negative thoughts.

In this podcast, David and Fabrice answer several fascinating questions submitted by listeners: Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts? Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week. Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?

"I'm a failure. . . I'm not good enough. . . My life will be empty and meaningless without . . . " Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering. Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems. Today, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.

Let's face it--nearly all of us fall into the black hole of depression, anxiety, shame, and self-doubt at times. Then it's time to ask yourself what you're telling yourself, write down your negative thoughts, identify the distortions in them, and substitute thoughts that are more positive and realistic. Sound too easy? The results can be mind-blowing! David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT. David hopes to make the actual video of this dramatic therapy session available soon right here at www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.) While listening, you can download pdfs about each of seven steps to help you break out of bad moods and boost your self-esteem.

Procrastination is one of the most common causes of unhappiness, and this bad habit is almost universal. We all put off the tasks we dread because they make us anxious, and because we're tempted to do other things that are way more rewarding. But the longer you procrastinate, the worse you feel, and this robs you of motivation. As a result, you fall into a vicious cycle where procrastination triggers negative feelings like depression, anxiety, and guilt, and your negative feelings, in turn, reduce your motivation and trigger more procrastination. A vicious cycle. Fabrice and I are going to show you how to break the cycle and boost your happiness. To get started, please think of ONE thing you've been procrastinating on. It could be anything, such as working on your taxes, cleaning your garage, filing papers, working on a paper or presentation you've been avoiding, reading something you have to read for school or work--anything at all. Now I want to ask you a question. Would you like to overcome the procrastination so you can get started on that task? If your answer is no, you can come back and listen later when you do want to solve this problem. If the answer is yes, then I have a second question for you. WHEN would you like to overcome your procrastination and get started? Today? Or later on? If your answer is today, then we're ready to rumble. If you say, "tomorrow," or some later time, then I'd encourage you to come back to this podcast when you are ready to solve the problem. I can ONLY help you overcome your procrastination today! NOT tomorrow. Finally, I want to know if you'd be willing to devote a very small amount of time to getting started TODAY. I'm asking you to invest something like five minutes, and I'm also asking you to agree to limit your work this small amount of time. This is crucial, because if you tell yourself you have to do the entire job, that may take hours, and you'll probably feel so overwhelmed that you won't do a thing! Finally, I want to know if you'd be willing to get started for five minutes even if you're not "in the mood," and even if you're completely unmotivated, and EVEN if the very thought of the task makes you anxious and guilty. If the answer is YES, then we've got a deal. But if you want to wait for the motivation, I urge you to turn off the podcast and come back to it at some later time. One philosophical principle is the approach we're going to teach you is NOT to wait for motivation. Most procrastinators think that motivation comes first, followed by productive action, but this is an illusion, because you'll probably NEVER feel motivated to do some awful task you've been putting off. If you're waiting for motivation, you'll be waiting forever! As I wrote in my first book, Feeling Good: The New Mood Therapy, highly productive people know that ACTION comes first, followed by motivation. In other words, you have to get started on some task before you'll feel motivated. You're not entitled to feel motivated until you've start accomplishing something! Waiting for motivation is the trap that keeps your procrastination alive and prospering. I'm going to make things simple for you using a tool I created years ago called the Anti-Procrastination Sheet! To make this podcast experiential, think about the specific task you've been putting off, like filing papers, preparing your taxes, cleaning the garage, a paper or report you have to prepare--anything at all. Now take a look at the Anti-Procrastination Sheet. As you can see, it has five vertical columns, but they're different from the columns on the Pleasure Predicting Sheet that we discussed in last week's podcast. In the first column you break the task into small, or even tiny, steps, and number them. Make sure that each step can be completed quickly and easily--for example 30 seconds, or a minute or two. You don't have to outline the entire task, just the first four or five steps. And make sure the steps are small enough so you can complete all or most of them in five minutes or so. The philosophy behind this is called "little steps for big feats!" If you aim to do just a little, you may end up doing a great deal. But if you aim to do it all at once, the odds are high that you'll just end up procrastinating, because the task will seem overwhelming. After you've outlined the first few steps, predict how satisfying or rewarding each step will be in the second and third columns, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity. And make sure you do it on paper, and not just in your head! Now complete the first step, and indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100% in the fourth and fifth columns. That's all there is to it! Now do the same thing for the second step of the task.

David begins with a brief discussion of the philosophy of happiness, including the ancient Buddhist idea that everything in the universe is transitory and constantly changing, including our positive and negative moods, so the idea that you will be hopelessly depressed forever, or endless happy, are both illusions. Happiness, or pleasure, are transitory, and can only be achieved at specific moments. However, you can significantly increase the number and duration of the happy periods in your life. David briefly discusses research evidence that simply doing potentially satisfying and rewarding activities, whether or not you're "in the mood," can reduce depression and enhance feelings of happiness and joy in daily living. This simple treatment method, called "Behavior Therapy," was pioneered by Dr. Peter Lewinsohn, from the Oregon Research Institute, and has been shown to have significant anti-depressant effects. One way of doing this is with David's famous "Pleasure-Predicting Sheet." It's pretty simple to use. As you can see from the link, it is a sheet with four vertical columns. In the first column, you schedule activities with the potential for pleasure, learning, personal growth, or helping others. You can include activities that are not overly time consuming or burdensome. In the second column, record who you plan to do each activity with. If you do the activity alone, put "self" in the second column, since you're never truly alone. You're always with your "self." In the third column, predict how satisfying or rewarding the activity will be, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity! And make sure you do it on paper, and not just in your head! Once you've completed each activity, indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100%. That's all there is to it! Then you can compare the last two columns (the predicted and actual satisfaction). Sometimes, depressed individuals think that things they used to enjoy will be boring or unrewarding, so they give up on things, fail to answer the phone, and mope around at home in a state of hopelessness and self-pity. Of course, that's a self-fulfilling prophecy and a vicious cycle, because when you stop doing things, you will probably become more depressed, and then you'll be even more likely to give up doing things for pleasure. In contrast, when you do things, you may discover that many activities are more rewarding than you anticipated. You can also compare the satisfaction you experience when doing things by yourself versus the activities you do with others. Many depressed people with the Love Addiction believe they cannot be happy when they're alone, thinking they must be loved to feel truly happy and fulfilled. David describes a woman who tested this belief, and made an unexpected discovery, after her husband rejected her for another woman. You can see her Pleasure Predicting Sheet if you click here. Finally, David gives an example of how a depressed, perfectionistic medical professor made another unexpected discovery with a modified version of the Pleasure-Predicting Sheet. The Pleasure-Predicting Sheet is one of only 50 to 100 methods that David has learned or created for defeating depression and anxiety. He doesn't see it as a complete treatment for depression, but it usually has some nice mood-elevating effects. Fabrice and I encourage you to try it this week, so you can let us know how it works for you! Next week, we'll have another cool tool you can use to boost your happiness by overcoming procrastination!