Avsnitt
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Tahn Wanders . . . and Wonders A Young Monk's Search for Peace and Happiness
Today we are honored by a second visit from Tahn Pamutto, who first appeared as a podcast guest on November 4, 2024, where he described his transition from a soldier in Iraq to an ordained Buddhist monk. He also gave us a taste of Buddhist teachings, and compared them to what we to in TEAM-CBT.
There were certainly a number of areas of overlap. For example, as a psychiatrist, my goal is often to help bring patients as rapidly as possible from a state of unhappiness and depression to a state of joy and enlightenment, using a number of specific psychological techniques we call TEAM-CBT. But part of this is spiritual in nature as well.
Tahn’s role as an ordained Buddhist monk is similar, in part. His goal is help people who ask for guidance how to discover the cause of unhappiness, and the path to happiness, using a number of spiritual exercises, including meditation. But part of these exercises are psychological as well.
Today, Tahn began by contrasting a spiritual vs a materialistic view of life, and emphasized that the materialist view cannot solve the problem of unhappiness or provide us with happiness. This is, in part, because material things are impermanent, and will all ultimately disappear.
Negative feelings, like unhappiness, actually result from our thoughts--how we view the world. The world is the world, and you can accept that, or you can protest and shout angrily that things “should” be different or “shouldn’t” be the way they are, but your feelings will always result from the way you think about the world.
He said that when he was growing up, all his needs were taken care of, and happiness was fleeting, so he embarked on a search for answers. Who was I, and why was I struggling with so much unhappiness?
He said,
“To explore and really find out who I was, I’d have to depart from my comfort. When I joined the army, it sounded great. It was all about patriotism, loyalty, honor, service, and all kinds of positive values. . .
But then at some point, they say that’s time to invade this or that country, and you have to try to make that work, since you can’t challenge the mission. The Iraq war was going on, and I spend 13 months there.
But if your mission is wrong, you will keep suffering, no matter how hard you try. Did the people in Iraq really want us there? Are we really doing anything that’s positive or good?
And what is it that I really want to do with my life?
One thing we have to recognize is two things that cannot be denied: our mortality and the existence of unhappiness. As I began to accept these two inevitable facts, I also realized that there is no quick solution, and that the reality is that our unhappiness may not end on its own. We may go to sleep, and escape for a while, but when we wake up, we will still be unhappy. We could even imagine being reincarnated and having a different body, a different religion, or living in a different time, but our suffering still won’t change. I may be a different person, but I will still be unhappy.
I asked myself if and how I could train myself to accept what life brings me. . . and wondered whether is would be possible to pursue unending happiness? And if so, how would I go about it? What I do?
When I was in Iraq, I applied for conscientious objector status and eventually got out on an early retirement. Then, I began looking for an experienced, humble teacher who could share their knowledge with me.
I bought a backpack and some hiking shoes, and began to search so I could learn what I needed to learn. I didn’t have much knowledge of Buddhism at all at that time.
I left my mother’s house in New Jersey and started walking. I walked 20 miles, but realized I was going in the wrong direction, and had to walk 20 miles back and start over, walking in the opposite direction.
The first night of my journey, I got exhausted and slept on a park bench. In the middle of the night, I thought I heard loud explosions, and woke up feeling terrified, but it was just acorns falling down from the oak tree I was sleeping under.
In the Army I had learned the wrong way, and that’s why I decided to search, but any old street in New Jersey probably didn’t have what I was looking for. I decided to search for the answer in Asia instead, and wandered in India, Thailand, Korea, Japan, and Taiwan.
I went into Temples and Mosques. I had the romantic notion that some wise bearded man would come out of nowhere and tap on my shoulder and say, “We’ve been waiting for you, Tahn! You have finally arrived!”
But it doesn’t work like that.
In Thailand, there is a monastic level to society, as well as a commercial level. Thailand and Burma are certainly not perfect as countries, but have a higher than average level of happiness because the people are generous and help each other. If I wanted, I could just go and stay at a Temple. Much of their society is based on the joy of giving and receiving. People in the monastic level are living primarily on donations.
I decided I wanted to become a monk. That was what I wanted to do.
I learned about the importance of the “Contemplation of Death.” Most people want to avoid thinking about death. But death and the loss of all materialistic things is inevitable. You cannot avoid it, and might want to base your daily decisions on this fact.
For example, you could ask yourself, “Suppose I knew that I would die this evening. What would I do today? Would I continue shopping for a couch? Or feuding with my neighbor?”
If you did this contemplation every day, you might discover that you’re doing what you think you should do, rather than what you want to do. You may be pursuing materialistic goals that inevitably cause unhappiness.
Let’s say you live in a small cabin, and notice some leaves on the floor. You might decide to sweep the leaves out of the cabin. Then, if you die, they will find your body on a clean floor. That would make it easy for someone else to move into the cabin.
This path (the daily Contemplation of Death), he explained, is one way to get to the destination of unconditional happiness.
Rhonda asked Tahn why he decided to become a teacher. He explained that he did not make that decision, but as he wandered and practiced the monastic life, people would stop and ask him questions about truth and enlightenment and the meaning of life, and so forth. Over time, he realized that because of his travels and searches, he began to gain more and more experience, and sometimes had something to offer individuals who were earlier in their journeys, and also looking for guidance.
He said that the reality of being a monk is not glamourous. Our needs are really pretty minimal. We need food, shelter, clothing, and medicine if we are sick.
But beyond that, the monk gets little. If you need clothes, you may have access to a pile or rags that you can sew together to make a piece of clothing, or you may have to eat the leftovers when others have finished eating. You have to learn to live on what extras might be given to you.
He explained that
I’ve actually been surprised by how much love and support there is in the world. I’ve been well-taken-care-of. My main interest has been to learn about the mind. Of course, we have our basic needs to survive, but what are we doing to develop spiritually?
He mentioned that the monastic order is not structured, it is not a hierarchy, and you can come and go anytime you want. The Buddha accepted the strong desire of his followers to evolve into a church, as a structure to preserve the teachings, but this was a compromise. The Buddha was simply sharing something that had already existed before he was born, something that anyone can discover, with or without a structure or system.
At some point, you may say, “I quit,” and start to do what you want to do, know that your time to be alive is limited.
Here are some of the questions people ask Tahn in his travels.
How can I deal with my intense anger?Tahn said, "When people “find me” when I am traveling, or wandering, they often think that “this encounter was meant to happen.”
He said that Buddhists do not proselytize, and there is no concept of “conversion.”
He teaches people that “You are going to have to die. You’re are going to have to give it all up one day.”
He asks, “What are you seeking? What is ailing you?”
He tells us that the Buddha taught us the cause of all unhappiness, and how to find happiness. Anyone can find what the Buddha discovered.
The goal is the cessation of unhappiness.
Is never-ending happiness possible?
Tahn said:
We certainly know that clear days, with no clouds, are possible. The clouds are not a part of the sky, they are just droplets of moisture, and the sky is not affected by the clouds. Clouds and unhappiness are very evitable.
Tahn finished by saying, “Our unhappiness is independent from our happiness.”
That’s my best translation of the interview, and I’m sure I missed a lot, and misinterpreted parts as well. I do know that it was a great pleasure and honor to spend 90 minutes with Tahn. I hope you learned something and found Tahn’s story interesting.
And here’s one tip that’s helped me, and it might help you on your own journey. Sometimes, when I hear a Buddhist story or teaching, it sounds nonsensical at first. I can’t “get it.”
Then, a few days later, the meaning often comes, or at least A meaning, and I feel happy to have learned something kind of cool!
Hope you have that experience, and apologize for any incoherence you find in the show notes, today!
Warmly,
Tahn, Rhonda, and David
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Live work with Joshua-- The Secret of Self-Esteem
I was recently a guest on the “Philosophical Weightlifting” podcast with host Joshua Gibson (link). At the end of the interview, he asked if I could give an example of some of the techniques in TEAM-CBT, so I decided to jump right into a live demonstration, in real time, which we are publishing on today’s podcast. I am very grateful to Joshua and hope you enjoy the session as much as we did!
The session covers a number of topics that just about everyone can relate to, including a couple extremely common Self-Defeating Beliefs:
The Achievement Addiction The Love Addiction The Inadequacy Schema (“I’m not good enough.”)It also covers some familiar territory, including the question, “Am I good enough?” It also provides an answer to the questions: “What is the secret of self-esteem,” and “what is the secret of sex appeal?”
To kick things off, Joshua shares an upsetting event along with some of his negative thoughts and feelings. The upsetting event was feeling attracted to a young woman who waited on him in a restaurant, and then going to his car and wishing he’d asked for her personal information for a date. Then he courageously went back and did just that, but got shot down.
Paired with this experience, his overwhelming thoughts and how strongly he believes each one are:
I won’t be successful. 85% I won’t get to live the life I want to live. 70% I won’t find love. 90% I’m not attractive. 100%This is a list of Joshua’s negative feelings, and how strong each one was at the start of the session:
Feeling % Now % Goal % End Anxious 95% Sad 90% Guilty 85% Inadequate 90% Lonely 90% Embarrassed 90% Hopeless 85% Frustrated 70% Angry (with self) 75%Two things stand out when you examine this list. First, Joshua is an attractive, friendly, and personable young man hosting a popular podcast. If we didn’t have these estimates of his feelings, you would have NO WAY of knowing how he felt inside.
These feelings are all very severe. So many people we greet in our daily lives are similar—looking terrific on the outside, but dying of loneliness and unhappiness within.
Second, he is experiencing nine different types of similarly elevated negative feelings, and not just one negative feeling. This confirms statistical modeling I’ve done with data from the Feeling Great App. There appears to be an unknown “Common Cause” in the human psyche that activates numerous feelings simultaneously.
This is like the “dark matter” of the human psyche. We can prove its existence, but don’t yet know precisely what it is! However, our goal today will be to see if we can help Joshua change the way he’s feeling, regardless of what’s causing his pain.
Positive Reframing Tool
Feeling Positives Frustration It has motivated me to work hard It shows I have not given up Anxiety Keeps me from putting myself at risk It has inspired me to face my fears and grow Sadness Shows how much I care about others Helps me understand others who are suffering, like my mom Shows I have high standards and high expectations Guilt Shows that I want to live up to my expectations Shows that I have a strong moral compass Inadequacy Shows I’m honest about my flaws and eager to improve Show I’m humble Makes me approachable Loneliness Has helped my develop independence and autonomy Has motivated me to reach out to close community and to create my own Embarrassment Makes me behave in socially desirable ways Hopelessness This serves as a driving force Shows that I’m a critical and realistic thinker Protects me from disappointment Anger (at self) Shows that I have high expectations for myself and hold myself to a nigh standardYou can see Joshua’s goals for each negative feeling after we used the Magic Dial. The whole idea was to lower his negative feelings, not all the way to zero, since that would also wipe out all these positives, but lower them enough so that he would suffer less and still preserve all the many positives we listed, and more.
Feelings Table with Goal column filled in
Feeling % Now % Goal % End Anxious 95% 20% Sad 90% 10-15% Guilty 85-90% 15% Inadequate 90% 10% Lonely 90% 20% Embarrassed 90% 10-15% Hopeless 85% 20% Frustrated 70% 20% Angry (with self) 75% 5%As you can see, he decided to lower all of his negative feelings if possible. Now, we’re ready for the M = Methods of TEAM-CBT. Joshua said he wanted to work on, “I’m not attractive” first. I asked Joshua how and why he came to this conclusion, since he is clearly a large and attractive guy.
He confessed he had severe acne when he was an adolescent, and now has scarring that makes him look “disfigured”.
Although he probably does have some scars, I asked Joshua if he thought this thought might contain some cognitive distortions. He immediately mentioned All-or-Nothing Thinking (AON). I asked Joshua to “Explain this Distortion.” Specifically, I wanted him to imagine that I was a fourth grade student, and to explain to me in simple terms WHY this thought is an example of AON, why the AON in this case is unrealistic and misleading, and why it is also unfair.
He did a great job, and this reduced his belief in the thought to 50%. As an exercise, can you think of some additional distortions in this thought? Briefly stop this recording so you can write them down on a piece of paper, and then you can look at the answers at the end of the show notes.
“Explain the Distortions” was an excellent first step, but it was not enough, so we went on to the Paradoxical Double Standard Technique. I played the role of a long lost identical twin or best friend who was just like Joshua. I explained that I thought I was not attractive, and asked him what he thought.
He did a tremendous job, and argued that this was not really valid, and I asked if he was being honest or just trying to cheer me up. He said he was being completely honest.
Then we switched into high gear, using a much more aggressive technique, the Externalization of Voices, including Self-Defense, the Acceptance Paradox, and the Counter-Attack Technique, with perhaps a couple additional techniques thrown in. He got some strong momentum and blew all four negative thoughts out of the water.
We were out of time, but did take the time to rate how he felt at the end, which you can see below.
Feelings Table at the End of Session
Feeling % Now % Goal % End Anxious 95% 20% 0% Sad 90% 10-15% 0% Guilty 85-90% 15% 0% Inadequate 90% 10% 0% Lonely 90% 20% 0% Embarrassed 90% 10-15% 0% Hopeless 85% 20% 0% Frustrated 70% 20% 0% Angry (with self) 75% 5% 0%Answer to the quiz question above:
The thought, “I’m not attractive contained many distortions in addition to AON, including:
OG = Overgeneralization
MF = Mental Filtering
DP = Discounting the Positive
MR = Mind-Reading
Mag/Min = Magnification and Minimization
ER = Emotional Reasoning
LAB = Labeling
SH = Hidden Should Statement
SB = Self-Blame
I was extremely grateful and honored to be a guest on Joshua’s wonderful podcast, Philosophical Weightlifting, and invited him to join our Tuesday psychotherapy training class at Stanford because of his work in coaching.
If you are a mental health professional, including a therapist or coach, contact me and let me know! The classes are two hours weekly and free of charge, although some course materials are required.
Thank you so much, Joshua, for sharing your “inner self” with me and all of your and our podcast fans!
And thank you, all of you, for listening or watching today!
Rhonda, Joshua and David
The following is an awesome email I received from Jason Meno right after he listened to the Joshua session.
Hey there!
I just finished listening to the last hour segment of David's "Philosophical Weightlifting" podcast episode with Joshua Gibson (it starts at about 1:13:52). It was fun to see a 45-minute TEAM session in action.
I thought the Externalization of Voices (EoV) that was done here that seemed to work really well, really fast. It also highlighted a lot of complex dynamics that I see David use a lot. Here's my analysis of what went down and what I think we can learn from it:
Joshua's attack: Joshua's negative thought was "I'm not attractive", but when it came time for him to attack, he said, "You know Joshua, you are disfigured and because of that you're unlovable and that's an unavoidable thing you're going to have to deal with."
This attack is a lot more powerful than just the thought "You're not attractive." It digs into hurtful labels, hopelessness, and frustration. When you are in the position of roleplaying as the negative voice, there's often new and subtle dimensions that come out of it. Right now we are making it easy for the user to attack the AI by just printing out their negative thoughts, but I think letting the attack be more dynamic would be a lot better.
David uses Be Specific: "Can you tell me in what way I'm disfigured?"
I REALLY like Be Specific. It sets things up very well. I'd love to do this as part of the EoV formula.
Joshua answers: "Yes, so you had acne growing up and now you have scars as a result and that makes you look different from everyone else."
David uses Paradoxical Acceptance / Humorous Magnification: "Well, thank you, wise guru. I'm enlightened now and see that I'm some kind of ugly monster who's going to scare all the women in the United States. But what you're saying is a lot of horseshit, and you know it."
David's sarcastic tone belittles the negative voice's criticism, which also lightens up the absurd magnification that follows. He then quickly rejects the absurd and flows into healthy acceptance following this.
David uses Straightforward Acceptance: "But it's true I'm not perfect, and I did have acne, and I do have scars, and there there's plenty of Hollywood movie stars who have some kind of fantastic looks."
There's something very powerful about going from the absurd magnification into this healthy acceptance. It's kind of like framing the horrifying absurd with the moderately painful truth makes the truth a lot easier to accept.
David uses Defense: "I have a lot about me that's attractive that I can be proud of, including my love, my humility. I've built a tremendous body that 99% of men would be the envy of, and 100% of women would love to touch and fondle."
The self-compassion and focusing on specific strengths and pride in accomplishments seems to a very effective defense. There's also a little magnification and humor going on here too that works well. This is a lot stronger than a lot of defenses I see where people just say the thought is being distorted or unfair.
David sets up the Counter-Attack Technique: "But there is one thing that's very, very unattractive about me that you didn't mention."
Joshua asks: "What's that?"
David uses the CAT: "That's that effing crappy voice in my head belittling me and constantly putting me down. And when I'm not listening to you, I'm feeling pretty damn happy. So, to quote the Buddha and Jesus alike, shut the f up."
One of the things that seems to make the CAT really effective is when you can take the negative voice's criticism and throw it right back at the negative voice itself. In this case, the negative voice is the real unattractive quality.
Awesome work David, and I'd love try out this EoV framework in the app.
Best,
Jason
Roughly one week after the session with Joshua, Rhonda and David interviewed him for his reflections on the session and an update on how he's doing now.
He said:
I've reflected a lot on this, and what has changed for me. There were many things that impacted me, but positive reframing was a game-changer. For example, if I get anxious, I welcome the feeling, and tell myself, "This anxiety will help me with this project."
I was getting a tattoo, and it hurt, so I told myself, "I'm glad it hurts. This pain protects my body."
And, of course, people with leprosy lose the ability to feel pain, and the consequences are disastrous and tragic. He continued,
I have become more accepting, and talk openly about my appearance. I've had the courage to face that fear. The theme of my life has been, "I'm not good enough." But now I remind myself that I've done all kinds of cool stuff. For example, I coached several people into the top five in the United States in power lifting. I'm way less self-critical now. I visited, and loved, the Tuesday group at Stanford. I didn't judge myself but just jumped in and did what I could do!
We concluded the session with some Relapse Prevention Training, using Externalization of Voices to challenging his previous negative thoughts, including the thoughts he will have when he relapses. such as
I'm not good enough. I'm a hopeless case. The therapy didn't work on me because I'm different. I'm a hopeless case.We used Externalization of Voices with role-reversals, and Joshua won "huge!" His final response was, "There's pain and joy in life. I'll feel joy and love!"
Thank you for listening today. We hope you enjoy the intensely personal work with Joshua. Let us know what you think, and if it touched you if you've ever felt like you weren't "good enough!"
Warmly,
Joshua, Rhonda, and David
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Saknas det avsnitt?
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The Story of My Life, Part 1 David is interviewed by Joshua Gibson, Host of the Psychological Weightlifting Podcast
Hi! Today will be a bit different. I appeared as a guest on a cool podcast called Psychological Weightlifting, hosted by Joshua Gibson. I kind of described the trajectory of my career, starting with my post-doctoral depression research at the University of Pennsylvania School of Medicine, with an intermediate stop at the former Presbyterian University of Pennsylvania Medical Center, where I had a run-in with a violent individual named Bennie, and culminating in my work refining TEAM-CBT in my years on the adjunct faculty at the Stanford Medical School.
Joshua and I really hit it off, and at the end of the podcast, he asked me if I could briefly illustrate some of the techniques I’ve developed in TEAM-CBT. I asked if he had an negative thoughts that we might work with, and boy, was I in for a big surprise.
In fact, you’ll hear all about it next week!
Thanks for listening today!
Joshua, Rhonda, and David
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Waking Up Dreading the Day Mother-Daughter Problems Patients Who Are Afraid of Their Feelings Romantic Problems, and More
Questions for today:
Rose asks: I wake up dreading the day. What can I do?! Maggie integrates TEAM-CBT with prayer and asks for help with mother / daughter issues. Simon asks: “How can we deal with patients who are afrad of their feelings?” Amanda asks: “Help! I have a romantic relationship conflict! What should I do?” Aaron asks: Why are feelings of depression and anxiety correlated? In other words, why do they frequently go hand in hand?The following questions and answers were written prior to the live podcast. Make sure you listen to the podcast to get the full answers, including role-play demonstrations, and so forth.
Rose asks: I wake up dreading the day. What can I do?!Hi David,
I've been reading your book, "Feeling Good," for help with my anxiety ever since my 100-year-old mom moved in with me. Your techniques are helping, but every morning I wake up anxious, dreading starting my day. Is there a technique to help with this?
I really am working to change my thoughts from negative to more positive thanks to you.
I look forward to hearing from you.
Rose
David’s reply
In my book, Feeling Good, I urge people to write down your negative thoughts, and emphasize that it won’t work very well unless you do this. Many people refuse. How about you? What were the thoughts you wrote down when you woke up feeling upset and dreading your day.
Could use as an Ask David on a podcast if you like.
Best, david
Rose wrote: Thanks for your speedy reply. I'm new at this and just started reading the book yesterday, but I will start writing down my thoughts. Thanks for your help.
Maggie integrates TEAM-CBT with prayer and asks for help with mother / daughter issues.Dear Dr. Burns,
I want to begin by expressing my deep gratitude for your work, which has had a profound impact on my life. Your book Feeling Good: The Workbook helped me overcome a very dark period of depression after being diagnosed with infertility. It truly transformed my mental health, and I continue to rely on your techniques—especially your list of cognitive distortions, which I use often to stay grounded.
Your podcast has also been a great resource for me, and I’ve noticed recent episodes touching on the self and spirituality, which caught my attention in a special way. I felt compelled to share something personal with you. While your methods gave me the tools to change my thinking, I also found solace and strength through my faith. Prayer was an essential part of my healing process, and for me, it provided something beyond my own power. In moments when I felt I couldn’t make it through on my own, the belief that there is a God I can turn to brought me peace and comfort.
Both your work and my faith were crucial in my journey. Your research and teachings helped me take control of my thoughts, but my relationship with God gave me hope when I needed it most. I believe that the combination of these two—your scientifically backed methods and the power of prayer—made a tremendous difference in my recovery.
I’m also excited about your app, but as someone living in Honduras, I was unable to download it. I would love to know if there are plans to make it available outside the U.S. in the near future, as it would be an incredible resource for me and others in similar situations.
Lastly, can I make a suggestion for a podcast subject? Mother daughter issues. I really need help in this area of my life.
Thank you for your dedication to helping others. I hope that sharing my experience offers some insight into how both your studies and faith in something greater can bring peace and healing.
With gratitude,
Maggie
David’s reply
Thanks, and we’d love to read part of your beautiful note, with or without your correct first name, on a podcast.
If you can give me a more specific example of the mother daughter issue you want help with, it would make it much easier to respond in a sensible way!
Warmly, david
Maggie responded
Dear Dr. Burns,
Thank you so much for your thoughtful response and for asking me to clarify my suggestion regarding mother-daughter issues. I deeply love my mother, and I know she means well, but our relationship has become increasingly challenging as she gets older.
One of the major difficulties I face is her tendency to offer passive-aggressive criticism, which leaves me feeling undermined. I’ve always known her to be this way—she was never very affectionate, and I’ve gotten used to that. However, lately, it feels like it’s getting worse. She’s hard of hearing, even with a hearing aid, and often adopts a “my way or the highway” attitude, which makes conversations with her exhausting. Simple moments where I hope to share something exciting are often met with dismissive or critical remarks.
Here are three examples of the kind of interactions that affect me:
I recently purchased tickets for a trip to Australia with friends, and her response was to ridicule my choice, saying that Spain or Italy is a much more beautiful destination. I had just bought the tickets, and all I wanted was for her to share in my excitement. I sent her a picture of a new piece of art I was excited about, and her immediate reaction was, “I liked the other one better. That one doesn’t match the color of the walls.” As I was about to leave for a party with my husband, she commented, “Don’t you think you’re wearing too much makeup?”These kinds of remarks constantly make me feel inadequate, and it’s emotionally draining. As a result, I’ve found myself avoiding calling or visiting her. However, this leads to feelings of guilt, especially because I love my father very much, I enjoy his peaceful company and wise conversation and advice, and not visiting them also affects my relationship with him.
What I struggle with most is that I know I might regret not spending enough time with her as she gets older, even though she isn’t sick or dying. I just don’t know how to manage the criticism without feeling constantly undermined, and I’d appreciate any advice you might offer on how to navigate this dynamic while preserving my sense of self-worth.
Thank you again for your time and for the incredible impact your work has had on my life.
With gratitude,
Maggie
David’s reply
I notice you’re pointing the finger of blame at her. If you want to shift things, it can be helpful to examine your role. I’m attaching a copy of the Relationship Journal. Please do three of these, one for each example below. You already have half of Step 1—what, exactly, did she say. To complete Step 1, circle all the feelings you think she may have been feeling.
Then complete Steps 2 and 3, which should be fairly easy.
Then I can take a look, and we’ll see what we can figure out, if you’d like. Also, this will not be therapy, but general teaching. LMK if that’s okay.
Best, david
Here are the three examples she provided, along with how she responded to her mom:
Three Maggie examples of interactions with her mother (Ask David podcast)
#1 Mom said: Dear, I would never have thought of Australia as a destination. I would much rather fly to Italy or Spain, filled with culture, art, and great food. Sydney would be the LAST place I’d want to visit!
I replied: Well, mom, we’ve already been to those places, and we love a great adventure, and we’re really excited by the outdoors.
#2 Just as we were about to leave, Mom said: “Don’t you think you’re wearing too much make up?”
I replied: I probably am, I didn’t notice (and rushed immediately to my room to remove it.)
#3 I share a piece of art I brought home, and Mom said: “I liked the one you had before. It matched the walls much better than this one. Why did you change it? Who is the artist?”
I replied: “Well, we have to like it because it’s the only wall in the house where it will fit, so we’re just going to have to live with it.”
Simon asks: “How can we deal with patients who are afraid of their feelings?”Dear Dr. David Burns, Hi, my name is Simon and I'm a clinical psychologist from Chile, sorry if my English is kind of broken, it isn't my first language. First of all, I want to tell you how grateful I am for your great work and all the knowledge you give to the general public for free. Of course I also must praise the work of the entire team working at the podcast (which I am the biggest fan from my country). I hope one day I can be a certified team cbt therapist myself in the future, but that would be a different story. I think the world needs more people with such a love for mental health and I hope I can continue to listen to your content for more years to come.
Today I wanted to ask you guys some questions related to feelings. I have applied some techniques to myself and my patients and it's really mind blowing noticing how effective they are.
Nevertheless, I still have one patient who struggles with accepting or permitting himself to feel his feelings. He is grieving the loss of his father and he is very good convincing me that if he does feel his sadness or anxiety (as I suggested him), he may go crazy and commit suicide. He reports good empathy from me, but I'm afraid that he may be too nice to criticize me.
So, I ask for your opinion: How can we deal with patients who are afraid of their feelings? How can we build a solid relationship with our patients regarding this subject so they can finally vent these feelings?
Thank you all for all the hard work and have a great day!
With Love,
Simon
David’s answer
Hi Simone,
Thanks for your kind words, and may want to use your question on an Ask David. LMK if that’s okay.
Here’s the quick answer. It sounds like venting feelings is your agenda. Nearly all therapeutic failure comes from well-intentioned therapists who try to “help” or “rescue” the patient. I get the best results working on the things my patients want help with.
Rhonda has a free weekly group on Wednesdays at mid-morning, and I have a free weekly training group at Stanford on Tuesday evenings (5 to 7 PM California time.) You’d be welcome to join either.
Best, david
Amanda asks: “Help! I have a romantic relationship conflict! What should I do?”Hi Dr Burns!
Firstly, I would like to thank you for your tremendous work and heart to help people who are suffering from depression & anxiety around the world. I found your book in 2021 through a YouTube video you did with Tom Bilyeu and the rest was history. I went down to our local bookstore to get Feeling Good and I was reading it everywhere I went. It saved my life and cured my anxiety! Every time I hit a roadblock, I will go back to the book and try the techniques. I also love the podcasts as they have been very helpful for me. Shoutout to Rhonda and Dr Matt May too!
I currently face an issue and would like to submit it as a question for Ask David series.
Please address me as Amanda.
I am in a stable and committed relationship (for 8 years) but am facing issues with my boyfriend which causes resentment between us. Meanwhile, a friend pursued me despite knowing that I am in a relationship. He told me during a meetup that he felt attracted to me and asked if I will choose him if I am single. I was attracted to this guy as he is confident, funny and carefree, which are qualities that I desire and find lacking in myself. I like him but I know that he is not a good match for me because of his actions and behaviour. The actions seemed manipulative and reflected some narcissistic tendencies.
At the start, he would text me frequently then the messages became short when I declined to meet up on a 1-1 basis with him as I want to protect my own relationship. He would drop me a short message every week, using intermittent reinforcement, to ask me how I am doing and then asked if we could meet up for a meal. Example 1: Guy-"Lunch?" Me-"Ok if it's with the group." Guy-"Ok." End of communication. Example 2: Guy-"How are you recently?" Me- "I am feeling better, thanks for checking in!" Guy- "Thumbs up emoji" End of conversation. If I initiate a meetup to run errands or for a meal, he would accept it readily. In a way, there is only communication and interaction when we meet up and I know this is not a healthy interaction or something that I want.
Fast forward, I ignored him and he is in a relationship now but our dynamics remain the same. If I reached out to him for a meal, he would respond and behave in a caring way when we met. He offered to buy food for me when I was sick and find ways to continue to meet up. I feel that this guy is just trying to get me as it gives him an ego boost (and thrill) that I care for him even though I am in a committed relationship. In our last meetup recently, I made sure to record how I felt and noticed that the satisfaction level has gone down to about 60% as compared to previously when I was eager to meet him. I would like to reduce it to 10% or even 0%. I also recorded my satisfaction level when I did things alone or with my boyfriend. I realized that my satisfaction/pleasure level is higher and more consistent when I do things that I set out to do on my own and there are times it is enhanced/lowered when I spend time with my boyfriend.
Using the daily mood log, the upsetting event is: I will ignore this friend for a period of time then I will go back to the same communication and meetup with him. Then, I'm stuck in the same dynamic again. My negative thoughts are:
I will never be able to get out of this. I am doomed. I have no power or control, he has all the power. People always take advantage of me because I'm weak. I am a loser because I keep going back. I will never be happy again since I cannot overcome this. Things will be as such. This chapter will leave a mark on my life and I will be miserable. I am a horrible person for allowing myself to fall for someone while being in a relationship.I have been re-reading the chapter in Feeling Good on love addiction and spending more time with myself to build a relationship with myself so that I can be happy alone. I am also using the cost benefit analysis to melt my own resistance so that I do not go back but I do not seem to be able to totally defeat the negative thoughts above.
I hope to receive some guidance related to this on the podcast if possible. Thank you so much!
Love,
Amanda
David’s Reply
Hi Amanda,
Thanks so much. There are many paths forward, but one thing that might help would be to use the Decision Making Tool since you seem to be unclear on what you want to do. That might be a good first step, or next step. You can download it from the bottom of the home page of my website, feelinggood.com.
I can understand your negative feelings and confusion and self-doubt, anxiety, discouragement, frustration. I’m just speculating.
There are many ways to challenge your thoughts, but some good positive reframing might help before trying to challenge them, so you could check out your goals for each negative emotion. Including a recent Daily Mood Log, in case you don’t have one.
All the best, david
PS What you are doing all makes good sense, developing a relationship with yourself, doing a cba, etc., Kudos!
In addition, the “25 things I’m looking for in an ideal mate” tool in Intimate Connections might also be helpful.
Aaron asks: Why are feelings of depression and anxiety correlated? In other words, why do they frequently go hand in hand?Hi Dr. Burns,
I am rereading When Panic Attacks, this has lead to a question. In the book you mention that one theory about why people have both anxiety and depression is that they "can't distinguish different kinds of emotions." Can you expand on this to help me better understand what this means?
My interpretation now has me thinking that people are just saying they are depressed and anxious because they don't understand what each word for the emotions means.
Thank you for your help,
Aaron W. California---LMSW (Idaho)
David’s reply
David D. Burns, MD
Sure, but that is not my thinking, just a common theory that of course deserves respectful consideration and testing.
To me, depression is the feeling that accompanies loss, and anxiety is the feeling that accompanies the perception of imminent threat or danger. Beck put it like this: Anxiety is like clinging by your fingertips at the edge of a cliff, fearing you will fall at any moment. Depression, in contrast, is more like thinking you have already fallen, and you are at the bottom of the cliff, broken and injured beyond repair.
Here are a couple other things that might interest you. When people are depressed, they will also report feelings of anxiety nearly 100% of the time. However, when they are anxious, they will only report feelings of depression about half the time. This is because you can have some type of anxiety, like a phobia such as the fear of heights, or elevators, or flying, but not feel depressed about it.
And here is one more tidbit. My research on the beta test data from our Feeling Great App indicates that all seven negative feelings we measure are strongly correlated and go up or down together, which was quite unexpected.
The statistical models that simulate the data provide strong evidence for an unknown “Common Cause” that activates all negative emotions simultaneously. We are trying to figure out what that Common Cause might be. It is a bit like “Dark Matter.” Scientists have proven it’s existence, but don’t yet know what it is. And this unknown Dark Matter represents 95% of the matter in the universe.
The statistical models also provide strong evidence that the Feeling Great App helps people because of its strong causal impact on this unknown “Common Cause.”
Would love to include this an Ask David in a podcast. Would it be okay?
Warmly, david
Aaron replies
Hi Dr. Burns,
I would be honored if you used my question in your podcast. Please let me know when that podcast is posted! I would love to watch it. In the email you sent, are you saying that one theory is that people just cannot accurately define what they are feeling?
David replies again
Yes, that is one theory, and I have seen that some people, including therapists, have trouble recognizing the names of feelings that their patients are having, based on what the patient says, and also they sometimes have trouble knowing how they are feeling, using “I Feel” Statements.
This is, I think, part of what has been called “Emotional Intelligence.” And, just like any skill or talent, there is a great deal of individual difference in “Emotional Intelligence,” and likely some cultural differences as well. I have heard that up until recently, the Chinese did have a word for “depression,” but when a person was appearing depressed, they were kept indoors out of a sense of shame.
Thanks!
david
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How to Give Critical / Negative Feedback In a Loving, Constructive Way AND How to Avoid the Common Traps
Today’s podcast features Dr. Jill Levitt, Director of Training at the www.FeelingGoodInstitute.com in Mountain View, California and co-leader of David’s weekly TEAM-CBT training group at Stanford. Rhonda and I are psyched, because every podcast or teaching event with Jill is almost certain to be fabulous. And this podcast is no exception!
Rhonda asks members of her Wednesday training group (see below for contact information of you think you might want to join) to take turns teaching the group. One week she was puzzled because almost no one filled in their feedback forms, and when she asked them why, they said that they had some concerns about the teaching but didn’t feel comfortable criticizing the person who taught.
Some of the criticisms they share with Rhonda were:
It was boring. I didn’t learn anything new. The teacher didn’t explain anything in a way that I could understand.Is this a problem that you have as well? Do you find it hard to criticize others, and keep quiet on the assumption that saying nothing is better than opening your mouth and saying something hurtful?
If so, I have some good news and some bad news for you. First, the bad news. Tonight, you’ll discover exactly why and how saying nothing is actually a pretty hostile and mean thing to do.
But here’s the GOOD news. You’ll also learn the secrets of how to deliver criticism in a way that’s loving, authentic, and helpful if—and that might be a big IF—that’s something you’re willing to do!
A sage—cannot remember who—once said that “When you say nothing, you’re actually shouting quietly.
What in the world does THAT mean?
And Robert Frost, in his famous poem, Fire and Ice, wrote:
Some say the world will end in fire,
Some say in ice.
From what I’ve tasted of desire
I hold with those who favor fire.
But if it had to perish twice,
I think I know enough of hate
To say that for destruction ice
Is also great
And would suffice.
Essentially, Frost is saying that if you’re angry, there are two classic ways of being aggressive; you can be fiery and agitated and attack the other person, verbally or physically, or you can be cold and withdraw, saying nothing, so as to freeze the other person out. These are opposite extremes but are equally destructive. And, for most of us, difficult impulses to resist.
But there’s a third alternative, which might be, according to Robert Frost, the “road less traveled by.” You can express your negative feelings, including anger, in a respectful, or even loving way. And that’s the focus of today’s show.
My show notes will only give an overview, but the richness of this particular podcast is in the actual dialogue and role-play demonstrations with critical feedback. We began with an overview of some of the key techniques when giving someone negative feedback, including stroking and “I Feel” Statements, but emphasized that your tone, goal, and spirit is the entire key to how you come across, and how the other person responds.
Jill told a moving and dramatic story of an interaction with her mother, who has been quite ill, and she’d been having a really hard week. Her mom sent Jill a lengthy text outlining all of her problems and ending with, “you guys don’t really know how I’m hurting,” and the implication was, “you don’t know--or care.” This was understandably hurtful to Jill.
Jill’s about the most awesome daughter any mother could have. Jill wanted to clear the air and tell her mom how she’d felt, rather than keeping her negative feedback hidden. Her mom clearly felt lonely, so when Jill saw her in person, she said something along these lines: “I know you’ve been struggling, but I felt hurt and discounted when I read your note. I felt like the things I’ve done didn’t matter, and I felt hurt.”
Her mom began to cry and said, “the last thing I want you to feel is that I don’t appreciate you.”
This conversation was challenging, but brought them much closer together.
The podcast crew discussed the important question of our mixed motivations about sharing our feelings, and our confusion about how to do this in an effective, loving way, if you do decide to open up.
Rhonda confided that she’d never had those kinds of open conversations with either of her parents, and that these kinds of difficult conversations can come from a place of love.
You can review the Five Secrets of Effective Communication if you click HERE. The Five Secrets are all about talking with your EAR: E = Empathy, A = Assertiveness, and R = Respect. However, there’s a lot of intense resistance to using the Five Secrets, so I promised to include my list of 12 GOOD Reasons NOT to
Listen (E = Empathy) Share your feelings (A = Assertiveness) Treat the other person with respect (R = Respect)That makes 36 reasons in all! You can link to the list HERE.
People want to feel understood, and the best way to make that happen is by giving what you hope to receive. And you can learn how to listen more skillfully If you read my book, Feeling Good Together, and do the written exercises while reading. You’ll learn a ton that can change your life and greatly enhance your relationships with the people you love.
Thanks for listening today!!
Jill, Rhonda, and David
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The Feared Fantasy Festival! Featuring Jill Levitt, PhD
Rhonda asked about the differences between the four Feared Fantasy Techniques and what each one is used for. So we're dedicating today's podcast to answering that question and bringing them all to life. We are honored to be joined by our beloved and brilliant Dr. Jill Levitt, the Director of Clinician Training at the Feeling Good Institute in Mountain View, California.
Below I have listed the four Feared Fantasy Techniques. As you can see, each one targets a different Self-Defeating Belief.
Approval Addiction: I need everyone's approval to feel happy and worthwhile. Perceived Perfectionism: I must impress others to be love and respected. People will not love or accept me if they see my flaws and shortcomings. Achievement Addiction: My capacity for happiness and my worthwhileness as a human being depend on my achievements, intelligence, success, and productivity. Love Addiction: I need to be loved to feel happy and worthwhile. Submissiveness: I must make others happy, even at the expense of my own needs and feelings.Here are the Feared Fantasy Techniques used for each SDB:
Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No PracticeDuring the live podcast, we did a deep dive on each of the four Feared Fantasy techniques, and emphasized that the goal is actually enlightenment, and it's based on the teachings Tibetan Book of the Dead that when you finally challenge and confront the monster you've feared and run away from in all of your previous reincarnations, you will discover the the monster has no teeth, and that your fears throughout all of those reincarnations were based on a cosmic joke. This can create something called "laughing enlightenment," so you no longer have to go through the life death cycle, but can go instead to Nirvana--or something along those lines!
You really must listen to the podcast to "get" the impact of these Feared Fantasy role plays, and role-reversals, to see how simple, easy, and obvious self-acceptance, and enlightenment really are, and you will see and hear how we fight to protect and defend ourselves from attack, and end up feeling trapped yet again in our needs to be "special" or "worthwhile." David pointed out that when you let go of the idea that you have a "self," your suffering can disappear because you will no longer have to wonder whether your "self" is good enough, or worthwhile enough.
Jill complemented this line of thinking by pointing out that the technique, Be Specific, is one important key in most of these techniques. We can be flawed in all kinds of specifics, but that will never hurt unless you generalize to your "self." No self, no problem, as some mystics have said. And that is SO TRUE!
David also discussed throwing away the idea that you are worthwhile, or that you need to be more worthwhile, and described how he and his wife saved a mouse that had somehow gotten into their house, but the poor thing was terrified and heroically tried to survive, hiding out in their kitchen. Instead of trying to kill it, they fed it nuts and grapes. Eventually, they caught it in a safe trap, and set it free, and left a last meal for it outside, which it found and happily ate.
It was a deep dive on Feared Fantasy and lots of spiritual and philosophical topics, and we hope you enjoyed it!
Although we did not cover this topic in the podcast, there are quite a number of additional role play techniques in TEAM-CBT, too, as you know, including:
to help with Self-Critical Thoughts:
Paradoxical and Straightforward Double Standard Externalization of Voicesto help with Uncovering Techniques, like the Individual Downward Arrow
Man from MarsTo help with Tempting Thoughts
Devil’s Advocate Technique Tic-Tok Techniqueto help with Resistance
Externalization of Resistance How Many Minutes?to help with the Five Secrets / Relationship Conflict
Intimacy Exercise One Minute-DrillPerhaps you can think of more, too! The generous use of role-playing techniques is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. This is perhaps unfortunate because they tend to be more potent, emotional, and fast acting than many if not most other techniques.
Warmly,
david
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Ask David: Getting Off Benzos How Does Music Stir Our Emotions? Combatting Negative Thoughts about the World Treating Schizophrenia with TEAM The Four Feared Fantasy Techniques and more!
Questions for today:
Mamunur asks: What’s the best way to withdraw from benzodiazepines? Gray asks: How does music evoke such powerful emotional reactions? Josh thanks David for techniques that have helped in his personal and professional life. Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Moritz asks: How do you help people with bipolar, schizophrenia, etc.? John expresses gratitude for our answer to his question on Positive Reframing, which triggered an “ah ha moment.” Rhonda asks: What are the four Feared Fantasy Techniques?The answers below were written prior to the podcast. Listen to the podcast for the dialogue among Rhonda, Matt, and David, as much more emerges from the discussions!
Mamunur asks: What’s the best way to withdraw from benzodiazepines?Ask David, Bangladesh question
Dear Sir,
I am writing to you from Bangladesh. Your book Feeling Good is a phenomenal work, and it has greatly helped in promoting the development of a healthy mind through logic and reason.
Sir, I have a question regarding benzodiazepine withdrawal, which is often prescribed for mental health disorders. Is there a specific CBT (Cognitive Behavioral Therapy) approach that can help in withdrawing from benzodiazepines? Your guidance on this would be invaluable, as many people have been taking it for years, either knowingly or unknowingly, without being fully aware of its severe withdrawal effects.
Thank you, sir, for your kind contributions to humanity.
Sincerely,
Mamunur Rahman
Senior LecturerDavid’s reply
Dear Mamunur,
Thank you for your important question! I am so glad you like my book, Feeling Good, and appreciate your kind comments!
As a general rule, slow taper off of benzodiazepines is recommended. This might involve slowly decreasing the dose over a period of several weeks.
When I was younger I used to take 0.25 mg of Xanax for sleep, because it was initially promoted as being non-addictive, which was wrong. It is highly addictive. The dose I used was the smallest dose.
When I realized that I was “hooked,” I tapered off of it over about a week, and simply put up with the side effects of withdrawal, primarily an increase of anxiety and difficulty sleeping. These disappeared after several weeks.
Abrupt withdrawal from high doses of any benzodiazepine can trigger seizures, as I’m sure you know. That is the biggest danger, perhaps.
I do recall a published study from years ago conducted at Harvard, I believe at McClean Hospital. The divided two groups of people hooked on Xanax into two groups. Both groups were switched to Klonopin which has a longer “half-life” in the blood and is supposedly a bit easier to withdraw from than Xanax, which goes out of the blood rapidly, causing more sudden and intense withdrawal effects.
After this initial phase, both groups continued with slowly tapering off the Klonopin under the guidance of medical experts. However, one of the groups also attended weekly cognitive therapy groups, learning about how to combat the distorted thoughts that trigger negative feelings like anxiety and depression.
My memory of the study is that the group receiving cognitive therapy plus drug management did much better. As I recall, 80% of them were able to withdraw successfully. However, the group receiving drug management alone did poorly, with only about 20% achieving withdrawal.
My memory of the details may be somewhat faulty, but the main conclusion was clear that the support of the group cognitive therapy greatly enhanced the success of withdrawal from benzodiazepines.
I decided early in my career not to prescribe benzodiazepines like Ativan, Valium, Librium, Xanax, and Klonopin for depression or anxiety, because the drug-free methods I and others have developed are very powerful, and the use of benzos can actually make the outcomes worse.
Years back, a research colleague from Canada, Henny Westra, PhD, reviewed the world literature on treatment of anxiety with CBT plus benzos and concluded that the benzos did not enhance outcomes. Here is the link: https://pubmed.ncbi.nlm.nih.gov/12214810/.
I hope this information is useful and I will include this in a future Feeling Good Podcast.
Gray asks: How does music evoke such powerful emotional reactions?Subject: Re: Podcast question: love songs
Hi David,
That's a really tough question. Music has a unique way of cutting straight to emotions for me, and it makes it especially hard to identify the thoughts behind them. My best way of explaining is with these two thoughts, which have to be viewed as a pair to get that emotional reaction:
My life would be perfect if I had that I'm so far away from thatThese thoughts don't resonate quite right for me, but it's something like that, going from imagining bliss to crashing to hopelessness within the space of a moment.
Thank you so much for your response.
Gray
David’s reply
You’re right. Music can be so beautiful, especially of course, the songs we love, that it is magical and emotional to listen to! It seems more like a sensory experience, than something mediated by thoughts, but we certainly have perceptions of beauty, etc.
Similar with some incredibly delicious food. Creates incredible delight and satisfaction, and no words are necessary other than “delicious!”
Sorry I can’t give you a better answer to your outstanding question!
Best, david
Josh thanks David for techniques that have helped in his personal and professional life.Dear Dr. Burns,
I am sure you are swamped with substantive emails and fan mail, but I just wanted to express appreciation to you for all I have gained from your publicly available content. I have learned so much that I have applied in my personal life. I have also benefited tremendously in my work with clients.
So much of what you say about anxiety, and especially the hidden emotion technique, has allowed clients to have in almost every session an aha moment. I have not yet been able to see a complete removal of symptoms in one session yet, but as a therapist, I too have many skills yet to improve and much work to do.
So, in short, thank you so much for making your experience and wisdom available for free, and thank you for doing it in such an engaging manner.
Sincerely,
Josh Farkas
David’s Reply
Thanks, Josh. You are welcome to join our weekly virtual free training group I offer as part of my volunteer work for Stanford, if interested.
For more complete change within sessions, a double session (two hours) in my experience is vastly more effective. Is it okay to read your kind note on a podcast?
Warmly, david
Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.”Dear Dr. Burns,
First of all, I would like to thank you for all your work and your outreach. Your books have profoundly influenced my thinking and value system. I really admire how you exemplify both scientific rigor and human warmth. Finally, I want to thank you for promoting the idea of “Rejection Practice! I haven't had a breakthrough yet, but some unexpected, very encouraging experiences.
I first came across Feeling Good 12 years ago when I developed moderate depression in the context of living with my ex-partner, who probably had borderline personality disorder. I tried the techniques in Feeling Good and also psychotherapy, but unfortunately without much success. I only started feeling a lot better when I began to rebuild my social life and leisure time activities (ballroom dancing, getting involved with a church, ...). Several months later, I also broke up with my ex-girlfriend. Since then, I've had ongoing mild depression.
I recently tried the techniques in Feeling Great but wanted to ask you for your opinion on a couple of negative thoughts I'm particularly stuck with. My issue is that I'm normally not attacking myself, but life in general. I keep on telling myself things like "Life is just one crisis after the other," "Life is for the lucky ones," "Really good things just don't want to happen," "Life is so much suffering and so little joy," and the depression itself makes these statements all the more convincing. (Triggering events can be rainy holidays, romantic rejections, grant interview rejections, etc.)
I think it could be helpful if in a podcast you could give more examples on resolving negative thoughts attacking life / the world rather than oneself. I also have many more questions for podcasts if you are interested.
Thank you for reading this, and thank you so much again for all your work!
With very best wishes,
Harold
David’s Reply
Happy to address this on an Ask David, and it would help if you could let me know what negative feelings you have, and how strong they are. I will be answer in a general way, and not engaging you in therapy, which cannot be done in this context. Is that okay?
I’m attaching a Daily Mood Log to help organize your thoughts and feelings. Send it back if you can with the Event, Negative Feelings and % Now columns filled out (0-100), and Negative thoughts and belief in each (0-100).
You can also fill in the distortion column using abbreviations, like AON for All-or-Nothing, SH for Should Statement or Hidden Should, MF for Mental filtering, DP for Discounting the Positives, and so forth.
Thanks!
If you were in a session with me, or if we were just friends talking, I would reply to your complaints with the Disarming Technique, Thought and Feeling Empathy, “I Feel” Statements, Stroking, and Inquiry, like this:
Harold: “Life is so much suffering and so little joy."
David: “I’m sad to hear you say that, but you’re right. There’s an enormous amount of suffering in the world, like the horrible wars in Ukraine and in the Mid-East. (I feel; Disarming Technique) It makes sense that you’d be upset, and have all kinds of feelings, even anger since there’s so much cruelty, too. (Feeling Empathy)
And even people who appear positive and joyful often have inner sadness and loneliness that they are hiding. (Disarming Technique) Your comment tells me a great deal about your core values on honesty and compassion for others. (Stroking) Can you tell me more about the suffering that you’ve seen that has saddened you the most, and how you feel inside? (Inquiry)
But I’m mainly interested in you right now. Can you tell me more about YOUR suffering, and especially if there’s some problem you might want some help with? (Inquiry; Changing the Focus)
I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test.
If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?”
I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself?
I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test.
If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?”
I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself? I ask this because your negative thoughts are very general, but I always focus only on specifics, specific problems and moments. What’s has been going on with your parents or in the past or present that you are distressed about? I’ve found that when I (or my patients) solve one specific problem that’s bugging me, everything seems to suddenly brighten up.
For example, you wrote : “I asked someone out I like; she surprisingly said yes. After 10 days of not hearing from her, I messaged her, . . . “ I wrote a book about dating, Intimate Connections, because I was a nurd and had a lot to learn about dating. One idea is that waiting 10 days might not be a good idea to arrange the specifics of the date, as that might make her feel uneasy. There’s a lot to learn about dating, for example.
A tool like the Pleasure Predicting Sheet can sometimes help, too. And finally, a good therapist can also often speed things up. Sometimes two heads are better than one. You seem extremely smart and willing to work hard, so there’s all kinds of room for growth, learning, and greater joy.
The Feeling Great App is NOT therapy, but the tools there might also be helpful, especially since you are willing to work hard a do a lot. That’s super important.
Can I use this email in my reply in the show notes if we discuss your excellent questions? And should I change your name to Harold?
Warmly, david
Best, david
Moritz asks: How do you help people with bipolar, schizophrenia, etc.?Hi David,
You have mentioned a few times that there are only a handful of "real" psychological disorders with known causes, as opposed to just a collection of symptoms.
Could you please tell a bit about how you would go about helping somebody with one of the "real" disorders (like Schizophrenia or Bipolar) using TEAM therapy?
Most of the episodes with personal work seem to fall into the other category (anxiety, depression, compulsive behavior), so I'd be really curious about some examples.
Best regards,
Moritz Lenz
David’s Reply
Hi Moritz, Thanks! Good question, and happy to address this on an Ask David. Here's the answer in a nutshell. When working with someone with schizophrenia, the goal is to help them develop greater happiness and interpersonal functioning, exactly the same as with anyone else, using TEAM. The goal is not to cure schizophrenia, because we still do not know the cause and there is no cure. But we can help individuals with schizophrenia with problems that they are having.
Bipolar: in the manic phase, usually strong meds are indicated, and often at least one hospitalization. For the rest of their lives, including depression, TEAM works great.
Can add more in the podcast.
Best, david
John expresses gratitude for answer his question on Positive Reframing, which triggered an “ah ha moment.”Hi David and Rhonda!
I have listened to Episode 415 and your response to my positive reframing question!
I had a bit of a aha moment! I think I had been approaching it in the cheerleading sense and trying to encourage myself with these positive qualities rather than attaching the positives to the negative thoughts and feelings themselves!
This has created a much stronger emotional response during the positive reframing section! The building up of the negative thoughts and feelings is a gamechanger! Thanks so much for the time and attention given to it during the podcast.
Thanks so much again, I appreciate you folks way more than you could know!
John
David’s Reply
Thanks, Rhonda and John. Yes, you’ve pointed out a huge error many people make when trying to grasp positive reframing. If it is okay, we can include your comment in a future podcast.
Warmly, david
Rhonda asks about the four Feared Fantasy Techniques:David’s Reply
Here are the four Feared Fantasy Techniques
Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No PracticeThere are quite a number of additional role plays, too, as you know. Maybe a question about all the role plays, bc we all have:
Self-Critical Thoughts:
Paradoxical and Straightforward Double Standard Externalization of VoicesUncovering Techniques
Man from MarsTempting Thoughts
Devil’s Advocate Technique Tic-Tok TechniqueResistance
Externalization of Resistance How Many Minutes?Five Secrets / Relationship Conflict
Intimacy Exercise One Minute-DrillI’ll bet you can think of more, too! This is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. As you know, on average they tend to be way more potent and emotional, and of course fast impact.
Warmly, david
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Meet Tahn Palmetto Theravada Buddhism--the Thai Forest Tradition
Our dear colleague, Jason Meno, generously invited five high-profile Buddhist monks / teachers, to appear on our Feeling Good Podcast, hoping we could feature one every week during our "Enlightenment Month." He included his dear friend and ordained Buddhist monk, Tahn Palmetto. Happily, Tahn accepted Jason’s invitation, and we are thrilled to chat with him today about his feelings of depression as a young man in the army to his search for happiness and peace through meditation.
Tahn began his journey when we was young, 20 or 21 years old. After he enlisted in the army, he was lying on the floor, staring at the ceiling and realized he was depressed. He also realized that he didn’t actually want to go to war, and saw that the best of good intentions often lead to pretty terrible outcomes.
Jason and David described the basis of cognitive therapy, confirmed in Jason’s recent research on meditation, that the degree of upset from any negative thought depends on how strongly you believe it to be true. Tahn said he also realized that his negative feelings did not depend so much on what he was doing, but how much he believed his thoughts.
He got out of the army and searched for spiritual teachers, and eventually settled on Theravada Buddhism, also known as the Thai Forest Tradition. He said, “I found that you can have a lifestyle that triggers feelings of unhappiness, and committed my life to achieving happiness and peace.”
He said that some people who come to the monastery discover that they don’t want to commit themselves to the monastic life, and some commit to it but do it poorly. He said that your commitment will depend on how strongly you want to feel happy and enlightened. Believing that this is possible requires a paradigm switch.
It is possible to have a mind that is clear, but even on a clear day, there will be clouds. The clouds, however, are only temporary.
Our suffering comes and goes. If you twist your knee, it may hurt for life. But if you have a cold, you can recover completely. Even in a monastery, people have their squabbles. Within the Buddhist practice, Than explained that it is important to try to identify the disease and only then prescribe the effective treatment.
Jason mentioned that some people come to the monastery but leave feeling hopeless. Others stay and are successful. Tahn explained that in Asia it is common for someone to enter the monastic life for a brief period, for example when they are experiencing grief. He said that if you grieve over the loss of a loved one, time alone will heal your grief, and once the suffering is relieved, they leave the monastic life.
Rhonda asked if mindfulness meditation could be harmful to some people.
Tahn explained that mindfulness does not cause negative feelings, but often reveals the presence of negative feelings. If you have a condition that prevents you from experiencing enlightenment, the condition is getting in the way. Sometimes the practice will give you the stability and the peace of mind to deal with it.
If you come to the practice of mindfulness or the study of Buddhism for the wrong reasons, you might stay for the right reasons. If it does not work or help, you can always seek some other type of treatment.
Tahn explained that mindfulness or Buddhism addresses unhappiness caused by mental or physical pain, and that people are often surprised by how it helps them. He believes that mindfulness meditation is “the thing” that treats someone’s stress. It treats the “dukka,” which is a fundamental Buddhist teaching that refers to (according to the internet) the “suffering” or “unhappiness” of life. It is one of the first “noble truths” of Buddhism; namely, that suffering cannot be avoided.
Apparently dukka comes in three flavors:
Physical and emotional pain and discomfort Suffering from the inability to accept change The profound dissatisfaction of existence.Tahn said that you develop greater resources when you meditate. Then you may have extra resources to help others:
You learn to deal with everybody’s stuff. You learn to be aware of your body. This is your perspective for everything you do. It makes me happy to think about my eyeballs. When I meditate on this, it becomes funny, and I laugh.
Tahn suggested that when you meditate, you learn to be aware of your body, because that is the center point of your world. This is your perspective on everything that is going on in the world. When you become aware of your body and what it is doing, you know the context of everything in your life.
What does his day look like? Tahn said:
I answer emails, I troubleshoot problems. Lately we’ve had a problem with scorpions. But we don’t try to kill them.
Tahn talked about how Buddhism defines Truth as reality, and that the definition of happiness is “non-suffering.”
There are three patterns that lead to unhappiness:
Attachment, which he defined as greed and desire, especially when you seek some external object(s). An extreme example would be disregarding the needs of others or even endangering others to get the object of your desires, or an attitude of only wanting or caring for things that you like or want. Aversion which refers to feelings of aggression, anger, and hatred. Aversion’s opposite is loving kindness. When we experience Aversion, we push away (usually aggressively) the things that we dislike. If we allow our ignorance to take over, we can conjure up hatred for the things that we dislike and the people we see as blocking our desires. We saw from the meditation experiment that Jason described last week, how meditating on loving kindness brought about a reduction in people’s negative thoughts. Ignorance refers to delusion, confusion and dullness. Ignorance defuses understanding serving to confuse you and prevent you from doing something functional. This can be experienced as an inability to see the truth or reality of ourselves or the world around us. Asking questions like “Am I real” is the basis of the first two in this list.Tahn also discussed how the mind precedes the thoughts.
Then we talked about the concept of the Self, in that we think that we exist. However, there is no stable “I.” All we find are temporary phenomena. For example, you don’t need to have a “self” to drive to a picnic. All you need is a car and a tank of gas.
The group discussed the Buddhist concept of “laughing enlightenment.”
Thank you for listening today!
Tahn, Jason, Rhonda, and David
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The Mindfulness Mystery Tour! And Two Mind-Boggling Discoveries about Meditation! Featuring Jason Meno
Today, Jason Meno, our beloved AI guy on the Feeling Great App team, shares some incredible and innovative research he recently did on the effect of meditation on how we think and feel. As you know, basic research is a high priority of our app team, and our major focus is to make basic discoveries in how people change, and especially on what triggers rapid and dramatic change. We use that information to develop and refine the app on an ongoing basis, and also to contribute to basic science.
Jason recently created a “New Cool Tools Club” which has 160 members who Jason can notify whenever he has a cool new app tool that he wants to test. If you are interested in joining, you can find his contact information at the end of the show notes. There is no charge if you’d like to join this group!
Jason had a strong background in Buddhism and has been working with our company for several years, focusing in the last year on the AI chat bot portion of the Feeling Great App. He has meditated for many years, and uses TEAM-CBT as well to deal with his personal moments of stress and unhappiness, something that most if not all of us experience at times!
Introduction
Jason was interested in evaluating the short-term impact of meditating, and did a literature review but found that most or all of the published studies had a focus on the effects of daily meditation over longer periods of time, like two months for example.
He was also interested in how long and how often people should meditate, and what types of meditations, if any, were the most effective.
So, he decided to test a one-hour meditation experience consisting of five ten-minute recorded meditations, including
A body scan meditation, systematically relaxing various parts of your body, beginning with your feet and toes. A breathing and counting meditation, where you focus on your breathing and count the breaths going in and out. A loving kindness meditation, starting with sending feelings of love, happiness, and health first to someone you love, then to yourself, then to someone you aren’t especially close to, or don’t particularly like, and on and on until you are projecting love and kindness to the entire universe. A mindfulness exercise where you notice if you are thinking, hearing, watching, remembering, and so forth as various thoughts pass through your mind. A “Do Nothing” meditation where you are instructed to simply “do nothing” for ten minutes.Because previous research on meditation did not use scales that assessed specific kinds of negative feelings in the here-and-now, he decided to use the highly accurate 7-item negative feelings sliders as well as the 7-item positive feelings sliders prior to the start of the medicine, after each meditation, and at the end of the app.
He also asked many questions about motivation and expectations prior to the start of the meditation experiences, all answered from 0 (not at all) to 100 (completely), including
How familiar are you with David’s work? How familiar are you with meditation? How strongly do you believe that meditation will make you feel better? How strongly do you believe that meditation will be rewarding? How strongly do you believe that meditation will only have a small effect? How strongly do you believe that meditation will be a waste of time? How strongly do you believe that meditation will make you feel worse? How strongly do you believe that it will be painful or difficult?You can find these data at this link.
He also asked every participant to generate an upsetting negative thought, like “I’m a loser,” and use 0 to 1000 sliders to indicate how strongly they believed that thought, and how upsetting it was.
60 individuals started the experiment, and 35 completed it, with 25 dropping out prematurely before they completed some of the meditations.
He presented the data as a two-group analysis, those who completed and those who failed to complete the hour of meditation. Here, are just a few of the preliminary findings, and more refined analyses are planned so we can look at causal effects.
Both groups were moderately to very familiar with David’s work and with meditation. The completers had higher scores on the questions about positive expectations than the dropouts, although the differences were not great. The dropouts had substantially higher scores on four questions about negative expectations for the experience, like “it will be a waste of time” or “it will be painful or difficult.” The initial scores on the belief in the negative thought were similar in the two groups (76% and 74%, respectively), but the Upsettingness of the thought was a bit higher in the completers (83% and 79%. The mean of the initial scores on the 7 negative feelings sliders was significantly higher in the dropouts (37% and 46%, respectively), while the initial scores on the 7 positive feelings sliders was somewhat lower in the dropouts (49% and 45%, respectively). Both groups expected a modest reduction in negative feelings and a modest boost in positive feelings during the hour of meditation.Results on the 35 completers
After the first ten-minute meditation, there were significant reductions in the negative feeling sliders (from 37% before to 25% after) and increases in the positive feeling sliders (from 45% before to 55% after). There did not appear to be any additional improvements in negative or positive feelings in the subsequent four meditations. There was a significant reduction in the belief in the negative thought after the first meditation, and the reduction continued throughout the next four meditations. (76% to 54%), for a reduction of 29%. There was a significant reduction in the upsetness caused by the negative thought after the first meditation, and the reduction continued throughout the next four meditations (79% to 47%) for a reduction of 40.5%.You can find the remarkable results if you click here!
There are many fascinating results, but one of the most amazing--which we've replicated almost exactly in independent beta tests--is the remarkable similarity between the changes in negative and positive feelings the participants predicted, and the actual results. They are so close it looks like somebody faked the data, but that's not the case at all.
We will have to do more analyses to figure out what this means, but in simple terms, this seems to be iron clad proof that our expectations of the mood changing results of any intervention can be tremendously powerful. In fact, you could argue--and it would need further statistical analyses to test--that the causal impact of the expectations eclipsed the causal impact of the actual intervention, which in this case was meditation.
One of the cool things about quantitative research is that it nearly always shoots down our favorite hypotheses, and also gives us new and totally unexpected gifts to stimulate our thinking! In this instance, there were at least two mind-boggling and toally unexpected results:
When people mediate, the improvement in negative feelings is accompanied by parallel reductions in participants belief in their negative thoughts. Participants predictions of the changes in seven negative and seven positive feelings by the end of the hour of meditation were spot on, and seemed almost impossibly accurate!Discussion
The findings are exciting and specific, and suggest that the reduction in negative feelings during meditation may be, and is, mediated by the reduction in the users’ belief in their negative thoughts. We will attempt to look into this more deeply using non-recursive analytic methods with SEM (structural equation modeling).
All samples are biased, and it can sometimes be extremely helpful to understand the bias in your sample when interpreting the results. The sample in this case included users favorably disposed to meditation, and responding to an email inviting them to participate in a meditation experiment. Only those who persisted the full hour were analyzed in the final outcome data, which could be another source of bias in the data. How much improvement would we have documented if we were analyzing completers (45) AND dropouts (35)?
Actually, this type of analysis is possible using Direct FIML (Full-Information Maximum Likelihood) with SEM techniques. I will, in fact, do these analyses as soon as I get the data set from Jason. This will allow me to estimate the scores at the end for all participants, including those who dropped out. It seems mathematically impossible, but it actually can be done.
If those who dropped out are systematically different from those who continued, it will “know” and correct for this. For example, if those who dropped out were, on average, doing more poorly, then the estimates based on those who persisted will be biased, and the degree of bias could potentially be infinite. The SEM analyses will also tell us if there are no significant differences in those who persisted and those who dropped out.
Finally, the data LOOKS like the meditation “caused” some fairly significant improvements, although the results were in some ways puzzling. Using SEM, I should be able to determine whether, and to what degree, the improvement was simply a “placebo” effect resulting from the participants expectations of improvement, as opposed to an actual result of the meditation.
So, stay tuned for updates on this amazing and deeply appreciated research initiative by our beloved Jason Meno!
Thanks for listening today.
Rhonda, Jason, and David
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Ask David How Can I Change an SDB (Self-Defeating Belief)? How Can I Cope with Intense Public Speaking Anxiety? Featuring Rhonda Barovsky, Psy.D., Matthew May, MD, Jason Meno and David Burns, MD (Jason is an AI Scientist on our Feeling Great App Team) Anonymous asks: How can I change an SDB (Self-Defeating Belief)? Hiranmay asks: How can I deal with my intense anxiety before public speaking. Answers to Your Questions
Note: These answers below were written BEFORE the podcast, and the live discussion always adds new and different angles.
Today, Jason Meno, our beloved AI guy on our app team, also chimes in on the many super questions submitted by Andrew (#3 - #10.)
1. Anonymous asks: How can I change an SDB?
Dear Dr. Burns,
I’m an avid listener of the Feeling Good podcast and for the past few weeks, an avid user of the Feeling Great app. Thank you for your incredible work and dedication to making people everywhere feel better about themselves.
I have a question about self-defeating beliefs that I’m hoping you can address, either on the show or on your website. You have mentioned on several occasions that SDBs are the root cause of negative thoughts and consequently of negative feelings.
Yet, to me it doesn’t feel like SDBs are really addressed enough on the podcast. There seem to only be a handful of episodes covering the topic. It also seems there is a very limited toolbox of methods to use on SDBs, almost like dealing with them is considered an afterthought. If SDBs really are the cause of it all, shouldn’t the primary focus be on defeating them first and only then, on defeating negative thoughts?
I’m just a little bit lost when it comes to defeating SDBs, which seem to be way harder to deal with than negative thoughts. Any insights or thoughts on the subject will be greatly appreciated.
Sincerely,
Anonymous
David’s reply
Dear Anonymous,
Will start a new Ask David with your excellent question. Thanks,
david
First, you can look up Self-Defeating Beliefs in the search function on my website, and you'll find many great examples. Here's what I got just from "Self-Defeating Belief." You could also search for a specific type, like Perfectionism, Perceived Perfectionism, Achievement Addiction, Love Addiction, Approval Addiction, Submissiveness, etc.
In general, there are two approaches to any SDB. Four approaches can be used in this order:
Do a Cost-Benefit Analysis of the SDB. If Disadvantages outweigh Advantages, use Semantic Technique to modify the SDB. Do an experiment to see if the SDB is actually valid. Use the Feared Fantasy Technique to put the lie to the SDB at the gut level.Here's our latest thinking, which is a step beyond the four steps above. Do a Daily Mood Log on one specific moment when you were struggling with your SDB. We will discuss these ideas in greater depth on the show, of course!
You can also find a great deal on SDBs in my books, like Feeling Good, the Feeling Good Handbook, and more. But right now, I don't even know what SDB you might want help with / more information about.
Also, in the Feeling Great App, there's a terrific class called "Your PhD in Shoulds." It includes a lesson on perfectionism.
2. Hiranmay asks: How can I deal with my intense anxiety before public speaking without working on the negative thoughts I have afterwards, like
“I am going to mess this up” “People are going to notice something obviously wrong in my presentation that I missed, and I will look like a fool.“ “This talk is important, it must go well!Here’s his email:
Dear Dr. Burns,
I love your books and the feeling good podcast. They have made such a huge difference in my life (in a good way of course).
I have an “ask David” question on acute anxiety:
If I have to play a badminton match or give a presentation, I usually get some or a lot of anxiety the day before the big event as well as the morning of. I then use all the methods you have taught, and the anxiety reduces. However, it usually comes back with a bang just before I give the talk or play a match. Cognitive techniques are not very helpful to me 30 minutes or 5 minutes before the presentation or match. I don’t have the time to sit down and write my thoughts or cannot focus at all on my thoughts. Are there any strategies to reduce this form of acute “relapse” or nerves.
Here are some more details:
Event: 30 minutes before my presentation. I just entered the seminar room, and the first speaker is about to start their talk. I am next. I can feel my heart starting to pound and I am getting the familiar sense of anxiety and nerves.
Thoughts: “I am going to mess this up”. “People are going to notice something obviously wrong in my presentation that I missed, and I will look like a fool“. “This talk is important, it must go well”.
Although to be honest, this is my analysis of what my thoughts were after the fact. 5-15 minutes before the presentation, I usually just notice my thoughts racing.
To reiterate: I am not looking for help with working on these thoughts after the presentation. Any strategies to acutely deal with anxiety or rather relapse of anxiety when I don’t have time to use all the wonderful TEAM tools would be very helpful.
Thanks so much.
Best,
Hiranmay (pronounced he-run-may) living in Basel, Switzerland.
David’s Reply
Sure, as a starting point I’d like to see your work with these thoughts on a Daily Mood Log. Do you have one that you could send me, with the percents filled in, etc.
That will allow me to see what your strategies are on challenging these thoughts, and whether you can knock them out of the park, or only challenge them “somewhat.”
Best, david
You can see Hiranmay's excellent DML if you check here.David Continues
Hi Hiranmay,
It sounds like are not interested in help with the thoughts you recorded in your email below, since this, by definition, is “after the presentation.” If you like, you could perhaps “make up” some thoughts you might be having BEFORE you start to speak.
As someone who has had, and recovered from crippling public speaking anxiety, I have tons of powerful techniques, but would need some help from you so I’ll have something to go on.
By the way, I absolutely DO NOT BELIEVE you when you say those are not the thoughts you are having in the minutes before you begin to speak! So, your requirement that we are not allowed to work on them is a bit of a hindrance.
As an aside, I will include this in an Ask David podcast, if that is okay!
Sincerely, david
I asked H to send me a copy of his Daily Mood Log, which was really well done, and responded with a few suggestions.
Then I sent this note:
David’s Subsequent Response
One thing I noticed on your Daily Mood Log is your fear of making a mistake, or having a critical question from someone in the group, or not being able to impress your audience sufficiently. These fears are common in public speaking anxiety. We've all struggled with them at one time or another, I think!
I have changed my focus from needing to impress the audience with myself or my talk, and instead I try to remember to try to impress them with themselves, and how awesome they are.
Here's an example. I once gave a presentation on the serotonin theory of depression for about 1,000 psychiatrists at a prominent medical school in Texas. It was going well and suddenly a man at the rear stood up and started shouting something like this:
“I’m so sick of all you establishment researchers thinking you know so much and ignoring my work. I have discovered the cause and cure for depression in my laboratory. (He claimed it was some kind of vitamin deficiency.) But everyone is ignoring my work (and more ranting and raving.)
There was a chilled silence in the room. Here’s how I responded:
“I appreciate was you’re saying, and I agree. I think our current focus on deficiencies in brain serotonin is extremely misguided, and predict, as you say, that research will show that the chemical imbalance theory of depression is not valid. And often, the most important breakthroughs come from laboratories like yours, where someone who is unknown discovers the actual cause of an illness after being ignored for years and years. I’d be honored if you’d approach me at the end of my talk so I can learn more about your pioneering research!”
Notice I did not defend myself, but tried to make HIM feel good.
At the end of my talk, about 20 or more people came crowding up to the podium with questions and such. I saw him at the back of the group, pushing his way to the front. I braced for another attack. He said,
“Dr. Burns, that was the best presentation I’ve ever heard by far on the serotonin theory of depression. If you would give me permission, I would love to show your slides to my students and colleagues!”
I have very little fear of being attacked by people in the audience, and I now speak all the time in front of groups. I used to have paralyzing public speaking anxiety. But the monsters I feared were all in my brain!
Warmly, david
Andrew asks 8 cool questions! (#3 - #10) which are listed below, along with my answers. Jason Meno also sent some awesome answers, which you'll find below as well, right after my answers to the 8 questions.
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418 The Fear of Driving Featuring Werner Spitzfaden, LCSW and Rhonda Barovsky, PsyD
Today, we feature Werner Spitzfaden, LCSW, a Level 3 certified TEAM-CBT therapist who recently treated Rhonda, who's driving phobia returned during the pandemic because she did very little driving at that time. After you overcome any fear or phobia, it has a way of returning if you don’t continue confronting your fear. Werner describes his skillful and compassionate work with Rhonda!
Werner is a dear colleague and friend with over 35 plus years of clinical experience treating phobias, such as the fear of flying, claustrophobia (the fear of being trapped in small places), and driving (especially over bridges and overpasses). He also treats depression, panic and other forms of anxiety, and works in corporate environments to improve communication and teamwork.
Let's dive right in, Please take a look at Rhonda’s completed Daily Mood Log,
As you can see, the upsetting event was thinking about driving over an overpass, and she rated her initial anxiety cluster at 100%, indicating extreme anxiety. She was also 90% ashamed, and 80% Inferior, worthless, inadequate, defective, and incompetent. She was also feeling 99% embarrassed, foolish, humiliated, and self-conscious, and 85% hopeless, despairing, frustrated, stuck, angry, annoyed, irritated, upset, and devastated. Her sadness was only modestly elevated at 25%.
There are several teaching points. First, most of Rhonda’s negative feelings were severely to extremely elevated. Second, although she is asking for help with a phobia, anxiety often goes hand-in-hand with a wide variety of negative feelings, including shame and inadequacy. This is because anxious individuals often feel like there’s something terribly and shamefully wrong with them.
Rhonda's feelings of shame are not unusual. Shame is a central feature of anxiety, whereas a loss of self-esteem is a central feature of depression. Werner added that the fear of driving often goes along with the fear of heights as well as claustrophobia.
Rhonda admitted to engaging in many “safety behaviors” which typically make anxiety temporarily better but worse in the long run. Rhonda's "safety behaviors" included going out of her way when driving to avoid scary overpasses as well as asking her husband to drive her many place. As you can see, these totally understandable “safety behaviors” relieve your anxiety in the here-and-now because they are forms of avoidance, but that’s why they makes anxiety worse in the long run. The urge to avoid of the thing(s) you fear is universal among individuals struggling with all forms of anxiety.
Werner emphasized the importance of empathy in the initial phase of treatment, and throughout the treatment, since trust and the courage to face your fears is so central in the treatment of all forms of anxiety and, of course, depression as well.
Rhonda invited Werner and another TEAM-CBT colleague, Lee Flowers, to stay with her in Berkeley during the recent TEAM intensive that David and Jill Levitt directed at the South SF Conference Center near the airport. She drove the group to and from the workshop to face her fears and get some motivation and support at the same time.
You can see many of her negative thoughts about driving on Rhonda’s completed Daily Mood Log, including these:
The bridge will collapse. 95% Other cars will make the bridge unstable. 100% I’ll have a heart attack. 95% I’m so dumb for not driving on this overpass. 1005 I’m an ass. 100% I can’t do this. 100% I’ll die. 100% Lee and Werner will see me at my worst. 100% I need to study the exact route before I start. 100% I’ll get into an accident. 100%As you can see, the list includes a mixture of fear-inducing thoughts as well as self-critical thoughts and shame-inducing thoughts, like "Lee and Werner will see me at my worst."
Whenever you are working with anyone with anxiety, you have to emphasize first, to create trust, warmth, and understanding. This won't cure anyone of anything, but will give your patients the courage to face their fears when you get to the M - Methods portion of your TEAM session.
After you get your A in empathy, you can move on to A = Paradoxical Agenda Setting. That where you bring Outcome and Process Resistance to conscious awareness. Then you melt them away using a variety of TEAM-CBT techniques. Outcome Resistance means that Rhonda may have mixed feelings about a “cure” for her driving phobia. In other words, although she WANTS to get rid of this fear, she may subconsciously NOT want to get rid of it.
Can you think of why? Take a moment to think about it, and make a guess. You’ll find the answer at the end of the show notes.
Process Resistance means she may WANT a cure for her driving phobia, but may not be willing to do what it takes to defeat this fear.
What will she have to do? Take a moment to think about it, and make a guess. You’ll find the answer at the end of the show notes.
Werner and Rhonda described a number of TEAM-CBT M = Methods that they used to reduce Outcome Resistance, including
The Miracle Cure Question The Magic Button Positive Reframing The Pivot Question The Magic Dial.To put this phase in a nutshell, Werner highlighted how Rhonda's intensely negative feelings helped her and revealed many positive things about her core values as a therapist and human being. This is a shame-reducing technique and you can use the Magic Dial to ask your patient what they would like to dial each negative feeling down to, without reducing them all the way to zero. You can see Ronda's goals on Rhonda’s completed Daily Mood Log in the Emotions Table
Next, Werner worked on Process Resistance, bringing the work on Paradoxical Agenda Setting to closure.
At the start of the M = Methods portion of their work, Rhonda identified the distortions in two of her thoughts (“I’m dumb,” and “I can’t do this.”). See how many distortions you can find. Wrote them down on a piece of paper and when you're done you can see the answers at the end of the show notes.
Werner pointed out that Rhonda’s anger, directed against herself, had become a springboard for agitation which intensified her anxiety.
Werner and Rhonda challenged some of her negative thoughts with Examine the Evidence, Externalization of Voices (illustrated live during the podcast),Double Standard Technique and the Paradoxical Double Standard Technique as well as a Fear Hierarchy, which you can see if you click here.
The also did Cognitive Flooding (also called Imaginal Exposure) three times, and by the third time Rhonda could only increase her negative feelings into the mild range, whereas they had started out in the extremely elevated range.
They also used breathing exercise plus getting into the here-and-now to calm herself while driving over overpasses.
All of this was background work for actually driving during the intensive, and the highlight was driving home in the dark on the third evening of the intensive. For Rhonda, this was the most fearful thing of all! She said at the start her anxiety was "greater than 100%," but she felt triumphant when she arrived home.
Werner gave her specific homework, like driving over a specific overpass four times, and also encouraged Michael, Rhonda’s husband, not to give in to her requests to do the driving on a planned trip to visit friends in Sacramento.
I am deeply grateful to Rhonda for giving us such a raw and real glimpse into her courageous and victorious win over her intense driving phobia, and a big thanks also to Werner for being such a kind and powerful TEAM-CBT therapist, teacher!, and beloved friend!
Thanks for listening today,
Rhonda, Werner, and David
Solution to puzzles above
Outcome Resistance: If she’s “cured,” she’ll have to start driving much more, and that will include driving over overpasses and bridges. This concept will freak her out now, because she’s still afraid something horrible might happen if she stops avoiding them. Process Resistance: To overcome her fears, she’ll have to face them and experience some fairly intense fear along the way. Werner can support her, and drive with her, as he did, but she will still freak out at first when driving on overpasses and bridges. The distortions in those two negative thoughts included All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Mind-Reading, Magnification and Minimization, Emotional Reasoning, Hidden Shoulds, Labeling, and Self-Blame. -
Podcast 417 Bullying Featuring Manuel Sierra, MD (pictured above)
Today, we welcome an old friend, Manuel Sierra, MD, who practices pediatric psychiatry in Idaho, and Dr. Matt May, a familiar and beloved colleague, to discuss bullying.
Below you’ll find a great list of questions Dr. Matt May submitted just prior to today’s podcast, along with some links you may wish to explore for more information. We addressed some of the questions, but certainly not all, during the podcast!
Manuel described bullying, and said the ¼ of children and adults have experienced bullying. The consequences can be severe, including suicidal urges or completed suicides, along with shame and a severe loss of self-esteem, and more. He pointed out that bullies are good at zeroing in on aspects of ourselves that we feel insecure about, including how we look, our ethnicity, our aptitudes, and more. He provided links to resources on bullying.
The bully picks on someone who is weak, so there is a power imbalance, and does the bullying to gain popularity and power, at the expense of the victim. David and Manuel emphasized that the bullying per se cannot cause the depression, shame, and so forth, but rather the victim must buy into the bully’s mean-spirited statements, like “you’re weak,” or “you have an ugly zit on your nose,” “your mother is a dirty whore,” and more.
Then, the inner dialogue of the victim often goes like this:
I must be a terrible and horrible person to get bullied like this. I’m worthless. All the kids are looking down on me. Everybody hates me! Everyone is laughing at me. I’m just a loser.And that, of course, is the voice of the “inner bully” who does all the emotional damage. Manuel and David both emphasized that the goal of treatment is to help the victim see that the “badness” is not with them, but rather with the kid (or adult) who’s doing the bullying.
Because the victims nearly always feel ashamed, they will often suffer in silence, keeping the bullying a secret. David described what he calls the “abuse contract” that many, and perhaps most, humans buy into when being hurt or exploited. It’s really a contract between the abuser and the abused, and there are there parts to the agreement.
I get to hurt you for my own pleasure. This might include sexual, physical, financial, or psychological torture or abuse. You, the victim are entirely to blame for this. You are the bad one. I am superior and totally innocent. You deserve what’s happening to you. We have to keep this a secret, even from ourselves. You cannot even hint that I am doing something wrong. If you try that, I will REALLY hurt you.David emphasized that the tendency to “accept” this type of horrible contract is not limited to children, but includes adults as well.
He emphasized that sometimes the child who is being bullied will tell parents, who then tell the teacher or school officials, who will tell the bully to stop. This is rarely effective, and often makes the situation worse, since the bully tells the victim that they are a snitch and now they will REALLY get what they “deserve.”
Matt described many types of bullying, including physical, psychological, and cyber bullying. Manuel described some of the signs to look for if you suspect a problem with your child, including:
Not wanting to go to school. Saying things like “everyone thinks I’m terrible.” Changes in sleep, eating habits, and energy. Somatic symptoms such as stomach aches and headaches.Manuel emphasized that the goal is not to eliminate negative feelings entirely, but rather to reduce the time you spend feeling anxious, humiliated and upset after being bullied. He also emphasized that ongoing practice talking back to your own negative thoughts is an important key to change, in exactly the same way that athletes must commit to ongoing daily practice to boost their physical skills and stamina.
Manuel emphasized the importance of empathy and support, as well as asking victims if they’d want some help combatting their automatic negative thoughts and feelings. He shared that he endured considerable bullying as a kid, and was bullied because he was poor, of Mexican heritage, short, wearing glasses (“four eyes”), and young, and sometimes called “a fag” and other hurtful things.
He said that reattribution is one useful strategy, among many, for combatting automatic thoughts and negative feelings. Instead of automatically blaming yourself for the bullying, you can ask questions like this: “What is it in their life that makes them want to do things like this.?” And “They are trying to hurt and embarrass me. Why are they doing that.”
The goal is to help the victim see that the “badness” and shame really reside within the bully, and not with them. The bully is trying to tear you down. Ask yourself why? The bully thinks that this is the best way for them to gain popularity, power, and importance.
Toward the end of the podcast, I, David, again emphasized that the Outer Bully can hurt us physically, by hitting for example, but only the Inner Bully can make us suffer emotionally. And if you’ve used the Externalization of Voices to crush the inner bully, and you no longer feel intimidated or ashamed when some tries to bully you, it becomes infinitely easier to respond effectively to the Outer Bully, using the Five Secrets, including Disarming and Stroking, as well as humor.
To demonstrate this, I invited the other guests to try to bully me as an old person (I’m about to turn 82), and urged them to say the cruelest things they could think of. This is called the Feared Fantasy Technique.
I was surprised and pleased at how incredibly easy it was to get “the edge on them. “ I hope you enjoy that aspect of the podcast.
We will likely approach this topic again, with a focus on cyber bullying, and will restrict our focus to children and teens.
How to Help!
Matt once worked with a child who encountered their own 'inner bully' in the form of negative thoughts that would occur when they were unable to assemble LEGO's. The child could express certain thoughts, but was too young to write, so Matt wrote these down:
I'll never be able to do it It’s impossible I'm not good at anything There is something wrong with meMatt asked the child if they would like to learn a trick for how to feel better and the child agreed.
Matt wrote down some new thoughts for the child to choose from to describe the situation that was upsetting to them.
Multiple Choice Positive Thoughts:
I really, really want to do this! It's ok if I can't do it, yet Some things take lots and lots of practice I may be able to do it later I can do lots of things really well already I can probably get better with practice People love me and like to help Nobody's good at everything all the time Everybody messes up sometimes It might help to take a break I can always choose to like myselfThe child said they really liked #11 and felt better right away and during future 'relapses'!
Thanks,
Matt
Thanks for listening today. Below you’ll find the email Matt sent prior to the show.
Manuel, Rhonda, Matt, and David
Matt wrote:
Just to stir up trouble and make you all sweat, I'm sending a few questions we might address:
What is bullying? How are we defining this term? Is it Liberal Propaganda? How dare I say that? What's the difference between bullying and micro-aggressions / gaslighting? Am I crazy, if I think I'm being gaslighted? If I avoid bullying, in-person, including physical, emotional and verbal abuse...am I safe, on the Internet, at least? Is there such a thing as 'Safety'? Isn't that the thing we need, the most? Whose job is it, to make me feel safe? Why do some people think that safety doesn't exist? What is the significance of bullying? Does it matter or have any tangible effects on individuals or society? Link: https://www.ncbi.nlm.nih.gov/books/NBK390414/What are some common misconceptions when it comes to bullying? Here are some that Matt has seen on DML's:
It was all my fault / I deserved it / This happened because I am (insert label: bad/weak/defective, etc.) Bullying is normal, nothing can be done about it. Everyone gets bullied. It builds character. I should just get over it. I shouldn't *still* feel upset. That was a long time ago and I've done a lot of therapy. I can't speak up or talk about it, it's just too disturbing and upsetting. People would judge me and reject me, if they knew what happened to me All conflict is dangerous and must be avoided, at all costs I'm just a loser, a born victim, worthless in every way. This will always happen to me and people who believe #2 are correct I should be more accepting of bullies, they're people, too. Bullies shouldn't be bullies and should be hunted to the ends of the earth, and destroyed.What is the *cause* of bullying behaviors? Why would anyone choose to be cruel, manipulative and selfish?
What is the 'Dark Triad'? Which feature of the 'Dark Triad' is most closely associated with bullying? Link: https://en.wikipedia.org/wiki/BullyingWhat can be done about bullying?
How can TEAM therapy help someone who is being bullied? Can TEAM therapy help a bully? What can parents do, if their child is being bullied? Can TEAM help? What can parents do, if their child is bullying? Can TEAM help? What can society do?Other Questions:
What is the “Internal Bully”? How does the “Internal Bully” relate to depression? What is the greatest predictor of bullying behavior and thinking? Who's to blame, anyway, here? -
Podcast 416 Ask David is it reckless to question the existence of the "soul?"' How can I make myself accountable? Do we have a "personality," or is that just another illusion? Do questions about the "self" and "free will" involve All-or-Nothing thinking?
The answers below were prepared prior to the podcast, and simply based on email exchanges. Be sure to listen to the live podcast discussion to get a variety of opinions and comments!
Questions for today’s podcast.
#1: Weren’t your comments on the self a bit reckless, given that the existence of / or belief in the “soul” is a prerequisite for most religions?
#2: How can I make myself accountable for doing the exercises in your books?
#3. Holy asks if the concept of having “a personality” is the same as the question of having “a self?”
#4. Could questions about the “self” and “free will” involve All-or-Nothing Thinking?
Question #1. (not question, just a comment worthy of a response)
Your comments on the “self” were shallow, mocking and restless.
The recent episode on ‘Do I have a self?’ (Episode 406) was very shallow and mocking of people who thought there was a soul/self. Given a soul is a prerequisite for most religions, dismissing it out of hand without meaningful discussion seems reckless.
David’s response
Thanks, there’s a lot of truth in your comment and we’ll definitely include this on an upcoming Ask David!
To give a brief response prior to the show, I would say that I am not trying to defend or attack any religion, but don’t want to give up my right to freedom of thought. I, David, am not saying that the “soul” does not exist, but what I am saying is hard to convey, and I probably won’t be successful now, either.
But, when you talk about a “soul,” I do not have any idea what you mean by that word, or what you are referring to, if anything. To me, words like “self” or “soul” are simply language that is “out of gear,” as Wittgenstein might say. Meaning can only occur in a specific concept. It is not the case that there are “pure meanings” for abstract concepts. Thinking along those lines was the huge error that Plato and Aristotle made.
Now, let’s say I go to YouTube and listen to some really kick-ass music that I totally love. I might say, “Wow, that guy (like James Brown, for example) really has soul!”
What I’m saying is that I tremendously admire and appreciate his talent, his energy, and so forth. I am not referring to something metaphysical.
My concern about your comment is that it sounds scolding, at least to my ear, like the “morality police,” perhaps. Personally, I have seen a great deal of evil done in the name of this or that religion, and I have no doubt that you have, too!
Still, I am sure you have strong religious beliefs, which I respect, and apologize for having offended you. But I admit I am ambivalent, and partially happy that you are offended, and speaking out, because I believe that critical thinking is also tremendously precious, just as your religious beliefs are precious to you.
In a selfish way, I have to confess I am also happy for the criticism, because controversy stirs up interest, and I am trying to interest people in our podcasts, which are ultimately dedicated to healing and relief of suffering.
Still, I cannot deny the truth in your comment, that my “critical thinking” can be a disguise for a put down.
When I wrote Feeling Good, I was very aware already (in the 1970s) that the chemicals categorized as “antidepressants” had few or no clinically significant effects above and beyond their placebo effects, and subsequent research has validated this.
But I did not emphasize this in that book because I did not want to pull the rug out from anybody, and hurt anybody’s feelings. After all, if you are getting a nice “placebo effect,” that’s a good thing, at lest to some extent.
Now, I’m older, so I’m more willing to speak my mind, and let the chips fall where they may.
And you have bravely spoken your mind, too. Kudos to you!
And that’s the end of my prayer! Keep those good thoughts rolling along.
Amen
Best, david (PS I’m sure you’ll get way better answers from the others on the podcast tomorrow!)
Question #2. How can I make myself accountable for doing the exercises in your books?
Good to have Fabrice back. Regarding your books I have a question. I have trouble holding myself accountable doing the exercises in the book. Do you have any advice on how to prioritize doing the homework and being disciplined with it? How did other depressed people get better using your books? I already filled out multiple notebooks but appear to be stuck. Any help appreciated!
David’s Response
Thanks, we will address your question on a future Ask David podcast, if that's ok.
Question #3. Holy asks if the concept of having “a personality” is the same as the question of having “a self?”
@HolyLoveQuest • 1 day ago
Thank you for this video on this topic, it was very clear to me!
It's a shame that this chapter of your Feeling Great book was removed, because to me this philosophical point is one important tool (among the many techniques that you propose) to get read of negative thinking, and to heal.
What you said about the DSM is refreshing, and I agree with it. So, you said schizophrenia and bipolar1 are mental disorders, and you explained why, but what would be the third: psychopathy? It would be nice if you do another video where you dig on this. Your voice on it is really important. What the APA is doing is really concerning. Other psychiatrists disagree with this business of labelling people. And you're right, it's detrimental to human beings.
There is another psychological concept that you didn't talk about, but who looks similar to the "self", which is the "personality". What is your take on it, the same or different?
Lastly, now in the spiritual domain, is the notion of the soul the same for you than the "self"? Or, in your opinion, could it be a possibility of an essential part of us which links us all to the Spirit, to spirituality?
Looking forward to watching the other philosophical videos!
David’s Response
Will include in next Ask David Podcast!
Question 4. Could questions about the “self” and “free will” involve All-or-Nothing Thinking?
Matt send me the following email he received and asked if we could include it in our next podcast, and my answer was “of course!”
Hi,
I'd like to tell you about my experience with my son. He is 14 years old and despite our honest attempts not to label, he has always been the problem child: selfish, disobedient etc.
Recently we started him on Prozac and the changes have been incredible. Things that have been way beyond his best times are now simple, like going to sleep on time or having a good time with his brother. Every night my wife and I tell each other about some new miracle.
So, I wonder what you can say about this from the lens of free will. An obvious conclusion would be that the choices he made until now were not "free" because his brain was not presenting him with the same set of choices that other kids experience. On the other hand, if he is acting better now, we could say that it is not his choice, just a pill making the decision for him. I feel like that would be insulting and degrading.
I wonder if a lot of resistance to therapy and especially pharmacotherapy is related to anxiety about the question: "If I can be changed by a pill, then who am I?"
I had another thought after listening to the episode on "self". The position that self doesn't exist seems extreme to me, maybe like "all or nothing thinking". Maybe we could answer that question with a "magic dial". How much do we agree that there are selves and free wills? I agree that there are problems associated with having a self and free will, but I think there are practical and theoretical reasons on the other side as well.
Maybe the golden path is in the middle?
David’s Response:
Will include your excellent question in the next Ask David Podcast! I am so happy to hear the good news about your son!
At this point I will briefly say that concerns about “free will” might definitely include all-or-nothing thinking in the following sense. There is an awful lot of our thoughts, beliefs, feelings, behaviors, preferences, and so forth that is kind of hard-wired by evolution, genetics, and who knows what.
For example, I really love blueberry pie that way my mother made it, but I never cared for pumpkin pie. I cannot “will” myself to like pumpkin pie! So I don’t have free will in that sense.
Similarly, I can’t “will” myself to want to stop breathing permanently, or to stop feeling hungry when I haven’t eaten, and I can’t “will” myself to levitate when mediating or being able to high jump over something five feet high.
The list goes on and on. And even when I freely chose something, like what type of new shirt to purchase, I have no doubt by genes and innate preferences, and possibly my upbringing, will strongly influence my choices.
We all have biases, preferences, and desires that we do not choose, at least not consciously, Like sexual preferences, for example. We’re kind of stuck with what we’ve got.
Now we can make free choices, of course, but we cannot be “totally free,” because we exist and are human. A cat can’t “not” get excited by a wiggly piece of string or a mouse that’s running away.
But we CAN make conscious choices, obviously, just as I made the decision to print your excellent question and type out this brief response!
Warmly, david
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Question #1: John asks: Can you do TEAM on your own?
Question #2: John asks: Can you provide more insights or instructions on how to do Positive Reframing on your own? It seems to be an incredibly important key to TEAM-CBT.
Question #3: Ann asks: What can I do when I blush and my face turns bright red?
Question #4: Dylan asks: Can you have a delayed reaction to the CBT exercises?
#415 September 23 Ask, New questions
Question #1: John asks: Can you do TEAM on your own?
Oh, one other point that occurred to me, the people doing personal work on your podcasts are generally TEAM CBT therapists or people familiar with the TEAM model. They are obviously very familiar with the steps and techniques in TEAM, and yet they seem to require the insight and guidance from yourself and Jill.
Why do you think that is if they are so well versed in TEAM already? Does that mean that a person from the general public doing their own work using your books without the guidance of a TEAM therapist is futile? Or would you always recommend someone using a therapist?
Kind Regards
John
David’s response
Can we include it in another podcast? Would love to just read it and jam on it with R and M.
Warmly, david
Question #2: John asks: Can you provide more insights or instructions on how to do Positive Reframing on your own? It seems to be an incredibly important key to TEAM-CBT.
On Mon, Aug 5, 2024 at 9:24 PM John Macken wrote:
Hey there David and Rhonda,
I hope you're keeping well, this is John from Ireland, we had a previous correspondence on Should statements! David, thanks very much for asking for access to the beta app, I'm really enjoying the modules! I heard you say on one of your apps that you are planning some workshops in relation to the app, will they be available online do you think? Would love to tune in if possible!
I am always grateful for your inspiring work! I love your passion for the work that you and Rhonda do and that comes across from both of you during every podcast episode. Your FG community sounds amazing! Who knows, maybe one day I'll ditch the corporate career and join the cult!
I have another question on Positive Reframing! As someone who is still trying to find my own journey to enlightenment following many months of anxiety and depression, I feel I am falling at this positive reframing step. I still find I am bumping up against resistance and I feel that my positive values and benefits don't count. It’s almost as if there is some kind of discounting the positive going on like my negative points vastly outweigh my positive points. It’s like there is such a negative filter there is no space for recognizing positive qualities.
I was listening to the beginning of Episode 310 where a listener had an excellent contribution on Positive Reframing from your live work with Nasli. That got me thinking, would it be possible to hear more insights and detail on how to perform your own Positive Reframing work? Or do you have guidelines or a worksheet anywhere? It feels like the most powerful of all the steps!
Among the many incredible tools that have been created under TEAM it seems the Agenda setting piece is probably the most powerful and innovative. I have listened to many of your Live Sessions intently and it seems that your gift and that of Jill Levitt is in convincing the patient of the beauty of their depression and anxiety. It feels that they are almost recovered or very nearly once you go through that step.
On the face of it, it looks like what you're doing is very simple but there is a nuance and complexity to it that is incredible and without sounding too grandstanding or over dramatic this "gift" seems to be where the healing power lies. If you could bottle that gift you would change the world or be a billionaire or both! It is astounding to listen to. I would love to hear more about your insights into this area and how people can unlock this for themselves.
For example, I found podcast 387 on Acceptance and Daring to be average incredibly powerful and insightful and convincing and these are pieces I'm trying to implement in my life.
Love and admire your work and would love to make it over to one of your in person workshops someday when they are available to the general public,
Warm regards
John
David's response
We will address positive reframing on the show.
Question #3: Ann asks: What can I do when I blush and my face turns bright red?
Dr. Burns,
I hope you’re both doing well. I wanted to share with you that you have changed my life dramatically. I have always thought that everyone else had a problem as far as attitudes and behaviors. But you have taught me through all three of your books and podcasts that my thoughts are why I’ve been so anxious and depressed.
I have been on medication since I was 20 years old. Now, I’m weaning off of my medication because of all of the work I’ve done with your book and a therapist trained in TEAM therapy. My relationship is much better with my husband and it was me that was pushing him away from me. Talk about enlightenment!?
I’m anxious about getting completely off of my clonazepam because it helps me “control” my face from turning red. My red face makes me so anxious and I start sweating profusely whenever I’m in a situation that’s embarrassing. Thank God, my menopause has helped me with explaining why my face is so red. This has been going on since I can remember. I think I was 5 years old in school when it first happened. Most people stare at me because my face gets really red. I’ve repeatedly tried looking at people, while my face is turning red, to see if they are truly looking at me and sometimes they are and not. The redness lasts for around two minutes but if feels like hours. What can I do? I want to get off all of my meds but my psychiatrist says to do it slowly. I haven’t listened to all of your podcasts but I don’t think there’s one out there regarding a 49 year old lady suffering from a red face. Maybe an ask David? I hope I’ve been specific enough for you. I cannot thank you enough for everything you do for people.
Thank you,
Ann Zernone
David’s response
Yes, we actually had a podcast on this exact thing, and happy to add it to the next Ask David if you like. Best, david
88 Role Play Techniques: Feared Fantasy Revisited https://feelinggood.com/2018/05/14/088-role-play-techniques-feared-fantasy-revisited/
168 The Blushing Cure https://feelinggood.com/2019/11/25/168-ask-david-the-blushing-cure-how-to-heal-a-broken-heart-treating-anorexia-and-more/
Question #4: Dylan asks: Can you have a delayed reaction to the CBT exercises?
Hi David,
I’m a big fan of your work. Quick question: do you commonly come across people who do CBT exercises and they don’t get their anxiety or depression levels reduced super low right after doing the exercises but a couple days later they experience the results?
Dylan Aames
Unfit Productions, LLC
President
@JohnnyPlissken-xs7hq • 12 hours ago
David replies
Will talks about having this same experience on the live show.
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Feeling Down? Try the Feeling Great App for Free!
The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com!
Life Coaching: A New Dimension in CounselingToday we discuss the recent upsurge in life coaching, and feature one of the leaders in this emerging field, Angela Poch, and one of her wonderful students, Lorna Bird.
Lorna Bird
Angela Poch (see featured photo) is a Registered Professional Counsellor (RPC) with the Canadian Professional Counselling Association, certified Master Life Coach, and TEAM-CBT Level 4 Advanced Therapist and Trainer. She has been teaching health and wellness for over 30 years and was Vice President of Education with the Adventist Association of Health & Wellness Coaching. She has written several articles and books on health and wellness including, “The Truth Will Set You Free.” She has a YouTube channel (@talkingteamcbt) interviewing clinicians about their journeys with TEAM-CBT. She also has a channel on psychology and health (@bodymindhealth4u).
Lorna Bird holds a Diploma of Counseling from Australia and is a certified Life and Health Coach. She is also a Level 3 certified TEAM-CBT therapist https://www.yestohealth.com.au/
Angela and Lorna will give us the true scoop on coaching. To get started, what IS coaching, and how does it differ from psychotherapy?
I am aware that our podcast goes worldwide, so the answer may differ depending on the country or state where you live. According to AI,
“In California, the term "psychotherapist" is defined in the Civil Code to include a number of mental health professionals, including psychologists, psychiatrists, and clinical social workers. In general, anyone who provides psychotherapy or counseling in California, whether in person, by phone, or online, must be licensed.in California.”
Coaching is quite different. Again, according to AI,
“In California, there are no specific state-mandated requirements for individuals to use the term "coach" or practice life coaching, meaning anyone can technically call themselves a coach without obtaining a specific license.”
Angela Poch resides in Canada, and she has been a leading and beloved member of the TEAM-CBT community. She emphasized several differences between a “coach” and a licensed mental health professional:
Diagnosis: A coach does not diagnose clients into the familiar DSM categories of “mental disorders,” such as “Major Depressive Illness,” “Bipolar Disorder,” “Schizophrenia,” or any of the hundreds of “mental disorders” listed in the DSM. In the same vein, licensed mental health professionals will typically screen for suicidal thoughts and urges, and will treat suicidal individuals, but this is forbidden territory for coaches.
Purpose / aims of coaching: The purpose or aims of coaching do not, as a rule, involve delving into your past to search for the “cause(s)” of your problems, such as adverse childhood experiences or traumas. Instead, the focus of coaching is primarily on making changes in the here-and-now in how you think, feel, and relate to others. This might involve learning to challenge distorted negative thoughts so you will think and feel more positively about your life, as well as how to relate to others more skillfully. Coaching is goal-oriented and forward-moving rather than dwelling on the past. Of course, good counsellors and licensed mental health professionals may also provide tools to move forward as well, so there can be overlap.
Training / credentialing: Because coaching is so new, there are not yet any widely accepted standards or requirements for calling yourself a “coach.” There is a varying degree of training to be “certified,” which might just consist of watching a couple videos to 100’s of hours of supervision with the ICF (International Coaching Federation), and everything in between.
Here’s a generalized diagram Angela created to help with further clarification. NOTE: many TEAM-CBT therapists also are client/goal focused as well as and will often use coaching-style tools.
Angela described a 20-hour “Feeling Great Coach” certification program she has developed. Her program is based almost entirely on TEAM-CBT and includes a final exam you must pass to get certified.
She also offers a TEAM-CBT Masterclass & Mentoring Program for both coaches as well as therapists that includes live training twice a month, online practice groups, case consultation in small groups, one-on-one mentoring sessions, and personal work as well. She said this integrates seamlessly with FGI’s Fast Track program, any of David’s intensives, or the Tuesday group for those who want more individualized support and training.
Lorna enthusiastically described her experiences learning from many of Angela’s training programs. I (David) have had the pleasure of knowing and working with Angela for many years now, starting with her attendance at a number of my intensives and two-day TEAM-CBT training programs in Canada. Lorna is really enjoying the Masterclass Mentoring Program and recommends you take Angela’s free workshop called “Effective Compassion.” You can check it out at
www.teamcbt.ca/effectivecompassion
How do I, David, feel about coaching? I am, for the most part, enthusiastic, but with a few reservations. I would have to confess that I spent 5 years in medical school, four more years in psychiatric residency, plus two years in post-doctoral research training at top institutions, but did not learn much at all, if anything, that has really helped me treat human beings who are hurting. Of course, I did learn how to prescribe drugs for those with severe difficulties, like Bipolar I Disorder, or Paranoid Schizophrenia, but that definitely did not require years and years of intensive medically oriented training.
All I ever really wanted to do was psychotherapy. In my last year or so of post-doctoral psychiatric training, I discovered cognitive therapy, although it was not a part of the required curriculum, and learned quite a lot that has been really helpful in working with patients.
But for the most part, all of the extensive medical training I received had very little, at best, to do with how I now work with patients, and an awful lot of what I do was things I had to figure out for myself. I do have great respect for psychology training (either clinical psychology or PsyD training), because of the emphasis on research and critical thinking, but I do think there is lots of room for new approaches such as coaching to emerge and evolve, and it seems to be the case that more people than ever are still struggling with depression, anxiety, addictions, rage, and more.
Like any field, I think coaching is vulnerable to misuse by narcissistic individuals who wish to deceive or exploit the general public, and individuals who are naïve or unaware of the background or training of their therapists are perhaps at great risk of abuse. But I would also say that this problem is in no way limited to coaching, since a great many licensed mental health professionals have been charged and convicted of all manner of unethical conduct and as well as malpractice over the years as well.
That’s why I’m enthusiastic about responsible leaders who, like Angela Poch, are blazing new trails and setting the bar high for those who wish to enter the field of life coaching. I’m also delighted to see that for years now, the Feeling Good Institute (FGI, feelinggoodinsititute.com) has included coaches in their superb training programs as well, and many high profile individuals you may be familiar with, like our beloved Professor Mark Noble, have taken and benefit from TEAM-CBT certification via the FGI.
To learn more, contact Angela at [email protected] or visit https://angelapoch.com/ to learn about Angela’s many training and treatment programs.
You can reach Lorna at:[email protected] or https://www.yestohealth.com.au/
And here is the contact information for TEAM-CBT Australia: https://www.teamcbtaustralia.com.au/
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Ask David Disturbing Intrusive Thoughts--
where do they come from? Alone and Liking It--is that Okay? Help with those darned Shoulds, and more!The following show notes were written before the show. The actual live discussions will vary somewhat from the answers you will find here, which simply included David's email exchanges with those who asked the questions. .
Rodolfo asks about disturbing and unwelcome intrusive thoughts. Brittany asks if it’s okay to enjoy / prefer being alone. John, from Ireland, asks, “Help! I’m shoulding on myself again! What can I do? Please do another podcast on Should Statements.” Rodolfo asks about disturbing and unwelcome intrusive thoughts.1. Rodolfo asks about ADHD & Intrusive Thoughts
Hello Dr. Burns, my name is Rudy. First and foremost, your writings and podcasts have been life changing for me. You’re AMAZING!
I was recently diagnosed with ADHD and I started experiencing intrusive thoughts around November of last year. I thought I had OCD, but apparently intrusive thoughts are a common companion in ADHD. What would be the best course of action in defeating them? How would I apply TEAM to them?
David’s Response
In all my books, like Feeling Great, I outline a step by step approach to writing down and challenging thoughts. You can also listen to the podcast on the four models for treating anxiety.
Can we use your great comment on a podcast, and add your question to our next Ask David podcast?
Can you send me an example of the types of intrusive thoughts you’re having? Sometimes writing them down and challenging can be helpful, but need to see what we’re talking about.
Best, david
Rodolfo responds
Thank you for the swift response! Ok, so writing down my intrusive thoughts, regardless of their nature, and challenging them. I don’t, however, know which method/route to challenge them with. I have Feeling Great, so I will read through it again. I will also check out the podcasts.
My intrusive thoughts have been disgusting violent acts involving my wife and son. ***I HAVE NO INTENTIONS OR DESIRE TO COMMIT ANY OF THEM***. I’ve had images of my wife getting shot, not necessarily by me. Sometimes I’ll see my arms give out and my son will fall. I’ve seen my wife sitting down, and she gets hit in the back of the head.
When they appear, I begin to freak out immensely because they are the complete opposite of who I am and what I want to do, which is protect them. I know I’m not doing something right when it comes to your methods because I still freak out.
David Responds
Thanks! Although disturbing, this is a very common and often easily treatable OCD type of problem. Best, david
Rodolfo responds
What a relief. I thought I was going insane here! I would be honored if you all covered it in a podcast. All I listen to in my car now is the Feeling Good podcast!
David Responds
Often, intrusive OCD thoughts reflect suppressed problems / feelings people have, especially when the person is exceptionally "nice," and used to sweeping feelings under the rug, so to speak. I cannot treat you in this medium, obviously, but I'm wondering if you have some negative feelings, like anger or frustration, toward your wife and child? When these are "squashed," they can come out indirectly, disguised as anxious thoughts and feelings. This is called the Hidden Emotion Technique, which you can look up using the search on my website, if curious, or read about it in my book, When Panic Attacks.
Best, david
2. Brittany asks if it’s okay to enjoy / prefer being alone.
Hi Dr. Burns,
I was listening to your podcast on self-acceptance, and it was really interesting hearing the results. I like how you said that just because we accept something about ourselves doesn’t mean we aren’t still working on it. I think people confuse that a lot.
One thing I’ve accepted about myself is that I really do enjoy being alone. I think in the past I would try to find a buddy in uncomfortable situations like the first day of work or orientation or going to a baby shower alone etc. but now I find that I am most comfortable when I’m not included with everyone else. However, I think it can come across as off putting to some.
Sometimes I get the feeling they see me excluding myself as rejection to them. That’s not my intention and nobody’s ever actually said that but it’s a thought that pops up.
Just wondered if you think this form of acceptance is good or bad? I mean it’s been good for me. Just maybe it’s bad for others?
-Brittany
David’s response
This is a cool question and nice comment, too, about our podcast. Can we read this on a podcast and use it for an Ask David?
Personally, I am trying to say "no" more often when asked to do things with other people, and sometimes it's hard. But if I don't say no, I get way too much on my plate and can't keep up!
Warmly, david
Brittany’s reply
That makes perfect sense to me. I’ve kind of taken the position where I don’t really want to make more friends because I feel like I’m already falling short with spending enough time with my cats and everyone else. Let alone time for myself.
David’s reply
Exactly! Our culture has this myth that's it's somehow impossible or immoral to enjoy just being with oneself!
David
3. John, from Ireland, asks, “Help! I’m shoulding on myself again! What can I do? Please do another podcast on Should Statements.”
Hi David and Rhonda!
Love the podcast and the work you folks are doing! I listen to the podcasts regularly and you are both bringing such great benefits to the world!
I would love to hear another podcast on should statements. I've been going through a pretty bad and extended period of anxiety and depression in recent months and have been really trying to challenge my thoughts without much success. I'm addicted to shoulds unfortunately and beat up on myself relentlessly.
I've tried to do a cost benefit analysis and the motivation piece is a huge part of the benefits side that is keeping me stuck. I really want to give up my should statements, they are making my life a misery. But I'm finding I don't want to let go of the motivation piece.
I have given a sample below. I'd love to know if there were further steps/techniques I could use aside from the CBA to address the benefits and the perceived motivation piece so I can fully let go of the shoulds!
Thanks so much both, John from Ireland
Negative Thought: “I should have plans on a Saturday.” 99% SHLD, ER, SB, MF, DP.
Benefits
Lets me know when I’m not performing to the standard I set for myself Shows me my passion/goal in life for doing fun exciting things Motivates me to move to make plans, scolds me until I do so. Keeps me vigilant that I’m aware of my shortcomings Reminds me of the value of being socially connected, meeting and having fun with friends. It’s easy, it’s familiar, it’s such a habit. (process resistance)Costs
Emotional Cost. Beats me up relentlessly, makes me feel depressed, anxious and lowers my self-esteem. Reinforces perfectionistic beliefs Counterproductive in terms of motivation, makes me feel so low, Huge interpersonal cost, feel isolated alone. Prevents intimate connections Not able to be present or flow in a conversation, quality of conversation/connection drops Self-fulfilling prophecy, if I’m telling myself that then I ignore other possibilities.Benefits 40 / Costs 60
David’s reply
Feeling Great is now available in the app store, and you can try it for free. It also has a class called “Your PhD in Shoulds.”
I’ll add your question to our next podcast list for an Ask David.
Since you’ve told me you can’t yet get the app in Ireland, I’ll send you the script of that lesson.
Thanks!
David
John continues the exchange
Hi David,
Thank you so much for taking the time to correspond today and thank you so much for all the work you're doing for free. The world would be a better place with more Rhonda's and Dr. Burns' in the world. One of the things that has brought me some peace in the last few weeks is going for a long walk in the evening after work listening to your podcasts!
I have attached a DML that I've been working on to give a bit more context. I made some inroads on that original should statement, however, as you can see from the DML more shoulds keep popping up. I have identified the Self Defeating Beliefs that resonate with me at the bottom of the document. I'm working hard to find healthy acceptance, I know this is key for me. I'm not entirely sure a lot of the time what exactly I should be accepting. That I'm a flawed person with many defects, just like everyone else maybe?
To give some further context and without overburdening you with too much detail:
I feel my anxieties are one of the main parts of my problem and I would love to get over these. I feel defective that I'm not resilient enough for the challenges of life. I have fears mainly around people, fear of letting people down, fear of being judged or rejected and just feeling different to others I suppose. I've struggled with recurring anxiety and some depressive periods from when I was a young child (likely biological - my dad has the same issue). I have strong feelings of defectiveness and not being up to standard compared to my peers. I have a very busy corporate finance job where I've been working very long hours over an extended number of weeks and months. I don’t' love my job, fell into it really. Could be a hidden emotion thing going on. I started working from home more and more in recent months as my workload increased and my anxiety and mood really started to dip as work took over my life. I started to get really burned out in April. A lot of why I enjoyed the job previously was having fun with my teammates but that has become impossible in recent times due to everyone's workload. I do CrossFit which is probably an extreme form of exercise and between that and work I fell into some kind of perfectionism where I couldn't really find joy out of anything, aiming for higher and higher achievements. This brought on tons of shoulds and all or nothing thinking and self-blame, I think. My dad, who had been doing well for a good few years fell into a deep depression and anxious state around April time too and has been in hospital for a number of weeks and our family is trying to support him through this. We're finding the standard of mental health care in Ireland really really poor unfortunately. I find his issues quite triggering for me a lot of the time and I'll believe I'm defective because he is defective and there is nothing I can do about it. Dad is entirely dependent on medication to get him out of his slump and has a bad case of do-nothingism. He is beating himself up relentlessly too and I gave him a copy of Feeling Good to read but he hasn't looked at it at all. I have just turned 40 and I’m still single, so I feel like I'm letting my family down for not being emotionally able for a relationship or kids or be a better brother/son. I know I'm probably being harsh here as they say the opposite, but I feel I could/should be doing more.I have probably fired way too much detail at you, so I'll stop there!
Thanks so much again!
John
Listen to this podcast for the great discussions and commentary by Rhonda, Matt, and David
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Feeling Down? Try the Feeling Great App for Free!
The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com!
What's a Give-Get Imbalance? What's the Best Treatment for Anxiety and Dysthymia? Can you do Externalization of Voices on Your Own?The show notes for today’s podcast were largely written prior to the show. Tune in to the podcast to hear the discussion of these questions by Rhonda, Matt, and David.
And keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks!
Suzanna asks: What’s a “Give-Get” imbalance? And how can you get over it? Martin asks: What’s the best treatment for anxiety and dysthymia? Eoghan (pronounced Owen) asks: Can you do Externalization of Voices on your own?1. Suzanna asks: What’s a “Give-Get” imbalance? And how can you get over it?
Description of Suzanna’s problem.
Suzanna is a woman with a grown daughter with severe brain damage due to a severe brain infection (viral encephalitis) when she was an infant. Suzanna was constantly giving of herself and catering to her daughter. She explains that her daughter can be very demanding and throws tantrums to get her way, and kind of controls the entire home in this way.
She can only talk a little and has the vocabulary of about a two-and-a-half-year-old. She can mostly express the things she wants or doesn`t want on a very basic level. She mostly understands what I want from her, but mostly does not want to do what I ask her to do. She can be very stubborn. And I cannot reason with her because she has her own logic and, in her eyes, only her logic is valid. Maybe all a little bit like a two-and-a-half-year-old.
Suzanna struggles with negative feelings including guilt, anxiety and depression, because she is constantly giving, giving, giving and feeling exhausted and resentful. And she tells herself, “I should be a better mum.” Can you spot any distortions in this thought?
Put your ideas in the text box, or jot them down on a piece of paper, and then I’ll share my thinking with you!
What are the distortions in the thought, “I should be a better mum”?
There are many distortions in this thought, including All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Magnification and Minimization, Emotional Reasoning, Self-Directed Should Statements, and Self-Blame. There may be one or two more, too!
The first step in change nearly always includes dealing with motivation and resistance. Suzanna decided to do a Cost-Benefit Analysis, as you can see below, and a revision of her Self-Defeating Belief, as you can see below.
Another helpful step might include “No Practice,” which simply means saying “no” so you don’t constantly get trapped by “giving,” as well as “giving in.”
A third critically important strategy involves the mom and dad making the decision to work together as a loving team in the management of a troubled child, rather than fighting and arguing with each other, as we've discussed on previous podcasts. However, in many, or possibly most cases, the parents are not willing to do this. They are more concerned about being "right" and so they continue to do battle with each other, as well as the child who needs a more loving structure.
David
Cost-Benefit Analysis Self-Defeating Belief: I should be a better mum to my daughterAdvantages of this belief
(How does believing this help me?)Disadvantages of this belief
(How does believing this hurt me?)This thought motivates me to:
Put myself out. Push myself to give what I have. Find ways to advance her development. Find ways to involve her in everyday life. Invest myself into her and her life as much as I can, physically, emotionally and time wise. Try to find ways that my daughter can have a fulfilling life. Try hard to connect to her, her pain, her needs, her sadness and her frustration. Try to make her life as easy as possible. Try my hardest to see her world through her eyes and gain deeper understanding of how she feels. Try to understand what is upsetting her when she throws a tantrum. Stay healthy and fit to have energy for her. Try to make her life rewarding and meaningful. Fulfill my duty as a mum to my daughter who needs my support. I can feel good about myself. I satisfy other people’s expectations of me. Protects me from criticisms from my husband I am a prisoner to my daughter. No matter how hard I try I don`t seem to make a meaningful difference to her life and to her development. I am a “Siamese Twin” to her. I cannot move or do anything if she doesn`t want to. I reason with my emotions instead of thinking rational at times. I let my daughter get away with “murder”. I find excuses for her behaviour. I find excuses for her why she cannot behave differently. I beat up on myself when I feel I failed her. I take all responsibilities away from My daughter and make them my own. I blame myself when I cannot motivate her to do something. I blame myself when she is bored and unhappy. I feel guilty doing my own things. I feel guilty when I do not involve her in my activities. I feel guilty when I expect her to do entertain herself for a while. I cannot live my own life. I cannot be myself at times. She rules my life, and she lives my life. I feel trapped and frustrated. I feel I need to constantly entertain her. I feel responsible for her happiness. I feel responsible when My daughter is sad and frustrated. I feel exhausted and overwhelmed at times. I feel unhappy and unfulfilled. Advantages: 20 Disadvantages: 80Semantic Method: Re write your personal value
I want to be a mum to My daughter and help her along and invest myself into her. But I also want to treat myself the way I treat her. She has a “right” to live a happy and fulfilling life, but so do I. Our needs and desires are equally important and deserve the same attention and care. I can only continue to look after My daughter well if I look after myself too and take myself and my needs and desires as seriously as I do hers. There needs to be a give-get balance so that both of us can be healthy and happy and stay healthy and happy. I want to help her to slowly take new steps into independence and support her lovingly along the way.
2. What’s the best treatment for anxiety and dysthymia?Hello Dr. Burns,
What method of treatment would you suggest for GAD and dysthymia? 3rd wave CBT, ACT? What is best based on science?
Can you recommend some books please?
thank you
Martin
David’s Reply
My books are listed on my website, FeelingGood.com. They all describe my approach, which is a bit like CBT on steroids. But every patient is treated individually and uniquely, following a structured and systematic approach that facilitates rapid and dramatic change.
I don’t recommend “methods of treatment” or “schools of therapy” based on so-called “diagnoses,” but treat the individual with TEAM. Every session with every patient is an experiment, with precise measures at the start and end of every session.
The new Feeling Great App, now available, gets a mean of 50% or more reductions in seven negative feelings, such as depression, anxiety, and more, in 72 minutes of starting to use the bot. You can check it out for free! Anxiety and depression often co-exist, and the app targets both.
My book, When Panic Attacks, describes my approach to anxiety, based on four models of treatment: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. If you use the search function, you can find podcasts describing those models. Also, there's a free anxiety class on this website.
Thanks, Martín, for your excellent question!
Best, david
3. Can you do Externalization of Voices on your own?Hi David,
Long time listener of your great podcast and huge fan of your book Feeling Great.
I’ve often heard you mention that “externalization of voices” is one of, if not the most powerful CBT techniques. I am just wondering if it is still almost as effective when done solo without a therapist i.e. the person takes on both the roles of positive and negative by recording themselves talking or similar?
Also, have you any data comparing the efficacy of TEAM CBT work carried out solo using Feeling Great/your podcast as a guide vs. TEAM CBT performed with a trained TEAM therapist?
I am very much looking forward to the Feeling Great app launch in the UK as hopefully that will be a much more effective way to do personal work without a therapist.
Many thanks,
Eoghan (pronounced Owen)
David’s reply
Thank you, Eoghan! Appreciate your support and thoughtful question.
I don’t have any data on the use of EOV on your own. One could use a recording device, like your cell phone, and record your negative thoughts in second person, “you,” and try to defeat them when you play them back, one at a time.
But in my experience, people nearly always need an experienced role player to do role reversals to show them how to get to a “huge” win. People almost never get a huge win when doing it for the first time, because the therapist (in the role of positive self) can model unfamiliar strategies for the patient.
Generally, a hugely successful response involves a combination of self-defense, self-acceptance, and the CAT, or counter-attack technique. And sometimes other methods as well, like Be Specific, for example
Radical new learning is definitely the key to success with EOV.
Now, thanks to the app, everyone can practice, since we’ve trained our Obie Bot to role-play with users, do role reversals, give feedback, and so forth.
Great question that I will include in the next Ask David if that’s okay!
We are also exploring the combination of the Feeling Great App plus a trained TEAM therapist from the Feeling Good Institute in Mountain View, California.
We are hoping that 1 + 1 may equal 3. Wouldn’t that be awesome?
What I’ve found when doing research is that the results are virtually always wildly unexpected! Somethings come out great, and some things come out dismally. I always tell myself that “the Lord giveth, and the Lord taketh away!”
Seems to be the rule in research! Especially when you’re wanting to be guided by the truth, and not so much by your hopes and expectations.
Best, David
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Ask David: What’s Self-Esteem? What’s Self-Acceptance?
In today’s podcast we address six common questions about self-esteem, including:
What is Self-Esteem? How does it differ from self-confidence? How does it differ from self-acceptance? What’s the difference between conditional and unconditional self-esteem? What’s the best way to develop self-esteem? What do you mean when you say that once you develop unconditional self-esteem, you should get rid of it as fast as possible?Please keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks!
Brandon Vance and Heather Clague begin today’s show with a pitch for their upcoming Feeling Great App Group, an 8 week experience that will begin in September. If you use the Feeling Great App, or plan to get it, this group would be an inexpensive and incredible enhancement, so you can meet with like-minded people once a week to schmooze, practice the techniques in the app, and get your questions answered by compassionate and personable experts.
For more information go to www.FeelingGreatTherapyCenter.com/appgroup.
Feeling Great App Group Sept-Nov 2024Led by Brandon Vance MD and Heather Clague MD, meets online for 80 minutes for 8 weeks, offered Mondays 4-5:20pm Pacific Time, September 23rd - November 11th. Cost is $12 per session ($96 total) plus the cost of the app ($99 per year after 7 day free trial). Sliding scale for both the group and the app are available. No one turned away for lack of funds.
Feeling Down? Try the Feeling Great App for Free!It's now in the IOS and Android app stores, and you can check it out for free. It's works super fast. Let us know what you think! Thanks!
Rhonda, Matt, and David appreciate your support. Keep your questions and testimonials coming. They mean a lot to us!
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Feeling Down? Try the Feeling Great App for Free!
The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com!
What's the Meaning of Life?Before we start today, I have a special shoutout to Max Kosma, our new colleague, friend and brilliant technical guru who helped make our new video studio possible! Next week, we’ll see if we can pipe him in to say hello to all of you. His spirit is joyous, infectious, incredibly generous and supportive.
Thanks, Max!
Rhonda opened today’s podcast with a vibrant and inspiring endorsement from Jeff, a podcast fan who was raving about the Feeling Great App. Thank you Jeff, and please check out our new app at FeelingGreat.com.
Important Announcement
Rhonda, along with a group of dedicated TEAM Therapists, including Amy Berner, Brandon Vance, Leigh Harrington, Mariusz Wirga, and Mark Noble, has just created a new non-profit organization called TEAMCBT International (TCI). TCI will provide seed money in the form of no-or-low-interest loans for groups around the world who want to offer TEAM-CBT intensives for therapists in your country. Rhonda has been instrumental in the organization of successful intensive workshops in India, Poland, Mexico, England and Ireland. They have been well received, but can be somewhat costly to produce, so Rhonda’s new group is ready to provide a helping hand.
I’ve had the honor of presenting keynote addresses, live therapy demos, and Q and A sessions in many of those programs, and have totally enjoyed them. A big hug and THANKS to Rhonda once again! To learn more, just go to TEAMCBT.International.
Today, Matt joins us for a discussion of the meaning of life, something young people often worry about, but people of any age can be concerned. So, today, you may finally find the answer to that lofty question!
But first, I (David) mentioned a little about one of last week’s questions, “Is the universe real?” I provided the type of answer the famed philosopher, Ludwig Wittgenstein, might have provided. Namely, that the question is nonsensical, it is language “out of gear.” So, we can dismiss the question, as opposed to trying to answer it.
HOWEVER, the question DOES make a ton of sense when we ask if human beings are “real.” And I am not referring to some metaphysical nonsense, but rather the tendency of many people to present a happy or confident false front, all the while feeling empty, lonely, anxious and ashamed inside.
Two of the now more-than-140 TEAM techniques include Self-Disclosure and the Survey Technique, where you take the chance of opening up about some of the secrets you’ve been hiding, and ask others what they think about you. Although this takes tremendous courage, it often results in tremendous warmth and connection to others.
I provide a description of a young man who disclosed a tremendous amount he’d been hiding in our recent Tuesday group at Stanford, and he was convinced the group would judge him and look down on him. But just the opposite happened. He encountered a flood of warmth, admiration, and respect from the people in our group.
A small miracle, perhaps, but a real and meaningful miracle at the moment when his universe suddenly became “real” and radically different from the dangerous and critical world he’d feared and imagined.
Then we tackled today’s philosophical question: “What’s the Meaning of Life?” As usual, our brilliant and beloved Matt May began with a description of an extraordinarily depressed patient he once treated who’d been hospitalized for 180 days with no improvement, including a very dangerous suicide attempt.
Matt was worried for the patient’s safety, so told the referring doctor that he’d been willing to talk with the patient while the patient was still in the safe environment of the hospital. The patient called Matt and, after some listening and empathy Matt said he would like to help and that there would be committed to helping the man and thought he could help him make a complete recovery, work with this man, and thought there was an excellent chance for significant progress, perhaps even complete recovery, but the patient probably wouldn’t want to work with him.as long as he’d be willing to give Matt what he needed in order to work together effectively. Matt suggested the patient give him a call.
On the call, Matt told him he might not be able to afford treatment, since part of the “cost” of therapy was that the patient had to make a commitment to life, and that he must agree never to attempt suicide no matter what, for the rest of his life.
After a couple days of reflection, the man convinced Matt that he WOULD make that commitment.
Then Matt described the man’s problem. Both of his parents were world famous, successful scientists, and during his upbringing, his parents emphasized how fantastic and rewarding a career as a scientist could be, and he was convinced that his parents expected him to follow in their footsteps. He had "learned that doing science was the "meaning of life" and would inevitably result in his feeling satisfied, joyful and proud.
So. sure enough, this young man, who was extremely bright, pursued a scientific career, and eventually one of his papers was accepted for publication in one the world’s most prestigious research journals.
There was a big party at his laboratory, and everyone congratulated him and sang his praises.
But there was one big problem. He felt nothing!
Of course, he smiled and didn’t let on that he felt nothing. He tried to act happy, but simply WASN’T. He said, “I faked it.”
He concluded that he must be defective, since he’d done what he was supposed to do, in order to feel joyful and happy, but he felt nothing, even though he had fulfilled his parents dreams and expectations for him. This plunged him into his severe depression, with the familiar theme of “I’m not good enough. In fact, I am deeply flawed and defective, incapable of feeling joy or happiness. There must be something terribly wrong with me!”
Sound familiar? Did you ever feel like YOU weren’t good enough?
During an early session, Matt asked his patient what he really enjoyed, what he’d really LIKE to do with his life.
The patient confessed, after much resistance, that he felt that his fantasies were totally ridiculous, but what he really loved were trains, photography, and painting. He said his dream job would be to be a conductor or engineer on a train where he could take pictures of the scenery and especially, the people on the train.
BUT, he said, that would be meaningless, since he wouldn’t be contributing to science and would be letting everyone down., etc. etc. etc.
I bet you can guess what followed! If you were his shrink, what would you say or do?
Put your ideas here, into the text box, and then I’ll tell you!
If you took a guess, thanks! If you didn’t, no problem.
Matt suggested he do those very things—take a train somewhere, start snapping photos, and do some painting. Predict how satisfying each thing will be (0 to 100) BEFORE you do it.
Then do it, and record how satisfying each activity actually was on the same scale of 0 to 100.
He exclaimed, “I’d LOVE to do that,” and started crying. His depression score immediately fell to zero.
The next week he brought a large cardboard box to his session. It was filled with books on ancient philosophy and how to find the “meaning of life.” He said, “I don’t need these anymore, so they’re a gift to you!”
Matt said, “I don’t need them either!”
Now you know about the “meaning of life.”
We discussed some of the many meanings in this story, including:
Rhonda pointed out what Kurt Vonnegut said on the meaning of life. He said, “We’re all here to fart around!” David discussed the basic idea that it’s not what we’re doing, but our thoughts, that trigger ALL of our feelings. And at the moment you learn to turn off that critical voice in your brain, you will experience your own “enlightenment. David has also said, over and over, that when you discover that you no longer need to be “special,” you can experience the “Great Death” of the “self,” but it’s not like a funeral. It’s more like a celebration, because when you lose your “self,” and discover you didn’t “need” the things you wrongly thought you needed (like love, achievement, perfection, etc.), at that moment you’ll experience enlightenment and you’ll inherit the world, and life, and deeper connections with the people you love. There’s not one “meaning” to life. There are many meanings every day. And today, for Matt, Rhonda and David, it is VERY meaningful and joyful just to hang out with each other, and with you, so we can shoot the breeze together! Or, as Kurt Vonnegut said, so we can "fart around" together.Please keep your wonderful questions and comments flowing, and be sure to catch us in our new video version on my feeling good YouTube channel.
Warmly,
Rhonda, Matt, and David
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Feeling Down? Try the Feeling Great App for Free!
The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com!
Is the Universe One? Is the Universe Real? Is the Universe Real?These two philosophical problems used to seem nonsensical to me, and certainly not relevant to much of anything in my life—or anyone’s! But now the picture has changed a bit!
When I was a student at Amherst College, I majored in the philosophy of science. On this show, I’ve often talked about my hero, Ludwig Wittgenstein, who attempted (successfully in my opinion) to “solve” all the problems of philosophy. He wanted to help those of us who were “afflicted” by an attraction to philosophical problems to see through them and understand precisely how and why they were nonsensical. He hoped to provide a “treatment” for philosophers so we could give up the need to obsess about nonsensical philosophical problems.
Once you see through the these problems, they become kind of like a joke, and you can use jokes to help other people see through them. For example, here’s a kind of lame joke about the question of whether or not the universe is “real.” Wittgenstein said that before we try to answer questions like that, we might want to ask ourselves if these questions even makes sense! And if it a philosophical problem doesn't make sense, it isn’t a real question, so we won’t need to deal with it. In other words, questions that don’t make sense don’t need to be answered because they’re not real questions.
Take the question, "Is the universe real?"
You could ask, “Well, what would it be like if the universe weren't real? What would that look like? How would things be different?” If you can't answer that question, the question might not make sense.
To most of us, philosophical questions wound nonsensical because we are taking words, like “real,” out of the contexts in which it DOES make sense. For example, we can ask : “Is this painting real? Or is it a fake?” That question does make sense. It has an obvious meaning, since many valuable paintings are copied and are fakes, and they try to pass them off as the “real” thing.
But what would a "real" or "fake" universe look like? How would it differ from our universe?
Now let’s think about another example that is mildly humorous. Let’s imagine you’re driving through Iowa in the summer, and you spot a farmer working in his corn field. You’re interested in speaking to him because you are writing a story about your travels in Iowa, and want to talk about the lives of farmers.
So, you pull your car over to the side of the road and shout, “Howdy! What are you doing in the field?”
The farmer seems pleased and grabs a gorgeous stalk of corn and holds it up and proudly shouts, “I’m growing corn, and it is real!”
Well, that’s great that he's happily growing corn, but what does the tag-on, “and it is real” mean? It doesn’t actually mean anything, because farmers don’t grow “unreal corn.” So, in this context, the word has no meaning.
Now, if you were on a movie set, they might actually be using artificial corn as a prop, so now the contrast between real and unreal corn becomes meaningful.
This is a very humble point, but it’s the very heart of what Wittgenstein was trying to make us aware of. Philosophical problems kind of sound meaningful and puzzling, but most of the time, they are simply a kind of nonsensical use of language.
Now, in personal relationships, we might also have a notion of when people are being “real” or fake. And we often act fake because we don’t think we’re good enough just the way we really are. So, for example, you may hide your shyness in social situations because you’re ashamed, and telling yourself that your shyness is incredibly weird and abnormal, and makes you “less than” other people.
One method of helping people overcome shyness is simply to disclose it to others. This TEAM-CBT technique is called "Self-Disclosure." Instead of hiding your shyness and feeling awkward and ashamed in social situations, you share your feelings openly. Shame depends on hiding, so when you open up, the feelings of shame will often disappear.
For example, in a recent podcast of a dramatic, live therapy session, a man named Chris revealed many troubling things about his teenage years that he’d been hiding for years. When he opened up, he began sobbing intensely, thinking he’d let his father down with his wild behavior when he was a high school student.
His grief, he was incredibly compelling, and his courageous self-disclosure was appealing to most of us who were privileged to witness that session. Showing us his “real” self became his path to enlightenment, joy, and deeply meaningful relationships with himself and with all of us who witnessed that amazing session.
So, although the question, “is the universe real” is silly and nonsensical, the question, “are we being real with each other,” is definitely NOT silly or nonsensical. Being real and vulnerable is an important key to connecting with ourselves as well as other human beings.
Is the Universe One?How about “Is the universe one?” This philosophical question also seemed nonsensical to me for years, although I was intellectually aware that some Buddhists make claims that the universe IS one and that the failure to “see” this is the basic of all evil. That's because if you see other humans, for example, as being "external" to yourself, you may feel you have the right to abuse and exploit them.
However, for years I thought the idea that the universe is "one" seemed like sheer nonsense. For example, I am sitting in a chair typing, and there is a cup on the desk. People have never call that cup “David,” and no one has ever called me a coffee cup (although lots of people have sad some pretty bad things about me!) So, I concluded that the cup and I are not “one,” and so the whole thing about the universe being one seemed nonsensical and silly.
But when I began to think about it in the context of my work with patients, my thinking suddenly changed. For example, the TEAM interpersonal model I’ve developed was based on research I did early in my career that suggested that Blame was one of the main causes of troubled relationships, and perhaps the most important and powerful cause.
And this is certainly true in my personal life and in my work with individuals with troubled relationships who are unhappy in their marriages or people who are angry with their neighbors, or family members, or anyone. We almost always see ourselves as victims, and the other person as the one who is to blame for the problem. This triggers feelings of frustration, anger, and moral superiority, and can easily and often lead to arguments, mistrust, divorce, hostility, and violence, murder, and even war.
Now, I’m beginning to see that the idea that we are separate from others, who are doing something TO us, does, in fact, lead to hostility, and arguably to evil. And once you “get it,” the same insight applies to our relationships, not just with loved ones, friends, and other people in general, but also our relationships with animals, with the environment, and with the planet earth. If we think of them as “other,” then we may conclude that it is okay to exploit or use them for our own advantage.
In the interpersonal TEAM model, we focus more on circular causality, or interpersonal connectedness and ask the question, how do we actually shape and cause the very behavior in the other person that we complain about so vigorously? I have developed a fast, powerful tool that allows any to pinpoint their own role in a relationship problem very quickly and with reasonable accuracy. It’s called the Relationship Journal (RJ), and we’ve talked about it often on this show.
Essentially, it’s simple to use the RJ, but it can be startling and illuminating but incredibly painful. All you have to do is write down ONE thing another person said to you that you found upsetting, and EXACTLY what you said next. Choose an interaction that did not go well; otherwise, it’s a waste of time.
Then, the RJ will take you through a step by step analysis of your response, and it's implications.
When you discover how you are actually forcing the other person to treat you shabbily, it can hurt. This is one of the four ‘Great Deaths” of the self, and it’s the most painful of all, in my experience. This is the "Great Death" of the angry, blaming "self."
I hate this great death! But if you have the courage to use it and take a look, it can be incredibly illuminating and liberating, and can put you on the path to far more loving relationships.
As an exercise, I will list a number of common complaints that people have about loved ones, friends, or family that they find irritating. Your job will be to show how you could FORCE them to do the exact thing you are complaining about. The other person could be your partner, friend, son or daughter, etc. Your complaint about that person might be that they
Refuse to talk to me. Can’t (or won’t) open up and express their feelings Constantly whine and complain, and ignore and resist my good advice. Constantly argue, and always have to be right. Won’t listen. Are relentlessly critical. Always have to get their way. Doesn’t treat me with respect.In each case, see if you can figure out how you could FORCE the other person to do that exact thing. We will discuss a couple of these on the show and lustrate solutions to give you a feel for how this works.
Rhonda’s and Matt shared their wise and interesting thoughts on both of these philosophical questions, and how you can understand them in the context of your own lives, and, if you're a shrink, how you can use them in your work with patients.
Thanks for listening today!
Matt, Rhonda, and David
- Visa fler
