Exploring Therapeutic Models for Anxiety Management

Ask David: The Awesome Hidden Emotion Technique Featuring Matthew May, MD with Rhonda and David The following answers to Ask David questions were written prior to the live podcast where Matt, David, Rhonda, and others discuss the questions in real time. Their answers may differ from Dr. Burns responses listed below. 1. Michael asks: How did you invent the Hidden Emotion Technique? It’s been incredibly helpful to me! Hello, Dr. Burns, Your lifelong work continues to be invaluable to me and so many others, and I apologize if this question was answered on a previous podcast. To my knowledge, it hasn't been. I was wondering how you discovered or created the hidden emotion model? I recently struggled with inexplicable death anxiety that came on every night since college started back up, and I was at a loss, until I remembered the hidden emotion model and wondered if there was something I wasn't acknowledging? Sure enough, I discovered I was actually quite resentful of my new schedule not allowing me to easily fit the gym into my schedule unless I wanted to forgo valuable sleep. Once I had addressed this resentment, the death anxiety vanished. I would love to know how this wonderful technique became part of your phenomenal practice! -Sincerely, Michael Polus. David’s reply You can read all about it in When Panic Attacks, when I learned about it accidentally based on an interaction with a patient who was stuck. Perhaps we can answer it on a podcast. Thanks! david   2. Janie asks: How can I help a patient who ruminates? My client ruminates, that is she experiences repetitive thoughts about conversations and gets stuck in the negative feelings that come from dwelling on those thoughts and conversations. She has referred to it as repetitive thinking about conversations that were distressing in some way. She replays the conversation in her head, and evaluates and re-evaluates her responses. She then plays the conversation using possible different responses she COULD have used and worries whether these would have been better responses. The first individual is a friend where the friendship is very challenging and interwoven into many parts of my patient's life. My patient ruminates about conversations and wonders over and over if she said the right thing or wonders how the friend took what was said. It is a loop that my patient often gets stuck in for long periods of the day. The second individual is my patient's husband. With him, she ruminates about how to say things to him so she can motivate him to be involved in the ways she wants him to be. We will work on these relationships using the 5 secrets eventually, but first she'd like to work on the rumination because it takes up so much of her time. How can I help her? David’s Reply I would recommend

1. 1. TEAM CBT in a step-by-step manner. I do not, in general, like to throw techniques at people based on a description of a problem.
   2. Motivational techniques to reduce resistance and bring resistance to conscious awareness.
   3. Paradoxical Cost-Benefit Analysis
   4. Dangling the Carrot / Gentle Ultimatum / Sitting with Open Hands
   5. The Hidden Emotion Technique
   6. What If / Downward Arrow Technique
   7. ERP (Exposure plus response prevention)
   8. Many other techniques inspired by methods a and b above (TEAM CBT)
   9. Feared Fantasy: confronting her worst fear
   10. Five Secrets of Effective Communication
   11. Work on acceptance: she is perfectionistic and self-critical
   12. Hidden Emotion: anger

Thanks for listening (and reading the show notes),

David, Rhonda and Matt