Confronting Fear and Negative Thoughts in Anxiety Treatment

 

Announcements: Feeling Great Book Club

We're excited to announce a Feeling Great Book Club for anyone in the world, supporting people in reading and learning from David Burns' powerful and healing TEAM-CBT book Feeling Great with questions and answers, exercises and discussions in large and small groups.

It will meet online for an hour at a time for 16 weeks on Wednesdays starting March 17 at 9am and 5pm Pacific Time - which should allow for fairly reasonable hours from anywhere in the world.

Note that the group is intended to provide education but NOT therapy or treatment. Cost is 8$ per session paid in advance, but people will be able to pay whatever they can comfortably afford and no one will be turned away for lack of finances. The group will be primarily led by Brandon Vance, a psychiatrist who is a level 4 TEAM therapy trainer who has studied with David Burns since 2011.

Please go to https://www.feelinggreattherapycenter.com/book-club to find out more and to register.

Your Book Club Teacher: Brandon Vance, MD Upcoming Virtual Workshops

February 28, Self-Defeating Beliefs: How to Identify and Modify Them, a one day workshop for mental health professionals. 7 CE credits. Featuring Drs. David Burns and Jill Levitt, sponsored by FGI, Mt. View

Click here for more information including registration!

 

March 24, 2021, Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver

Click here for more information including registration!

 

April 7, 2021, Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver

Click here for more information including registration!   Today's Questions

Brian asks:

1. Can negative thoughts lead to high blood pressure? Thank you

Jim asks:

2. I’m having panic attacks! What should I do?

Adam asks:

3. Shouldn’t we get rid of the terms, “Positive Thoughts” and “Self-Defeating Beliefs?”

Phil asks:

4. Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions?

Nandini asks:

5. How do I get your Decision-Making Tool for help with habits and addictions?

A man from France asks:

6. After listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with does not feel comfortable in sharing his/her feelings and thoughts, or does not know how to deal with feelings and thoughts when hearing them?

Thomas asks:

7. What would you say to a person who wants more ego strength.?

* * *

1. Brian asks: Can negative thoughts lead to high blood pressure? Thank you

Thanks Brian. I don’t know the answer to your excellent question. One big problem is that much, if not all, of this type of research is of pretty poor quality. When I review research articles, my focus is not on “what are the implications of these findings,” but rather on “what are the flaws in this research study?”

Usually, the flaws are so severe, at least to my way of thinking, that the findings are not worth interpreting.

I apologize for this answer, as it is way less exciting than speculation!

On minor point would be that if you believe negative thoughts, you will experience feelings like depression, anxiety, anger, and so forth. So the real question would focus on whether elevations in negative feelings are associated with increases in blood pressure.

One common phenomenon is that some people get very anxious when their blood pressure is measured, and this, it appears, can lead to temporary blood pressure elevations. So, sometimes the doctor or nurse will ask the patient to sit quietly for a little while, and will then repeat the blood pressure measurement.

So, it might be the case that people who are more prone to feelings of anxiety would have more fluctuations in blood pressure. But the question then might be—are these temporary fluctuations associated with generally elevated blood pressure?

I don’t think they are, but I’m not up on the latest thinking on this topic.

david

Brian adds: David Burns Last night, I was having stressful thoughts about family and I checked my blood pressure and it was way up, so I think it does. 🙂

Cool, nice research! You can also see if changing those thoughts and feelings leads to a reduction in BP! d

Dr. Burns i did and my stress lowered and so did my blood pressure

Way to go, Brian! Kudos! david

* * *

2. Jim asks I’m having panic attacks! What should I do?

Dear Dr. Burns,

I recently bought copies of Feeling Good, Feeling Great, and The Feeling Good Handbook, and studying them has been remarkably helpful so far. Thank you for writing them!

I hope this is not too forward, but I am struggling with one immediate difficulty: within the past two weeks, I have had two panic attacks that brought on heart palpitations, and it's created a cycle of anxiety that I can't seem to break.

My central issue is that I can't seem to isolate a thought that brings on the initial feelings of worry (followed by flushing of the face and then skipped heartbeats) The first attack happened in the car after visiting a store, and the second happened while waiting on line at a store.

I have seen a cardiologist, and so far all my blood work and EKGs have come back normal.

Whatever help you can give or resources you can share would be sincerely appreciated.

Thank you,

Jim

David responds by emphasizing:

• My book, When Panic Attacks, will give you great tools for understanding and overcoming panic.
• I use four models in treating all forms of anxiety, including panic:
  • the cognitive model
  • the hidden emotion model
  • the motivational model
  • the exposure model

You can find podcasts that detail all of these approaches.

• I describe the kinds of thoughts that typically trigger panic, and how to defeat them!

* * *

3. Adam asks: Shouldn’t we get rid of the terms, Positive Thoughts and Self-Defeating Beliefs?

I have a few questions about some of the Semantics on the Daily Mood Log and the Self-Defeating Beliefs list:

1. On the Daily Mood Log, there is a section for positive thoughts. My understanding is that the goal isn't necessarily to think positively, but instead to correct distortions so that the person is thinking realistically. A lot of the thoughts I hear reframed on the podcast aren't necessarily positive, but instead capture a more realistic or balanced perspective. If I'm understanding correctly, positive thinking may actually cause your thoughts to be distorted in the opposite direction. My experience has been that often times when you speak with people about positive thinking, they will end up in the territory of positive distortions. I'm wondering what you would think about calling this column 'Realistic Thoughts'?
2. One of my favorite tools that I've used both for myself and for my clients is the list of Self-Defeating Beliefs. So often when I use the "Downward Arrow" technique with a client, it leads to one of these beliefs, and it is really helpful to have clients identify the beliefs on their own accord.

With that being said, one thing that I personally feel some reservation about is calling the beliefs "Self-Defeating." Similar to positive reframing, it often seems like the goal of these beliefs is to protect the person or give them some benefit, and that the side-effect of that protection is the self-defeating part.

For instance, being perfectionistic may be intended to protect people from criticism (protective and helpful), however never allows them to see that it's okay to make mistakes (unhelpful and self-defeating).

This is often revealed through the cost-benefit analysis, and I like the idea that the individual gets to decide if the belief is self-defeating or not after the CBA. In that way, I wonder if calling them "Self-Defeating" from the start may bring up resistance, as it assumes the belief is more unhelpful than helpful before the client has really done the work to decide that. I've had a harder time thinking of another name that captures this, but I'm wondering what you think about the term possibly leading to resistance?

As always, I appreciate the effort that you and Rhonda have put into the podcast and I'm looking forward to what you have to offer in the next year!

Be well,

Adam Holman, LCSW, SUDS

Hi Adam.

Thanks for your ideas! I’m kind of sticking to the current wording for many reasons. One problem is that any terms you might suggest will have tons of positive and negative aspects, and the art is in the delivery of the therapy, and not so much in the names of things. I have not run into any resistance with SDBs, but rather enthusiasm from most (nearly all) folks. Still, your ideas are all correct. SDBs have huge positives, absolutely.

In Philadelphia, we started with “Automatic Thoughts” and “Rational Responses,” which were Beck’s terms. However, 25% of the patients at our inner city hospital had not made it through the fifth grade, and they found these terms intimidating. But they DID understand Negative Thoughts and Positive Thoughts!

People used to think the term “psychotherapy homework” was aversive and people would be more compliant ii if we changed the name to “self-help assignments.” But the name was NOT the issue, motivation was the issue, and the term “psychotherapy homework” is actually way more useful, as it lets the patient know what will be required if they want this type of treatment.

If they do want a form of therapy that requires “homework,” then I am not the therapist they are looking for!

Semantics are important, and different people will perhaps want their own words and terms for things!

Sincerely, david

* * *

4. Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions?

Hi Dr. Burns,

First of all I want to wish you and Rhonda a very Happy New Year. We are off to a rocky start, but things will get better soon!

I loved the podcast on jealousy and anger as it really showcased a ton of TEAM techniques and tools. I had a question that perhaps you'd be willing to answer. Or not!

1. Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions. At least mine do! Obviously writing down the distortions will certainly reinforce the fact that you can pinpoint the distortions at hand, but will it make a big difference either way?

Also, way back when I requested and received a few free chapters in your new Feeling Great book and received the chapter on the Decision-Making Tool which I thought was terrific. I can't for the life of me find the email/link which contained the blank Decision-Making Tool but if you could direct me to find it I would very much appreciate it. I knew you said you were planning an App for it so perhaps that's where it might reside.

I loved working with you, Jeremy and Alex on the Beta Testing. It was a lot of fun and if there is any more way I can help out, let me know.

Keep up the great work!

Phil McCormack (Philomablog!)

Thanks, Phil,

Identifying and explaining the distortions is a great help to many. But if you’re super experienced, you can often take short cuts!

When you’re doing this for the first time, it is necessary to write them down, however.

David

* * *

5. Nandini asks: How do I get your Decision-Making Tool?

Hi Nandini,

The free chapter(s) offer is at bottom of the home page of my website.

d

* * *

6. A man from France asks, after listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them?

Hello Dr. Burns,

Many thanks for this podcast. It's been really helpful. And I do agree that practicing the 5 key of Effective Communication is extremely important.

I would like to have your opinion with regard to the 5 Key to Effective Communication.

I had a really mild argument with my teenage 17year-old son, last night. I bought him an M size jacket instead of an S size. When I asked him if the jacket suited him, he replied "why don't you ever listen to me! I asked you to get me an S size, but still, you buy me an M size!

I replied I got him an M size because the website warned that the clothing size fit small.

Then he went back to his room... whereas, I, ran to my Relationship journal and started to work on this little argument I sure did feel bad, and worthless as I wasn't able to get him what he requested.

I decided to use the 5 key to Effective Communication and did my best to include the 5 steps, and when I expressed my feeling with regard to what he had said, he snapped right back at me saying "oh, stop acting as if you were a victim there !

Though it is very difficult to express my feelings (as I was taught from childhood to hide them/put them aside), I also can understand how difficult it can be, to hear someone expressing his/her feelings.

My son was able to hear the empathy I had towards his thoughts and feelings, but was not ready to hear how I felt about my feelings.

Where did I do wrong?

How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them?

Your insights would be greatly appreciated.

Warm regards,

From France

Hi man from France,

Send me your Relationship Journal and all will be revealed. That’s the only way to get a handle on the errors you made in the interaction.

Thanks!

David

In the podcast, I emphasize the role of blame in relationship problems. The man in France appears to be blaming the other person for not being comfortable sharing feelings, but in my experience, we are creating the problems in our relationships, and the answer is to examine your own errors. Read Feeling Good Together and do the written exercises if you really want to learn.

* * *

7. Thomas asks: What would you say to a person who wants more ego strength.?

Thanks Thomas! I would say, “what time of day would you like it,” and ask them to fill out a Daily Mood Log for that moment of insecurity!

I focus on specificity, and avoiding big words and abstract concepts.

d