Do You Believe in Exposure?

299: Ask David: Retirement blues; patients who refuse homework (and the therapists who love them); ADHD; David's new pooping story; and more!  We regret that our beloved Matt May, MD could not join us today due to an emergency involving his website. We look forward to him joining us next time for more exciting Ask David’s that will include: Does the “self” exist? Does God exist? And MUCH more! We open with two announcements: 1. Return of the awesome Feeling Great Book Club, with Drs. Brandon Vance and Heather Clague, will meet weekly, starting on September 13th. This will be a terrific experience, and only costs $12 per week with a sliding fee scale if you cannot afford it. You will go through the Feel Great book, learn techniques, have fun, and practice in small groups. This is a fantastic opportunity for everyone. For more information, go to:  https://www.feelinggreattherapycenter.com/book-club. 2. The TEAM-CBT World Congress, Warsaw Poland, August 18 - 21. This first of a kind event will take place live and virtually, and will be somewhat like David''s famous Intensives with teachers from around the world, many of whom have been featured on this podcast.  The CONGRESS will feature interactive sessions which participants can learn and practice the elements of the powerful TEAM system while receiving expert coaching on TEAM techniques. This event is organized by Daniel Minte, Mariusz Wirga, and Yehuda Bar Shalom. For more information, please go to:  https://teamcbt.eu Today’s questions: Retirement depression / anxiety; patients who refuse to do exposure or psychotherapy homework; treating procrastination and ADHD; David’s new pooping story, and more! 1. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives? I’m in that boat. 2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do? 3. Heather asks: Hello David! How would you treat ADHD with TEAM-CBT? 4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. In some cases, I did not have time to polish and edit my responses below. I’ve been super busy developing the Feeling Good App, which is coming along tremendously well. It has the potential to help millions around the world who are struggling with depression and anxiety, but I have to be super careful with my time these days. If interested in beta testing, you can sign up here. 1. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives? I’m in that boat. David’s reply Have you read the introduction to Feeling Great? Or done any of the written exercises in that book, or in any of my books? Of listened to my free Ted Talk on my website? We can provide more specific information in the live discussion on the podcast. 2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do? Dear Dr Burns, Many thanks for your blogs, podcasts, books and TEAM CBT. I have experienced (and I am experiencing) being hypnotized with a Panic Attack patient with Border Line PD- . I know this after the sessions. During the sessions I feel I cannot even think well. I see this client through SKYPE, And cannot see her face to face due to distances. I have try to follow your approach, but she’s resistant, I do include exposure exercises that she never completes. How to do a Shame Attacking Exercise when I cannot go with the patient to the places she needs to in order to do the exposure. I have even been in the phone and she driving, but 2 years later nothing works. Any thoughts will help! Many thanks in advance. M. David’s reply Thanks, great question! Some training or individual case consultation or both, or workshops, would help a lot. We have two free weekly training groups for therapists in California and therapists around the world. For example, the last two weeks in our Tuesday group we have focused on the negative thoughts and feelings therapists have during sessions that interfere with their ability to do excellent work. So your question is very timely and relevant! Also, the www.feelinggoodinstitute.com has free and paid training. Two of the finest teachers are Mike Christensen and Dr. Jill Levitt, and there are many others as well. Jill has just released an introductory recorded class on TEAM-CBT that you can purchase and watch whenever you like. She is a brilliant teacher! And yes, you HAVE been hypnotized during sessions! David 3. Heather asks: Hello David!! How would you treat ADHD with TEAM-CBT? Hi there! It is Heather Donnenwirth, from podcast 267. I hope you are doing well. I really enjoyed being apart of the podcast with you, Rhonda, and Kyle. Thanks again for including me in that experience. I have another question for you about the podcast you did on ADHD. I totally agree with you about ADHD not being a diagnosis and agree that is more helpful to treat the symptoms. Many of the clients that I work with have been diagnosed with ADHD or are convinced that they have it. Procrastination seems to be a common symptom of "ADHD" that people want help with and that can be treated easily with the TEAM model and with the anti-procrastination and motivational tools. The symptom that people ask for help with that I am feel less confident about helping them with is difficulty with focus and distractibility, and would love your thoughts about how to treat these symptoms? I have improved my own focus with motivational techniques and with practicing bringing my attention back to what I want to focus on when my mind starts to wonder. Also, taking notes has helped me to stayed focused, but I am curious if you have any other ideas about increasing focus? Sometimes the people I work with have distorted thoughts about focus as well, such as: "If I'm not interested in something, I can't focus on it," and "I need medication to focus," etc. Anyway, I value your knowledge and opinion and wondered if you have any tools for increasing focus? Also, do you treat hyperactivity and excessive talking? I have also noticed that parents some time play an enabling role with kids diagnosed with ADHD, and don't require their children to do schoolwork that they think is too hard or if they are bored and having a hard time focusing. Sorry this is long!!! I hope you are doing well!!! Warmly, Heather Donnenwirth David’s reply I’d just ask the person to focus on one moment when they had that problem and then do a Daily Mood Log, as you’ve pointed out, and also brainstorm with them on how to solve the problem. But first, would have to do empathy and assessment of resistance, same as with anybody! As you point out, the motivational factors can be enormous. For example, Adderall is just the same as Dexedrine, and highly addictive and euphoric street drug. If I had some right now, I’d be highly excited and write 30 pages of stuff! In addition, I can use ADHD as an excuse for not doing stuff that’s boring. Someone who is motivated can easily find a solution. The summary before college I was lucky to get a job in a bank in Phoenix. My job was filing checks by hand. Boy, that was boring! I made it a bit less boring by trying to find the most unusual names while I was filing checks alphabetically. One of the many unusual (to my young and uneducated ear) names was J. Karekin Moojian! As freshman in college, I found I had trouble concentrating and grasping what the professors were saying in lectures to large classes of a couple hundred or so students. And I had NO IDEA whatsoever what the teacher was talking about! What helped was simply asking another student as we were walking out of the class. I’d say, “What was the professor trying say?” Then the other student, who seemed way smarter than me, would just give a one sentence summary, and I’d suddenly “get it.” So, if you’re motivated, you can find a way! In medical school, I had to memorize gross anatomy. I had little aptitude and no interest. I had never even take a biology class in college, and did not know what was in the “abdomen” or “thorax.” So I made up little games, sitting for hours in the library memorizing stuff. It got me through—just barely1 David   4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper? Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper. Thank you. David’s reply Interesting question! Probably okay either way. No research on this issue! I slightly favor doing it by hand, but that is likely because I have done it that way for 40 + years! d Thanks for listening and reading today! Rhonda, and David