Ask David: Featuring Matt May, MD What causes anxiety? Is recovery permanent? What if the cognitive distortions aren't helpful? Do hormones cause anxiety and depression? What's the role of vitamins and nutrition? How do Exposure and Response Prevention work? And many more answers to your questions! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below. But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is! Hi Dr. Burns: I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it! "I’ve replaced my copy close to ten times, as I keep lending it to friends who never give it back." https://girlboss.com/blogs/read/feeling-good-david-burns-review Have a great day! Rob Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well. When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous. David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time! What if your client/patient understands the Cognitive Distortions but doesn’t believe them to be true? David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that’s triggering your anxiety or depression, you will almost instantly feel relief. And here’s the precise answer to your question. When someone says, “I understand the distortions but it doesn’t help,” they still believe their negative thoughts. Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist’s efforts to “help.” Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person’s nutrition? Could it be that vitamins that are lacking? David's Answer.  First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings. In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother’s negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared! People want to “biologize” emotional problems, and I started out as a “biological psychiatrist” and researcher, but found the biological explanations to be erroneous and unhelpful. Could you please give a brief overview about Exposure with Response Prevention for OCD treatment.  Thank you! David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth. END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST The answers to the questions below were written by Dr. Burns but not discussed on the Podcast. Questions can I ask to overcome the Cognitive Distortion “jumping to conclusions”? That is the toughest for me. David’s Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common forms of Jumping to Conclusions. Feelings of hopelessness always result from Fortune Telling. All forms of anxiety always result from Fortune Telling as well. Social Anxiety typically includes Mind-Reading, and Mind-Reading is almost universal in relationship conflicts. In addition, I never treat a distortion, an emotion, a diagnosis, or a problem. I treat human beings systematically, using the T E A M algorithm. Matt’s Answer. There are many methods in TEAM that can be applied in the form of a question. These methods and how they are carried out, depends on the circumstances and the specific thoughts a person is having. Below are some examples of negative thoughts (NT’s) and the types of questions that might help overcome them. (NT): ‘Something really bad is going to happen’  (Be Specific Technique): ‘Like what? What’s going to happen?’  NT: ‘I’ll fail my biology test’  What-If Technique: ‘What if I failed my biology test, why would I be worried about that? (write down any new thoughts) What if those things happened, too, what then? (write down any new thoughts) What’s the absolute worst thing that could happen? (write this down).  Measurement: How certain am I, that these things will happen? On a scale from 0 – 100%, how likely are each of these predictions, in the form of negative thoughts, to occur?  Socratic Outcome Resistance: What do each of these negative thoughts say about my values that I can feel proud of? (write these down) What is appropriate about how I’m feeling and thinking? (write these down) What are the advantages of having these thoughts? (write these down). What would I be afraid of, if I didn’t have this thought? (write these down)  Pivot Question: Given the many positive values related to worrying, the advantages of doing so, the disadvantages of a carefree existence and the many reasons why my worry is appropriate, why would I change this?  Forgetful Clone (Double-Standard Amnestic Technique for Outcome Resistance): What would you say, to a dear friend, in an identical situation, when they asked these questions: ‘I’m really worried about failing my biology test, would you be willing to help me? (if ‘yes’, then continue) … Don’t I need to keep worrying? Won’t that protect me from failing? Don’t I need to worry, so that I’m highly motivated to succeed? Don’t I need to worry, so I avoid making mistakes? Don’t I need to worry, to maximize my rate of learning new material? Won’t I get lured into a false sense of security, if I stop worrying? Won’t I jinx it, if I get too confident? What would you recommend to me? How much do you think I should worry? I am prepared to do so … would it be helpful for me to go into a sustained panic, at this time?’  Cost-Benefit Analysis: Is worrying about failure worth the price? How would you weigh the advantages of worrying about failure against the disadvantages? What are the pro’s and con’s? How would you divide 100 points, to reflect the power of these two arguments?  Examine the Evidence, Motivational: What evidence is there that worrying improves academic performance, concentration and learning? What evidence is there that worrying worsens academic performance, concentration and learning? Magic Dial Question: ‘‘Should I remain maximally worried, at all times, forever? (If not, keep going) ’What amount of worry is best, for me, in this moment?’, ‘How about future moments? How frequently do I need to worry and for how long?’  Process Resistance for Activity Scheduling, Worry Breaks/Cognitive Flooding, Self-Monitoring/Response Prevention: ‘Would it be alright to ignore my worry most of the time and only focus on it during scheduled times? Let’s say I could learn how to be extremely calm and focused most of the day, without worry … would I be willing to worry as intensely as possible, for ten minutes, three times per day, to achieve this? When my worry comes up at other times, would I be willing to observe and record that event, then return to the task on my schedule?  Socratic Questioning: Am I absolutely certain that this thought is true, that I will fail? How do I know that I will fail? What specific questions will be on the Biology test that I will get wrong? What number grade will I get? A 60? 58? 39?’, ‘Would I bet money on my getting precisely that grade? Why not?’.  Examine the Evidence (cognitive): ‘What evidence is there that I will fail? What evidence is there that I will pass?  Reattribution: Let’s say that I fail. Would that be entirely my fault? Are there any other factors, outside my control, that might have contributed to this outcome? My genetics, for example? Or the nature of the world, into which I was born? Did I choose my genetics? Did I choose the world into which I was born, when I was born, my parents, teachers, etc.? Could any of these factors have played any role in the outcomes in my life?  Other examples of Inquiry-based methods, using different NT’s:  Negative Thought: ‘People will be angry and judge me, if I fail’  Interpersonal Downward Arrow: ‘What kind of people are they, if they judge me and look down on me, when I fail? How would I feel towards those types of people? Is it possible I feel angry? How do I express that feeling? What ‘rule’ am I following, in my relationships?’  Outcome Resistance: What’s good about me, for feeling anxious, rather than angry? What are the advantages of keeping my feelings inside? What would I be afraid of, if I expressed my feelings?  Process Resistance, 5-Secrets: Would I be willing to spend the time to learn the skills required to express my feelings, including anger, to people, in a way that made them feel good?  Negative Thought: ‘I’ll get sick and die’  Be Specific: ‘When? What time of day will that occur? What illness is going to kill me?’  Negative Thought: ‘I’ll lose my mind, crack up and go crazy’  Examine the Evidence: Has that ever happened to me? When was the last time? When you are working with clients, how do you handle it when they can challenge their thoughts very convincingly using a variety of techniques, state that they can see the logic in their restructured thought BUT they are still experiencing heightened anxiety and state that this hasn’t helped them? David’s Answer. They still have a strong belief in their negative thoughts. It is 100% untrue that they have “challenged them very convincingly.” Here’s an example. Let’s say you have an intense fear of glass elevators. You will say, “I can see that they are unsafe, but I am still terrified of going in one.” The moment you get on the elevator your belief that you are in danger will suddenly skyrocket to 100%. In other words, you still believe your negative thoughts. Of course, it is nearly always easy to overcome phobias, including an elevator phobia. As stated above, I use four models in treating every anxious patient. Simplistic formulas are just that—Simplistic! Treating humans is not like changing the oil in your car! Matt’s Answer: I am hard pressed to add anything of value to David’s awesome response, above. I might just reiterate that the Cognitive model, challenging the logic behind negative, anxiety-producing thoughts, is the least powerful of the approaches we have to anxiety. It is necessary, but almost always insufficient. Exposure, motivational methods and Hidden emotion are the real heavy-hitters. Until trying these, it is likely that the negative thoughts can be disproven ‘intellectually’ but not at the emotional level. How do you work with clients who state they are anxious all the time, experience strong somatic symptoms (body sensations) and cannot identify specific thoughts. They don’t catastrophize these somatic symptoms but really, really dislike them and want them gone! David’s Answer. I just ask them to make up some negative thoughts. That works well. For example, they may have the belief that the anxiety must be avoided because it may never disappear, or may believe that they are on the verge of going crazy, and so forth. Matt’s Answer, Anxiety can cause people’s brains to shut down, experiencing the ‘deer in the headlights’ phenomenon. Try to identify just one upsetting thought, then use the ‘what-if’ technique to expand on that. You’ll be off and running! How do you do techniques with a person who has active suicidal thoughts? David’s Answer. I don’t “do techniques.” I find out if they’re actively suicidal and in danger. If I know for certain that the person is safe, I treat them like human beings, with T E A M. I’m not a formula person. Each person will be different, and will respond to different methods. My books and podcasts are chock full of examples of actively suicidal people who responded. Matt’s Answer. I let them know that I don’t have the skill to help them unless I know they’re safe. If I’m worried for their safety, I’ll be afraid to use aggressive methods that may be required for them to recover. I’d need them to convince me of their safety before agreeing to work with them. If they can do so, I offer TEAM. If not, I ask if they’re willing to escalate the level of their care, e.g. to meet with me while hospitalized in a safe setting. I don’t work with patients who are at risk of harming themselves because I don’t believe in my ability to be helpful to them. Is it really okay to keep continuing the experimental technique when the patient does not want to continue? And, what if the therapist is not confident and something goes wrong in this situation? David’s Answer. I would need a specific example, but you are right that 75% or so of therapists are afraid of exposure and will not use it, fearing that something will “go wrong!” Matt’s Answer. It’s important to identify the resistance before initiating the method of exposure and to talk it through. Why would they not want to continue? What are they afraid of, if they get really anxious, during exposure? Write this down. Then, surrender, acknowledging that these are some excellent reasons to avoid exposure, in which case we can’t help them with their anxiety. Perhaps there’s something else they want help with? If they can convince you, and themselves, that exposure is precisely what they want to do, and they’re willing to keep doing it, even if it makes them very anxious, it’s appropriate to push a bit, in the moment of their doing exposure, to bolster them and help them through the rough patch. That said, I always give my patients a way out, if they don’t want to continue. That’s their choice, I just want them to be aware of the consequences, including a worsening of their anxiety. When doing experimental method, or the exposure method for example with who has sweating issue, how do you handle the hyper-vigilance he would have with people around, especially if someone actually laughed at him? David’s Answer. I would use the Feared Fantasy Technique, and Self-Disclosure. I would likely go with the patient into the real world to do these things, and have done so on hundreds of occasions. How would you work with someone who suffers from  Selective/Situational Mutism? David’s Answer. I have not run into that in my clinical practice. But 100% of the time, I would want to know what the patient’s agenda is. I would also want to know if there are powerful motivational factors that need to be addressed, looking at the whole person rather than the symptom. How different are Team CBT treatments for teens as compared to adults? David’s Answer. My experience is limited, but I would say no difference, really. I have loved working with teens, even though my main focus was on adults. When working with little kids, I think you need to incorporate play and games, although the basic concepts are the same. For example, you can do Externalization of Voices with puppets, the “Bad, Mean Self” and the “Positive, Loving Self,” or some such. We have featured shrinks who work with kids on many times on our podcasts. Thanks for joining us today! Matt, Rhonda, and David

Ask David: Featuring Matt May, MD How can I help my son? Is rapid recovery just "First Aid?" Do early "attachment wounds" cause anxiety? What's the Hidden Emotion Model? Are anxious people overly "nice?" And more! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below. Guillermo asks: How can I get close to my 11 year old son? Hi, Dr Burns Thank you for all the knowledge you share through your books and your podcasts. “the way you think creates the way you feel” has changed the way i view life. I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said “just throw it away” and i raised my voice and said “I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?” (I was rude and loud) To which, he got startled and teary eyed and said “no”. And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him. I later came to his room and apologized for my behavior and gave him a hug. I said “im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me” and i gave him a hug. That same night I heard podcast 278 or 279 and you said “the road to enlightenment is a lonely one, my friend” when responding to someone asking about the other person in a relationship. I thought, damn that’s true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize. I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this? Thank you again for all you do, Guillermo David’s answer: I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?" In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing! Warmly, david ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required? David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any “first aid” problem! Matt’s Answer: I agree with a lot of this.  While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to ‘relapse’, at some point in the future.  Educating people about this is important and part of ‘Relapse Prevention’.  Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences.  As the Buddhists say, ‘we all drift in and out of enlightenment’.  Relapses, the ‘drifting in-and-out’ is a sign of a healthy brain.  Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts.  While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you’ll occasionally go back to old habits in thinking.  So, achieving optimal mental health requires an ongoing practice with the methodology.  Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place.  If it was Exposure, you’ll have to keep on doing that.  If it was talking back to your negative thoughts, then you’ll have to do that, occasionally, etc.  This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection.  Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery.  That is to say, ‘Enlightenment’ is not a ‘perfect’ mental state but an acceptance of an imperfect one.  If this seems distasteful, Enlightenment may not be what you’re after!  For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery.  You’ll still need Relapse Prevention, including a commitment to continue to practice on an ongoing basis.  This leads to a higher level of recovery, in which you become your own ‘best therapist’.  Another place where I agree with you is that one might achieve (imperfect) recovery from anxiety and depression, and even take on the responsibility of maintaining these results, and yet still not be satisfied with some other aspects of life.  It’s possible (in fact likely) for any given person to suffer, not only from mood problems, like anxiety and depression, but from other types of problems, like unwanted habits or addictions, or relationship problems.  TEAM contains methodologies that address these concerns as well.  ‘Recovery’ from these conditions is the same as for mood problems, in that recovery will be imperfect and impermanent and require practice to sustain.  What type of practice that might be depends on the individual and we can’t predict, in advance, what types of exercises will be effective, for a particular person.  In fact, there’s a danger in assuming we know what will be effective and closing our minds to alternative approaches.  It’s a common error, for therapists, to pick up one tool and use that, regardless of results, rather than trying new approaches.  This is kind of like having a hammer in your hand, and seeing all your patients as nails!  I like how David says it: ‘Treat people, not conditions’.  So, I think I agree with what you’re saying, in that it requires trial-and-error with multiple methodologies to achieve initial recoveries, as well as ongoing practice to achieve optimal results.  I also feel compelled to observe the tendency for certain dangerous and wrong ideas to persist in our culture, kind of like ‘Urban Legends’ or ‘Mythology’.  One example is the revolution that occurred in medicine when people realized that pathogens, like viruses and bacteria, cause disease.  It had previously been thought that disease states were caused by an imbalance of the ‘Four Humours’, blood, bile, phelgm and calor (heat).  The treatment, for pretty much anything that ailed you, back then, was leeches and blood-letting, in hopes of restoring the balance of these ‘humours’.  A revolution in our understanding of disease occurred with the invention of the microscope.  It was now possible to visualize microscopic organisms, like bacteria, that we now know, after many experiments, are responsible for disease states. This allowed us to develop medications, like Penicillin, that kill bacteria and lead to rapid recoveries from infections, like pneumonia and immunizations that prevent infection.  Despite undeniable scientific evidence, people are prone to believing the old mythology, keeping the wrong and outdated model alive.  For example, many people are afraid, on a cold day, because they think that exposure to cold temperatures will lead to having a disease, which is even called a ‘cold’.  Meanwhile, we know, scientifically, that it’s not cold temperatures or an imbalance of any ‘humour’, that is causing colds, flus, and pneumonia.  It is microorganisms, like viruses and bacteria.  If you don’t want to get a cold, it’s better to sanitize your hands and wear a mask, than to bundle up on a cold day.  Instead of bloodletting and leeches, try vaccines and antibiotics.  Of course, people also make up new mythologies, around these, much to their detriment and at great cost to society.  My advice would be to listen to develop a skeptical mind and read the scientific literature.  Or, try to understand Neil DeGrasse Tyson, when he says, ‘Science is True, whether you believe it, or not’.  A similar revolution in our understanding has occurred in the field of Mental Health.  Like seeing bacteria, for the first time, after the invention of the microscope, we are returning to the understanding (which ancient Greek and Buddhist philosophers noted, as well) that it is our negative thinking that causes our suffering, more than our circumstances.  We know, now, that psychoanalysis is not required, to optimize mental health, any more than bloodletting or leeches is required to treat Pneumonia.  Thanks to Dr. David Burns, there is now a rapid, highly effective and medication-free treatment for depression and anxiety, called TEAM. Is the Hidden Emotion Model suitable for anxiety caused by early attachment wounds? David's answer. These big words are out of my pay scale, although they certainly sound erudite! In fact, the cause of anxiety is totally unknown, so when you say “caused by” we are in different universes! But the simple answer is yes, in 75% of cases, anxiety is helped greatly by the Hidden Emotion Model. Thanks! Matt’s Answer:  The Hidden Emotion model would always be on my list of methods to try, for an individual who wanted help reducing their anxiety.  That said, it’s better to select methods based on an individual’s specific negative thoughts rather than the presence or absence of trauma in childhood.  In fact, the assumption that we know the cause of anxiety is problematic because it may lead to a kind of therapeutic ‘tunnel-vision’ and delayed recovery, as time is wasted, trying the same approach, repeatedly, expecting different results. For example, assuming that ‘early attachment wounds’ are the ‘cause’ of anxiety may trigger the false belief that the most effective treatment would be many years, even decades, of Psychoanalysis.  This has been disproven, scientifically, yet it lingers in our minds, as a kind of mythology, passed down from our past.  Rather than subjecting our patients to decades on the couch, talking about their childhoods, it’s far more effective to ‘fail our way to success’, using multiple methods and measuring outcomes after each one, to discover what is actually effective for them.  Once you find the method(s) that are helpful, these will continue to be helpful, for that individual, throughout their lifespan, and it’s just a matter of practice. Another question about the Hidden Emotion model: when do you consider it “niceness” in anxious people and when is it the fear/anxiety to upset others due to the anxiety? David's answer. That can happen, but not usually in my experience. The “niceness” typically results from automatic suppression of uncomfortable feelings and problems. When they hidden problem or feeling is brought to conscious awareness, in most cases the anxious individual deals with it or expresses the feelings, and that’s when the anxiety typically disappears completely. As a part of my anxiety disorder, at times, I feel flat, emotionless and disconnected from everything around me. How do you treat that? David's answer. I use T E A M, not formulas! I do not treat symptoms, I teat humans. Matt’s Answer:  You could start with a Daily Mood Log, writing down the details of what was happening, in one specific moment in time, when you felt this way.  Include what you were thinking and feeling, including ‘flat’, ‘emotionless’ and ‘disconnected’.  For example, let’s imagine you had thoughts like, ‘nothing will ever change’, ‘this is pointless’, ‘I’ll never feel better’ and/or, ‘I shouldn’t be feeling so disconnected and flat’ or ‘I should be more in-touch with my emotions’ and/or ‘I need to be more up-beat’ or ‘people will reject me if I’m not more enthusiastic’.  You’d have to identify your particular thoughts, these are just guesses. After this, you could decide what, if anything you wanted to change.  If some change is desired, you might imagine a ‘magic button’ that would achieve that change, without any effort on your part.  For example, the button might eliminate all the upsetting feelings on your Daily Mood Log.  However, everything else in your life would remain the same.  Can you identify any reasons NOT to press that button?  Are there any positive values you have, related to these thoughts?  Would there be any down-side to pressing that button?  This represents your ‘Outcome Resistance’.  Typically, there will be many pieces of resistance that would need to be acknowledged or addressed before methods will be effective in helping you.  You can read in one of David’s many excellent books, like ‘Feeling Great’ and ‘When Panic Attacks’ how to make the most of this approach and what the next steps are. Thanks for listening today. MANY more cool questions on the best treatment techniques for anxiety next week. Matt, Rhonda, and David

What's the Antidepressant Myth? Have We Been Scammed?     Today, Rhonda and I interview one of our heroes, Dr. Irving Kirsch, who is a giant in depression research and a fun, down-to-earth human being at the same time! Dr. Kirsch is Associate Director of the Program in Placebo Studies and the Therapeutic Relationship, and a lecturer on medicine at the Harvard Medical School (Beth Israel Deaconess Medical Center). He is also Emeritus Professor of Psychology at the University of Hull (UK) and the University of Connecticut (USA). Dr. Kirsch has published 10 books, more than 250 scientific journal articles and 40 book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. He originated the concept of response expectancy. This is the expectation that people have that a given treatment or intervention will be helpful. Kirsch’s 2002 meta-analysis on the efficacy of antidepressants influenced official guidelines for the treatment of depression in the United Kingdom. His 2008 meta-analysis was covered extensively in the international media and listed by the British Psychological Society as one of the “10 most controversial psychology studies ever published.” His book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, has been published in English, French, Italian, Japanese, Turkish, and Polish, and was shortlisted for the prestigious “Mind Book of the Year” award. It was also the topic of a 60 Minutes segment on CBS and a 5-page cover story in Newsweek. In 2015, the University of Basel (Switzerland) awarded Irving Kirsch an Honorary Doctorate in Psychology. In 2019, the Society for Clinical and Experimental Hypnosis honored him with their “Living Human Treasure Award.” In today’s podcast, we cover a wide range of topics, including a patient-level reanalysis of all of the data on the effects of antidepressant medications versus placebos submitted to the FDA. This analysis included more than 70,000 depressed individuals and indicated something troubling and surprising. The difference in improvement between individuals treated with antidepressants and individuals receiving antidepressant medications was only 1.8 points on the Hamilton Rating Scale for Depression. This test can range from 0 to 50, and a difference of 1.8 points is not clinically significant. In addition, the beneficial antidepressant effects observed in both the placebo and “antidepressant” groups are large, with reductions of around 10 points or so on the Hamilton Scale. These were the shocking discoveries that led to his popular book, The Emperor’s New Drugs (LINK), and to his appearance on the Sunday evening 60 Minutes TV show. In addition, Dr. Kirsch agreed that tiny difference between the “effects” of antidepressants vs placebos could be the result of problems in the experimental design used by drug companies. Because they give patients in the placebo groups pills with inactive ingredients, there are no side effects in the placebo groups. This makes it fairly easy for individuals to guess what group they were assigned to—the “real” antidepressant group or the placebo group. This might account for the differences in the groups, since many individuals in the medication groups may think, “Hey, I’m getting some side effects. I must be in the antidepressant group. That’s terrific!” This thought would be expected to trigger some mood elevation, but it’s the thought, and not the pill, that causes this. In contrast, some individual in the placebo groups may have the thought, “Hey, I’m not getting any of the side effects they described. I must be in the placebo group!” And this thought may trigger disappointment, and a worsening of depression. This would contribute to differences between the drug and placebo groups in drug company outcome studies with new chemicals that they hope to get approved as “antidepressants.” This problem could easily be corrected by the use of active placebos, like atropine, which produces dry mouth, a side effect of many antidepressants and has been used as an active placebo in a small number of trials. Most of the studies using active placebos have failed to show any significant effect of the antidepressant over the active placebo. Drug companies have been reluctant to implement this change in their research designs, perhaps due to the fear that it will “erase” the tiny differences that they have been reporting. This would be of potential concern since billions of dollars are at stake if the FDA gives you permission to call your new chemical an “antidepressant.” We also discussed Dr. Kirsch’s unlikely journey to Harvard. When he was in England, planning to return to the United States, he asked a colleague at Harvard if it would be possible for him to get a library card so he’d have access to articles in research journals. His colleague told him that it was difficult to obtain a library card for people not affiliated with Harvard. However, they were willing to offer him a position as Instructor on Medicine, given that he was the Associate Director of the  Program in Placebo Studies and the Therapeutic Relationship, which was hosted at one of the Harvard teaching hospitals. That’s a wow! But certainly deserved, and a most fortunate affiliation with unanticipated and highly positive consequences that have led to many important discoveries on how the placebo effect actually works. The placebo effect is not a bad thing, and has been one of the doctor’s best “medicines” for hundreds if not thousands of years. On the podcast, we also discussed the confusion—for patients, doctors, and researchers alike—caused by the placebo effect. For example, many people who receive antidepressants do improve, and some recover completely. They will SWEAR by antidepressants, and may feel hurt or disappointed by the results of Dr. Kirsch’s research. But in fact, there is no discernable difference between the effects of placebos and so-called “real” effects. And one of the downsides of the confusion about placebos is that people who take antidepressants and improve have improved because of changes in their thinking, and not from the antidepressant. But they wrongly give credit to the pills they took, whereas they deserve the real credit for overcoming their feelings of depression. We discussed many other topics, including pushback he has received from the psychiatric community and some in the general public as well who have not taken kindly to his findings. I, too, have experienced that when I have summarized the data in the Food and Drug Administration, and have had to be very careful in how I present this information, because none of us want to discourage anyone who is depressed. We have also invited Dr. Kirsch to consult with us on the research design we use in our beta testing of the Feeling Good App, and have developed tests of “expectations” (the so-called placebo effect) that we will use in our latest beta test as well. We want to “walk the walk” and not just “talk the talk” and find out how much the improvement we see in beta testers might be due to a placebo, or “mega-placebo” effect. Rhonda and I were honored and thrilled to have this chance to interview Dr. Irving Kirsch, a friend and research giant for sure! Thanks so much for listening to today’s podcast! Irving, Rhonda, and David

Integrating TEAM-CBT with Martial Arts Training! Podcast Episode 330, Featuring Dor Star Our guest today is Dor Star. Dor is an educational counselor (MA) and a level 2 TEAM practitioner who works with children in Israel who have emotional and interpersonal problem. He works with children as young as four years old, but most of his work is with children ages seven to twelve years old. The children he works with experience various challenges and difficulties such as: Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, tantrums, outbursts of anger, all kinds of anxieties, social difficulty, bullying and much more. His work is unique because he works mainly in small groups (4-6 participants) using martial arts and sports as therapeutic tools. In his work Dor uses the TEAM model with some adaptation, because of the children’s ages and sports methods, with great success! In fact, one can say that he discovered for himself, and for his patients, a new way to use the TEAM model. He also teaches sports and martial arts trainers who are interested in entering the field of child therapy. Dor describes his first encounter with TEAM-CBT, which blew him away, but he was initially frustrated because he was thinking of his conventional ways of dealing with kids VS TEAM. But after a few weeks he discovered that he could use the TEAM structure to improve his approach, and wow, did he ever start to shine, as did his results with TEAM. Today’s podcast was really a breath of fresh air! Dor began with T = Testing, and describes how he developed simple assessment tools to rate how his children (aged 4 to 11) were feeling at the start and end of his classes, but also how they felt about him. He uses simple questions like “Did I understand you today? How well did I listen?” He also asks them, “How much fun was the session,” and “How did you grade yourself?” Then they grade him on a scale from 0 (the worst) to 10 (the best.) So, it’s quick, easy, and . . . shocking. Dor says: “I found out that I wasn’t nearly as effective as I thought. Sometimes the kids thought the class was fun, but I got really low grades on Empathy, as well as how depressed, anxious and angry they were feeling at the start and end of each group session. Essentially, I discovered that I wasn’t achieving almost any of my goals for my kids. This was disturbing at first, and I had to let my ego die. But I decided to try to view it as valuable information that I might be able to use to learn and grow.” For example, I had one of the most amazing sessions with an 11 year who was smiling the entire time. I was absolutely certain it was one of my best sessions ever. But when I asked him for my grade, he gave me a 3 out of 10! When I asked why, he explained that at the start I didn’t introduce myself or ask him about himself! So, in this simple but compelling way, Dor has used the T = Testing to transform the entire way he works with kids! I believe he’s had the same experiences I’ve had with the T = Testing component of TEAM. Dor has made his patients his teachers, and this has led to some amazing and revolutionary developments in his approach. Dor emphasizes the importance of E = Empathy, and says that “the Five Secrets of Effective Communication” are incredible! For example, if they’re having a rage attack, or a temper tantrum, you can tell them they are absolutely right in the way they’re thinking and feeling.” He also uses what he calls the Five Ways of Love. Verbally expressing respect and liking Giving service: tying a child’s shoes, giving them some water during the training. These small acts can create feelings of trust and connection. Spending time with them, paying attention to them. This is especially important because so many are angry and try to push others away. They are good at getting other people to reject them and not want to spend time with them. Giving gifts, something they can take home and show to their parents. Making physical contact with them during the martial arts training, playing with them, having fun. I (David) would note that physical contact might be something to be careful with. Of course, when you are teaching martial arts, it may be perfectly justified and desirable. I came from the psychotherapy perspective, and I have been trained that ANY touching of a patient other than shaking hands at the initial and final sessions is grounds for a malpractice suit as well as an ethics charge. Dor also made some really illuminating comments on the A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) At the initial evaluation, he talks to the teachers, parents, and students. The agendas from teachers and parents are things like “he has an anger problem” or a problem paying attention in class, or whatever. However, 90% of the time, the children frequently are unaware of those agendas, or have no interest in the goals of the teachers and parents. Instead, he finds out what the children want to work on, and finds this to be the most and only effective way to approach the treatment. He says that it is fairly easy to set goals with children of any age, even as young as 4 years old, but those in the 8 to 11 years of age are the most difficult. He said that the children’s goals may be to learn how to hit back when they are being bullied in school, or to have fun and make friends with other kids. I was delighted to hear about Dor’s methods of setting goals with his kids and have felt strongly along these lines for many years! I say, Kudos, Dor! He also described doing a Cost-Benefit Analysis of crying when being bullied, and also helps his children see the positives in their symptoms using Positive Reframing. Dor explains: For example, I worked with a child who was bullied at school. In order for the work to be effective, I asked that the boy who bullied him be included in the group as well. After seeing the bullying happening in real time, I had two private five minute sessions with each child while the other kids played. In these sessions I used empathy techniques and received a score of 10 I started fooling around with the TEAM-CBT Agenda-Setting techniques. The goal was for the child who suffers from bullying to choose to behave in a different way. The child said he was willing to do it to prove to me that he is strong and to get back at the kids who beat him. I then talked to the bully boy and asked him if he was willing to help me work with that boy. He was happy to do it because he wanted him to stop crying all the time and get punished for it. After that the M = Methods part was really easy and fun. I hade the bully train the kid =whom he’d bulled. Two meetings after that they were best friends. In my experience (and I have done this process several times) the bully is the best therapist for a child who suffers from bullying! After Dor described his approach to helping kids who are being bullied, he said that if the parents or authorities step in to help it can make things worse because they child is placed in the role of being a baby, which may intensify the bullying. David asks: Dor, is a safety plan for the child important? Can the child always learn to deal with the bullying on their own? Any details or examples would be great! This was Dor’s answer: I didn't address it enough, but you can't provide good therapy without providing good education. That's why I like working in schools because I can easily talk to the teachers. It is clear that we as adults need to talk about values and set boundaries, and in severe cases we may need to intervene and provide a safety net for the therapeutic process. But I feel that it is my job as a therapist to give my patient the tools to deal with their problems on their own. And bullying, like any problem in a relationship, is about guilt. And as soon as I stop blaming the other and start trying to improve myself and treat the other and his wishes with respect the change begins to happen. David: I agree strongly with what you just said! My research when I was in Philadelphia years back strongly supported the notion that blame is one of the main causes of relationship conflicts. Dor continues: In another case of mine, I worked with a child who complained that whoever was sitting on him was yelling at him and throwing things at him. I wasn't sure what could be done and gave him all kinds of bad suggestions At this point a 10-year-old boy with autism stopped me () and asked him what he asked the boy who was bothering him. He said that the he was criticized for the exact same thing--he was making noises that disturbed the boy next to him. From there we continued with homework to find out what is bothering that child, to tell him that he is right, and to ask him if he is ready to stop hitting and yelling at the second patient and his behavior will change. It was a huge success. Dor continues to talk about the idea of specificity which is so central to TEAM-CBT: I discovered that the techniques we teach children should be direct and simple. In the past we believed in all kinds of indirect techniques that were supposed to somehow help the child. The idea is to stop using general definitions like "self-confidence" "concentration abilities" and "social problems." Instead, we can start being specific in our goals and techniques. Rhonda and I were thrilled to learn about Dor’s terrific work adapting TEAM to working with very young people. I encouraged Dor to consider a book on TEAM for TOTS (or some other title) so other therapists can learn how to adapt TEAM to work with children with specific problems such as intense shyness, autism spectrum problem, ADHD, anger issues, and more. Several days after the recording session, Dor was already working on his book. Awesome! Thanks so much for listening today! Rhonda, Dor, and David If you wish to contact Dor, you can email him at: dorstra@gmail.com

Ask David: Featuring Matt May, MD 329: How can you deal with a “narcissist?” In today’s Ask David, we respond to a listener who requested a podcast on the topic of narcissism, including how to deal with them, so we will focus on these topics. The following show notes were prepared prior to the actual podcast to provide a structure. For more great information, listen to the podcast, as much more was covered! David What is the definition of “narcissistic personality disorder”? Narcissism involves: Grandiose fantasies and feelings, thinking that you are superior to others Lack of empathy for others Extreme self-centeredness Intolerance to criticism or disapproval Urges for revenge on anyone who crosses you. We do not know whether these are just extremes of personality characteristics that everyone has in varying degrees, or whether it actually consists of a “disorder” that is qualitatively different and distinct. But it is definitely true that all of the characteristics I have bulleted above do exist to some degree in most, if not all, human beings. How do you treat narcissistic patient? I do not treat diagnoses, just human beings. This is a radical departure from the way many mental health professionals approach their work. No matter who I’m treating, I always start with the T and E of TEAM (Test and Empathy) and then move on to A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) The main idea is to find out what, if anything, the patient wants help with. It would be rare for someone with narcissistic qualities to want help with their narcissism. Generally, they want help with a troubled relationship or with feelings of depression, anxiety, or anger. Then I would ask them to zero in on one specific moment when they were upset and wanting help, and deal with Outcome and Process Resistance. If the patient can convince me that she or he does want help, then I move on to M = Methods, and the methods would have to do with the nature of the problem they want help with. I once presented a case illustrating rather dramatic and rapid recovery in a patient I was treating for depression and anxiety. To my way of thinking, it was a great outcome. However, during the Q and A I got an angry rebuke from a therapist in the audience who pointed out that I hadn’t treated the patient’s “obvious narcissism.” This is the “great divide.” I don’t feel like it’s my calling to evangelize for any model of “ideal mental health.” For the most part, and there are always exceptions to every rule, I do not impose my agenda on the patients, but try to work with what they want to change. I might suggest possible ways we could work together, but in the final analysis it is up to the patient. I liken my role to that of a plumber. If you’ve got a broken toilet, give me a call and I’ll fix it. But I don’t go from door to door promoting copper pipes! How can you deal with narcissistic individuals in the real world? Once again, it depends on the specific moment that you want help with. However, I always like to emphasize the value of the Disarming Technique and Stroking when interacting with someone with strong narcissistic tendencies. The goal, in my opinion, might be on “dealing with them skillfully” as opposed to “changing” them or “winning.” For example, (David can give example of Erik’s friend when growing up.) What are the causes of narcissism?  Scientists do not know, for the most part, what causes most of the so-called “mental disorders” listed in the Diagnostic and Statistical Manual of the American Psychiatric Association, but it seems possible, even likely, that there could be genetic and environmental causes, and the environmental causes could have to do with the past (childhood influences) and present. For example, when people begin to experience significant success, in academics, sports, or some other field, others begin to admire them and want to be with them. This can fire up our egos, and can feel good. And as they level of fame and status increases, the attraction of others intensifies, and eventually people fear saying no or contradicting the narcissistic person who has such power. So, the narcissistic person is constantly reinforced, even for bad behavior or irrational beliefs, with little or no negative feedback to correct his or her course of actions and thinking. Some experts also point to profound feelings of shame and insecurity under the surface, which might also be genetic, at least in part, or triggered by adverse childhood experiences. What you have to let go of to relate to someone who is narcissistic? To my way of thinking, you have to give up the idea that the narcissistic person is going to take you seriously or care about you, You may also have to give up the notion that you are going to “change” or “help” them. You may have to use a more manipulative approach, using lots of Disarming and Stroking, instead of being so sincere and serious. This involves “letting go,” and moving forward with your life. What is “Malignant Narcissism?” This is a severe form of narcissism where the person will resort to extreme tactics to get their way, including murder. You see this in politics and cults. Names like Jim Jones, Adolph Hitler, and even some politicians today around the world, and many despots throughout human history. What does it mean when someone is “manipulative?” David explain that he’s heard that term for years, decades really, but did not understand what it meant until a few weeks ago, based on a personal experience. The group contrasts a relationship based on using people, and seeing them as objects, vs a relationship based on warmth, vulnerability, trust, respect, and openness. Thanks for listening today! Matt, Rhonda, and David

"Overcoming Toxic Shame" Join Dr. Jill Levitt and me  at our fabulous new workshop Sunday, February 5th, 2023 8:30am - 4:30pm PST - 7 CE units Click here for information and registration In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her. Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients! In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING! Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world. You can reach Dr. Burns at david@feelinggood.com.

Live Therapy with Cody, Part 2 of 2 Last week we presented the first of our session with Cody, a young man wanting help with his fairly severe social anxiety since childhood. My co-therapist for this session was Dr. Rhonda Barovsky, the Feeling Good Podcast co-host, and Director, Feeling Great Therapy Center. Today, you will hear the exciting conclusion of his session, and the follow-up as well! Part 2 M = Methods We focused on cognitive work and interpersonal exposure techniques as well. I will leave it to you to listen to the podcast, as I became so engrossed in what we were doing that I stopped taking notes. However, we used a number of tools within the group, including: Identify the Distortions in his thoughts Examine the Evidence Externalization of Voices Self-Disclosure Rejection Practice The Experimental Technique The Feared Fantasy And more. Cody received an abundant outpouring of love, respect, and encouragement from those in attendance (LINK). We also gave Cody two “homework” assignments to complete following the group. Do at least three Rejection Practices in the mall and notify the training group members via email within 24 hours that he had completed this assignment. Complete the Positive Thoughts column of your Daily Mood Log. If you'd like to see Cody's complet4ed Daily Mood Log, you can check this LINK. If you'd like to see Cody's intimal and final Brief Mood Survey plus Evaluation of Therapy session, check this LINK. As you can see, there were dramatic changes in all of his negative feelings. However, he wanted to retain some anger toward his childhood friends who made fun of him. Here’s the email we received from Cody about his homework assignment. Hello groupers, I can proudly say mission accomplished! Although it took me around 7 hours to do it, I did it. A lot of emotions came up as I kept trying and chickening out. I really feel like something has changed in me, by the last person I felt almost no anxiety and now I keep asking myself why I was ever afraid of this (I hope it sticks. I know I'll need to keep up this momentum I'm sure). Having to do this email and being held accountable to you all was what drove me to the finish line. Thanks again, see you all next week! Thanks to you, Cody. You were incredibly inspiring in group and after and the work you did will touch the hearts of many people, just as you have already touched the hearts of all the people in our group! And thank you all for listening! Cody, Rhonda, and David

Featured pic of Cody in one of the small group practice sessions in David's virtual Tuesday training group. Live Therapy with Cody, Part 1 of 2 I recently treated Cody, a young man wanting help with his fairly severe social anxiety since childhood, during one of our Tuesday evening Stanford training groups. My co-therapist for this session was Rhonda Barovsky, PsyD, the Feeling Good podcast co-host. The full session will be broadcasted in two parts, starting today and finishing next week. Part 1 T = Testing At the start of the session, Cody’s depression score was only 6 out of 20, indicating minimal to mild depression, but his score on the loss of self-esteem was “a lot.” His anxiety score was 11 out of 20, indicating moderate anxiety, and his anger score was only 2, minimal. However his score on the Happiness test was only 11 out of 20, which is only moderately happy, indicating a lot of room for improvement. If you like, you can review his Brief Mood Survey at this LINK. We’ll of course ask him to take this test at the end of today’s session so we can see what, if impact, we made on his feelings. E = Empathy Cody described his shyness like this: “I’ve been shy for as long as I can remember and feel introverted. It started in middle school. I felt like I never fit in or connected with people very deeply. In middle school, you really want to fit in. “I wanted my friends to like me, and one day they all started to torment me. Our seats in school were assigned, so I couldn’t get away from them. I cried at recess every day for months. Then, one day, they suddenly went back to being my friends again, and I never understood why. “When they were tormenting me was the most painful moment of my life. I felt like they were judging me. “I’ve worked on my own and I’ve gotten over 90% of my social anxiety. At first, I was afraid of answering the phone or even ordering a pizza, so I got a job where I was required to answer the phone and got over it. “Now I’d like to date, but this has been a problem for me. Also, when I’m treating someone, and this topic of social anxiety comes up, I get uncomfortable. I think if I could overcome the rest of my shyness, it would boost my confidence. “The podcast you and Rhonda did with Cai on Rejection Practice (LINK) inspired me tremendously, and I managed to do one Rejection Practice. By now I’m chickening out again. I go to the mall determined to do it, but I just keep putting it off. Asking women to reject me seems incredibly frightening, and I’m afraid people will judge me or see me as a predator. I love in a small town, and most people know each other. “When I was thinking about the session all day today, I felt nervous and my stomach tightened up. Cody brought a partially completed Daily Mood Log to the session, which you can review at this LINK. As you can see, the Upsetting Event was thoughts of approaching someone at the mall for Rejection Practice. His negative feelings included the entire anxiety cluster, shame, the entire inadequacy cluster, unwanted, humiliated, embarrassed, the entire hopelessness cluster, frustrated, annoyed, and anger with himself. These feelings ranged from a low of 35% for shame to a high of 100% for foolish and humiliated and 90% for the hopelessness cluster. And as you can see, many of his negative thoughts focused on the theme of being judged by others who might see him and think he was strange, or a disrespectful jerk, and so on. He was also convinced that women would be annoyed by him, and that the word would spread so that he’d lose the respect of people he cared about. A = Assessment of Resistance Cody’s goal for the session was to feel motivated to do the Rejection Practice he’d been avoiding, and to get rid of the negative thoughts that were holding him back. He said he’d be reluctant, though, to press the Magic Button and make all of his negative thoughts and feelings disappear, so we listed what his fears might actually say about him and his core values that was positive and awesome. Here’s the list we came up with: Positives My anxiety My anxiety shows that I care about peoples’ comfort. My anxiety protects me from rejection or doing something foolish. My fears of being seen as a predator show that I want to fit in with the social norms and not be weird or threatening to women. My fears show that I want to be respectful towards women. My fears of being judged show that I care about friends and family. My anxiety shows that I care about my reputation. My feelings of inadequacy show that I’m aware that I have things I want to work on. Those feelings also show that I’m humble. My feelings show that I really care about connecting with others, which is one of the most important things in life! My negative thoughts and feelings motivate me to work hard on changing. They also show that I have high standards. My hopelessness shows that I’ve tried to do Rejection Practice six times and have always chickened out. So I’m being realistic. My hopelessness also protects me from getting my hopes up and then being disappointed. My unhappiness gives me greater compassion for my clients. My anger energizes me and motivates to do something new. Tune in next week for the exciting conclusion of the live work with Cody! David and Rhonda

Curing YOUR Social Anxiety— The Ridiculously Cheap and Awesome Shame-Attacking Marathon Jacob Towery, MD Michael Luo Today, we are joined by Dr. Jacob Towery and Michael Luo to promote their  upcoming, two-day Social Anxiety Marathon. Jacob Towery, MD is an adolescent and adult psychiatrist and therapist in private practice in Palo Alto, California.  Michael Luo is a fourth year medical student at the Chicago Medical School. More on them at the end of the show notes, but here’s the scoop. Jacob and Michael will be offering a mind-blowing, two-day marathon for anyone who struggles with social anxiety, which includes shyness, public speaking anxiety, and performance anxiety. They will both be present, along with more than ten experts in TEAM-CBT, coaching participants in the latest tools for quickly overcoming all social anxiety. And here’s the amazing thing. You can come and attend, and transform your life, for only a $20 donation to one of their four listed amazing charities. For information / registration, click here How cool is that? Don’t pass this up. It will be an in-person, hands-on training experience designed to free you from the fears that narrow your life. You will learn and participate in cognitive therapy exercises, identifying and smashing the distorted thoughts that trigger social anxiety, as well as the Self-Defeating Beliefs that trigger social anxiety like the Spotlight and Brushfire Fallacies, the Approval Addiction, and more. They will also illustrate and lead you in a wide variety of Interpersonal Exposure Techniques, including Smile and Hello Practice, Self-Disclosure (which Michael demonstrates in real time on today’s show), Rejection Practice, Flirting Training, Shame Attacking Exercises, and more. David claims that Jacob is likely the world’s top expert in Shame Attacking Exercises, and we illustrate several on the podcast. Rhonda described a Shame Attacking Exercise that I challenged her with. It was incredibly terrifying, but turned out really well! David also described the impact of self-disclosure on a wealthy and powerful businessman he treated who was so insecure that he was even terrified to be around his wife and children. People who are socially anxious nearly always try hard to hide their negative feelings out of a sense of shame, so others, even friends and family and colleagues, typically aren’t aware of how they feel inside. Michael courageously discloses his own negative thoughts that triggered feelings of social anxiety at being around Jacob, his mentor. Maybe I’ll make a mistake. I might be wasting Jacob’s time. Then he might not want to mentor me. These thoughts caused feelings of loneliness and shame. I felt much closer to Michael when he disclose these feelings. Jacob added that he was totally unaware that Michael had been struggling with these thoughts and feelings. The treatment of social anxiety is profoundly serious, because we are involved in changing the lives of people who are suffering and lonely and inhibited, but the treatment can also be fun, hilarious and of course, enlightening. Michael wraps up the show by describing the transformation this training has had on his own life. If you wish to attend, act rapidly because space is limited and will be given out on a first-come, first-serve basis. I hope you can attend, and make sure you let Rhonda and David know about your experiences! Thanks for listening today! Rhonda, Jacob, Michael, and David

Secrets of Overcoming Romantic Rejection Part 2 of 2 In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more! 6. Do you have any tips for moving on and realizing that maybe your ex isn’t as great as you think they are? David 20 qualities I’m looking for in an ideal mate. Rhonda Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different.  Fill out the form: “20 Qualities in An Ideal Mate” and review how many of these qualities your ex had. 7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who’s been cheated on in trying to get their confidence back? David YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average. Kyle Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you’ve been cheated on? Practice talking back to those. 8. How can we boost our confidence back up after a breakup in general even if we haven’t been cheated on? David SAME ANSWER. Rhonda Do things you love to do with people who love you:  go dancing, go to the beach, go hear music, read, etc. Daily Mood Log on the thoughts that lead to your lack of confidence. 9. Do you guys believe in the notion that you are capable of “healing completely from your ex (aka completely being over them and all the pain the breakup brought you)” or do you believe that it’s not possible. David I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU’LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU! Rhonda You may never be exactly the same, why would you want to be?  Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds). Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships.  Relationship Journal to see how you have contributed to the relationship problems.  Maybe do Reattribution to see what you contributed to the relationship problems and what they did. 10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations? David I DON’T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT’S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT “SEES.” Rhonda I can’t add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain. 11. Do you guys feel that you shouldn’t date for a while after getting your heart broken? David THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED. Rhonda This is a very personal decision.  Have you had time to heal before getting into a new relationship?  Have you had time to examine your role so you can make changes if you choose, so you won’t repeat the same mistakes in the next relationship? 12. Do you have to move on from your ex to go back out into the dating world again and to possibly be in a relationship again? Do you guys feel that “jumping” from relationship to relationship can be a bad thing? Why or why not? David THESE THINGS ARE ALWAYS ON AN INDIVIDUAL BASIS. I THINK IT CAN BE HEALTHY TO DATE A VARIETY OF PEOPLE AND NOT GLOM ONTO THE FIRST PERSON WHO EXPRESSES AN INTEREST IN YOU. THAT WAY, YOU CAN COMPARE A VARIETY OF RELATIONSHIPS AND IN ADDITION, YOUR DATING SKILLS WILL IMPROVE. THE “20 THINGS I’M LOOKING FOR IN AN IDEAL MATE” CAN BE VALUABLE. Rhonda “Jumping from relationship to relationship” sounds so judgmental.  Are you finding yourself in relationships where you have similar complaints from your last relationship, repeating patterns that you dislike?  Then I would pause and take time to heal and learn before starting another one. Kyle What does be “moved on” really mean here? Would you have to never have a thought about your ex again before dating? That might be impossible! I don’t think there’s anything wrong with dating multiple people or starting and stopping relationships with some frequency – especially if you’re looking for a good fit and it’s not working out with someone. 13. How do you overcome your trust issues when getting into another relationship after your heartbreak? David PATIENT WOULD HAVE TO GIVE ME A SPECIFIC EXAMPLE, AND NOT DEAL WITH THIS OR ANYTHING “ABSTRACTLY.” Rhonda Daily Mood Log work, starting with a specific event that led to the lack of trust. Let us know if you would like a third podcast on how to deal with romantic rejection at some point, since we have a number of remaining questions. Thanks! My book, Intimate Connections, will help you with dating and rejection issues! You can contact Dr. Kyle Jones at kyle@feelinggoodinstitute.com End of Part 2