293: The Five Secrets with Violent and Angry Individuals, Featuring Heather Clague, MD Heather Clague MD is a Level 5 TEAM therapist and trainer with a practice in Oakland, California and consult-liaison psychiatrist at Highland Hospital in Oakland. In addition to running an online consultation group for TEAM therapists, she is faculty for All Things CBT,  teaches for the Feeling Good Institute, and has taught the Five Secrets of Effective Communication to medical staff. Her writing can be found at psychotherapy.net. With Dr. Brandon Vance, Heather co-leads the Feeling Great Book Club, a book club for everyone, everywhere who wants to learn the magic of TEAM. In today’s podcast, Rhonda and David speak with Dr. Heather Clague who describes her working in the psychiatric emergency room at Highland Hospital in Oakland, California, and other emergency facilities including Fairmont Hospital in San Leandro, California, interacting with hostile and psychotic individuals who often have to be held against their will because they are a danger to themselves or others, or unable to care for themselves. Although today’s podcast will be of special interest to mental health professionals, it will also be of great interest to anyone having to interact with strangers, friends or family members who are angry and abusive. She explained that In these types of settings, we often have to give patients the opposite of what they want. For example, if they’re involuntarily hospitalized for dangerous behavior, we have to restrain them, or keep them in the hospital, when they desperately want out. Or, if they want to stay in the hospital, we may have to discharge them. Many of these patients are psychotic and lack judgment, so they may shout and act out in anger and frustration. The Five Secrets (LINK) have been a godsend, and when it works, the results are amazing. For example, if a patient is screaming for us to release them, the natural instinct to get defensive just agitates them more and is rarely or never effective. If in contrast, you say, “You’re right, we are holding you against your will and you have every right to be angry,” they usually feel heard and calm right down. In one recent case, an agitated and confused homeless woman needing dialysis was near death because she was refusing treatment and refusing to take her medications. She was manic, agitated, and talking rapidly, non-stop. I said, “I think you’re really upset because we’re keeping you against your will.” The patient shouted “Yes!” Then I said, “And you’re telling us that you do have a place to go to if we let you out.” The patient said, “yes,” in a softer voice, and let the nurse come in and give her her medications, which she took. Heather described phrases she uses to get into each of the Five Secrets in high-secrets situations when you don’t have much time to think and have to respond quickly, including these: For the Disarming Technique: “You’re right,” followed by a statement affirming the truth in what the patient just said. Thought Empathy: “What you’re telling me is” followed by repeating what the patient just said. This is helped greatly by writing down what the patient said. Without writing things down, this technique tends to be impossible for mental health professionals OR the general public. In spite of this, most people refuse this advice! Feeling Empathy: “Given what you just told me, I can imagine you might be feeling X, Y, and Z” where X, Y and Z are feeling words, like “upset,” “anxious,” or “angry,” and so forth. Inquiry: Heather emphasizes two productive lines of Inquiry: “Am I getting it right?” “Can you tell me more about how you’re feeling?” “I Feel” Statements: “I’m feeling X, Y, and Z right now,” where X, Y, and Z are feeling words like sad, concerned, awkward, and so forth. When done skillfully, this technique adds warmth and genuineness, and facilitates the human connection. Heather cautions against saying “I feel like you . . . ” since this ends up not as a statement of your own feelings, but a criticism of the other person. “I feel that . . . “ has the same problem. Stroking: This conveys caring, liking and respect, but cannot be done in a formulaic way. You might say things like “I care about you and I’m really concerned that you’re struggling right now,” or ‘What you are saying is very important, and I want to understand more.” For example, you might say this to an angry patient being held against his or her will: “You’re right, I am holding you against your will, and insisting that you stay, and I don’t like it either. But I’m very concerned that if I let you out now, you might get hurt, or do something to hurt yourself, and your life is precious. I don’t think I could forgive myself if I did that.” Of course, all of this has to come from the heart and has to be done skillfully, or it will not work. Heather described other inspiring stories of challenging patients she’d worked with, and we took turns modeling Five Secrets responses to ultra-challenging patients, including one who was brought into the ER by police on a gurney in leather restraints who took one look at her doctor and said, “Boy, are you ugly!” On another occasion, she walked into the room of a male patient, introduced herself, and asked if they could talk.  He replied provocatively, “Sure, if you get into bed with me, baby.” Rhonda and Heather reminisced about their meeting at one of my four day intensives for mental health professionals several years ago at the South San Francisco Conference Center, and became best of friends. They have traveled together to India and Mexico teaching TEAM-CBT and spreading the gospel according to Burns! I also reflected on my two years of internship and residency training at Highland Hospital, and my profound gratitude and admiration for that hospital and the many dedicated and talented health professionals who serve there. Thanks for tuning in today! Heather, Rhonda, and David

David Meets the British TEAM Group, Part 2: Burns vs. Van de Kolk, Treating somatic symptoms, chronic doubters, GAD, and more! Last week, David answered four questions posed by the British TEAM-CBT group. Today, he answers five more questions, including one on controversies in the treatment of PTSD. Peter – Positive Reframing in TEAM—How much is “enough?” When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach? Tom – Burns vs. Van De Kolk After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people. I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient? Sean – Treating Somatic Symptoms with TEAM I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms. I’m curious to know David's thoughts. Hassam – Treating Chronic Doubters with TEAM I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say: "Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?" Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry! End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions. Here is a note from Dr. Peter Spurrier to all who want more information about the UK TEAM-CBT training group: If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/ You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

David Meets the British TEAM Group, Part 1: Treating adolescents, Intrusive thoughts, TEAM-CBT homework, Surprises from the beta tests, and more. Greg – What were the Surprising Results of the Feeling Good Beta Test? What were the surprising results you referred to in the beta testing the new TEAMCBT App? Were there some things that weren’t effective or didn’t work in the way you expected? Rima – Is Psychotherapy “Homework” required in TEAM-CBT? I have a question about rapid recovery with TEAM CBT. Traditional CBT usually takes quite a lot of sessions and requires homework between sessions. How does this fit with a recovery in a single (two-hour) session? Do the patients still have to do homework? Paul – Treating PTSD with Intrusive Thoughts How can TEAM help an individual who has intrusive thoughts about a traumatic event in their past? Jessica – Treating Adolescents with TEAM-CBT Do you need to vary the therapy techniques when working with adolescents, as opposed to adults? And if so, how? Peter – Positive Reframing in TEAM—How much is “enough?” When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach? The following questions will be answered next week in Part 2 of David's encounter with the British group. Tom – Burns vs. Van De Kolk After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people. I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient? Sean – Treating Somatic Symptoms with TEAM I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms. I’m curious to know David's thoughts. Hassam – Treating Chronic Doubters with TEAM I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say: "Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?" Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry! End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions. Here is a note from Dr. Peter Spurrier to all who want more information about the British TEAM-CBT training group: If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/ You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

Podcast 290: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 2 of 2) Last week, you heard the first part of this live therapy session with Anita, a woman struggling with severe social anxiety. David and Dr. Stirling Moorey, from London, are co-therapists. Last week included the T = Testing and E = Empathy portions of the session. Today you will hear the A = Assessment of Resistance, M = Methods, along with end of session Testing and follow-up. A = Assessment of Resistance David asked Anita if she was ready to roll up her sleeves and get to work, or if she needed more time to talk and be listened to and supported. Because she was eager to get to work, David asked the “Miracle Cure Question:” He said, “What would happen in today’s session if it went really great and knocked your socks off? She said that her negative feelings and self-critical thoughts would be greatly diminished. David asked the Magic Button Question, and she said she’d press it for sure! David said he had no Magic Button, but did have some powerful techniques that could be super helpful, but was reluctant to use them. Anita was puzzled, and this led to Positive Reframing. He encouraged Anita to ask the three questions about each Negative Thought and feeling on her Daily Mood Logs: Why might this thought or feeling be perfectly appropriate, given your circumstances? What are some advantages, or benefits, of this negative thought or feeling? What does this negative thought or feeling show about your core values that’s positive, beautiful, or even awesome? Although puzzling at first, Anita soon got into the swing of it and came up with the following list of Positives. If I tell myself “I have nothing to say” in a group, I’ll listen more and learn more. I won’t risk speaking and making a fool of myself. So my social anxiety is really a source of self-protection, or even a form of self-love. My self-criticisms show I have high standards. My high standards motivate me to work hard and do my best. My self-doubt shows that I’m humble. My concerns about being judged show that I care for the people in the group and want to have positive relationships with them. Shows I’m not pushy, dominating, or arrogant. When I tell myself that “They are all better than me,” it shows that I have room to learn from all the people who are ahead of me. This shows I want to grow and do better. This shows I’m honest and realistic about my limits and flaws. This shows I’m accountable. This gives me “vicarious joy” in the accomplishments of others, a Buddhist concept. This thought shows that I can appreciate the gifts of others, which is a gift to them. When I tell myself, “I wasted a year,” it shows that I value hard work, learning, and dong a good job. It shows that I value what other people think, and take their criticisms seriously. It shows that I want to be seen for who I am! David pointed out that there were many positives on the list, and if we had time many more could be added, but asked Anita if the positives were: Real? Important? Powerful? She gave enthusiastic “yes” answers to all three questions, and then david asked the Pivot Question: Why in the world would you want to press that Magic button, because if you do all these positives will go down the drain, right along with you negative thoughts and feelings Anita suddenly didn’t want to press the Magic Button, but agree to use the Magic Dial and lower her goals for each negative feeling, which you can see if you click here. This concluded this part of the session, which brought us to the M of TEAM. M = Methods During the Methods portion of the session, David and Stirling used a number of techniques, including: Identify the Distortions Explain the Distortions Straightforward Technique Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique) And more, using frequent role reversal until she got to “huge” wins, which didn’t take long. Stirling also asked gave Anita how she might test if her fears about the way others saw her were accurate, and they devised some homework to do in the Wednesday training group to find out if other group members had experienced similar doubts about their abilities as therapists. This would involve using: Self-Disclosure - Survey Technique “I stubbornly refused” Technique You can see her final Daily Mood Log if you click here (LINK). We also jumped in and tried to work with Anita’s conflict with her supervisor, but ran out of time and might pick up that thread again in a future session if she is interested. I might add that both David and Stirling also used Self-Disclosure and Story-Telling during the session, as well as some spontaneous humor, which can also be viewed as a valuable treatment method, but one that is hard to explain or teach. You can see Anita's final Daily Mood Log with the outcomes of all of her negative feelings. As you can see, she exceeded her goals in every category, which is not unusual, and was feeling pretty terrific! She had the homework assignment to listen to the recording of the session and complete her DML, so you will only see a couple of the Positive Thoughts listed. Final T = Testing You can see Anita's final BMS here, and her  Evaluation of therapy Session here  As you can see, there were dramatic reductions in depression and anxiety, but only a modest boost in happiness. It would be interesting to see if the happiness goes up further after her "behavioral experiment" at Wednesday's tuesday group. Her scores on the Empathy and Helpfulness scales were perfect. Follow-up This is the email we received from Anita three days later, right after her "behavioral experiment" in Rhonda's Wednesday TEAM-CBT training group:: Hi Stirling, Rhonda, and David, I did the survey question in Rhonda’s Wednesday training group. Here’s what I said: “I am so nervous right now. I sometimes feel like I do not have much to say and so I stay silent in the group. I get anxious and think you all are so far ahead of me in your skills, so I miss out on sharing. I was wondering if any of you sometimes feel the same way?” So many hands shot, so many affirmed my question and thanked me for asking because they get anxious too. I was a little overwhelmed. Loved the experience! Rhonda I hope I did not take too much time.  Anita Rhonda, Stirling, Anita, and David

Podcast 289: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 1 of 2) Today, David is joined by one of his first students, Dr. Stirling Moorey, for co-therapy with Anita, a woman struggling with social anxiety. You may remember Stirling from Podcast 280. Stirling was one of David's first cognitive therapy students, and they spend a month doing cotherapy tether in 1979 and again in 1980. David described the magic of their work together in his first book, Feeling Good, and today they are reunited as a therapy team again for the first time in  more than 40 years! I, David, am super excited about working with Stirling again, and hope you enjoy our work with Anita. Rhonda, Stirling, and I are very grateful for Anita's courage and generosity in letting us share this very personal and real session with you! Anita is a member of the Wednesday International TEAM Training group run by Rhonda and Richard Lam, LMFT.  She lives in Nairobi, Kenya, and has a Master’s Degree in Counseling. Here is how she introduces herself: I am Anita Awuor from Nairobi, Kenya.  I have worked as a therapist for 20 years but only recently been introduced to the TEAM Model which has changed the way I work. I work with couples, individuals and families. And recently I worked with an NGO part time.  It’s an honor for me to be here to work with David, Rhonda and Stirling. Dr. Stirling Moorey had the good fortune to be trained by two founders of Cognitive Behavioral Therapy, Dr. Aaron Beck, and our own, Dr. David Burns. Stirling and David worked together in 1979, when Stirling was in medical school in London and came to Pennsylvania for an elective with Dr. Beck. Once he arrived, Dr. Beck asked David if he would work with Stirling, and then, history was made as David created the 5-Secrets of Effective Communication after watching Stirling provide deep empathy to the patients they worked with together. Stirling is currently a Consultant Psychiatrist in Cognitive Behavioral Therapy and was the Professional Head of Psychiatry for the So. London & Maudsley Trust from 2005-2013. He is currently the visiting senior lecturer at the Institute of Psychiatry, Psychology and Neuroscience in London. He is the co-author, with Steven Greer of The Oxford Guide to CBT for People with Cancer, and co-edited the book, The Therapeutic Relationship in CBT, published by Sage Publishing. T = Testing If you click here, you can take a look at Anita’s initial Brief Mood Survey, which was completed just prior to her session with Stirling and David. As you can see, her depression and anxiety scores were in the moderate to severe range, but her anger score was minimal, only 1 on a scale from 0 to 20. Her Happiness score was extremely low, and here marital satisfaction score was fairly good, but with some room for improvement, especially in the category of “resolving conflicts. E = Empathy You can take a look at the first of two Daily Mood Logs that Anita sent to us just prior to the session. It describes her anxiety while driving to a support group. As you can see, her suffering was intense. She also brought in a second Daily Mood Log which described her feelings after receiving a poor evaluation from one of her supervisors at work. The supervision did not involve her clinical work but some management work she was doing. Stirling, with backup from David, did explored and summarized Anita’s feelings. She explained that “Sadness has been a part of my life. I’m sad more often than I’m happy. Sometimes, the negative feelings are hard to live with. . . Problems in relationships often trigger my negative feelings, especially when others criticize me, and I’ve been down the last several days because of a poor evaluation I received from one of my supervisors at work. . . I don’t like criticisms or conflicts, and sometimes I tell myself that I’ll never be comfortable in groups.” Stirling asked about Anita’s negative thoughts when criticized: I’ll never be good enough. What’s wrong with me? It’s all my fault. She described a sequence where her negative thoughts about the situation lead on to more general self critical thoughts like “I’ll never be comfortable in groups” and she then ruminates about her perceived shortcomings. She said, “when I have these kinds of thoughts, the feelings of sadness, anxiety and worthlessness get very high.” David read her two Daily Mood Logs (LINK) and she described the criticisms she received from her supervisor, who suggested that Anita’s efforts had not been helpful. Anita felt hurt and angry, especially since this was the first time she’d received criticisms from her supervisor. Anita added that when she goes into a negative spiral, everything becomes ‘huge,” and she also tells herself, “I’m a bad mom.” Stirling asked what she does to cope when she’s in pain: “I cry a lot. I beat myself up. And sometimes I share my feelings with my husband, but sometimes I just hold it all inside. Sometimes sharing with my husband helps, but sometimes it doesn’t.” David asked Anita how she was feeling now, and she said that her anxiety had already gone down a lot. To bring closure to the Empathy phase of the session, David asked Anita to grade us on Empathy and she gave us As, and Rhonda had the same idea, scoring us as A +. I commented on the idea that Stirling's superb empathy skills were based, in part, on the "nothing technique." He systematically, skillfully, and compassionately summarized her words and acknowledged the pain they conveyed, without trying to make interpretations, and without trying to help or rescue. In other words, he gave her nothing but tremendous listening, which was exactly what she needed! Although this sounds simple, and nearly all therapists will think, "Oh, I do that, too," in my experience, this skill is actually quite rare. it can be taught, and that's on eo the goals of our two free weekly training groups for therapists. But learning genuine and effective use of the Five Secrets of Effective communication requires tremendous humility, dedication, and hard work on the part of the therapists who hopes to learn. End of Part 1. Next week, you will hear the exciting conclusion of the live therapy session with Anita!  

Podcast 288: TEAM-CBT for Video Game Addiction, Featuring Adam Holman, LCSW We are joined today by Adam Holman, who specializes in the treatment of teens and young adults with video game addictions. Adam was drawn to this field by his own 16 hour a day addiction to video games which caused him to fail his first two years of college. Following his recovery, he decided to become a therapist so he could specialize in the treatment of this problem, and the rest, as they say, is history. He was drawn to TEAM-CBT because of the emphasis on measuring outcomes with every patient at every session, using my Brief Mood Survey and Evaluation of Therapy Session. Prior to that, he said he felt like an “imposter,” and had no evidence that he was actually helping his patients. He explained that his clinical supervisor wasn’t much help, and simply said, “Well, Adam, your clients are coming back, aren’t they?” implying that this meant they were improving and satisfied with the treatment. Adam explains how he created his own measures first, and then found an online therapist group at Reddit, and heard about the Burns measures, which, he says, “were a gift to me and my clients.” By looking at his feedback, he learned he was “helping” too much and trying to solve problems prematurely, before really “listening” and empathizing with his patients. He had some tips for the parents of kids with gaming habits. The first is for them to recognize that the addiction is not the problem, but rather the child’s solution to the problems in his or her life. In his own case, for example, he explained that he was struggling with enormous amounts of anxiety, but felt relief when playing video games. Nearly all the kids he’s treated are struggling with depression, anxiety, and relationship problems, and often feel considerably better just by having the chance to talk and have someone show an interest in them. He said that most of his patients start out with a scowl, arms folded, defiant that someone is going to try to control them or tell them what to do, and they aren’t looking for “help” because, in most cases, their parents bring them to treatment. They are surprised when Adam empathizes and tries to understand their thoughts and feelings. He said most do have issues they want to work on, although it’s not usually their gaming habits. Initially, this can cause conflicts between Adam and the parents, because they think Adam is siding with their children instead of “fixing” them. He said the paradoxical techniques in TEAM are especially helpful, helping them identify all the really GOOD reasons for their addictions using tools like the Triple Paradox, although this is enormously confusing to the kids at first. They have to list all the positive advantages and benefits of their addictions, plus all really sucky things about quitting, as well as what the addiction / habit shows about them and their core values that’s positive and awesome. They get excited and want to share their lists with their parents. He completes the Triple Paradox with the Acid Test question: “Why in the world would you want to change, given all of the positives?” So, Adam’s second tip for parents is to focus on your relationship with your child and not on his or her gaming addiction. Adam teaches parents the Five Secrets of Effective Communication, and they find that the problem usually disappears on its own. However, he agreed that learning to use the Five Secrets skillfully requires a lot of commitment and hard work from the parents.  Adam recommends reviewing podcast episodes 65-70 on The Five Secrets to learn more. Rhonda mentioned that in many cases, the kids are struggling with social anxiety, and Adam mentioned that when they are playing video games with others online, they usually do not feel anxious because they don’t feel judged.  Once again, the games are a solution to a problem, fulfilling the need for socialization and connection. Adam uses the concept of “Sitting with Open Hands” to find out what the kids want to work on, instead of imposing an agenda on them. He described one client who was socially anxious and thought people were “creeped out” by him. Adam asked if he wanted to get over that “right now” and persuaded the young man to go outside where there was a lot of foot traffic and start doing “Smile and hello” practice as well as “Self-Disclosure” to strangers. One of the first people he said this to said he was, in fact, shocked, but added, “You made my day!” This was a huge relief. The young man began feeling less anxious in social situations. He developed an interest in tennis and felt more comfortable playing with his peers, and his interest in computer games reduced significantly. Adam uses the full spectrum of TEAM-CBT techniques in his treatment, including the Devil’s Advocate Technique, Stimulus Control, and more. Here are some of the tempting thoughts a video gamer might have: Common now, it’s okay, everyone plays! It’s going to be really fun! It’s way more fun than homework! Homework is not that important anyway. I can do the homework later. Adam’s third tip is to avoid trying to convince your child to change or to provide solutions for them. He explains that this creates a dynamic where it’s the parents vs. the child and the video game; a battle where neither side wins and both sides end up angry. For more on this topic, Adam would recommend podcast episode 146: When Helping Doesn’t Help. Related to this, he described a case of a boy with a 12-hour a day habit, and his grades were suffering. The parents had tried everything to try to fight and control his behavior, including hiding all his power cords. Feeling as though this was unfair, he stopped at a garage sale on the way home from school and bought a used Gameboy. Clearly, this type of strategy is not effective. Then the parents got better at listening, with the help of Adam, and they found success. Instead of restricting access to the games, they worked with their son to strike a balance. Their son developed an interest in skiing and the focus on video games diminished. Adam’s fourth tip for parents is to try to encourage balance and stand with your kids, working together as a team. For example, you can ask them, “We understand that you enjoy playing games because it’s fun and helps you to relax, and we want you to be able to have fun and relax! What do you think would be a healthy and appropriate use of video games?” In Summary, here are Adam’s four tips for parents: Recognize that the addiction to video games is not the problem, but rather the child’s solution to problems in their lives. There are many good reasons they have likely found to play games ranging from relieving anxiety, to social connection, to simply having fun instead of doing boring homework. The best way to support your child is to focus on your relationship with them and not necessarily the video game addiction. The Five Secrets of Effective Communication are a great tool for this. Avoid trying to convince your child to change and don’t try to provide solutions for them. While boundaries are important, this creates resistance and his often ineffective. Stand alongside your child and work with them to encourage balanced use of video games. This may involve encouraging other hobbies or agreeing on a plan together with regards to how much video game use is healthy and appropriate. If you would like to contact Adam, you can find his information at mainquestpsychotherapy.com. Warmly, David & Rhonda

In this episode, David and Rhonda are joined by Matt May, MD. They answer challenging questions about addiction, procrastination, and internet surfing. They also discuss the importance of accurate testing in addiction, the process of challenging negative thoughts, and effective communication in relationships. Additionally, they explore the power of self-acceptance and share tips on overcoming procrastination and boosting energy levels.

Helping the Poor in Heart, featuring Victoria Chicurel and Silvina Carla Bucci One of my favorite New Testament quotations comes from the “Sermon on the Mount” by Jesus: “Blessed are the poor in heart, for they shall see God.” Matthew 5:8. I’m not 100% sure what this means, exactly, but it seems to me to suggest the values of compassion and humility, as opposed to self-aggrandizement. I once had the chance to speak to a Catholic priest with a PhD in philosophy who had just returned from several years working with the indigenous people in Paraguay. He said that although the people were poor, and sometimes experiencing the effects of repression from the government, he said they were mostly happy and supported one another. He also said that when he flew into Miami and walked through the airport, he was shocked to see so many overweight and visually unappealing people, after living for many years in Paraguay among the “poor.” Who, really, is “poor,” and who, in contrast, is “wealthy?” That’s kind of the meaning I attribute to the Biblical quotation from the book of Matthew. I looked him up on Google, and apparently he worked as a tax collector in Copernicium prior to becoming a preacher in Judea. At any rate, today’s podcast features two women who are working with the poor in Mexico and in the Pomona Valley in Southern California. Victoria Chicurel and Silvina Carla Bucci and working to promote TEAM-CBT in Mexico and Victoria is working with a group of Mexican women immigrants, some un-documented, most with limited English-language skills in the Pomona Valley teaching them a simplified version of TEAM-CBT.  Victoria calls these women, Promotoras. In a pilot study sponsored by an organization called Common Good, Victoria has trained a group of approximately ten women in the ten cognitive distortions as well as the Five Secrets of Effective Communication and other simple cognitive therapy techniques, so they can teach these skills, called “psychological first-aid,” as coaches, to women without access to mental health care. These lay coaches trained are paid $15 per hour by Common Good, and the clients are treated for free. They were very enthusiastic about the results of their informal study. (The director of Common Good is Nancy Minte, the sister of one of our esteemed colleagues, Daniel Minte, LCSW.) Victoria described a shame attacking contest organized by Daniel Minte, a Level 5 TEAM therapist. Shame-Attacking Exercises were developed by the late Dr. Albert Ellis from New York City, one of the founders of cognitive therapy,. Shame-Attacking Exercises are designed to help people with social anxiety get over their fears of looking foolish in front of others. You intentionally do something bizarre in public so you can discover that the world doesn’t come to an end when you make a fool of yourself. . The goal of the contest was to do the most weird and courageous Shame Attacking Exercise. The winner was a woman who was one of the promotoras working with Victoria who suffered from severe social anxiety and who was greatly helped by a “Shame Attacking Exercise.” In one of her English classes, she stood and announced she was going to do something ridiculous to overcome her fear of making a fool of herself in public, and warned them that she had a terribly singing voice. She then burst into song, singing the national anthem of Mexico, and received enthusiastic cheers from her classmates at the end. This experience changed her life! Prior to her experience, she had been so shy that she was afraid to express her opinions in public. After the exercise, her shyness instantly become a memory and she won first place in the competition! Many others have been helped, too. I mentioned the experience of Sunny Choi who worked for years with Asian immigrants in the SF Bay area. He said that these patients did not expect long term treatment, and often responded in just four or five sessions, even if they were struggling with very severe problems. Victoria said they were seeing the same thing, and described a woman struggling with perfectionism who recovered in just five sessions. The coaches in the program use my Brief Mood Survey, translated into Spanish, to track progress, and have access to the Spanish version of my first book, Feeling Good. Silvina is working to promote TEAM-CBT in Mexico and other Spanish speaking countries like Ecuador, Peru, Spain, and Columbia. She has even created a TEAM-CBT licensing program for Spanish-speaking mental health professionals. She says that her biggest challenge is one I have run into in my efforts to teach in the United States as well: The therapists are skeptical and have an attitude of “prove it to me.” In addition, they have difficulties learning to use the Five Secrets in their clinical work and personal lives, especially “I Feel” Statements and the Disarming Technique, as well as the paradoxical techniques of TEAM-CBT. For me (David) personally, I welcome skepticism, but find the arrogance behind some if it to be hugely annoying! Sadly, I think that our field of mental health / psychotherapy consists, to a great extent, of competing “cults” that are not based on science, or on data-driven treatment, but rather the teachings of cult-leaders, like Freud and the hundreds of others who have started this or that “school” of therapy. I often say that TEAM is NOT another new therapy , or “cult,” but rather a research-based structure for how all therapy works. I would love to see the gradual disappearance of schools of therapy and the continued emergence and evolution of data-driven therapy. I applaud the efforts of Victoria and Silvina in their work with the “poor in heart.” In the mid-1980s, I developed a large scale cognitive therapy program for the residents in our inner-city neighborhood at my hospital in Philadelphia. It was a group program based on my book, Ten Days’ to Self-Esteem, and the therapists were simply people from the neighborhood who received some training in CBT and followed the Leaders Manual for The Ten Days’ to Self-Esteem groups they were directing. The program was largely free and very successful. Many of our patients could not read or write, and some were homeless. Most had few resources, and many might be considered among those are “poor in heart.” But they were definitely not poor in spirit! Our hospital had “Feeling Good” days every six months, and they even had a Feeling Good jazz band. That program was the most successful and gratifying program I have ever been associated with. Rhonda and I are very proud of these two fantastic women! If you would like to learn more about their work in Mexico and in the Pomona Valley, please feel free to contact them at www.TEAM-CBTMexico. Thanks for tuning in today! Rhonda, Victoria, Silvina, and David  

Podcast 285: TEAM-CBT for Chronic Pain. Featuring Derek Reilly-- with the Exciting Findings from a New British Outcome Study Rhonda begins the podcast with two inspiring emails about our recent podcast on “The Unexpected Results of the Latest Beta Test id the Feeling Good App, Part 1 of 2, published on2-28-2022. One is from Vivek Kishore, who used to come to all of my Sunday hikes prior to the pandemic, and Rizwan Syed, from Pakistan, who is an enthusiastic member of my Tuesday training group at Stanford as well as Rhonda’s Wednesday training group. Here’s what Vivek wrote Dear David and Jeremy, This is so amazing and has the potential to change the world. I am sure millions across the globe will benefit from this app. Can't wait for its launch. Thank you! Vivek Here’s what Rizwan wrote: Dear David: Reading your books changed my life completely. I am so much happy and optimistic about life compared to highly critical of myself and others and had been so much bitter. I am sure your team therapy app would be as mind boggling and revolutionary as had been your bibliotherapy. I am no God. Had I been one, I definitely would have chosen you as my prophet to spread my message. Rizwan Today, we interview Derek Reilly, a Cognitive Behavioral Psychotherapist, and Registered Mental Health Nurse with 20 years of clinical practice  specializing in the treatment in chronic pain. He is an Accredited CBT therapist with the British Association for Behavioral and Cognitive Psychotherapies in the United Kingdom, and a TEAM certified Level 3 TEAM-CBT therapist. Derek is also a founding member of the new TEAM-CBT UK group. He has published papers on panic, OCD, and pain. He lives in Darfield, a small village in South Yorkshire, which is a mining area in England. Derek, like a previous guest, Dr. Peter Spurrier, attended a two-day workshop I conducted on TEAM-CBT in the treatment of anxiety disorders in London in 2015. Although I felt quite discouraged during and after the workshop, thinking I’d done a poor job, and since the crowd size was modest at best, a number of those who attended apparently got the message and became excited about TEAM. Derek said that the emphasis on T = Testing and on A = Assessment of Resistance made the biggest impact on him. He explained it like this: David described the four forms of Outcome Resistance and the four forms of Process Resistance. I suddenly realized that resistance was huge in the population I was treating, and that my biggest error had been trying to “help,” which usually just triggered more resistance and yes-butting by my patients, who would complain that no one was helping them with their pain. Dropout rates were high, and I also felt frustrated with the lack of progress I was seeing in my patients. Both Derek and Peter then attended my four-day intensive at the South SF Conference Center in 2017 and got hooked. Derek said: I thought about testing, and where it could be improved, and developed my own Pain Problem Survey (PPS) of the most common kinds of negative thoughts I was seeing in my patients, as well as the negative feelings these thoughts were triggering, like frustration, anger, anxiety, and more. I asked them to rate three emotions on a scale of 0 to 10, as well as their cognitions and behaviors, and tried to figure out what the resistance was all about. I also discovered that the simple step of T = Testing helped greatly with the E = Empathy, because my patients began to feel understood. This was different from the way I’d been trained which was to push this or that technique to “help” with their pain. He said that the concept of “acceptance” is a popular and common buzzword these days among mental health professionals, but there’s a huge difference between intellectual “acceptance” and acceptance at the gut level. He liked the fact that TEAM offered specific tools to bring resistance to conscious awareness and to quickly reduce the resistance as well, as the paradoxical techniques that David has developed. Some of the common Negative Thoughts he heard from his patients included: I should bed doing things quicker. I should be responding faster. The doctor should fix me. Why is this happening to me? This is unfair! Many had been feeling demoralized that there was no medical solution, and ashamed of the fact that the could no longer work and do things that had once been automatic, like housework, or picking up and hugging the grandchildren, or going to work and earning money. Their disabilities seem to contradict their personal values, and they felt like they were letting people down. He said: Many of my patients had 10 or even 20 years of suffering and failed treatments, including multiple surgeries in some cases for back pain, for example, and often complained that nobody had been listening to them. That’s why the E of TEAM was so important, and I practiced using the Five Secrets of Effective Communication to respond to their complaints. I worked especially hard on Feeling Empathy. Previously, I’d been way to quick to try to “help,” that just turned my patients off. I was helped by the empathy technique David developed called “What’s my grade?” I ask my patients, “would you give me an A, a B, or a C or lower so far?” This was crucial. Then, when I went on to the A = Assessment of Resistance, we began to uncover, or discover, what their negative thoughts and feelings showed about them that was positive and awesome. Because I was practicing in an economically deprived area, I, and many of my colleagues, thought this would be a waste of time, and that my patients might not “get it” because it would seem too brainy or intellectual. But it was the opposite, and by the third session, many were already beginning to see things through an entirely different set of eyes. For example, they could see the many positive in their feelings of shame, inadequacy, anxiety, hopelessness, and even anger. So they began to feel proud of their negative thoughts and feelings. It was also helpful to take the “shoulds” out of their negative thoughts and feelings using methods like the Semantic Method and the Double Standard Technique. These approaches proved much more effective in helping people come to terms with loss/change. Derek described his work with a man who’d been struggling with chronic back pain and depression and daily alcohol abuse, who’d had a suicide attempt and felt useless. Derek said: He was open to examining his own role in his problems, and agreed to cut down on his alcohol intake. He found the Positive Reframing to be helpful, and saw that his negative thoughts and feelings were actually an expression of his high standards, and that his frustration was the expression of his determination not to give up. His guilt and shame showed that he had a conscience, and a moral compass, and that he was honest with himself, and that his frustration and depression about being unable to work showed his core values. Then we did the Magic Dial to see how much he wanted to dial down each negative feeling, like guilt, and used a variety of M = Methods to challenge and crush his negative thoughts. Once he pinpointed and challenged his Hidden Should Statements, his feelings of self-acceptance increased dramatically. Then we ended up using the Externalization of Voices to wipe out his negative thoughts. Derek and I discussed the role of negative emotions in patients with chronic pain and other “medical” symptoms, like dizziness, and chronic fatigue. I summarized my experience as a medical student working in Stanford’s outpatient medical clinic with Dr. Allen Barbour, and how that approach was similar to the approach that Derek was taking. I summarized my statistical modeling of three data bases that all showed identical results that the correlation between physical pain and emotional distress is not because physical pain causes emotional distress, but because emotional distress causes an amplification in the experience of pain. This is true of physical pain with a clear medical cause, such as arthritis, as well as so-called “psychogenic pain” where no physical cause can be detected. Derek summarized his recent study of 60 chronic pain patients he treated with TEAM, which was a retrospective “clinical audit,” or chart review study. The study indicated a 57% reduction in scores on the PHQ-9 & GAD7 (commonly used depression and anxiety tests). These reductions were significant at the p < .0001 level. The changes  in the scores on the PPS were also significant. This is the first piece of preliminary evidence in the UK to show effective TEAM-CBT can be in the treatment of chronic pain. He is writing up these finds with a colleague, Anne Garland, a Consultant Nurse Psychotherapist, and hopes to publish them soon. He also found that other negative feelings were also comparably reduced, including the “big three:” frustration, guilt, and anxiety. Derek and his colleagues have their own Tuesday training group in England, and I will soon be joining them with Rhonda for a 90 minute Q and A session. If you’d like to learn more about Derek’s work, or if you’re interested in training, you can contact him at dwr1971@yahoo.co.uk or www.feelinggood.uk.com. Rhonda and I greatly enjoyed the recording and share great enthusiasm for Derek’s work spreading the word about TEAM-CBT in England. We hope you enjoyed the podcast as well, and thank you for your support of our efforts! Rhonda, Derek, and David

284: Ask David, Featuring Matt May, MD Defeating your Self-Defeating Beliefs. Help with fear. Dealing with people who gossip. Today, Rhonda, Matt and David answer three challenging questions submitted by fans like you. Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step? Al asks: Can you help me with fear? Khoi asks: How do you deal with colleagues who gossip about your boss? 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. 1: Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step? Hi David I finally got all the CBAs from my Self-Defeating Beliefs done. I have a ton of them. I also did a CBA on Self-acceptance and a CBA on Self-Criticism. I found out, that the disadvantages of my Self-Defeating Beliefs are massively higher than the advantages. Only with Self-Acceptance the Advantages were much higher than the Disadvantages. Now that I have got all these CBAs done, what do I do with my findings? Do I rewrite my Self-Defeating Belief into something more realistic or lets say, into something with acceptance? Thanks for your help! Many greetings Caroline David’s reply Great work. Yes, you can, as a first step, or next step, rewrite each belief so the disadvantages disappear, and you get to keep the advantages. This will be different for each person, and it is called the Semantic Technique, but here is an example: SDB: Achievement Addiction: My worthwhileness depends on my productivity and achievements. Revised version: I can enjoy working hard and being productive, but my “worthwhileness” as a human being does not depend on my successes, failures, or hard work. There are many things in life I can love and enjoy. It isn’t just all about achievement and productivity. I can learn from failures and mistakes. They make me more “human,” and not “worthless” or even “less worthwhile.” In fact, I have no desire or need to be “worthwhile.” It’s a nonsensical, meaningless concept. People don’t much care about how “worthwhile” I am. They care about how I treat them! That’s just an example of how I deal with this particular belief. Giving up the “Achievement Addiction” actually helps me achieve more, because the pressure and the anxiety is gone. But I still enjoy working and creating stuff! Another dimension has to do with giving up the habit of beating up on yourself. We are talking about depression and inadequacy here. It touches also on anxiety, but anxiety can have other SDBs as well. d 2: Al asks: Can you help me with fear? Dr Burns, I need help with fear. Can you send me podcasts dealing with that subject? Thank you very much. David’s reply Tell me which of the many already published, and available via search function on my website, you have already listened to? And how much of my book, When Panic Attacks, have you read? May make this an Ask David, since it seems lots of folks are not using the massive free resources I’ve already developed. Have you take the free anxiety test and course on my website, feelinggood.com? The free anxiety course is, in fact, a compilation of some of the best podcasts on fear. david 3: Khoi asks: How do you deal with people who gossip about your boss? Hello Dr Burns, Thanks for your time to write so many great books and creating this podcast. I am from Vietnam and know about you and your book thanks to the publisher to translate into Vietnamese. When I read your book, it is very simple fact but very true at the same time. I wonder how can I not know about your book earlier? Actually, I read a lot of self-help books but I find most would say about what should I become or be, but don’t really show me how to do it. As you said, the idea I feel because I thought is not new, but I don’t know how to change my thought and beliefs after reading these books. Your books show me simple techniques but very useful and effective. And I really like your 5 Secrets of Effective Communication, especially these podcasts, because it helps me understand more clearly. One difficult situation that I don’t know how to apply, is when somebody attacks somebody else, not me. For example, my colleague criticizes my boss (behind his back) via email message or face to face with me. I am afraid if I agree with her, my boss might think I talked behind his back too. So, should I just keep silent for this case because she does not attack me? Another situation is when 2 people attack each other, like 2 of my staff argue with each other, and I cannot agree with one side because it will make the others get mad with me. Do you have any advice on this? Thanks Dr Burns. David’s reply Good question, and I will include in an Ask David, if that is okay. My short answer is that in most situations, and especially in a business environment, I do not try to "help" other people who are arguing or not getting along. That is simply asking for trouble and push back. When someone is bad mouthing another person, you can possibly use Feeling Empathy and say "it sounds like you're pretty unhappy with person X, and I know that can be uncomfortable when you're not getting along with someone," or some such general comment. Then you could distract the person with some Stroking, like "I really admired your report at the company meeting," or some such thing. We can check with Rhonda and Matt and see what they think on the live podcast. In a personal situation, you could use an "I Feel" situation, like "I actually get along with person X, but of course we all have our flaws, or some such thing. But in a work environment, I think you are right that it is important to play it safe and to be thoughtful about interactions with colleagues! So, I commend you on your excellent questions, even though I might not yet have the best answer for you! David  Rhonda, Matt, and David