Podcast 283: The O of OCD: Featuring Thai-An Truong, LPC, LADC Overview: The "O" of OCD (obsessions) is treated differently from the "C" (compulsions.) Thai-An Truong teaches us what really works! Compulsions can be treated with Response Prevention. The techniques for treating the Obsessions include Flooding, Cognitive Techniques, Motivational Techniques for Outcome and Process Resistance, the Hidden Emotion Technique, and more. OCD (Obsessive Compulsive Disorder) consists of frightening thoughts, or obsessions, plus rituals people do in an attempt to prevent or undo the danger. So, for example, if you go to bed and have the thought, “what if I left the burners on the stove turned on,” you might get up and check the burners. Doing this once could be considered normal. But if you do this repeatedly, you definitely have the symptoms of OCD. Rhonda wanted me to share how I treat the obsessions in OCD (Obsessive Compulsive Disorder), also known as "pure O." I often say I wasn’t looking to treat OCD, but OCD found me, since I do a lot of work with postpartum women struggling with feelings of depression and anxiety, they are actually about 2.5 times more likely than the general population to develop OCD. We're not sure why, but my theory is OCD attaches to the things we value the most (e.g., health, children’s well-being), and not much is valued more greatly than our baby. “Pure O” is actually a misnomer. We think that some people with OCD only have obsessions, without the rituals, because they have lots of mental rituals that people can’t see. So therapists wrongly conclude that they just have a “pure O” variety of OCD. We usually think of compulsions in OCD as mainly behavioral (e.g., handwashing too prevent contamination or checking the mail box repeatedly when you put your letter in to make sure it didn’t get “stuck”), but mental compulsions (rituals) are also very common. Obsessions are the thoughts or images that cause distress; compulsions, in contrast, are the behavioral or mental acts people engage in to try to decrease the distress. Mental acts, compulsions, and rituals can include: Praying Counting Repeating words silently Recalling events in detail Repeating a mental list to ensure safety Mentally reviewing the past like a video Self-assurance: “I’m okay, nothing bad will happen.” Saying the number 4 to reduce the distress of seeing 6, associated with the devil Thinking of a positive image to replace the disturbing obsession/thought Those are just common examples, but there are many more. Dr. Edna Foa, who has done a lot of research on OCD and the effectiveness of Exposure and Response Prevention (ERP) for the treatment of OCD states that patients who have ONLY obsessions or ONLY compulsions are unlikely to have OCD. Over 90% of people with OCD reported having both obsessions and behavioral compulsions/rituals. When mental rituals were included, just 2% reported “pure O”. Foa, E., et al (2012). Treatment That Works: Exposure and Response Prevention for OCD, Second Edition, p. 12 She states we need to assess patients carefully to weed out other disorders: Only O may be depression or GAD. Only C may be trichotillomania, Tourette’s syndrome, autism, schizophrenia – all can display repetitive and ritualistic actions. Trauma can look like OCD. For example, a woman who was raped obsessed about harm coming her way and compulsively checked the doors and windows in her apartment. She may need trauma treatment instead of OCD treatment. Specific Phobias: fear of animals (dogs, snakes, etc), heights, needles, storms, flying, driving, etc. Paraphilia: pedophilia, voyeurism, exhibitionism, etc. Dr. Burns’ EASY Diagnostic System can be a great tool for pinpointing these and many other diagnoses. How I’ve helped clients: A step-by-step approach: Disclaimer: This is not meant to be a substitute for therapy. It is frequently most helpful to have a therapist work with you through this process. Initial Assessment: Dr. Burns EASY Diagnostic System Y-BOCs – Yale-Brown Obsessive Compulsive Scale - not diagnosti. This tool is great for identifying types of obsessions, compulsions, and avoidance behaviors. T = Testing – Brief Mood Survey E = Empathy Psychoeducation about OCD and nature of obsessions The more we engage with them, try to suppress them/control them, the stickier they become Share with them about exposure and response prevention and TEAM-CBT approach to treatment Ultimate goal is to eliminate all compulsions – since they the OCD and are the food that feeds the OCD monster Normal for obsessions content to shift from one subtype to another Let them know I will not provide reassurance. Anything expressed/done once is educational, more than once becomes reassurance Include the family in this process A = Assessment of Resistance DML of most disturbing obsession Identify the feelings and thoughts to increase your understanding of the content and level of disturbance Can use the What-If Technique to identify the patient's root fear Do positive reframing ONLY ONCE – otherwise can become a big reassurance (e.g., you are a good person, etc.) Here is a driving analogy for how we don’t lose our core values or safety just because anxiety has decreased. For example, think of when you first started learning how to drive. Where was your anxiety 0-100? Mine was probably about 90%. This was tied to the values of wanting to stay safe, keep other’s safe, valuing people’s lives and my own life. Think of where your anxiety with driving is now, 0-100, after you’ve driven almost every day for months or years. Mine is mostly around 0-5%, unless I’m next to a semi, then it's maybe at 10%. Did you find that your morals and values changed once your anxiety decreased? Did you suddenly start to drive recklessly without caring about others’ well-being? Most likely not. This will be the same with our work with OCD. Through exposure, your anxiety around your obsessions will also be dialed way down, but your moral compass and values will still stay intact. 5. Use Burns' Triple Paradox for compulsions Goes beyond moment in time: make a list of all compulsions – want to stop all of them (response prevention). Go back to moment in time, list benefits of compulsions, values, and cost of change She described Voicing the Resistance (also known as Externalization of Resistance): The therapist might say: “Let’s look at this list of powerful benefits of your compulsions, the important values it shows about you, and all the costs of change. Given all those powerful reasons to keep your compulsions,  why would you want to do this work to let go of them? “After all, your compulsion give you  immediate relief from your anxiety.” "Then the therapist can review the entire list of benefits and costs of change, and ask, ”Why in the world would they want to change considering x benefit and y cost?” 4. Motivation script: I rate the patient’s motivation to get rid of compulsions (0-100) before and after the Triple Paradox, and after Voicing the Resistance. If Voicing the Resistance boosted their motivation to change, I have clients write out or record their responses when we went through Voicing the Resistance. Their homework is to read this motivation script or listen to the audio recording of it it every day and as needed, knowing that there will be moments when the temptation to engage in the compulsion is 100%. 7. M = Methods: Thai-An, do not used any traditional cognitive tools (e.g., id distortions, double standard, examine the evidence), but David does and finds them to be helpful, just not the whole ball of wax! Thai-An points out that John Hershfield, MFT,  a major author in the OCD field also talks about using identify the distortions to build awareness. Of course, David sees a missive contribution of TEAM-CBT methods that goes way beyond building "awareness." Address self-doubt in their ability to change with TEAM structure and cognitive tools Always explore hidden emotion first (case example of OCD cured by hidden emotion) Here and now exposure as obsessions come up Fear hierarchy In Vivo Exposure (case examples) – exposures in real life Imaginal exposure – exposures in your mind Anything that can’t be done in vivo Only with the most disturbing obsession (flooding Uncover core fear with What If Technique You can use David's Devil’s Advocate for the compulsions Rate how tempting it is to engage in compulsion (0-100) E.g., OCD: You really should replay that memory one more time to make sure you didn’t molest your baby; Client: That’s OCD talking and I’m choosing to move forward with my life. Record this and then process the experience after exposure: What happened during the exposure? Did your fear come true? Were you able to tolerate the distress? How was the outcome different from what you expected? What surprised you about the outcome? What did you learn from this exercises? What could you do to vary this exposure? Relapse Prevention Training should always be done following the initial recovery.. Thanks for tuning in today! Rhonda, Thia-An, and David Thai-An practices in Oklahoma City, but teaches online for everyone. For more information about her clinical work, visit www.lastingchangetherapy.com. For information about r her TEAM-CBT training, visit www.teamcbttraining.com. Through her training website, you can sign up for her free TEAM-CBT webinars, which are held every other month. Her upcoming TEAM-CBT Conference in Oklahoma will be from March 30-April 1, 2022. Here's the info about the conference: TEAM-CBT Conference: Practical Tools for Overcoming Anxiety, Depression & Addictions Get more info, register, and pay here: www.teamcbttraining.com/conference Dates: Wed, March 30th - Fri, April 1st Times: Wed: 9:00-5:30 CDT, Thurs & Fri 9:00-5:00. CEUs: 20 CEUs approved for Oklahoman psychologists, LPCs, LMFTs, LADCs, & LCSWs, including 3 of ethics and 10 specific alcohol and drug hours. 20 TEAM-CBT Certification Units approved.   Any therapist can attend, but CEUs only for Oklahomans at this time. Must attend the conference in full to get your CEUs/certification units. Not late arrivals or early departures. Perks: 25% off coupon for Dr. Burns's tools 50% off Level 1 TEAM-CBT Certification through FGI Lots of interactive, practical learning through didactics, live demos, and a live session to show the TEAM treatment process from beginning to end. You'll also see a recording of my habits & addictions process with a woman working on decreasing alcohol use. Dipti  Joshi, PhD will be joining us all the way from India and will help to teach uncovering techniques on Thursday morning.

The Feeling Good App: Part 2 of 2-- The Surprising Basic Science Findings-- How Does Psychotherapy REALLY Work? And Why Did Everything Change So Fast?   Feeling Good Podcast Special Edition #2: March 07, 2022 Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications. Here's a portion of what we’ve discovered so far. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2 Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes. If you would like to see the standardized output of the SEM model, click here. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory! At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include: A cognitive variable: the user’s belief in his or her negative thoughts. A motivational variable: measured with extremely precise and sensitive instruments. the user’s liking of the app. The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work. CLICK HERE FOR THE FULLL REPORT However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause. The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast. If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last. Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions. We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day. So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers! David and Jeremy Rhonda, Jeremy, and David  

The Unexpected Results of the Latest (and Largest) Beta Test Feeling Good Podcast Special Edition #1: February 28, 2022 Today’s special podcast features Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the most recent beta test which included 140 participants with depression ranging from no depression at all to the most severe depression that one can possibly experience. David explains that in the middle- to-late 1970’s he first conceptualized the possibility of creating an electronic version of himself that could treat people without any assistance from an actual shrink. He explains that My first fantasy was a small booth you could go into, like the ones for taking photos, where you would be presented with a hologram of a shrink who would talk with you in just the same way that a human therapist does. I also imagined creating kiosks that could be placed in groceries stores or places like Epcot Center in Disney World. where people could insert 25 cents and have their emotional or marital problems analyzed, or their depression treated, and so forth. I imagined that the kiosk would be loaded with powerful statistical software that could analyze data on the fly, and create huge data bases, and do research on the causes and cures for emotional and relationship problems. Once the internet evolved, my fantasy change slightly, and I imagined creating an electronic version of myself that would be available to anyone in the world as an app. In addition, because of some promising published research on the antidepressant effects of my first book, Feeling Good, I had a hunch that I could create an app that might be as effective, or even more effective, than human therapists. Two years ago, Jeremy and David teamed up to see if this dream was possible. Today, they present the incredible results of the latest beta test of the Feeling Good App. They measured changes in seven negative feelings as well as happiness in 140 individuals who had access to one portion of the app—the Basic Training—for one day only. The seven negative feelings were depression, anxiety, guilt and shame, inadequacy, loneliness, hopelessness, and anger. All feelings were measured on the same scale from 0 (for not at all) to 100 (for completely). The reliabilities of the negative feelings scale were .91 at the initial evaluation and .93 at the end of the day. David divided the participants into two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The results indicated, unexpectedly, that they may have already achieved their goal. Here’s what they found: The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62%and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively. (Click here for the complete report). Individuals in both groups also reported boosts in happiness, with a 33% increase in the mild group and a mind-boggling 80% increase in the severe group. The lower (but significant) boost in happiness in the mild group was because many of these individuals were already pretty happy at the start of the app, so there wasn’t a lot of room for improvement. CLICK HERE FOR THE FULL REPORT One of the most exciting features of the Feeling Good App is that it does research on itself in real time and shows us which parts are the most and least effective. In fact, one part of the app in this beta test was not helpful, and actually made depression somewhat worse, on average. In spite of that, the changes in all the negative feelings were spectacular by the end of the day. We have already modified the parts that were not effective, and anticipate the app will become more and more powerful over time. This is just the beginning, and the sky’s the limit! The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice. And of course, similar information is rapidly and radically transforming our app! Once again, our “patients,” or more accurately “app users,” have become our best teachers. In the next podcast a week from today, we will discuss the basic science we are doing with the help of the Feeling Good App. We are asking questions like these: How does the Feeling Good App really work? What are the ingredients of therapeutic success? What are the variables that can trigger such rapid and dramatic changes in negative feelings as well as happiness? What is the cause of depression? Is there any support for the theory that depression (and all other negative feelings) are caused by distorted negative thoughts? Is there any support for the theory that changes in negative feelings are actually mediated by reductions in our distorted negative thoughts? Is there any support for David’s prediction, first made in the Journal of Consulting and Clinical Psychology in 1998, that an unknown “Common Cause” simultaneously triggers depression and other negative feelings, like anxiety, and accounts for the strong correlations among these feelings? Here's the reference: Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. Are some groups easier to treat and more responsive? For example, the beta group included therapists and non-therapists, as well as individuals with no or very little familiarity with David’s work, plus individuals very familiar with his work. Which groups responded better to the app? This is important because most of the world is NOT familiar with David’s work. Will they be at a disadvantage when using the app? Are the causes of negative feelings, like depression, anxiety, and anger, the same as the causes of happiness? Or does happiness have its own, totally independent causes? Stay tuned for the answers to these questions. But in the meantime, make your own predictions, and then you will find out what the data told us! If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques. So, hopefully, the new study will be pretty cool, too! David and Jeremy Rhonda, Jeremy, and David

Podcast #282: Mike Christensen on Deliberate Practice: Was David Right All Along? Rhonda and I are thrilled to welcome Mike Christiansen, head of TEAM-CBT in Canada. Mike is a fantastic clinician and teacher, and an old beloved friend. Today he talks about the impact of David’s work that is finally being felt and appreciated by innovators in the field of psychiatry and psychology. Rhonda begins the broadcast by reading a really touching endorsement from a young man in Turkey whose life was changed by David’s work after he came close to suicide. One of the key’s was David’s statement that we are disturbed, not by events, but by our thoughts about them.” Of course, that incredible idea goes back all the way to the Greek philosopher, Epictetus, nearly 2,000 years ago. It is so basic that most people don’t “get it,” but once you do, it can be mind-blowing. The young man ended his note to David by saying that, “Life is beautiful now. Thank you!” Mike described a similar enlightenment experience when he was doing counseling, and first attended one of David’s intensive workshops in Canada. He knew that his training did not provide him with the tools to make much of an impact on his patients. He was excited by what he learned, and subsequently attended many of David’s workshops, and became certified in TEAM-CBT. Mike now teaches from around the world at the Feeling Good institute in Mt. View, California. He teaches a highly acclaimed 12 week introductory course in TEAM. If you are looking for some in depth training, Rhonda and I would STRONGLY recommend this class. Mike described a vitally important new direction in psychotherapy called “Deliberate Practice,” and is co-authoring a book on this topic with Maor Katz, MD, head of the Feeling Good Institute, and two pioneers in deliberate practice, Tony Rousmaniere & Alex Vaz. Essentially, Deliberate Practice refers to two things. First, therapists must use rating scales, like the ones David has created, to assess patients progress in multiple dimensions, as well as their perceptions of therapist empathy and helpfulness, at every single session. This keep therapists on their toes, and gives them a crystal clear picture of their effectiveness or lack of effectiveness with every patient at every session. Although this can often be painful for the therapist, it can transform the therapist’s clinical skills and turn every patient into the finest teacher the clinician has ever had! Second, deliberate practice refers to refined training tools for therapists to practice on an ongoing basis, not only when learning therapy for the first time, but throughout your entire career. The key is doing short, role plan exercises that focus on specific tools, like the Five Secrets of Effective Communication during the E = Empathy step of TEAAM, or the “Invitation Step” at the start of A = Assessment of Resistance, or the Externalization of Voices during M = Methods. And here’s the most important part. After the role play, the student is given a letter grade plus specific feedback on what she or he did right and what needs improvement. Then you do repeat role reversals until the student gets an A. David compares this to the type of training a professional athlete might receive to improve his or her skills at basketball or any sport. However, this also requires great motivation and courage on the part of those who are learning and teaching, because every error is highlighted—there’s no hiding! That’s why the philosophy of learning in the spirit of “joyous failure” is crucial to survival and success! Rhonda, Mike, and David demonstrated this strategy several times, focusing on the Invitation Step of the Assessment of Resistance with an “easy” as well as a more “challenging patient. Sure enough, grades below an A WERE received, and errors WERE pointed out. And, in addition, grades of A were fairly readily achieved, showing that this type of “deliberate practice” definitely DOES work. During the podcast I took the opportunity to vent some of my frustrations with the field, and Mike and Rhonda kindly didn’t point out that I probably sounded like a half-demented loony. But I do feel strongly about this topic, and extremely proud of the amazing work that Mike is doing on so many levels. Most therapists resist rating scales. One of my students did a survey for his PhD research, and it seemed like only a small percent (less than 5%) of the psychologists he polled who advertise in the Psychology Today website are using ratings scales to track patient progress. To me, this is both unethical, anti-scientific, and totally unacceptable. Therapists have endless excuses for resisting, and all of the excuses are spurious. For example, they think patients won’t be honest, but the big problem is that the overwhelming majority of patients ARE honest, and therapists don’t want to hear the truth bout their errors and ineptitude. I do not support, but rather condemn, therapists who refuse to use rating instruments. To me, this is the “unforgivable sin” in our profession. I also believe that the use of valid and highly reliable rating instruments will eventually be required for licensure, and the “science resisters” will soon be a thing of the past. The field of psychotherapy definitely needs to move into the data-driven scientific era, and leave the current “schools of therapy,” which compete like religions, or even cults, behind, just as physics and astronomy broke away from the Catholic Church during the Copernican Revolution hundreds of years ago. So, Mike is definitely working on the cutting edge, and he’s just awesome! If you get the chance to take one of his TEAM-CBT classes, jump on it! He will connect with you intellectually, emotionally, and, if I can use a politically incorrect word, spiritually! Warmly, David, Rhonda & Mike

Sanjay asks: How can we convert our “needs” into “wants?” Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed? Cliff asks: I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do? Upcoming Questions in Ask David podcasts William asks: How would the T.E.A.M. model look with addiction and procrastination? 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? Matt asks: How do we help patients who don’t “get” the Acceptance Paradox? Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Al asks: Can you help me with worrying and fear of symptoms? Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives?  I’m in that boat    Sanjay asks: How can we convert our “needs” into “wants?” Dear Dr. Burns I thank you for pointing out “dramatic shift” in the foot notes and it has given me immense satisfaction . So my learning from this is that ‘Low Level Solution’ remains just a “first aid” only because it is still in the category of “NEED” has not yet moved into the category of “WANT”. A further question comes to mind So what is the process / formula to keep the deepest desires of ours from not entering into NEEDs and remain in the WANT zone. and yet we can work with highest passion and love to achieve them . OR in other words , how do you keep your biggest desire of your APP in the WANT zone and still maintains the highest level passion to achieve it . what is he process to reach that stage? You have already given us the answer to this and shown us the way towards Enlightenment via FOUR GREAT DEATHS of the “self.” Still if you would like to say something more that will help us to grasp the process of keeping the desires in WANT only. warm regards Sanjay   David’s reply In reply to Sanjay Gulati. You can also do two Cost-Benefit Analyses CBA. For example, the first might be a CBA on the Adv and Disadv of Needing love, achievement, or approval, for example, and the second would be a CBA on the Adv and Dis of Wanting the same. You could also use the semantic Technique. What could you tell yourself instead of “I NEED great achievement (or love or approval or whatever) to feel happy and fulfilled.” A third could be to do an experiment and see if it is really true that happiness always or only comes from achievement, love, approval, etc. A fourth strategy would be to do a Feared Fantasy and have a conversation, in imagination or in role play with a therapist, with someone who has achieved tremendously. That person would have to explain that she or he looks down on most other people because they haven’t achieved as much, so s/he feels they are less worthwhile. You might suddenly discover that such a person doesn’t actually seem especially “worthwhile,” but more of an egotistical type. With regard to the app, I’m just having fun with it, and making all kinds of amazing discoveries. Parts of it are really effective. Other parts are ineffective and need to be changed. But it is all an adventure. I can’t control the outcome—will it be popular? Will we develop a business model that allows us to pay our bills? Maybe yes, maybe no, maybe partially. But to be honest, I don’t really care! And not “caring” or “needing” frees me up to care way more effectively, and more creatively, and more lovingly. And with inner peace along the way. Here is something else. You begin to realize that there is no such thing as “failure,” only information. For example, if people don’t like some lesson, or some word I have used, I just change it and make it better. Most of the negative and positive feedback is totally unexpected and surprising, which is really fun! I feel privileged, not pressured. These feelings are quite rewarding and addictive. I realize, too, that most people don’t really care how “successful” I am, including you. Most people do appreciate it when I treat them well, however. Same with our cat that we adopted at the local humane society after her owner died. Might make this an Ask David if it is okay! Thanks, david By the way, you subsequently emailed me and asked me to comment on “intense wants” vs. “needs,” so here’s a little more. When I was a young man, I used to collect antique paper money from around the world as a hobby. I can vividly recall seeing a rare uncut sheet of banknotes at a trade show that I feel in love with instantly. It was from the US Virgin Islands from the 1850s, if I recall correctly, and it consisted of a one thousand dollar bill and three five hundred dollar bills. It was gorgeous and I was instantly hypnotized, thinking it was one of the rarest and most desirable things in the world! But sadly, I was a poor graduate student and could not afford it, and I’m not sure the dealer, a really nice guy from New Mexico named Larry Parker, was willing to sell it. Finally, I gave up on it and stopped thinking about it. Years later, that exact same item came up in an auction in Los Angeles, and I was starting my clinical practice in Philadelphia. So I called the auctioneer, who I knew, just an hour or so before the end of the auction, and asked how much I should bid in order to be sure that I would win that intensely coveted item. At the time, the bidding was around $2,000, and I thought I could likely get a loan from the bank to buy it. The auctioneer told me that no matter how much I bid, there was no chance I could win it. I asked why. He said the wealthiest man in Caribbean was bidding on it and would pay any amount of money to get it, no matter what. I was devastated and felt my chance for true happiness and worthwhileness had just evaporated! My “intense want” was not fulfilled! Years later, similar notes started appearing in auctions, and I was able to figure out they were all reprints, including that original uncut sheet. Although they had some modest value, they were easy to obtain, and . . . suddenly I had no desire at all to own them! And it also dawned on me that all those years when I couldn’t have that “fabulous” (or so I thought) uncut sheet, I’d been absolutely happy. So much for our so-called “needs!” Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed? Hi Dr. Burns, First off thank you so much for your podcast and books. They've helped me immensely grow and I am forever appreciative! Recently, I've been hearing statements like "American democracy may not be around in 10-15 years", "America is becoming a totalitarian state'', and "We're heading to nuclear war" from both sides of the political spectrum. All of these statements make me very anxious to hear. I know that thoughts create feelings, so even if something is true (like the threat of nuclear war, or that voting rights are being infringed upon, etc.), is there a way we can think upon these issues without becoming anxious or depressed over them? Thank you so much, Vanessa B. David’s reply Hi Vanessa, Thanks. I’m sure many people have similar concerns. However, this is a very general question, and you have not given me any specific examples of your own negative thoughts. So, I can only give you an equally vague and general response, which is guaranteed not to be helpful. That’s because general questions and answers tend to be little more than babbling. All that being said, I will say that there is a healthy and an unhealthy version of every negative feeling. So, some alarm and concern is probably totally appropriate and healthy, but getting crippled with excessive anxiety and depression is perhaps not useful. Healthy negative feelings result from valid negative thoughts; unhealthy negative feelings always result from distorted negative thoughts. But, as I pointed out, without a single example of your negative thoughts, all of the “good stuff” will remain unseen! Thanks. david PS I will make this an Ask David for an upcoming podcast.   I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do? Hey Doc! Very glad I ran into your work. Started with a video and have been reading and listening to your stuff for a couple days now. I’ve been diagnosed with OCD (PURE O). I struggle with intrusive thoughts. I have had a lot of trouble exposing myself to the thoughts in order to face them. I’ve tried a writing a narrative of my fears etc…. I just can’t seem to get the right exposure. A couple examples: I get stuck on… I don’t believe in God, or don’t believe enough or that maybe there isn’t a God? I get stuck on… what if I go crazy? I wish there was a dirty sink I could go touch or something tangible I could face. Any suggestions? Cliff (name disguised) David’s reply Hi Cliff, Sure, and sorry you've been struggling, and fortunately, the prognosis is very positive. But I have a few questions so I’ll know what you’ve done already. First, which of my books have you read, and did you do the written exercises while reading? For example, When Panic Attacks is all about techniques for anxiety. Second, have you done a search for OCD as well as anxiety on my website? You will find many resources. Third, have you completed the free anxiety test and class on my website? Fourth, sometimes a therapist with expertise in exposure can help with exposure, although that is one of a great many powerful techniques for treating anxiety. Trying to treat OCD or any form of anxiety with exposure alone is a huge mistake. Fifth, have you used the Hidden Emotion Technique? Let me know, and thanks. david Rhonda, Matt, and David

The Feeling Good App: Part 2 of 2-- The Surprising Basic Science Findings-- How Does Psychotherapy REALLY Work? And Why Did Everything Change So Fast?   Feeling Good Podcast Special Edition #2: March 07, 2022 Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications. Here's a portion of what we’ve discovered so far. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2 Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes. If you would like to see the standardized output of the SEM model, click here. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory! At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include: A cognitive variable: the user’s belief in his or her negative thoughts. A motivational variable: measured with extremely precise and sensitive instruments. the user’s liking of the app. The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work. CLICK HERE FOR THE FULLL REPORT However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause. The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast. If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last. Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions. We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day. So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers! David and Jeremy Rhonda, Jeremy, and David

Podcast #280: A Beloved and Brilliant Voice from the Past: Dr. Stirling Moorey! Rhonda and I are thrilled to welcome Dr. Stirling Moorey, from London, England, to today’s podcast. Stirling was one of my first students, and he sat in with me my on all my sessions as a co-therapist for a month for two summers in the late 1970s. I wrote about Stirling in my first book, Feeling Good: The New Mood Therapy, which was published in 1980. One of the miracles of the internet, and zoom, is the chance to reunite with friends and colleagues from the past. Needless to say, Rhonda and I were SO EXCITED when Stirling accepted the invitation to join us! Rhonda starts the podcast by saying that “Dr. Stirling Moorey had the good fortune to be trained and supervised by two pioneers in the field of cognitive therapy, Drs. Aaron Beck and David Burns. In 1979, when Stirling was still in medical school in London, he did an elective with Dr. Aaron Beck at the Centre for Cognitive Therapy in Philadelphia.“ I (David) might put it a bit differently. I would say that during the early days of cognitive therapy, I had the fantastic opportunity to do co-therapy together with Stirling with many patients. I learned a tremendous amount from Stirling, even though I was, in theory, the “expert” and he, in theory, was a totally untrained and green novice. But he was phenomenal right out of the gates, and those months were among the happiest of my life. What I learned by observing Stirling’s superb interactions with my patients eventually morphed into my Five Secrets of Effective Communication and my first book, Feeling Good Together! Rhonda continues: "Stirling was one of the first British therapists to study CBT when that discipline was in its infancy. David described their fantastic collaborative work with Stirling in Feeling Good, and has described Stirling’s brilliant empathy skills in dozens of workshops. Stirling is currently a Consultant Psychiatrist in Cognitive Behaviour Therapy, and was the Professional Head of Psychotherapy for the South London and Maudsley Trust from 2005-2013. He has been a Visiting Senior Lecturer at the Institute of Psychiatry, Psychology & Neuroscience in London." Stirling is a highly regarded therapist, trainer / supervisor / teacher and workshop leader. His main research interest is in the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and has contributed to five randomized controlled trials in both early and late stage cancer. Stirling is also co-author with Steven Greer of The Oxford Guide to CBT for People with Cancer, and has co-edited a book entitled The Therapeutic Relationship in Cognitive Behavioural Therapy, published by SAGE (Moorey & Lavender, eds.) During today’s podcast, Stirling reminds us that one of the aims of cognitive therapy is encouraging patients to examine their distorted negative thoughts and self-defeating beliefs in a way that is not threatening. If patients don’t feel validated, they may feel attacked and become defensive, which, of course, can undermine the therapist’s effectiveness. He also reminded us that the grandfather of cognitive therapy, the late Dr. Albert Ellis from New York, often attacked the beliefs of his patients in a somewhat aggressive manner, and that this can frequently trigger therapeutic resistance. In fact, an overly aggressive therapeutic style can split patients and colleagues into two camps: those who love you, and those who may stubbornly resist and oppose you. During the podcast, we reminisced a bit on shared memories, and Stirling said that “David took me under his wing with such willingness to share his knowledge and experience . . . and I was just an ordinary medical student. We had many great moments!” Although Stirling was tempted to relocate to America, he decided to remain in England, and has never regretted that decision. For one thing, he met and married his beloved Magda. My own wife, Melanie, and I were honored to take our two kids to England to attend their marriage. We all loved England and had a ball! Magda, Stirling's wife We discussed some of Stirling’s amazing work with the patients we saw together in Philadelphia, as well as his visit one summer when we were in California visiting with Melanie’s parents in Los Altos, where we now live. Stirling recalled that when we were out shopping one day, my wife and I tried to persuade him to purchase a large Stetson hat, but he resisted! Stirling described the three ways in which he encourages people to change their negative thoughts using the Socratic Technique of gentle questioning: he  asks if the negative thoughts are realistic, if they are helpful, and if an alternative perspective can be taken. The reality testing approach focuses on the important differences between healthy negative feelings, like healthy sadness or grief, which don’t usually need any treatment, and unhealthy negative feelings like depression, or a panic attack. One key difference is that healthy negative feelings always result from valid, undistorted thoughts. For example, if a loved one dies, you may tell yourself, “I still love him with all my heart, and I’ll miss the many wonderful times we spent together.” In contrast, unhealthy negative feelings result from negative thoughts about the person who died that are distorted. For example, a young woman who’s brother committed suicide told herself, “It’s my fault he was depressed because our parents love me more when we were growing up. I should have know that he was considering suicide the day he died, so I, too, deserve to die.” Of course, the distorted thoughts don’t have to result from a traumatic event. For example, a chronically depressed patient may tell himself, “I’m a loser, and I’ll be depressed forever.” A more pragmatic treatment approach focuses less on whether thoughts are distorted or not, but rather on their effects. It’s possible for a thought to be realistic but unhelpful. If a tightrope walker in the circus thinks during their act, ”If I fall I will die,” this may be realistic but not very helpful! Stirling talked about how the third way to look at changing thoughts is based on the fact that our lives always have a narrative—a story we tell ourselves about what has happened, or what is happening right now in our lives. These stories can have a powerful impact on how we all think, feel, and behave, and may often function as self-fulfilling prophecies. We can change these stories to make them more adaptive for us. For instance, rather than seeing the glass as half empty, we can see it as both half empty and half full; or we may choose to focus on what you can control vs. what you can’t. What I’ve written so far are just some general ideas, summaries of things that we talked about on the podcast. But when you listen to the podcast, you will perhaps notice the warmth, richness, and depth in the way Stirling thinks and communicates. Then you will “see” and experience his true genius and his immense compassion! We hope that we can entice Stirling to present to one of our free weekly training groups, and perhaps even see if he might agree to do another co-therapy sessions with me that we can publish on a podcast, so you can actually see and experience this master therapist in action! Rhonda, Stirling and David

Podcast 279: Dr. Leigh Harrington on Goal Setting for Habits and Addictions or Using Habits to Feel Better Today, we are joined by a very special member of the TEAM-CBT family, psychiatrist Leigh Harrington, MD, who will teach us how to set goals that work when battling habits and addictions. Leigh Harrington, MD, MPH, MHSA, is a psychiatrist, TEAM-CBT Therapist and Trainer.  Originally from Michigan, where she completed medical school and graduate school, she had the good fortune to meet Dr. David Burns in 2004 during her psychiatry residency at Stanford University when she joined his original group of Tuesday night students.  She specializes is helping therapists and individuals reach their goals especially in the areas of Interpersonal Exposure, Relationships, and Habits.  She lives in Davis, California with her two beloved daughters. Leigh begins by saying that there are many parts of the TEAM-CBT model than help when battling unwanted habits and addictions. Our habits definitely result from how we think, and the stories we tell ourselves, and treatment can sometimes be more than just treatment, but a transformational experience. She explains that “I gained 20 pounds following my last pregnancy, so I began to set three kinds of goals: Mental goals Physical goals Relationship goals” Mental goals She continues: “I focused on reducing the many Should Statements I was battering myself with, like “I should have done this or that,” or “I should do this or that.” These kinds of statements sounded demanding and triggered feelings of guilt and frustration that actually made it harder to achieve my goals. “So, I decided, instead, to notice my thoughts, and focus instead on appreciating things. This was just one of many approaches to rewiring my brain. “For example, I realized I had been letting my brain run itself each morning. When I woke up my mind would start to tell me all the things I needed to (should) do that day. . . Sometimes I would wake up feeling “okay,” but I was definitely not in a state of bliss, gratitude or joy. “Sometimes it seemed as if my mind would look to find reasons I might not be feeling top-of-the-world: ‘Well there is this issue… or this… and also this…’ “Which told me a story of my unhappiness, or simply a lack of joy. Of course, my mind was well-intentioned, trying to help me out, but it didn’t end in greater joy, but in the weight of ‘shoulds’ and reasons to feel crummy. It had become a habit--a thinking habit. “I was struck by the idea that I didn’t have to let my mind think whatever it wanted and wondered if I could break this thinking habit. In habit work, we determine the new habit we want, check our motivation, plan solutions to any problems, and commit to the new habit. “I thought I would keep my new habit simple, believable, and incorporate gratitude, as that can sometimes be helpful, too. “My new habit was to catch myself while I was still in bed, as soon as I recognized I was having thoughts, and say to myself something I believed that, was non-controversial. When I caught myself thinking any shoulds or telling myself any unhappy stories, I said to myself, ‘I love my bed. I love my house. I love my lamp.’ “This might seem simple, trivial, or silly. But the point of the new habit was not to be profound and brilliant. The point was to change my thinking in the smallest of ways and to prove to myself I could create a new thinking habit. “This simple thought habit has allowed me to start my day on a better note and has allowed me to prove to myself I can change my thinking habits.” Physical goals Leigh explains: “Here’s how I lost the 20 pounds I had gained. Instead of focusing on one strategy – like, “I will only eat vegetables,” or “I will exercise 2 hours per day,” I focused on achieving the goal by any means. I used the experimental technique and went through a series of habit experiments. “First I tried just thinking I’d like to lose the weight. I. This may seem crazy, but there have been times in my life when I’ve seemed to effortlessly loose weigh, so that seemed like an easy first go. “As you might imagine, it didn’t work as well in my 40’s as it did in my 20’s. As long as I kept giving in to my urges to have a sugary treat in the afternoon as a pick-me-up, and refusing to be in deprivation, nothing at all happened with my weight. “I also allowed myself to eat as much as I wanted to, just as I had when I was pregnant and nursing my daughter. “Since that didn’t work,. I experimented with some green juice in place of sugary snacks. I felt healthier, but there was no change in my weight. “Then I decided on a multi-pronged approach. I would keep drinking my fruit-smoothies in the morning, along with a protein shake mid-morning, and a normal lunch, plus a normal dinner – just one serving at lunch and dinner, and no more than one dessert per week, Whenever else I was hungry I would drink a protein drink and lots of water. I also committed to walking every day for 30-60 minutes and going to the gym at least once per week. “And, I committed to doing this until I saw the results I was looking for. I weighed and measured myself. But in two weeks, I had lost only one pound and zero inches. “I was discouraged. “But I was committed to stick with it, no matter what, for as long as it took. “Three weeks in thee was still not much change. “But at 4 weeks I started noticing a difference and by 12 weeks the scale read 20 pounds lighter – the same as I weighed in college. Most importantly I felt great and I experienced a sense of accomplishment! Relationship goals Leigh continued: “I also decided to focus on developing better personal relationships with six people, including my mother. I had always felt that she was critical of me, this thought caused me to distance myself from her. I had a better relationship with my dad. So I decided to focus, instead, on what I loved and appreciated about her. For example, she was amazing with my kids. “This is a little funny, but I was in the middle of a difficult time in life and hired a coach specific to this situation.  I felt sad about the loss of a friend and I found her wisdom really helpful. She suggested, ‘you only need six people, your pall bearers.’ “Since I have a tendency to enjoy and like many people, it made a lot of sense to me to focus my energy on a treasured few. “I had always prided myself on being a loyal and committed friend and didn’t’ want to give any up.  Even though the suggestion of only 6 didn’t ring true for me, it helped me drop the strongly held belief, ‘I must keep all friends forever.’ I found releasing some relationships allowed room for some really awesome new ones to grow. “I’m loving those now. And low and behold, I started enjoying hanging out with my mom, and began to realize I had a kick ass mother!” Leigh summarized some of the keys to successful goal-setting, including the importance of setting small, measurable, and specific goals. She described her upcoming “Boot Camp” on overcoming habits and addictions. For more information, contact Leigh at www.TeamTherapyTraining.com. Following today’s podcast, we received this lovely note from Leigh: Hi David and Rhonda, I so loved being with you both today!! Thank you for being so gracious and welcoming about these ideas on how to modify habits and addictions! I love growing together.  David, it really struck me how you were breaking things down into steps and making so clear for your listeners - it felt like your intellectual mind and your heart were going at the same time. Rhonda, I love how you brought up ideas and framed things in such a clear way. You guys rock!! When we finished up, I thought of a more thorough response to David’s question about slogging today. I was reminded of perfectionism and how I’m trying not to be so perfectionistic. I still remember David’s article on perfectionism from Psychology Today Magazine way back in 1980, when Feeling Good was first released. It was entitled, “The Perfectionist’s Script for Self-Defeat.” I’ve been working on doing “B” work, and I’ve gotten so much more done and - when I don’t fall into perfectionism again - having so much more fun. So, I like the idea of holding ourselves accountable, being committed to ourselves and our goals, and to letting ourselves do B work, instead of aiming for perfection. It seems kind of counter-intuitive, but that combo leads to getting more done and being a lot happier! Maybe you have some insights, David or Rhonda? Much love to you both, Leigh David wrote back: Hi Leigh, Thanks for the beautiful note. I have also struggled with perfectionism, especially when I was younger, and I agree with your conclusions 200%. But perfectionism has many tentacles, and is always lurking in the shadows, waiting to jump out and grab us again!! David Rhonda wrote back: Hi Leigh, I also struggle with perfectionism, and when I am feeling overwhelmed I tell myself, “I have an abundance of time to accomplish all I want to do today, calmly, peacefully, and with unhurried grace.'” That’s not an empty affirmation, but a positive statement created after writing out a Daily Mood Log, seeing the positives in my perfectionism, and looking at the distortions in my thoughts. Rhonda We hope you enjoyed this podcast, Rhonda, Leigh and David

  #278: Buddhist Strategies for Financial Abundance, Featuring Zeina Halim Jan 24, 2022 Today, we feature the work of Zeina Halim, a beloved member and small group leader in our Tuesday training group at Stanford, who specializes in the treatment of anxiety.  This is Zeina’s third appearance on our podcast. Previously she helped us with a fabulous program on family conflicts at the start of the pandemic (Corona Cast 3, 4-06-2020) and later did live some personal work on one of the Self-Defeating Beliefs, the Achievement Addiction (Podcasts 211, 10-12-2020, and 212, 10-19-2020).  Today Zeina brings us something radically different: Buddhist Strategies for Financial Abundance. What in the world does that mean, and why should you care?  She starts by describing her study of Buddhist practices, and cites some books that have inspired her, including The Diamond Cutter:  The Buddha on Managing Your Business and Your Life, by Geshe Michael Roach.   Zeina explains the quasi-mystical concept of “Karma,” which is the idea that you get what you give. In other words, the energy and spirit you convey to others, and to the universe, will come back to you. For example, when clients who are not a good fit for her practice contact her, Zeina goes out of her way to help those clients find a great fit with another therapist.   This “Karmic practice,” she explains, has paradoxically caused many patients to suddenly seem to show up, asking for treatment. In other words, when she meets the needs of others, the universe meets her needs.  She says that she doesn’t need to do very much at all of the kinds of traditional marketing that most other therapists do in an attempt to build their practices. This “karmic practice” has been mostly sufficient and far more effective than traditional marketing methods. This is a theme that I (David) resonated with, since I also give away almost everything for free, and have received an abundance of positive and loving gifts from the universe in return. Zeina cautions that this, and all Buddhist practices, must be done with balance and thoughtfulness: “When I started, I gave too much, and this can actually cause self-harm.”  She said that some people have raised the question: “But isn’t this an inherently selfish practice, since you are hoping for abundance for yourself?”  Her response to this is that when you receive financial abundance, you can give even more to others for free.  She also described another book of Geshe Michael Roach’s, The Karma of Love, where you try to give to the other person and meet their needs instead of worrying about whether they’re loving you enough or meeting your needs.  In a previous relationship, this led to inner peace and, paradoxically, she felt much more loved, although nothing observable had changed in the way her partner treated her. The change in her feeling loved all came from changes SHE made, not her partner. This aligns very closely with the TEAM-CBT approach to relationships, as well as the teachings of most religions. We also discussed group TEAM-CBT vs. individual therapy.  I described my phenomenal experiences in Philadelphia creating a large intensive group therapy program at my hospital, which was in a rough, inner city neighborhood. Most of our patients had few resources, and many could not read or write. Some were homeless. The program was more or less free to all of them, and our patients and their families gave us so much in return.  I was absolutely thrilled that Zeina also loves doing therapy in groups. Many patients and therapists alike think of group therapy as a kind of inferior approach, but my experience has been the opposite. If given the choice, I’d treat everyone in groups. Zeina will be starting a TEAM-CBT anxiety group within a week of this podcast. The group will focus on all the anxiety disorders, such as chronic worrying, shyness, phobias, OCD, PTSD, and more. There will be one group for adults and one for young adults, aged 18-24. If you’re interested, feel free to text Zeina at 1-408-412-5678, email her at ZeinaHalimTherapy@gmail.com or visit her website at ZeinaHalimTherapy.com  As an aside, we’ll find out if Zeina’s Buddhist Karmic Marketing works. She did not ask me to promote her group. I just decided to promote it a little bit because I’m so excited about what she’s doing, and I hope her practice grows and prospers to the max!  Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing. This year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen!  Rhonda, Zeina and David

Rejection Practice: A Love Story, Featuring Dr. Cai Chen Jan 17, 2022 Rhonda starts today’s podcast by reading two wonderful recent endorsements from listeners. A therapist from San Jose, Ca was moved and inspired by the two podcasts (Episodes 268 & 269, published 11-15-2021 and 11-22-2021) with Dr. Carly on the tragic loss of her baby via ectopic pregnancy, and another listener described TEAM-CBT as “revolutionary” due to the emphasis on reducing resistance. She compared the approach to the indirect hypnotic approach developed by the late Milton Erikson.  Dr. Cai Chen recently completed his psychiatric residency in Texas, and then moved to California to join the TEAM-CBT community and unite with the love of his life, who happens to be a member of our Tuesday group.  Cai attributes much of his dating success to one of the techniques he read about in my book, Intimate Connections, called “Rejection Practice,” because he practiced that technique to successfully defeat his negative thoughts about all the awful things that might happen if he tried to talk or flirt with an attractive woman.  He would tell himself things like: She’ll think I’m being too forward. She’ll be offended and might call the police. People who see me trying to flirt will be offended. I’ll be rejected.  He described what happened when he forced himself to get 20 rejections in a mall in order to overcome his fears. His stories about what happened are both funny and inspiring.  Cai also describes his initial intense resistance to using this technique, giving himself messages like, “I shouldn’t have to learn to flirt because it’s beneath me!” I heard excuses like that all the time when I was in clinical practice, working with shy, lonely men!  Rejection Practice is a powerful and potentially super-effective technique you might want to try if you’re also struggling with social anxiety or if you treat patients with this problem.  We also illustrated the hilarious Feared Fantasy Technique on the podcast, where Cai enters an Alice-in-Wonderland Nightmare World, and meets the “woman from hell” who represents all of his worst fears, and verbalizes things like this to him: You’re assaulting me and I’m going to call the police.  You’re the last person I’d ever date! You’re forgettable! you You’re too forward. I can see that you’re very insecure! In addition, he meets the “observer from hell” who verbalizes things like this to Cai:  I’m terribly offended that you tried to talk to that woman.  It’s highly inappropriate to flirt like that in broad daylight.  You shouldn’t be doing that.  I condemn and reject you! Cai was surprised to discover that the monster has no teeth and experienced some enlightenment and freedom from his fears. Rhonda, Cai, and I had a lot of fun with these techniques, and hope you enjoy them, too. Again, if you’re a therapist, you might consider including these techniques if you work with shy individuals.  We also discuss the idea of “Physician, heal thyself,” a quotation from the New Testament (Luke 4:23). We are all convinced that doing your own personal work can vastly increase your skills and depth as a clinician, because you can tell your patients, “I know what you’re going through, because I’ve been there myself. And what a joy it’s going to be to show you how to overcome your shyness and develop greater confidence, and more loving relationships with others.” And that’s exactly what happened to Cai. He found the love of his life. You’ll hear all about it if you listen to this heart-warming podcast!  Dr. Cai is just starting his TEAM-CBT practice at the Feeling Good Institute in Mountain View, California. However, since he is a trained physician and psychiatrist, he can also prescribe medications if patients need them in addition to the therapy. Dr. Cai Chen is a warm and brilliant young psychiatrist. If you would like to contact him, you can contact him at Cai@FeelingGoodInstitute.com, or call him directly at 1-916-877-4749. Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing, since I have refused to monetize the podcasts. So our budget is meager at best.  Still, this year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen!  Warmly, Rhonda, Cai and David