Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

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

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

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

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