The Sara Session—Total Blow Away! (Part 2 of 2) Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session. If you click here, you can see Sara’s Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on “Empathy” and “Helpfulness” were excellent. If you click here, you can see Sara’s Daily Mood Log at the end of the session. By the end of the session, all of Sara’s negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she’d been procrastinating for years at promoting and developing her private practice. I don’t like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn’t focused on this emotion at all during the session. You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot! There were quite a few teaching points, including but not limited to these: Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success. Several days after the session, Sara sent this beautiful note to the Tuesday group. Hello, Tuesday Group! I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second). 😝 Anyway, I will try to make this email short because I tend to go overboard and write too much, and I know everyone is busy. I will just share a few things that have happened since my personal work two weeks ago. I am also forwarding the email I sent David and Jill Tuesday evening after the magical evening. First of all, THANK YOU all for your awesome support and empathy during that beautiful evening. At that time, I did not realize how much this is the story of many of us in the group (the learning disability and being bullied, humiliated and teased because of it.) I felt very connected to you and felt your love and deep compassion and understanding. Thank you! So, I was not kidding when I wrote that I am dancing away. You see, during the last two weeks when I have been at a grocery or department store, I have been dancing away to the music playing in the store. For some reason my body just gets moving and doesn’t want to stop no matter what song is playing. As you can imaging, this is not typical of me. As a matter of fact, I am not a music person let alone a dancer. I prefer to listen to NPR or a Feeling Good podcast when I’m in the car and don’t play any music at home. Anyway, when I have been at a store these last few days, I have let loose. It was really funny when a lady at the end of the aisle noticed me dancing, and said to me, ‘You go girl!” We both giggled and I kept dancing even after the song was over. I am NO longer inhibited and have allowed my body to do what it needs to do, and I really don’t care what anyone thinks or says. What a liberating feeling this is! My husband also thought it was funny that I have made silly sounds, especially during meals, and we would just burst into laughter. Needless to say, a lot has gone on since my personal work. I am definitely more relaxed, and therefore, less serious and more playful. Enjoying life!!! The main shift has been my thought that has been ingrained in me my whole life: “Que van a pensar?” which translates to "What are they going to think?” I used to care and believe this !00% but now I don’t believe it (0%) and it does not matter to me what people think. My new thought now is more powerful and I believe it 100%: "I don’t care what she (they) think. What matters is what I am telling myself!” I have noticed myself shifting to this new thought quite a bit and it has been so liberating and empowering. I cannot express enough how freeing this feels. In case you are wondering, the plans for the trip to Mexico will include a visit to my birthplace and gatherings with extended family members and high school classmates as well as some site seeing. Oh, my goodness, I said, I would make this short, and here again, I went overboard. Sorry! Once again, thank you for all the love and support!!! With immense gratitude, Sara Shane I want to thank my brilliant and beloved colleague, Dr. Jill Levitt, for her brilliant work in Sara’s treatment, and I want to thank Sara for this fabulous gift she has given all of us! When you actually SEE the magic happening, it makes all the difference in the world. And when you see the actual techniques that Jill and I were using, you will hopefully realize that you, too, can learn to use TEAM-CBT in your clinical work if you are therapist, or in your personal life if you are struggling with feelings of depression, insecurity, anxiety or low self-self-esteem. Remember, too, that we still offer unlimited free TEAM-CBT training for California mental health professionals in our Tuesday group and for therapists from around the world in Rhonda's Wednesday group. If you’re interested in the Tuesday group, contact Ed Walton edwalton100@gmail.com. If you’re interested in the Wednesday group, contact Dr. Rhonda Barovsky rhonda@feelinggreattherapycenter.com. Thanks for listening! Rhonda, Jill, Sara and David

The Sara Session—Total Blow Away! (Part 1 of 2) In one of my recent Tuesday psychotherapy training groups at Stanford, we reviewed the Interpersonal Downward Arrow Technique. This is a high-speed technique I created that allows you to rapidly identify the roles that you play in your relationships with others so you can pinpoint the patterns that create tension and unhappiness for yourself as well as the people you care about. The Interpersonal Downward Arrow Technique is similar to what psychoanalysts try to do with free association on the couch, except it only takes five to ten minutes, as opposed to five to ten years. In addition, I have also developed fairly rapid ways to change and modify those dysfunctional patterns—IF this is what you want to do. Some of the psychoanalysts call these hidden patterns “core conflicts.” The late Dr. Lester Luborsky (https://en.wikipedia.org/wiki/Lester_Luborsky), a prominent psychotherapy researcher at the University of Pennsylvania School of Medicine, has written about core conflicts extensively. He gave as an example of a core conflict, a person who might have the belief that “my needs will never be met in my personal relationships.” Beliefs like this not only create unhappiness, but they can also function as self-fulfilling prophecies. In addition, most people re not aware of these “core conflicts,” and do not realize they are just beliefs. Most people just believe that “this is just the way the world is,” and think they have a profound insight into the reality of human nature. But we actually create our own interpersonal realities at every moment of every day. Since we usually cannot “see” what we’re doing, we may wrongly conclude that we’re victims of the “badness” of others. And, of course, there is always a grain of truth in that belief as well! During the training group, we had group members identify some of their own “core conflicts,” using the Interpersonal Downward Arrow Technique, and this hit one of our members, Sara Shane, like a ton of bricks. She discovered that she sees herself as “an outsider” and has always believed she is stupid and inferior to others. And this intense belief has caused tremendous suffering for Sara for decades, including her participation in the Tuesday training group, where she is usually totally silent. Sara traced this pattern to her childhood, growing up in a village in Mexico, where she was bullied and put down because she was short and overweight, and had the darkest skin of any of her many siblings. In addition, she struggled with a learning problem and was frequently put down and labeled as stupid. Sara’s sudden decent into emotional hell was fueled by the fact that she was planning the wedding of her niece at a town in Mexico which was only two hours from the town where she grew up. And the thought of showing her daughter that town filled her with feelings of shame and terror, fearing she would run into the people she grew up with, including the people who cruelly put her down. Here’s what she wrote prior to doing personal work on this problem in a subsequent Tuesday group: Hello Jill and David, Where to begin…all day yesterday it was very painful as I thought about emailing you... As I’m writing this, I am in tears and I know it is going to take me a while to write everything I want to say. But first let me say that it has taken me a long time to even sit in front of the computer because this has been very difficult for me. I had earlier said I would email you yesterday morning but I know now why I could not. I procrastinating mainly because this hurts a lot, beyond what I had earlier experienced. Right now, I am not even paying any attention to proper writing because I just want to write this without worry about correctness and just express my feelings. Let me describe what I have been feeling physically all week long since Tuesday. I have been feeling sick to my stomach especially when I was working on the DML. I felt a hole in the pit of my stomach. I felt anxiety all over my body and felt overwhelmed. At times I could not even go one. I had to push myself to complete the Cognitive Distortions on the DML. I just wanted to run away from it all. It was that painful. But I also knew this was a good thing because I was getting down to something very important that I wanted and needed to face. So the Interpersonal Downward Arrow has been very enlightening, but also, extremely painful. And David, you are absolutely right, there is no doubt in my mind (not that there ever was), that all of our problems are encapsulated in one brief moment in time and that we create our own interpersonal reality at every minute of every day. Let me explain what transpired on Tuesday that motivated me to be a volunteer during small group practice. After postponing it for more than a year due to COVID, my niece is having her destination wedding in Mexico in November. My husband and I along with our daughter are attending the wedding. While there, we were hoping to travel to show our daughter the town I was born in and where I completed my junior and senior year of high school. After more than 20 years in February 2020, I reconnected with one of my good friends from high school. During this conversation, we talked about making plans to get together with our classmates when I went to Mexico for the wedding. However, I have not been in touch with her since then. In making more concrete plans on Tuesday morning for our trip, I realized we would be able to travel to my birth town. So the possibility of visiting with my high school classmates whom I have not seen for about 38 years produced a lot of anxiety for me. This was very disturbing because this is not even a set event. It is only a possibility. Thus, I started wondering way it was making me so anxious just thinking about it and knowing that I did not need to visit with anyone if I did not want to. I was quite distraught, thus, I decided to share these feelings during small group practice. I was feeling anxious, insecure, and afraid of being judged and criticized. I’m so glad I was able to volunteer during our small group because prior to this I didn’t realize the multitude of feelings that were buried. One of the biggest revelation was how lonely I was feeling and the immense grief I was experiencing. But even more surprising was the extreme feeling of inferiority I felt although I denied it at first when Jill asked if I was feeling inferior. It was not until we were going over the “Rules” that govern the relationship that it was very clear to me how inferior I felt. And here lays all my PAIN: “I am always an outsider because I will never be good enough.” This brings me to tears! Although I understand intellectually that my suffering results from the belief that I have a self that is not good enough and a self that others can judge, as you so beautifully wrote David in your book, Feeling Great, it is still hard for me to let go emotionally. When doing the DML, I believed my negative thoughts 100% and found 7 to 8 distortions on each, which as I mentioned earlier, it was very painful to complete. Negative Thoughts: I am always an outsider because I will never be good enough I shouldn’t get close to people so I won’t be criticized nor judged I’m not professionally successful as I should be, after all, that is why I went to school Mexican people are very judgmental Perhaps instead of typing all the DML information on here, I should send you a copy along with a copy of the CBA. I will do this in a second email. Self-Defeating Beliefs: Perceived Perfectionism - My high school classmates will not accept me with all my flaws Achievement Addiction - My worthwhileness depends on my accomplishments, professional success, and the way I look (preoccupied with my overweight) Worthlessness - I’m basically worthless, defective, and inferior to others especially some of classmates Brushfire Fallacy - Everyone will talk about me and look down on me (“Mexican people are very judgmental”) Spotlight Fallacy - Talking to people feels like I have to put on an interesting mask and perform in order to impress those around me Superwoman - I should alway be strong and never appear weak in front of others As I worked through the DML, CBA, and S-DB these last few days so much has come up for me. I couldn’t help it but to feel lots of pain as some of my childhood memories emerged of the horrible times when I was humiliated, teased, and bullied primarily by family members (both immediate and extended family members). Sadly enough, in the Mexican culture, being dark completed, short, and chubby are frown upon and a reason to be ridiculed and humiliated. And unfortunately for me, I possessed all three characteristics beside having a learning disability which was translated as me being dumb, stupid, and slow. There were plenty of moments growing up that this was extremely painful especially moments when my own family crudely laughed in my face. I quickly learned to withdrawal and became rather introverted. As I got older, I also quickly learned to tell myself things like; “But one day I’m going to show them that I am not as stupid as they think I am” and “One day I will prove them wrong.” I believe this also became my strength, motivation, and determination to go to college. I was always just an average student in college, and at times, I struggled, but what got me through was my determination to succeed and ultimately prove that I could do it. However, this also created strong fears of being humiliated and ridiculed by people in general. Thus, I have protected myself from being criticized or judged by pushing and staying away from people and have been very cautious and guarded regarding having close relationships. Also, for many years, I have avoided family gatherings where I know extended family members that use to tease me when I was a child are going to be in attendance. I have been rather sensitive to people’s humor and hardly ever joked myself unless I knew the person very well. I am happy to say though that I have made some growth in this area ever since I have joined TEAM. And, that is thanks to your innate humor, David. ; ) Any way, I hope this makes sense… Thank you so much to the two of you for the opportunity to allow me to grow and learn from my painful thoughts. I know more than ever that the only way to over come this pain is by the death of my belief in the “self”. Love, Sara This will be the first of two podcasts showcasing the amazing work that Sara did in a subsequent Tuesday group. Dr. Jill Levitt and I worked together as co-therapists, and we went through the TEAM model in a step-by-step manner. In this podcast, you’ll hear the first half of the session (T = Testing and E = Empathy) and next week you’ll hear the last half of the session (A = Assessment of Resistance) and M = Methods.) If you click here, you can see Sara’s Brief Mood Survey at the start of the session. If you click here, you can see Sara’s Daily Mood Log at the start of the session. If you click here, you can see the CBA that Sara completed prior to her personal work. Thanks for listening! Rhonda, Jill, Sara and David

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More! Here are the questions for today’s Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky! How can I turn off my Shoulds!? Is there a downside to treating people for free? What’s the difference between Feeling Great vs Feeling Good? Isn’t it important to blame the other person when that person really IS to blame?  How can I turn off my Shoulds!? Nice podcast! (Maurice is referring to Part 2 of “I want to be a mother.”) It’s refreshing to see that we sometimes mix our needs with wants. I also have a huge problem with regret and shame, saying to myself “I should be far more ahead in life.” “I should have dated more.” “I should have used my energy to create art and being productive.” I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn’t deal with depression. I tried the semantic method to soften my thoughts regarding my should statements but telling myself “I wish I did xyz,” is carrying the same weight of regret as when I “should” myself. These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought. I often ask myself: ”Am I really a failure?” Maurice David’s Reply Thanks, Maurice You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting. I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed. For example, we could use “Let’s Define Terms,” as one of 15 or 20 potentially helpful techniques. It might go like this: Is “a failure” someone who fails all the time, or someone who fails some of the time. If you say, “some the time,” then we’re all “failures,” so we don’t need to worry about it. If you say, “all the time,” then no one is a “failure,” so we don’t need to worry about it. If that technique is not effective, we’d have tons more to try. You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts. Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise. david   Is there a downside to treating people for free? Dear David and Rhonda, I live in England, and I’m close friends with a team CBT therapist in Bristol (Andy Perrson), and I’ve been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people. I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I’d also like to use your methodology at a later date. In the meantime, I have a question for you. I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people. But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don’t do homework. I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge. David comment: I think the word “therapist” in the line above was supposed to be “patient.” I hope that makes sense. Thank you again to you and Rhonda for all your hard work. Kind regards Brad Askew (Bristol, England) David’s Reply We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free.   What’s the difference between Feeling Great vs Feeling Good? Dear Dr Burns, First of all, thanks for the great work that you do and also all the podcasts you did, I am planning to order a copy of Feeling Great, your latest book. I have a quick question below. I have been searching the answer on the web but still can't find the answer. Does Feeling Great cover ALL the key concepts that were discussed in your previous book, Feeling Good? Or does one need to read BOTH books to get a fuller picture? I already own a copy of Feeling Good. However, if Feeling Great already covers all the concepts discussed in Feeling Good and also comes with updates, i may just order Feeling Great and start with that instead. Thanks. Best, Calvin David’s Reply It really depends on the intensity of your interest. There is some overlap, but also significant differences. Even though Feeling Great is way newer, there are still tons of gems in Feeling Good. David   Isn’t it important to blame the other person when that person really IS to blame? Hi David, I’ve been listening to the show for awhile. Thank you for everything you do. I just listened to episode 254, and I’m not quite sure what to think about it in the context of my situation. I think it makes sense that people are afraid to look at their own faults and what brings them to a relationship and what they contribute to a situation. And that they tend to want to blame the other person to avoid working on themselves. But what about situations of more extreme abuse? How do you not blame the other person? I recently got out of a relationship where I was raped. While in the relationship, there was a lot of coercive sex where he ignored my signals to stop and then afterwards told me that things happened because I had wanted them to. Eventually his behavior escalated to the point where he drugged and raped me while I was unconscious. It’s only been 2 months since I figured out that the relationship was too unhealthy for me and left it. I’ve been in counseling 2-3 sessions per week since then. So at least I am working on myself. And I have no contact with him. Does that mean there is not a point in using the 5 secrets? Is that only for use on other people? But the things you said about blame rang true to me. I think I avoided working on my own issues for a long time, but this situation was like a giant neon arrow saying “work here!” I think I blame myself and him both. But I also worry about blaming myself too much—I think me blaming myself is one of the reasons I felt trapped and unable to leave the relationship in the first place. Because I felt at fault and ashamed of that, I didn’t tell anyone for a long time and that normalized his behavior and allowed the relationship to continue and escalate to its extreme. By not placing enough blame on him, I also didn’t consider that he might be acting selfishly, lying, or not have my best interests at heart. Which also led to the relationship continuing longer. So I am wary about where and how to place blame. Anyway, I don’t know what else to say about this except that it has all been very emotionally difficult and I never want it to happen again, so I am diligently working on myself and looking for help in all the places. Thanks, Rachel David’s Reply The thrust of the response could focus on the idea that Self-Blame and Other-Blame are both dysfunctional. I prefer the concept of accountability, and talk about this in Feeling Good Together, which might be helpful. I think Rachel is doing well to get help for herself and her own tendencies toward Self-Blame, and think that a lot of practice with the Five Secrets could also be tremendously helpful, especially for future relationships. David Rhonda, Matt, and David

Today’s podcast features Dr. Peter Spurrier, a British physician who has founded TEAM-UK. Peter describes how he spent most of his career as a physician in general practice, but was forced to see patients for only ten minutes due to the British health system. He didn’t like the “quick fix” approach to patients with emotional struggles, and at the age of 55, five years before he retired from General Practice, he decided that he wanted to do something more meaningful, so he began to get training in CBT which “helped me listen better.” However, CBT seemed stilted, and the outcomes weren’t very good, either. Then he attended a two-day “Scared Stiff” workshop I presented in London several years ago. The workshop was sponsored by my friend and colleague, Jack Hirose, from Vancouver, Canada. I was not aware that Peter was in the audience, but was really happy to hear that he like the workshop. I had been pretty disappointed in it, since the attendance was light and I ran into quite a bit of resistance from the audience. This was a huge surprise, since I thought they’d be eager to hear about all the improvements we’d made in traditional “Beckian” CBT. At the workshop, Peter purchased my Therapist’s Toolkit, but said “it just laid on my shelf for two or three years. Then, he began using it and decided to focus on TEAM-CBT full time. He began listening to the Feeling Good Podcasts, starting from #1 and eventually caught up. He says that “along the way, I learned by practicing the techniques I was hearing about.” He says he has always been a critical thinker, and initially was dubious about the T = Testing part of the TEAM treatment model. As a GP, he was required to use questionnaires for patients with anxiety and depression, but for some time he thought it wasn’t very accurate data. When he started using the Brief Mood Survey, he was shocked as he began to realize that this WAS good data, and that his reading of how his patients felt was frequently off-base. This, of course, is the foundation of the TEAM-CBT model, which is entirely and intensely data-driven. Then he attended one of my four-day summer intensives at the South San Francisco Conference Center, and loved the warm and encouraging atmosphere, commenting on the friendliness and encouragement of Rhonda, whom he met, and Dr. Angela Krumm, from the Feeling Good Institute in Mountain View, California. They both reached out to him. He said it was actually great to get the chance to work with people, and he was delighted by a demonstration I did on public speaking anxiety and social anxiety, which captivated the audience. After the intensive, Peter returned to London and founded TEAM-UK. He also looked up Dr. Stirling Moorey, who I’d mentioned in my first book, Feeling Good. I have also mentioned Stirling in numerous workshops, especially when teaching therapeutic empathy. Although Stirling was my student, I learned a great deal from him, especially in the area of empathy. Peter described an outstanding chapter on empathy, written by Stirling in a book he has co-edited with Anna Lavender entitled The Therapeutic Relationship in Cognitive Behavior Therapy. I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. His particular interest has been 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 is co-author, with Steven Greer, of The Oxford Guide to CBT for People with Cancer. I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. Peter wrote an article on TEAM-CBT for the newsletter of the British CBT group entitled “CBT Today.” He got zero response for several months, and then heard from Derek Reilly who uses TEAM-CBT in the treatment of pain patients. And, slowly, others began to join Peter’s TEAM.CBT.UK group, and now there are 25 to 30 members. Click here if you'd like to see the current edition of the Feeling Good UK newsletter! Peter also talked about the visit that Rhonda recently paid to the UK and TEAM UK’s first in-person meeting, at Oxford University. “It was such a great pleasure to meet and spend time with Rhonda. She formed strong connections with the group, which we hope will endure for years to come”. Rhonda on her visit to the UK TEAM group at Oxford University. We discussed the resistance to change that we sometimes run into among mental health practitioners. Peter said, “It’s often quite hard to get people to change their ways, and organizations are not always that flexible, either.” One of the things that drew Peter to TEAM-CBT was the fact that it offered a way to embrace the best from various approaches to CBT. This is a phenomenon I have encountered and wrestled with throughout my career as well, and is one of the reasons I would personally like to see an end to all of the schools of psychotherapy, with a switch to science-based data driven therapy. TEAM-CBT is NOT another new “school” of therapy, but rather a structure for how psychotherapy actually works. Although all the hundreds of schools of therapy that have cropped up over the decades have provided some insights into human nature, and some useful treatment techniques, I believe that on balance, they hold the field back and actually function a bit like cults, all claiming to have the best answers and most effective techniques—but the outcome studies simply do not support this notion. In the treatment of depression, all of the current schools of therapy come out about the same in controlled outcome studies, and none are very impressive. In fact, only slightly more than half of the patients even experience a 50% reduction in depression symptoms, which is not very good! The British Association for Behavioral and Cognitive Therapies is the over-arching organization and accrediting group that Peter’s TEAM-UK has joined. He explains that “we are a special interest group, within their membership of roughly 15,000 CBT practitioners.” Many of the members of TEAM-UK attend Rhonda’s Wednesday training group, and there are also two practice groups, weekly, in England. If you’d like more information about their activities, please visit their excellent and appealing website, FeelingGood.UK.com. If you are a British mental health professional, or in Europe, and you would like to learn more about TEAM-CBT, I would STRONGLY encourage you to contact Peter and join one of the ongoing practice groups. You can reach Peter Spurrier  by emailing him at:  docspurr@gmail.com Peter says that if there is one piece of advice he would like to give to his younger self as a doctor and for life in general, it would be to learn, absorb and practice the “Five Secrets of Effective Communication.” Rhonda and I are huge Peter Spurrier fans and hope you enjoyed today’s interview! From Rhonda:  Meeting everyone in the TEAM-UK group was an extreme pleasure for me.  It was a wonderful experience to meet people in person that I have only met on-line, and to get acquainted with TEAM therapists I had not met before.  Everyone is a dedicated, talented and enthusiastic TEAM therapist, and excited about building community.  Plus, everyone was fun and enchanting to hang out with.  It was definitely one of the highlights of my trip to meet everyone, and to have the opportunity to engage in discussion, to learn about about their hopes, dreams, visions and plans for the future for TEAM-UK! Rhonda and I will offer a free, two-hour workshop on habits and addictions on January 26, 2022 from 11:00 AM to 1:00 PM Central Standard Time, sponsored by PESI, so watch for the links on this or their website.  If you register, you will have access to a video following the event, in case you can't attend at that specific time. if you can attend, you’ll have the chance to try some mind-blowing techniques that will help you with overeating, drinking, drug use, nail biting, excessive shopping, or whatever you secret habit / addiction happens to be. Remember this presentation will be-- for Patients, Therapists, and the General Public It's Totally FREE Rhonda and David

Today’s podcast features an esteemed colleague and beloved friend, Dr. Angela Krumm, who will describe her personal victory over a recent weight gain. We will illuminate the TEAM-CBT techniques she used so that you can use them yourself if you’d like to lose some weight. But I have to warn you that you have to do these techniques using paper and pencil. If you try to learn and use them just from listening, they will not be effective. As an aside, if you go to my website, www.feelinggood.com, you’ll find a free chapter offer at the very bottom of my home page. If you click on it, you’ll receive two unpublished chapters from my most recent book, Feeling Great, with crystal clear instructions on the methods you’ll learn about in today’s podcast. Angela’s biosketch goes next, including how she joined David’s Tuesday training group when she was a post-doctoral fellow in clinical psychology and how she ultimately developed the TEAM-CBT certification program at the FeelingGoodInstitute.com. Hopefully Angela can help with this paragraph! As the podcast begins, Angela explains how she’s always viewed herself as a very fit, health-conscious woman who actually completed some marathons in the past. But during 2021, her life has been complicated by a number of tragedies and traumas, including: Angela’s father was sadly diagnosed with terminal cancer and died within four months. Angela had many personal injuries that impacted her capacity to exercise, including a laceration of her retina and a fractured toe. In addition, she fell backwards over a ledge in her backyard and plunged eight feet. She sustained a concussion and experienced many lingering symptoms for 6 to 8 weeks including dizziness, brain fog, and sensitivity to light. She described what happened next like this: All this time my weight kept creeping up. I stopped caring about exercise, and during the COVID crisis, food become a joy and an escape. Then, I had a wake-up call, an ah-ha moment when everything suddenly changed. Angela described attending a wedding, and her husband was the photographer. When she saw herself in the photos, she was shocked that she no longer recognized herself because of the weight she’d gained. She also noticed that the day of the wedding, she’d eaten six huge but delicious chocolate chip cookies that her niece had baked. She says, It hit me, and I didn’t have to think twice. There’s a history of diabetes in my family, and I didn’t want to keep gaining weight and struggle with all the medical complications of type 2 diabetes. I want to be healthy and fit so I can live to an old age and enjoy my children and grandchildren! She used behavioral and TEAM-CBT skills to tackle the problem, starting with setting specific goals for herself. She said that lots of her patients who are overweight have vague goals, like “I want to lose some weight” or “I want to get in shape,” but general goals won’t be effective. In TEAM, you always focus on something specific. Angela explained the critical difference between Outcome Goals and Process Goals. An example of an Outcome Goal would be telling yourself that you want to lose ten pounds or whatever your goal might be. There’s a big problem with Outcome Goals. You might go on an extreme, like fasting or eating very little, so you can lose weight fairly quickly. Then you will feel happy and tell yourself that you’re done when you’ve achieved your goal. The big problem is that you haven’t modified your eating habits, and that’s exactly why you will quickly gain back all that weight you temporarily lost. Process Goals are different. Instead, you focus on the number of calories you can eat each day in order to lose weight, and then you make wise food choices within your calorie limit. In addition, you start out with a gentle but consistent exercise regimen, and then you slowly build up to more exercise. Angela started with two workouts per week and built up to four weekly workouts over time. She also set modest and realistic goals for weight loss, setting a calorie limit that would allow her two lose weight slowly, at the rate of just ½ pound per week. This plan has allowed her to lose 21 pounds, and she was looking terrific today! She has been using a free app called Lose It which provides her with all the information she needs for tracking calories bd weight, along with her BMI (Body Mass Index). She’s now on a maintenance diet of 1800 calories per day and she’s really pleased with it. We also illustrated several powerful motivational TEAM-CBT techniques, including: The Triple Paradox. You divide a piece of paper into three vertical columns where you list Advantages of your habit / addiction: First, you list all the GOOD reasons to continue with the status quo of unlimited eating and little or no exercise. Disadvantages off change: Next, you list all the negatives and hassles associated with dieting and exercise. Core values: Finally, you list what your overeating and slacking on exercise shows about you and your core values that’s positive and awesome. As you can see, instead of pushing yourself, or your patient, to change, you go in the opposite direction. You take the role of the subconscious resistance to change, and list all the really powerful reasons to continue with your habit or addiction. In other words, you try to convince yourself NOT to change! Oddly, this usually triggers tremendous motivation to CHANGE. This paradox is one of the key features in all of TEAM-CBT. You can see Angela’s Triple Paradox workshop if you click here. The Habit / Addiction Log. Here you record your tempting thoughts, such as: One more treat today won’t hurt. I deserve it/ I’ve had a tough day! That brownie looks SO GOOD! I’m an active person so I deserve to eat whatever I want. The Devil’s Advocate Technique. This is a powerful role-playing technique where you challenge and crush the tempting thoughts. We illustrate this technique with role-playing on today’s podcast. Angela plays the role of her Self-Control thoughts and Rhonda and I play the role of the Devil, tempting Angela to give in to her tempting thoughts. The Problem / Solution list. You divide a piece of paper into two columns by drawing a line down the middle. In the left column (Problems), you list all the things that will sabotage your efforts to diet. In the right column (Solutions), you list solutions for all of those problems. You can see Angela’s Problem / Solution list if you click here. We also discussed the issue of therapist resistance to these rather unconventional techniques. The problem is that therapists and counselors are trained to help. This paradoxically triggers patient resistance. TEAM-CBT requires one of the four “Great Deaths” of the therapist’s ego—the death of the co-dependent self that feels the compulsion to save, rescue or help the patient. David gave a personal example of the extremely adverse effects of “helping” when he was the patient in an interaction with a health professional at Kaiser Permanente in California. The physician’s zeal for helping actually had the opposite effect of driving David away, and he did not go to the doctor for the next ten years. So now you have a feel for the TEAM-CBT approach to habits and addictions. These methods can be surprisingly powerful but remember. You’ll have to do them on paper, as Angela did, if you want success. Rhonda and I will probably offer a free, two-hour workshop on habits and addictions in late January, and if you attend, you’ll have the chance to try some of these techniques on for size. We hope you can join us! Thanks for listening! And thank you, Angela, for sharing your personal example and for your awesome teaching. Rhonda, Angela, and David PS, I thought you might enjoy this "selfie," showing the amazing results that are possible after just a few weeks with TEAM-CBT!. Keep in mind that I'm 79. Just imagine what a few weeks of TEAM could do for you!

The featured photo shows Dr. Carly Zankman at the Big Sur with her 8 month old nephew, Micah October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and last week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies. This will be the second of two podcasts featuring a live therapy session with Dr. Carly Zankman, a courageous young psychologist. Dr. Zankman has been struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother. Last week, we featured the first half of her session with Dr. Jill Levitt and me at one of our Tuesday Stanford training groups. If you have not yet heard part one, you can link to it (podcast #268) at the list of Feeling Good Podcasts on my website. In this podcast, you will hear the conclusion of our work with Carly. We are also delighted that Carly could join us in person today to tell us what has transpired since the end of her session some months ago. You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session as well as her Brief Mood Survey and Evaluation of Therapy Session at the end of her session. You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought. There were a number of teaching points in Carly’s session: Depression nearly always results from telling yourself, and believing, that you have lost, or don’t have, something you believe you “need” in order to feel happy and fulfilled. It could be something internal, like greater intelligence or talent, or something external, like a baby, or a family, or greater wealth or status. There is a difference between a high-level and a low-level solution to most depression. In a low-level solution, you find happiness by getting what you want. For example, you learn that you are pregnant, or that you got an important promotion at work, or that someone you’re attracted to has accepted a date with you. In a high level solution, you discover that you can feel happy and fulfilled without the thing you were so certain that you “needed.” Although therapeutic empathy alone has limited healing powers, it can be absolutely precious and essential. Sometimes, people have a desperate need to be heard and given the space to express their feelings and to be accepted. In addition, people who have experienced a traumatic event or series of events often need the time to describe their experiences in detail. This can function like exposure, allowing the anxiety to diminish. Therapy without a meaningful agenda is highly likely to fail. And sometimes, a therapist has to “sit with open hands,” even when the patient’s agenda may be a bit different, or even radically different, from you own. Our task is not to force the patient to conform to our standards and expectations, but to help the patient find happiness on their own terms, pursuing their own goals. The Downward Arrow Technique was helpful and revealing during the Empathy phase of the session. This technique allowed us to pinpoint Carly’s core belief, which was also a Negative Thought on her DML: “I’m never going to feel fulfilled in life without children.” It is okay for therapists to struggle with, and discuss, moments of confusion or uncertainty during a session. This type of dialogue can involve the patient and can often help you find your path forward. There were some additional steps that could have been taken but we were limited by time. For example, we could have explored the interpersonal dimension of how to enhance the communication of feelings between Carly and her husband, as well as between Carly and other family members. She sometimes feels ignored and hurt. This problem is exceptionally common and can be addressed with tools like the Relationship Journal, the Interpersonal Downward Arrow, and the Five Secrets of Effective Communication. However, this can take some time, and also requires an agenda for the patient to be willing to examine his / her role in the problem and practice some new communication skills. Our negative feelings always result from our thoughts and beliefs, and not from the actual events in our lives. However, sometimes patients can be extremely fixated on certain beliefs that trigger their pain and may even put up a powerful wall to protect those beliefs. This is human nature, and part of what makes the job of therapy incredibly challenging, fascinating, and rewarding. We are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. You can find her Brief Mood Survey at the end of her session here, along with her Evaluation of Therapy Session. You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought. For more on this topic, you might want to give a listen to one of Carly’s favorite podcasts, #79: “What’s the Secret of a Meaningful Life: Life Therapy with Daisy.” (https://feelinggood.com/2018/03/12/000-live-team-therapy-with-daisy/) After the group, Carly received this email from one of the Tuesday group members: Good afternoon Carly, I want to let you know what I enjoyed the work you did yesterday. Despite the challenging and emotionally charged topics you spoke with great clarity and poise. I suspect some of the points were uncomfortable to talk about at times. You went into great detail and I never felt disconnected or lost. It all seemed very fluid and I found myself following along closely to the story. That was quite impressive. I suspect this talent is very helpful for your clients. I was curious if I could get your viewpoint about the exchange you had with Jill that brought up an emotional response on your part. Burns seemed to describe it as more self-defense while I think you described it as more acceptance. Perhaps my memory is off here so feel free to correct me. To me it sounded like you didn't want to give up the idea of having a baby and tying that to fulfillment so, with Jill's lead, you stated that one way or another you will be a mother. That is important to you and you will make that happen. Perhaps this was the "self-defense" part. I am thinking that maybe the Acceptance part was the acceptance of the emotion of the strong desire to be a mother and how important this is for you. Acceptance that you have this strong desire and that is ok to feel that way. Maybe the tears you felt were the tears of liberation in realizing that it was ok to have this desire because you believe in it strongly while many people may have been pushing you to let go of that. So you may not have accepted the idea of not having kids and being ok with that but you have accepted the strong emotion that is driving you to have kids. I suppose this is also captured to some degree in the positive reframe and the dial of that emotion and NT. Am I reading the situation right? Does this make any sense or am I totally off? Thank you for any thoughts you may have. This was a great experience for me. Warm regards, Jason This was Carly’s response: Hi Jason, Thanks for reaching out with your kind words. I’m CC’ing the Tuesday group because I think your question is great and imagine others might wonder, too. I don’t know whether it was self-defense or acceptance, but let me try to explain what happened in that moment. During the Externalization of Voices, Jill took a turn at arguing against the thought, “I will never be fulfilled without children,” but instead of arguing against it, she accepted it and then proceeded to list all these ways that I could make having children possible. I don’t remember exactly what she said now (I wish someone had written it down), but hearing her say what she said led to an “a-ha” moment for me where I realized that she was right; no matter what, I will make it happen because that’s what I do and that’s who I am. She tied it back to my values that were brought out during the positive reframe, and I accepted that I don’t want to change that thought because it’s motivating for me. Hope that helps clarify! Warmly, Carly

The featured photo shows Dr. Carly Zankman at the Big Sur with her 8 month old nephew, Micah Podcast #268 : An Ectopic Pregnancy (Part 1 of 2) October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and next week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies. This will be the first of two podcasts featuring a live therapy session with Dr. Carly Zankman. Dr. Zankman, a 27 year-old clinical psychologist in our Tuesday training group at Stanford, is facing a serious crisis involving motherhood. She is struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother. The featured photo for this podcast is Dr. Zankman at the Big Sur with her 8 month old nephew, Micah. You can see the love and joy in her face, and her intense desire to become a mother herself. The session took place at my Tuesday training group at Stanford, and my co-therapist was Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California. You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session  The DML reflected her feelings several weeks before, when she felt that her chances for pregnancy were greatly diminished, and the BMS reflects how she was feeling at the beginning of our session. As you can see, she was still moderately depressed and anxious, and her happiness and marital satisfaction scores were quite low, indicating that she was unhappy and somewhat dissatisfied with her relationship with her husband. Carly was also anxious about being on the podcast, due to these additional negative thoughts: I’m not going to be able to describe what I’ve been through. She believed this 70%. There’s a potential to be judged by people. She believed this 100%. In today’s podcast, you will hear the T = Testing and E = Empathy portions of the session, and in next week’s podcast you will hear the A = Assessment of Resistance and M = Methods portion of the session, and hopefully Carly will be able to join us for a follow-up to see how she’s been doing since the session. The show notes for next week's podcast will include eight teaching points. Rhonda Jill and I are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. Thank you for listening, David, Rhonda, Jill & Carly

Hi everyone! This podcast offers specific help to LGBTQ individuals who are under attack from loved ones who might judge them and criticize their sexual orientation or gender identity. Plus, we all get slammed at times by people who judge us for all sorts of reasons, which can be immensely painful, so most of today’s discussion will apply to people more broadly. I recently received a great email from Heather Donnenwirth, a therapist in Ohio who works with LGBTQ individuals. She mentioned that some of her patients struggle with how to respond to critical or judgmental statements from loved ones, including parents, and provided several examples: "Being Gay is wrong/a sin" "If someone doesn't know if they are a man or woman, then something is messed up in their head." "We are worried that you are going to go to Hell for your lifestyle." "We don't want your partner at our house, and we don't want to see any displays of affection." Heather wanted to know how one might use the Five Secrets of Effective Communication to respond to these kinds of criticisms. I invited her to join us in the podcast, and she wrote: I was excited about this topic. Thanks so much for including me. David's work has improved my life in so many ways and Rhonda's Wednesday TEAM training group has been a wonderful way to practice my TEAM skills and improve the kind of care I can offer patients. I appreciate and admire you both so much!! Also, I can't wait to meet Kyle!! I also invited the brilliant and wonderful Kyle Jones to join us. Kyle is a TEAM therapist who joined my training group in 2016 before ever seeing a patient! He is completing his PhD in clinical psychology at Palo Alto University and his dissertation research focuses on psychologists who provide mental health treatment to LGBTQ people. Kyle joined us in 2018 for a FB Live TV program on dating and flirting strategies (https://feelinggood.com/2018/06/17/dating-strategies-today-on-fb-live-sunday-june-17-2018-at-3-pm-pst/) and in 2019 for Podcast 151 on treating LBBTQ individuals with TEAM (https://feelinggood.com/2019/07/29/151-working-with-lgbtq-patients-whats-the-team-cbt-approach/). During today’s podcast, we used the excellent statements that Heather provided in role-playing exercises with the Five Secrets of Effective Communication. We used the Intimacy Drill that I developed, which is by far the best way to master the Five Secrets. We also discussed the issue of the inner dialogue that always accompanies the outer dialogue with the person you’re in conflict with. If you get anxious, depressed, and angry when criticized, it will be much more difficult to use the Five Secrets skillfully, because you may feel defensive and resentful and inadequate. So some work with the Daily Mood Log may also be invaluable before trying to use the Five Secrets. Finally, we discussed the question of “Outcome Resistance.” This means asking yourself if you WANT to develop a more loving relationship with a loved one who is being highly critical of you because of your sexual orientation, or for any other reason. We decided it is perfectly acceptable to decide NOT to try to develop a more loving relationship, if that feels better to you. It may even be in your best interest or help keep you safe from harm if you’re an LGBTQ person facing discrimination and persecution because of your sexual orientation or gender identity. I explained my own anger toward my father who was a successful Lutheran minister. However, when he retired from his ministry at the Shepherd of the Valley Lutheran Church in Phoenix, Arizona, he began working with gay individuals at the Arizona State University, trying to convert them to a heterosexual orientation. This was profoundly disturbing to me, I felt a great deal of shame and anger, and it ultimately led to a sad rupture of our relationship. Rhonda, Heather, Kyle and David

266: Ask Matt, Rhonda, and David: Can we solve the pain in the world? How can we deal with someone who might weaponize our vulnerability? What can I do about my emotional eating? And more! Today's podcast features awesome questions from viewers like you, with answers from Rhonda, David, and our brilliant guest expert, Dr. Matthew May. Here's the list of questions, followed by partial answers (prepared prior to the podcast) from David. Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world? Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies? Telia asks: Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life. Daniele asks: What “upsetting event” should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression? Anca asks: Should I work on a different upsetting event every day and do a Daily Mood Log? What about the days when I don’t have any distorted negative thoughts? Oliver asks: Dear Dr. Burns, How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)?  What is overkill when doing Positive Reframing? Sarah asks: Hi Doctor Burns! Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage.(By way of explanation, Sarah is referring to an episode on the Five Secrets where the wife was blaming her husband for saying, “You never listen” for 25 years, and was shocked to discover that she was causing the very problem she was complaining about.) * * * Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world? Thanks, Ezgi, I will read and answer this on an upcoming Ask David. I have committed my life to helping people who ask for help with depression, anxiety, and other problems. I do not evangelize or reach out, trying to convert people to some new way of thinking and feeling. Also, I only work with people one to one, (or in groups), and I think healing must begin with yourself. There are tons of free resources on my website, plus my books, like Feeling Good, and others, can be invaluable, including on the topic of suicide. You can get used copies inexpensively on Amazon, too! All the best, david * * * After Hearing Podcast 14 on the Five Secrets Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies? Thank you, I appreciate you and all you do to make the world a kinder and gentler place. David’s Response Hi Megan, Please provide a specific example. What did the other person say, and what, exactly, did you say next. One exchange is enough. Then we can do something amazing, and not just BS on an abstract level that will be useless. You see yourself, based on your note, as the sweet innocent victim of the other person's "badness." Once we have a specific example of an interaction that did not go well, and you focus on your own role, things will suddenly fall into a shockingly different perspective. david Will include this in an Ask David. * * * Telia asks: Hi David, Thank you so much for your free information and podcast #155 on emotional eating. Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life. I listened to episode 155 but I need more help like actual questions to ask myself or tools to use in the moment. I have suffered with this my entire life, and I know with your help I can be free from it. Thank you Telia from Australia David’s Response Hi Telia, Check out the free chapter(s) offer on bottom of my website home page. Full instructions are right there. Feel free to contact me if any questions after following the guidelines there, and doing the exercises on paper. d * * * Daniele asks: What “upsetting event” should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression? Hello Dr. Burns, i am reading your second book, Feeling Great. The first one, the new mood couldn’t help me or i couldn’t get it done right. And now i am trying Feeling Great. I like the book and your thoughts. I have struggled with anxiety and depression since 2014 - on and off. Lately more on.... My biggest problem with the exercise is that you have to put an event that make you depressed. I don’t know exactly why it started and i so it’s difficult to find an event. What can I do? I feel depressed and don’t know why. These days the fact that i couldn’t get rid of the depression for so long is the main reason why i am depressed. Thanks for your help, Daniele from Italy David’s Response Hi Daniele, You just have to focus on one specific moment when you were upset and want help. It can even be the moment when you are working with the Daily Mood Log. d Thank you, Dr. Burns! Daniele * * * Anca asks: Do I have to complete a Daily Mood Log every day? Hello Dr Burns, Thank you so much for the podcast and all the wonderful resources you are gifting to the world! I've been listening for the last 3 months, and I can say that your discussions with your colleagues and patients have improved my mindset and my perspective on life. They helped me to identify feelings of self-blame and other-blame that I didn't even know I had. I also didn't realize how toxic they were. I've bought the Feeling Great Book and completed 2 Daily Mood Journals. I am still in the beginning and try to improve my skills for challenging the negative thoughts. I am just wondering if I am approaching this correctly - sorry if I missed this from the book - Do I need to complete the Daily Mood Log every day? I am asking this because on the days I do feel down and do have a negative event and thoughts, it takes me a lot of time to complete the log, around 2 hours. On other days I feel ok, and don't have upsetting distorted thoughts. Should I record one negative event every day, with all the negative emotions and thoughts that come with it, or work on the same upsetting event every day, taking on one or 2 thoughts at a time? Thank you for your support and your generosity. With Gratitude, Anca David’s Response Hi Anca, Will make this an Ask David. The short question is that you can work on the DML a little bit every day. I would aim for 15 to 20 minutes a day, like meditation. On some days, you will want to put in more time, which is fine, but you get 100% credit after 15 – 20 minutes. You can work on a DML over several days. This is just one idea, and ultimately you are in charge! Congrats on the fantastic work you are doing! david David * * * Oliver asks: Dear Dr. Burns, How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)?  And how much time did they actually spend on a mood journal? From my experience, I seldom complete them in 2 hours, the time you set up for one session. A daily mood journal with 5 negative thoughts would often cost me 4 to 6 hours. I am wondering how much time your patients usually spend on one daily mood journal? Besides, when I was filling out one daily mood log, more upsetting events would float in my head. To avoid being distracted, I recorded the second upsetting event on another Daily Mood Journal. But I found I never had the chance to work on it because I seldom completed the first event. I am now unemployed, so I have enough time to work on an upsetting event, even if it cost me far more than 2 hours. However, I doubt if full-time employed people have enough time to do this homework, without sacrificing the time to be spent on families, sleeping, sports, and other activities. That is somewhat upsetting. Do you require your patients to finish a Daily Mood Journal in one day? I believe the guidance on this topic is not only important for me, but also for all of your readers and patients. And another question that confuses me is that what is overkill when doing Positive Reframing? And when to decide it will be overkill or not? Thanks. Oliver Smith David’s Response Thanks, Oliver. You can do a DML over several days, no need to complete it all at once. 15 to 30 minutes per day would be excellent. ON Positive Reframing, I wait until we “get a feel for it,” and we generally have listed a dozen or even 20 or so positives. I have an app I’m working on that will help with these questions. Will read your question on an Ask David, perhaps. Thanks! * * * Sarah asks: Hi Doctor Burns! Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage. If we all cause the very relationship problems that we are complaining about, what is it that the husband is doing to cause Sarah not to listen to him and explode in anger? I see that Sarah is not able to listen and empathize, however, It seems like the husband is able to listen and empathize. What would his next step be? Thanks! Sara David’s Response Thanks, Sara. This is an interesting but abstract question, and I never find that answering them is productive, as 100% of the learning is in the specific example. If he were asking for help, I would ask him to write down one thing that his wife said, as well as what, exactly, he said next, thinking of an exchange that didn't go well, and an example he wanted help with. Then we’d use the EAR technique to analyze his communication errors and show how he’s causing the exact problem he’s complaining about, followed by a revised response using the Five Secrets. You could do that for yourself, and we'll see what YOU might be able to learn! For example, what is something someone said to you, and what, exactly did you say next? Or, you could make up an example for me to comment on. * * * That's it for today! Rhonda, Matt, and David

Podcast 265: An Extreme Leech Phobia: Once Bitten, Twice Shy! Today’s podcast features the treatment of an extreme leech phobia in real time, using live leeches. Dr. Danielle Kamis, a clinical psychiatrist practicing in Los Altos, California, is our courageous patient, and Dr. Matthew May, a frequent guest on the Feeling Good Podcast, conducts the treatment, while David and Rhonda observe and comment. If you ever saw the famous Humphrey Bogart movie, “African Queen,” you know how terrifying leeches can be. But why in the world would anyone working in downtown Los Altos, California, need or want treatment for a leech phobia? Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world (Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world.  She has had a keen interest in global health work and has spent a significant amount of time doing research with indigenous population in the pre-Andes mountains of Argentina. She has also spent time living with tribes deep in the Amazon forest as well as the jungles of Sumatra. These experiences have transported her back in time to better understand the core components of humans in our most natural state. She described a terrifying experience while exploring in a jungle in Sumatra, where the leeches not only invade the water, but can also drop onto you from trees. After hiking through the beautiful, lush landscape for some time, Danielle began screaming and sobbing in terror when she noticed that her foot was bleeding because of a leech that had just detached itself. This was understandably embarrassing, and she realized that she needed to overcome this fear before going on another jungle adventure. In today’s therapy session live leeches will be placed on Danielle’s skin, and she will be encouraged to surrender to the anxiety and make it as intense as possible, rather than running away or trying to control or avoid it. This is an extreme form of exposure called “flooding.” It  can be incredibly effective, and often works quickly, but requires great courage on the part of the patient and therapist, as well as a high degree of therapist skill. To prepare for today’s exposure session, Danielle obtained four live leeches, which she kept at her apartment. She said that even looking at the leeches slithering around in the water and thinking about them biting her made her fear instantly jump to 9.5 on a scale from 0 (not at all) to 10 (the most intense anxiety). She asked Matt if he’d be willing to do the leech exposure first. Matt agreed, since we never ask our patients to do anything that we wouldn’t do, ourselves. This modeling by a trusted friend or therapist can be a useful tool in the treatment of anxiety. Danielle carefully removed one of the leeches with a spoon and placed it on Matt’s forearm. After crawling around for a minute or so, the leech attached itself and begin to engorge itself on Matt’s blood. Danielle watched in fascination and fear, and then it was her turn. She bravely placed a second leech on her forearm. She was afraid it was going to be extremely painful, but was surprised when it was just a mild feeling of sandpaper on her skin. Over a period of about ten or fifteen minutes, with episodes of nausea and profuse sweating, Danielle’s anxiety gradually dropped from 9.5 at the start all the way to 1, and she felt triumphant. You can see some photos and videos of the session here, including our lunch prior to the session at the Phoa Cabin in downtown Los Altos. It is a favorite local spot that features tremendously tasty Vietnamese food.  (LINK) Teaching points in today's TEAM-CBT session include the following: Avoidance is one of the major causes of all forms of anxiety. When you avoid or try to escape from your fears, they will always intensify. Exposure is a powerful treatment tool for anxiety, but is not a treatment per se, and there are many additional tools with powerful anti-anxiety effects. I (David) use at least 40 tools in the treatment of anxiety, but exposure must always be included in the mix. It is probably impossible to cure any form of anxiety without exposure. All patients and most therapists resist and fear exposure. Patients fear exposure because of the intense anxiety they must endure and their belief that something terrible will happen if they don’t avoid their fear, and most therapists are also afraid that the patient is too fragile, or the procedure is too extreme, and something terrible will happen. However, I (David) have never had a bad outcome when using exposure. I am convinced that poor therapy skills, and not exposure, cause negative outcomes in the treatment of anxiety. Excellent empathy is extremely important in treatment of Anxiety. Danielle mentioned the importance of her trust in Matt, and in his modeling of the exposure in the treatment. I (David) strongly agree with this, as I have had to use exposure in the treatment of my own fears and phobias and have also benefitted from doing exposure with someone I trust and admire. Once you’ve beaten a phobia, and no longer fear the thing that once caused terror, fears have a way of creeping back in, especially if you do not continue to face the thing our feared. To prevent this, ongoing exposure is needed. Although Dr. May treated Danielle for this problem successfully in the past, Danielle’s intense fear of leeches had returned during the COVID pandemic. While some form of relapse is almost always inevitable, the good news is that facing your fear frequently can massively reduce the frequency and intensity of relapses. Danielle seemed pleased with her session and agreed to do ongoing exposure on her own every day with the leeches as homework. The next day, we received this email from Danielle. Hello! I had a fantastic time yesterday with you and I am so grateful for all of your support and guidance. Thank you so much for taking the time to help me overcome my fear and help others do the same! It was so wonderful and special seeing you all again in person. Here are some awesome photos from the session as well as our lunch at the Phoa Cabin, and this link contains two videos. Rhonda, Danielle, Matt, and David