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

239: Ten Days to Self-Esteem, Featuring Dawn O’Meally Dawn O’Meally is a licensed mental health professional from Westminster, Maryland who purchased my book, Ten Days to Self-Esteem workbook (link) as well as the Ten Days to Self-Esteem Leader’s Manual for at a workshop she attended in 2002. This is a 10-class self-esteem training program for patients and the general public. The groups can be led by a therapist or lay person. This book was the basis of a large and successful treatment program at the hospital where I practiced in Philadelphia. Dawn described reading the books and telling herself, “I can do this!” Since that time, she has conducted roughly four Ten Days groups per year. The improvement in her patients has been phenomenal, due, in large part, to her spark, creativity, and gift for teaching and inspiring individuals struggling with depression, anxiety, and low self-esteem. In the podcasts she takes us through the first seven steps of the ten-step program, and reads testimonials from patients like Julie who wrote: “I had many WOW moments. This book is my bible!” If you are interested in setting up a similar program in your area, feel free to contact Dawn at dao@tcc4change.com. I think it is fair to say that today’s podcast is electrifying, and filled with the same excitement that Dawn brings to her patients! Dawn describes herself as a little like Miss Frizzle with her Magic Schoolbus. I’m not personally familiar with Miss Frizzle but it does sound like fun, exciting, and creative, three strong characteristics of Dawn. She describes how she makes patients accountable, requiring a $50 deposit they can earn back by coming to groups on time and doing their homework (HW). As a group, they also do a Cost-Benefit Analysis (CBA) on the Advantages and Disadvantages of doing the HW, and review the list of really GOOD reasons for NOT doing the HW in the book, with each member ticking off the ones that resonate with their own thinking. She said some of the most popular ones are: I’m afraid of what might happen if I DO change. I believe that others are to blame for my problems, so why should I have to change? I don’t trust Dr. Burns! I’m not convinced the exercises in this book will really make a difference in my life. Dawn described several of the “steps” in the group, including the exciting steps on “You FEEL the Way You THINK” and “You can CHANGE the Way You Feel.” She said that members found the lesson on healthy vs unhealthy negative feelings illuminating, and the lesson on the Acceptance Paradox was mind-blowing. The group trains participants in 15 techniques for crushing distorted thoughts, and some of the popular ones include the CBA, Examine the Evidence, the Double Standard Technique, and the Acceptance Paradox. She described the feared and famous “Mirror Method,” where patients pass a mirror around the group and each one has to look into it and verbalize his or her negative thoughts, like “I’m a failure,” and “I’m the worst mother on the planet.” Then they have to talk back to that thought, using the second person, “You,” as they talk to themselves in a more realistic and compassionate manner. She also does the T = Testing at each group session, tracking changes in depression, anxiety, and relationship satisfaction and sees significant reductions in scores on the mood tests by the end of the program. She also gives each participant a “report card” at the end of the program so they can see how much they progressed. Participants FEEL so much better! At the start of the group she tells participants, “If you attend the groups and do the exercises in the book, you WILL change. This material can’t not have a huge impact on your life.” She said that at the end of the ten sessions, the participants see that this really did happen. She emphasized that she greatly prefers treating people in groups, but calls them “classes” due to the stigma of “group therapy.” I, David, strongly agree, as this has been my experience as well. With a skillful group leader, and great material, magic becomes possible! Dawn has done much more, creating follow-up groups for interested patients, as well as a new program based on my new book, Feeling Great (link), so we hope to have an encore appearance from this bubbly and brilliant woman! Rhonda and David

238: Feeling Great Book Club Featuring Drs. Sharon Batista and Robert Schacter In today's podcast, Drs. Sharon Batista and Robert Schacter describe their visionary 16-week Feeling Great Book Club for mental health professionals that we mentioned in a podcast several months ago. The group was a great success, and I am super thankful to them for creating it! Sharon described how the group came into being. She’d been looking forward to Feeling Great and ordered the hardbound and the audio version as well. But she found, like so many mental health professionals, that it is difficult to keep up with career and family, and sent out a post to colleagues suggesting a possible book group to make the process of learning easier. Bob wrote back and said, “What a brilliant idea! Let’s do it!” Sharon and Bob reported that the more than 40 therapists signed up for the Book Club, which consisted of 90-minute sessions every other week. The participants ranged in experience from Level 1 to Level 4 certification in TEAM-CBT. Sharon explained that “People liked learning the parts of TEAM piece by piece. Being assigned to read 1 chapter per week gave them enough time to read and digest the material in small chunks. And people had a myriad of questions at every group.” Sharon and Bob graciously said that “a highlight for the group was the time David attended and generously gave us over two hours for Q and A.” For me (David) it was also a peak experience. Due, in part, to my narcissism, I just love answering questions, and they asked tons of really good ones! The other phenomenon they described was that “we became a group. It was comforting to see each other every two weeks with a common purpose and sense of community. People felt the group was relaxed and said they gained more understanding than from the training groups they’d been in. People were relieved to discover that they weren’t the only ones who thought TEAM-CBT was very complex.” Sharon added; “As therapists, we face lots of challenges and sometimes make mistakes. The participants got a lot of support and engaged in a process that involved learning and personal growth.” The questions from book club members began with clarifying the descriptions of the ten Cognitive Distortions. People asked questions like these: What is the difference between Overgeneralization and Mental Filtering? Why is a Should Statement a cognitive distortion? Why do some methods work better than others for various distortions? How do we know which ones to use? What is Unconscious Resistance? Why does the therapist need to become the voice of that resistance? What do you do when nothing seems to be working? Can you explain how the Magic Button leads to the “Switch” that makes someone decide to get better. How do you show empathy to someone who is suicidal? Can you explain the Death of the Ego? (This was a big question) When you are dealing with the spiritual side, how do you take the path of acceptance? What is the path of acceptance? What is the difference between a low-level and high-level solution? How can you be happy if the negative thoughts are true? How can you do TEAM-CBT when only 50-minute sessions are possible? Tell us what Enlightenment is! A major question was: Why do some people seem to not want to get better? How do you figure out what the resistance is, and how do you work through it? We shot the breeze about some of these questions in today’s podcast. If you would like to start your own Feeling Great Book Club for therapists or for lay people, and need more information, feel free to contact Sharon or Bob. Sharon M. Batista, M.D., FAPA, FACLP, FAMWA Medical Director, Balanced Psychiatry of New York  (212) 869-0515 drbatista@balancedpsychiatry.com Rhonda and I want to thank both of them and send them a big virtual hug!

Podcast 237: The Gentle Ultimatum: Can We Make Our Patients Accountable? April 12, 2021 At the top of the podcast, Rhonda reads several beautiful and thoughtful comments from listeners like you. One was an enthusiastic listener who found us on YouTube and wondered why we don’t have vastly larger audiences, since the quality of what we offer is not only free, but it beats out all the other “self-help gurus” by a large margin. Thanks for that. We are not experts in market and could use all the help we can get. So if you can spread the word for us, we’d appreciate it! David announced that his next workshop with Dr. jill Levitt will be on May 16, 2021, featuring David and Dr. Jill Levitt working with two audience volunteers who are struggling with depression and anxiety. Link to Registration Information It should be dramatic, inspiring, and profoundly educational, so you can see how TEAM-CBT really works in a live and spontaneous setting with no role-playing. This will be the real thing! One of the unique features of TEAM Therapy is the Gentle Ultimatum. At the beginning of therapy, we tell patients what will be required of them, and how the therapy works, if we accept them as patients. That way, they can make an informed decision about whether or not they want to work with us. This table illustrates what they’ll be asked to do. Problem What the “Gentle Ultimatum” involves Rationale Depression Psychotherapy homework David’s published research indicates that psychotherapy compliance has massive causal effects on recovery from depression. Anxiety Exposure Extensive research shows that Exposure is effective in the treatment of all forms of anxiety. Clinical experience indicates that full recovery from depression is difficult, if not impossible, without exposure. A Relationship Problem Giving up blame and focusing on your own role in the problem Research and clinical experience indicate that blame is probably the main cause of troubled relationships.   In the podcast, David and Rhonda discuss the rationale for the Gentle Ultimatum, as well as how to do it skillfully, and when. David describes his own reluctance to make patients accountable during the first seven or eight years of his practice, and what happened to change his mind, and how that led to the emergence of TEAM-CBT. David also describes the correct and incorrect way of presenting this to patients at the initial evaluation in a kindly, collaborative way. This requires therapist integrity, skill, and compassion. You cannot simply issue a crude “my way or the highway” demand. David also describes the Concept of Self-Help Memo that he created and began sending to patients prior to their first visit. The memo explains the rationale for requiring psychotherapy homework, briefly describes the ten most common forms of homework, and asks patients if they are willing to do homework if accepted into the clinical. The memo also asks how many days per week they’ll agree to, how many minutes per day, and how many weeks she or he will keep it up. The memo concludes with a list of “35 GOOD Reasons NOT to do Psychotherapy Homework,” and patients indicate how strongly they agree with each one. David illustrates how he discusses the memo, and the topic of homework, with new patients. David compares the Gentle Ultimatum with what happens when you go to the doctor with a broken leg. He or she might say you have to get an X-ray, and then we’ll give you a cast. If they patient protests and says that she or he is against X-rays and casts, and wants to be treated with “talk therapy,” the doctor would politely decline and explain that s/he is using a medical model of treatment, and that “talk therapy” is not offered for broken limbs. David and Rhonda explore the fairly intense resistance of many, and perhaps most therapists to making patients accountable. Rhonda describes her own inner fight about this, and how she had to terminate a patient recently because s/he refused to do homework, and opted for pure “talk therapy” from another therapist instead. The table above indicates that if the patient is struggling with anxiety, Exposure is the focus of the Gentle Ultimatum. If the patient wants effective treatment, Exposure will be required, and not an option. If, in contrast, you want help with a relationship problem, like a troubled marriage, you will have to agree to stop blaming the other person, and focus on pinpointing your own role in the problem, which can be immensely painful and humiliating. But it’s also liberating, because when you change yourself, instead of blaming the other person, you can transform trouble relationships into loving ones. Rhonda points out a potential conflict of interest with TEAM-CBT and the Gentle Ultimatum. It can lead to such rapid recovery that therapists need a large flow of patients. David mentions that one of the therapists in Rhonda’s FeelingGreatTherapyCenter.com, Sunny Choi, has this exact problem. His patients are getting better so fast he can’t keep his practice full. David urges potential patients to contact him, if interested, since Sunny is not only remarkably skillful, but he has a big heart and low fees, with a sliding fee scale, too. Thanks for listening today! Rhonda and David

Upcoming Workshops The Cognitive Distortion Starter Kit With David Burns, MD A One-Day Workshop on May 5, 2021 Click here for more information including registration! 8:30 AM to 5:00 PM West Coast Time: 7 CE Credits   Bringing TEAM-CBT to Life in Real Time Two Live Therapy Demonstrations with Drs. David Burns and Jill Levitt REGISTRATION CLOSES AT 5:30 PM PACIFIC TIME ON SATURDAY 5/15/21. NO EXCEPTIONS. Live Online Workshop with David Burns, MD and Jill Levitt, Ph.D. Click here for more information including registration! May 16, 2021 | 7 CE hours. $135 8:30 AM to 4:30 PM West Coast Time   Binoy asks: How does one know that a thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling one? What is the basis? Binoy also asks: Is there something called “objective truth” that we can all agree on? Kristina asks: I have been labeled codependent in therapy. Is it a true label? . . . Do you believe in highly sensitive or empathetic people that can feel others energy? Fabrice asks: What do you think about this definition of the “self?” Don asks: Is TEAM as effective as you say? Binoy asks: I live in an Arab country and some of the things on your list of Shame-Attacking Exercises could get me arrested. Is there a better way to overcoming anxiety? * * * Binoy asks: Hi David, I just listened to podcast 079: “What's the Secret of a "Meaningful" Life? Live Therapy with Daisy." One of the questions that came across my mind is, how does one know if a negative thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling distortion? What is the basis? Hi Binoy, thanks! Excellent question I might address on a future Ask David podcast. However, I would need you to give me a specific example of a thought you want help with. Specifics typically lead to illumination, whereas abstract thoughts sometimes lead to endless pontification. Binoy also asks: “Hi David, I did listen to the podcast #20 on “The Truth About Antidepressants.” I wish everyone agreed that there is something called objective truth. This is a question about truth or the existence of objective truth. Is the popular ideology that there is nothing called objective truth (everything is relative) correct? How can we talk about truth in a way that will help us be on the same page? So, I hope to hear from you again! Hi Binoy, this is also an abstract question, best answered through specific examples. For example, I can explain the concept of controlled outcome studies to test a drug against placebo, but even there you can find lots of ways to challenge any scientific study. We can also talk about distorted negative thoughts that trigger negative feelings like depression and anxiety. These thoughts are not really true. but we always focus on one specific thought at a time, and only from someone asking for help. I do not pontificate about “truth” in some abstract sense! All the best, david * * * Kristina asks: I have been labeled as codependent in therapy. Is it a true label? Hi Dr. Burns, Thank you so much for all your services and help that you offer Dr. Burns. It has been life changing and I’m just starting to help myself out of this anxiety and depression. I wanted to ask how you feel about the terms, codependency and boundaries. I have been labeled codependent in therapy and is it a true label? Do you believe in highly sensitive or empathetic people who can feel others’ energy? Thanks again for all you do! Thank you, Kristina   Hi Kristina, I had to look up the term. According to dictionary.com, someone who is codependent “is in a relationship in which one person is physically or psychologically addicted, as to alcohol or gambling, and the other person is psychologically dependent on the first in an unhealthy way.” David and Rhonda can mention: the “codependency” and compulsion to “help” or “rescue” that often gets therapists into trouble with patients. This is a kind of addiction that therapists have, and is the main cause of therapeutic failure. that I work with specifics more than labels. For example, if a patient wanted help with “codependency,” I would ask him or her to describe a specific time on a specific day when this seemed to be a problem. Then I’d figure out what was going on, and find out if it was an individual mood problem or a relationship problem. After empathizing, I would find out what, if anything, the patient wanted help with, and then I’d bring the resistance to change to conscious awareness. My research on empathy indicates that even therapists are not accurate in sensing how their patients feel. The same is true, I believe, of the general public. People vastly overestimate their capacities to understand how others are thinking and feeling, and this is super easy to demonstrate with simple experiments using rudimentary statistical analyses. David * * * Fabrice asks. What do you think about this definition of the “self?” Hi David & Rhonda, Start with this: When I refer to my "self," I am speaking of the sum of my experiences and the trails they have left in my mind, my body, and my life circumstances, as well as the material things that are associated with me, beginning with my body, symbolized by the name printed on my ID card. This "self" has certain characteristics, including past actions, habits, patterns, qualities, flaws, etc. So, the first question is, how can you say that this "self" does not refer to anything? I know very well who I am, and I am distinct from any other "self" that presents him/herself to me. The second question is, based on the previous definition, why can't I pass judgment on the different attributes of that "self"? If that self has never been able to solve a linear equation, can't I call it "bad at math?” If that self almost always turns in its assignments after the deadline, can't I call it "slow" or "procrastinating?” And so on. I agree that passing negative judgment on a self can lead to that self having some unpleasant emotions, but that doesn't mean that those judgments are meaningless. I suspect that some listeners were turning over thoughts like these in their minds. I hope that gives you something to sink your teeth into. I'll try to be more specific about future episodes. Take care, Fabrice Nye Hi Fabrice, Thanks! When I get time to redo the deleted chapter on the “self” from Feeling Great, I can perhaps include these questions, although I did pretty much cover them in several of the later chapters in Feeling Great on the impossibility of judging the “self,” as opposed to things we think, do, or say. My problem is that people don’t “get” or “grasp” what I’m trying to say. Below, you seem to think I believe the “self does not exist,” and you have some excellent attempts to define it and prove that it does exist. At least that’s my take on it. My position is radically different. To me, the statement “the self does not exist” and “the self does exist” have no meaning. The statement, “I don’t know if the self exists” also has no meaning to me. This is language that is “out of gear,” so to speak, as Wittgenstein might say. You can press on the accelerator all you want, but the car won’t move forward when it is not in gear. But most people, nearly everybody in fact, have tons of trouble grasping this. You probably “get it,” I don’t know! I am just referring to your email, where you say the self is such and such. Nouns do not always refer to “things” that could “exist” or “not exist.” Still, when I say this, it goes in one ear and out the other, I’m afraid! And that was why Wittgenstein was intensely lonely and frustrated, and often depressed, and perhaps why he never attempted to publish anything during his life. You can certainly say, “I’m not very good at math. In fact, I’m below average at math.” This means that your math skills are below average. Does it also mean that your “self’ is below average? Many of my skills and attributes are below average, but that does not upset me or threaten my feelings of self-esteem for two reasons: I don’t believe that my worthwhileness as a human being depends on anything. I don’t believe that “worthwhileness as a human being” has any meaning. I don’t believe the statement, “the self exists,” has any meaning. What would it be like if “the self” didn’t exist? What are we actually talking about? But if I judge my “self” to be “inferior” or “worthless” or “below average,” that type of self-critical thinking can cause a lot of emotional pain, and can, in extreme cases, even lead to suicide, thinking that “I am not good enough.” david I asked Fabrice if he wanted to comment on my response above, and if I should include it in the show notes. He gave a really cool answer: Hi David, Yes, you can absolutely include it. From your response here, you ought to make it clear that your point is that the language is not meaningful, therefore the word, "self," is not meaningful. But you may need to delve deeper into this. If you do that, you're going to end up at the same place the Buddha ended up when he discovered the ultimate emptiness of things. Of course, he didn't talk about "things," since that's meaningless too, just emptiness. Fabrice Nye By the way, you may enjoy Fabrice’s new podcast. Here’s the link: https://podcasts.apple.com/us/podcast/peace-at-last/id1496573038 The following email might also help. Hi Rhonda, Here is the other Ask David with the remainders from our last one. If we use this one, let’s please be sure to include your through about your “self” as “a mom,” “a psychologist,” and so forth, and how I responded to it, as I thought that was really helpful. We can judge and talk about what we DO, and not what we ARE. We can use the word, “self,” in a variety of ways that are meaningful. For example, Behave yourself. This means stop behaving badly. Just act like yourself on the date. This means don’t try to impress your date. Instead, show an interest in him / her. Why you write, try to tune I on your true “self,” and stop acting so fake. This means you need to change your tone of voice when you write. Share more of your feelings and vulnerabilities. All these uses have specific meanings. They are not metaphysical or philosophical claims, just attempts to influence someone’s thinking, feelings, or behavior. “Self” is just a sound that comes out of your mouth. It is not an esoteric or metaphysical “thing” that could “exist” or “not exist.” Aristotle thought that nouns were descriptions of “things” that existed in some ideal alternative reality. For example, he thought that tables are just imperfect examples of some perfect essence of “tableness” that exists somewhere. This erroneous view of language gave rise to most of the problems in philosophy, as well as most of our emotional problems of feeling we have a “self” that isn’t important, or isn’t worthwhile, or isn’t good enough, and so forth. d * * * Don asks: Is TEAM as effective as you say? Hi Dr. Burns, I feel compelled to say, with the greatest respect and affection, that the very concept of successfully treating my lifelong battle with depression, anxiety, and ocd within a few hours seems, at face value, far too good to be true! Is it really possible? I've endured countless disappointments and treatment failures from many, many therapists, all of whom wasted months or even years of my time, essentially to no avail. Tell me again: Is short term treatment, as described, as potent as TEAM promises. It's just so hard to believe! DBs Comment: Don went on to describe chronic severe mood problems and recent intense feelings of anxiety due to medical problems in his family. Hi Don, Good questions. Here are some thoughts. Effectiveness depends on the skill of the therapist, and TEAM is challenging to learn. I’ve been at it for more than 40 years, and have used T = Testing at every session with every patient. This has been my greatest teacher—my patients. Some of my students have achieved high levels of skill, and they are the ones who have put in tremendous effort to learn. There are not yet many of them, sadly, and that’s why I’m working on an app. . . . So I can make these tools available to large numbers of people who are suffering. We will be starting a new beta test in a few weeks. It is in progress, and very labor-intensive to develop, but if it works, it will be fantastic. An inexpensive way to find out if TEAM is for you, and you have perhaps done this already, would be to read Feeling Great and do the written exercises while reading. Then you’ll find out if you like the new methods, and if they are helpful for you. I assume you’ve already read Feeling Good and done the exercises. Is that correct? The results I report are the results of my work with patients, using TEAM. I only report truthful things, and don’t fabricate results! I am analyzing a huge data base of thousands of TEAM therapists at the Feeling Good Institute, but it is a naturalistic study, and interpreting the results is challenging for a variety of reasons. The mean reduction in depression scores in a large number of severely depressed individuals in four or five sessions was 59%, which is excellent. It is little bit hard to interpret that result because when patients recover, they drop out of treatment, so the mean depression score in the data you analyze at any session is the mean of those who are still in treatment who have not yet recovered. Therefore, the analysis is potentially biased in a negative direction, if you see what I mean. My published research shows that psychotherapy homework is crucial to success. Some patients are strongly opposed to doing homework, and they are likely served better by therapists who do not believe in the value of psychotherapy homework. The rapid recovery I see is in the treatment of depression and anxiety. Relationship problems are much more challenging to treat due to the intense resistance people have to looking at their own role in a problem instead of blaming others. Habits and addictions can be slower and more challenging, too, since the temptations to give are so pervasive and powerful. Thanks! I hope this information in helpful for you. Here’s an afterthought. Sometimes when people ask me if this will really work, they are actually skeptical or even annoyed, and expressing resistance or a lack of enthusiasm for the treatment techniques I have created. I do not try to sell patients on anything, and feel strongly that people should find an approach they are enthusiastic about, even if it is radically different from the methods I have developed! I strongly applaud skepticism and critical thinking, but it is also true that trust and TEAMwork are vitally important dimensions of successful treatment. If a patient is putting up a wall and resisting, that must be dealt with first before there is any chance for success. The approach to resistance is radically different from answering questions as I am doing here. I hope that makes sense! Here’s the type of thing I’m saying, or trying to say. If you’ve been burned in the past, and had negative therapeutic experiences, it would make sense that you’d be reluctant to trust, or to hope, or to collaborate, for fear of being let down yet again. I would want to bring this issue to conscious awareness at the start of therapy with anyone who has strong feelings of skepticism, and anyone who is saying “prove it to me” when we start therapy. Almost all the patients I’ve treated have had months, years, or decades of failed therapy in the past. But that’s not so crucial. The crucial question is, can we work together with some trust and enthusiasm and teamwork? And are you willing to do what will be necessary for a positive outcome? This might include doing regular psychotherapy homework, being willing to use Exposure techniques for anxiety, like OCD, and so forth. Lots of people don’t want to do homework or use exposure, and they may have other objections to the treatment, which I honor. I don’t try to persuade or twist arms, since those approaches are doomed to failure. Not sure if this makes sense, or if I’ve expressed my thinking clearly. david * * * Binoy asks: I checked the list of shame attacking exercises you have suggested for social anxiety. I live in an Arab country. Some of the things on the list could get me arrested. Is there a better way to overcoming anxiety? Hi Binoy, Perhaps you can tell me what Shame Attacking Exercises would get you arrested! Since I’ve listed more than 100, perhaps you could choose ones that will not get you arrested! In addition, I never throw techniques at people based on a diagnosis or problem, but work systematically using T, E, A, and M. In addition, I use four treatment models, and more than 50 techniques, when I am treating any form of anxiety. There is a free anxiety class on my website. Check it out!  

235: Anger in Marriage Several months ago. a professional dancer named Brian emailed me with an Ask David question on how to deal with anger in marriage using the Five Secrets of Effective Communication. I was pretty excited because anger in marriage is a problem nearly everyone can identify with, and something we all need some help with! Brian and his family Brian said that he and his wife, Michelle, have been married since 2009, and while he loves Michelle a great deal, their relationship runs hot and cold, with frequent angry clashes. I asked Brian for a specific example, including a partially filled out Relationship Journal (RJ), so I could get some details on what his wife said to him, and what, exactly, he said next, during one of their conflicts. Brian and his wife, Michelle The analysis of this exchange will provide us with a crystal clear example of the type of problem they are struggling with, along with the opportunity to pinpoint the specific errors Brian is making in responding to his wife’s criticisms. In the example he sent, she said that he wasn’t doing enough to help put the kids to bed one night, and he responded by saying nothing. He analyzed his response with the EAR technique from my book, Feeling Good Together. By ignoring her, it was obvious that failed on E = Empathy (he did not acknowledge how she felt), and A = Assertiveness (he did not share his feelings), and on R = Respect (he did not express any warmth, respect, or love for her.) He was able to see that this response will make the problem worse and force her to keep criticizing him. When he ignores her, she feels even more hurt, ignored, abandoned, and unloved. As a result, she’ll keep criticizing him since he hasn’t yet listened or “gotten it.” So although he feels like an innocent victim, he’s actually the secret creator of his own interpersonal reality. In other words, he forces her to do the very thing he’s complaining about. That’s the purpose of the Relationship Journal (RJ) —to help you see your own role in a conflict. It’s an amazing but pretty painful tool that’s potentially liberating. At my urging over the past several months, Brian worked really hard studying the Five Secrets of Effective Communication (LINK) and doing the written exercises in Feeling Good Together. After a rocky start, with some notable failures in his attempt to improve his interactions with his wife, he slowly began to “get it,” and their relationship began to improve a lot. Brian joins us today to describe his journey, and share his excitement about my first book, Feeling Good, as well as Feeling Good Together. I am really proud of what Brian has accomplished through commitment, practice, and hard work, as well as his courageous willingness to look at his own role in the problem. This is nearly always painful, and requires the “great death” of the “self,” or “ego.” During today’s podcast, we practiced with the “Intimacy Exercise.” This exercise can help you improve your skills with the Five Secrets. Here’s the way it works. To get things started, either Rhonda or David will play the role of Brian’s wife, and Brian will play the role of himself. We will criticize Brian in the way his wife sometimes criticizes him, and then he will respond, using the Five Secrets. For example, she recently said: “When I was on the phone with my best friend, you were rude and selfish, and making too much noise with the video you were creating.” Then he responded and we gave him a grade, and pointed out what he was doing right and what he was doing wrong that needed improvement. If you check your ego at the door, this can be a great, but challenging, way to learn! Brian gave himself a C on his response, which you’ll hear in the podcast, and Rhonda agreed. She also gave him a C. I gave him a B, as I thought he did some pretty cool things while making several errors. Here’s where he needed improvement. His use of the Disarming Technique needed upgrading. He didn’t strongly and directly endorse the truth in his wife’s criticism. For example, he might say something like this: “You’re right, I was being insensitive and selfish, and I’ve done that to you so often over the years.” His response would benefit from the inclusion of some “I Feel” Statements,” since it sounded a bit mechanical. For example, he might say, “I feel really sad and ashamed to hear you say that I was selfish and insensitive, because you’re absolutely right, and I love you so much.” There was no Stroking, and I included one way to do this in the “I Feel” response I just described. His Thought Empathy was good, but there was no Feeling Empathy. In other words, he did not mention how sad, hurt and angry his wife might be feeling. He did not finish with a sound use of Inquiry that would invite his wife to open up even more. For example, he could end by asking her to tell him more about how she feels when he’s being insensitive and selfish, and how hurt, angry, and lonely she might feel. Brian was non-defensive and open to this feedback. Then we did role reversals to give him the chance to try these new approaches and boost his grade. Here’s a comment he wanted me to share with you: Learning and implementing the 5 Secrets of Communication literally helped to save my marriage. The breakthrough came for me when I was really able to grab hold of Feeling Empathy, and really delve deep into understanding how my actions hurt my wife. This was one of the hardest challenges I've ever had in my life but the deeper I got into my wife's heart and mind, the more my anger dissipated and was replaced by empathy, warmth and love for my wife. I am no expert by any stretch of the imagination and in the podcast, both Rhonda and David went over some really cool role play to help sharpen my skills in the 5 Secrets. My hope is that by sharing my story it will help to provoke some helpful thoughts in the listener to help them continue to grow in their relationships. Brian Brian also said that he is a Christian, and loves Jesus, and that one thing he appreciates about the Five Secrets is that it is deeply connected to Christian teachings. For example, here’s a quotation from Matthew 7:3: “And why beholdest thou the mote that is in thy brother's eye, but considerest not the beam that is in thine own eye?” I strongly agree with Brian’s take on this, and believe that the Five Secrets of Effective Communication can be viewed as both a psychological and a spiritual tool. I would add that the Five Secrets, as well as all of the techniques in TEAM-CBT, are compatible with most if not all religious traditions. I have often said that the moment of profound change—the moment you recover from anxiety or depression, for example—will nearly always have a spiritual meaning, but the details of your interpretation will depend on your religious or philosophical upbringing. I like to emphasize this because my father was a Lutheran minister, but he seemed pretty suspicious of psychiatrists, thinking that psychiatry and religion were inherently at odds with one another. Some deeply religious people have seen me, as some kind of pariah, or enemy of religion. When I lived in Philadelphia, I went to Lancaster, Pa, on ten consecutive Saturday mornings to teach CBT at a beautiful religious hospital there. I enjoyed teaching their staff a number of new techniques for treating depression. They told me that one of the local evangelists had a Saturday morning radio show, and that whenever I came to town, he would say, “the snake has returned to Lancaster” on his show! I think it is because I quoted the Buddha on something, and some of the more conservative folks didn’t take kindly to that comment! I guess they thought that the Buddha was the same as the devil! I see religion and psychotherapy, in contrast, as synergistic. Although all of my work is totally secular, and based on research and clinical experience, the overlap of TEAM-CBT with all religious traditions is clear and unmistakable. I love it when clergymen, rabbis, or imams attend my workshops and point out the common grounds with what I’m teaching and their theological beliefs. We did more role playing during the podcast, as Brian also wanted to focus on his feelings of insecurity resulting from relentless self-critical thoughts, like, “I suck at dancing, so I’m worthless”. We used THE Externalization of Voices along with the Acceptance Paradox, the Self-Defense Paradigm, and the CAT (Counter-Attack Technique) to challenge his negative thoughts. We also used Positive Reframing to reduce his resistance to giving up his self-criticisms. We did a number of role plays with role reversals, just as we’d done earlier when practicing the Five Secrets. Brian was incredibly fun to work with, and Rhonda and I developed great affection and admiration from him. We’ll try to post some follow-up, too, once Brian has had the chance to listens to the audio with his wife We can perhaps get her responses to the show and include them in the show notes. There were at least two keys to the rapid progress Brian has made learning to use the Five Secrets of Effective Communication with very little input from me. He is very much in love with Michelle and intensely committed to improving their relationship. He has high standards and is willing to put in the work that is necessary to master the Five Secrets of Effective Communication, not only in his interactions with his wife, but also with people in general. He has also been willing to put in the work to learn to change the way he thinks and feels, so he can modify his internal dialogue as well as the way he communicates with others. Your internal and external dialogues will often fuel each other. You know that Brian is a professional dancer. Can you guess what he does for a living? I was surprised and delighted to learn that Brian runs a Break Dance School in Long Beach, California, for children, teens, and adults. Here is the link in case you want to contact him or sign up for some awesome break dance classes! Webreakdance.com Instagram.com/Webreak Here are some awesome video links you can watch: Webreak Soul Evolution Crew Performance: https://youtu.be/M4FzENnYXj4 Brian Breakdancing Solo: https://www.instagram.com/tv/CHjr8yXhGk7/?igshid=1341ipmr311ho

Announcements / Upcoming Workshops March 24, 2021 Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   April 7, 2021 Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! * * * Podcast 234: How To Deal with Whiners and Complainers In today’s podcast, we bring to life two of the earliest CBT techniques I developed way back before I wrote Feeling Good: The New Mood Therapy. The are: The Anti-Whiner Technique The Anti-Heckler Technique they are both based in two of the Five Secrets of Effective Communication: The Disarming Technique: You find truth in what the other person is saying Stroking: You find something positive to say to the person In addition, if appropriate you can include Feeling Empathy, especially in the Anti-Whiner Technique. This means that you acknowledge how the other person is feeling The Anti-Whiner Technique Most of us know someone who tends to whine and complain a great deal, and you might have noticed that when you try to help them, cheer them up, or give them some advice, their whining and complaining just escalates, so you end up secretly frustrated and annoyed. If you’re tired of this pattern, you might want to try the Anti-Whiner Technique, which can be incredibly effective, but it’s anti-intuitive. You simply agree with the person who’s complaining, and give them a compliment. Rhonda and David will illustrate this with complaints like these: Nobody cares about me! I never get to do what I want to do. Nobody likes me. I never get invited anywhere. I never get to do anything fun. I’ve tried everything and nothing seems to help. All the doctors just seem to care about themselves. Nobody listens to me! Life is unfair. People only care about themselves I have to do everything for myself. Nobody helps. I can’t hear very well, my sight is deteriorating, and I’ve got hemorrhoids! What can I do? Preparation H doesn’t help at all! My students just don’t listen. This younger generation is totally screwed up! Nothing helps! I’m depressed all the time. I’ve tried everything. No one every said one kind thing to me! I’ve got so much to do, but I just can’t get started, and everything just keeps piling up! The Anti-Heckler Technique I love treating public speaking anxiety because I used to struggle with this problem myself, but now I totally love public speaking. One of the many reasons that people fear public speaking is because they’re afraid someone in the audience will become critical or hostile, or ask them something they can’t answer. The Anti-Heckler Technique is fairly easy to use, and works like a charm if done skillfully. It’s similar to the Anti-Whiner Technique we just illustrated. Just make a list of hostile things that the audience member from hell might say during your talk, or during the Q and A period, and then respond with the Disarming Technique plus Stroking. Rhonda and I will illustrate this with these kinds of critical comments. You’re full of shit and you know it! What you’re saying isn’t true and doesn’t make sense. You’re a total fraud and a fake. You're not supposed to say that. You talk too fast. You are confusing. You don't know what you're talking about. You are not following the outline you gave us. It's too cold, too hot. You're wrong about that. You are quoting outdated research that's been debunked already. I didn't like it when you made jokes. You don't know enough to teach this class. You're disorganized, incomprehensible, and boring. You always call on the same people in the audience, you play favorites. Rhonda and David also explore why it is so hard to use these techniques in our personal and professional relationships, and why we lapse into adversarial defenses when we could collaborate with others in the spirit of mutual exploration and learning. Most of it has to do with the idea that we have a “self,” or “ego” to defend! As the Buddha so often said, “Selves are cheap. Selflessness is dear!”

Phillip with his brother, (Paul), his mother (Maureen) and Ladybug (Labrador). Phillip Lolonis joins us again with vital information we forgot to explore in his first podcast two weeks ago. Phillip's interest in the treatment of schizophrenia stemmed from his relationship with his brother, who suddenly and unexpectedly developed schizophrenia when he was 19 years old. and Phillip was 26, One of his motivations to become a therapist was his anger and disillusionment with the treatment his brother received that was medication focused and somewhat formulaic. Phillip thought the impact was somewhat detrimental. In today's podcast, we explore how to use the Five Secrets of Effective Communication, and especially the Disarming Technique, in interactions with individuals with schizophrenia. This can be difficult and challenging, because many of the things the patient says are delusional and can't possibly be true, like "I know you're plotting against me!" And yet, as David points out, if you listen to the "music" behind the words, you will see that the individual is saying something that's absolutely true. He or she is just expressing feelings in a symbolic manner. And if you find the truth in what the person is saying, he or she will nearly always calm down and feel heard and respected. Rhonda, Phillip and David demonstrate this in role-playing, using statements like "You're against me!" David recalls his treatment of an angry young university student with severe paranoid schizophrenia who responded beautifully to Dr. Stirling Moorey, a (then) visiting medical student from London who was doing cotherapy with David so he could learn the then-new cognitive therapy. Stirling used the Disarming Technique when the young man insisted that the police were trying to prevent him from seeing John the Baptist who had secrets about the spiritual human of the human race. When Stirling expressed interest and found truth in what the young man was saying, there were immediate and dramatic results. David described this interaction in his first book, Feeling Good. Phillip said he's experienced similar things with his brother, and that this new way of communicating has been helpful. Rhonda commented that we've had many podcasts recently on the Five Secrets of Effective Communication. These techniques are very challenging to learn, for technical and human reasons, but incredibly rewarding if you're willing to learn them and let your "ego," or "self," die. Phillip asked us to add these comments to the show notes:  I'd like to add that the place that has been a godsend for my brother and our family is called the Putnam Clubhouse he regularly attends but not during covid,  it's tough on everyone especially the severely mentally ill, in terms of isolation.  They do have zoom meetings and come by members' homes to deliver food and goodies during covid.   It's a place that provides socialization, work, gatherings with music/poetry and outings like going to a baseball game. They are part of a larger organization world wide.  This is the link to the Clubhouse in Contra Costa County. and this is the link to the international Clubhouse for the severely mentally ill            Rhonda asked me the question if have I ever been afraid of my brother. That was a good question, Rhonda and I didn't answer very well. Only once in the 20 years of my brother's disease have I been afraid of him.  People judge my brother as potentially violent when in fact he’s terrified daily because of the violent voices towards him he hears.  My brother is stigmatized by the world as dangerous when the facts state that most people with schizophrenia are preyed upon, like my brother has been over the years---people taking his money, people crossing the street to avoid him, people calling the police on him, etc.  When he is upset or angry, and I respond with 5-Secrets, especially a strong  "I Feel" Statement, his rage softens immediately. Your question itself, "was I ever afraid?" is a misnomer. Here's a better question: Is my brother afraid? Yes, every day he's afraid of being misunderstood, stigmatized, hospitalized by the police (5150) but mostly he is afraid of the voices hurting him. And my mother and I are afraid someone will eventually hurt him, or he will take his own life because he has stated that he has done enough over the years to defeat the voices but they won't go away.  So at times he feels hopeless.

The podcast discusses ego strength, panic attacks, habits/addictions, high blood pressure, sudden enlightenment, cognitive techniques for emotional well-being, understanding panic attacks, negative thought patterns, confronting fear, empathy in relationships, and upcoming virtual workshops on overcoming self-defeating beliefs.

This is the first of two podcasts featuring Phillip Lolonis, LCSW, who works with Rhonda at her new FeelingGreatTherapyCenter.com. Some of you may remember my descriptions and photos of my Sunday hikes for people in our training groups for the past ten years. Here's a photo from one my last hikes before the pandemic. Phillip is the one in red in the back row.  I hope to resume the Sunday hikes as soon as people are vaccinated! In today's podcast, you'll meet Phillip Lolonis who has transformed TEAM-CBT hiking therapy into a high and exciting art form on the California trails near Mt. Diablo. Phillip is a licensed clinical social worker and Level 3 TEAM therapists who is a member of Rhonda's new Feeling Great Therapy Center in the East Bay. He describes his love for "nature therapy" and pointed out that the Buddha experienced enlightenment when meditating under a tree. Phillip describes growing up on a farm and feeling at peace and profound connection with nature as he watched his father working in the fields. He said that his ancestors were all farmers in Greece for hundreds of years. Phillip first started "hiking therapy" when he was working with groups of individuals suffering from schizophrenia. One day, he decided to take his group out for a hike in the hills behind the hospital, and noticed the peacefulness and relaxation the patients experienced while hiking, and see the views of the San Francisco Bay from (describe the location at the top of the hike.) He said the patients seemed to experience much less of the internal, distracting stimuli that interfered so greatly with their attempts to connect with others. All of his patients complete David's Evaluation of Therapy Session after each session. This tools encourages patients to rate the therapist's empathy and helpfulness and describe what they liked and disliked about the session. Phillip works with a wide range of individuals, and says that whether they are 10 years old suffering from shyness, or executives from a tech companies who are facing burnout, they often say that they feel more open, honest and willing to go deeper when hiking in nature, than when they are being treated back in his office or on zoom. He pointed out that these days, a great many individuals coping with mental illness end up being "treated" in jails, which are frightening and actually intensify the symptoms of schizophrenia. Phillip has a special tenderness and compassion for individuals with schizophrenia because his younger brother struggles with this affliction. However, his "hiking" therapy is not limited to individuals with schizophrenia, but adults and families with the full range of emotional challenges, such as depression and anxiety. He explained how he integrates the four elements of TEAM: T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods while hiking with his patients / clients. He also discussed some of the ethical considerations, and how to gently create boundaries so that his patients will understand that this is a professional relationship in a natural setting. Phillip is convinced, and probably right, that a beautiful and peaceful outdoor environment actually facilitates treatment and speeds recovery. Here are some photos from his hikes. just to give you an idea of what his special "office" looks like. It's a bit different from the analyst's couch!       Take a look at this incredibly cute video of "talking turkey" on one of his hikes! [videopress McaWCx7u]

Ask David: Questions on self-esteem, recovery from PTSD, dating people with Borderline Personality Disorder, recovery on your own, and more! Jay asks: Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” Many patients can read your books and do the exercises and recover on their own. Is a teacher or coach sometimes needed to speed things up? Is it possible for a person to become happy WITHOUT needing anyone else if they have had depression in past and/or PTSD? Also, how would Team-CBT address treating PTSD? PTSD can involve a person having multiple traumas. * * * Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Thanks, Jay, I will make this an Ask david, if that is okay, but here is my quick response. Although many folks now show dramatic changes in a single, two-hour therapy session, they will still have to do homework to cement those gains, including: Listening to or watching the recording of the session Finish on paper any Daily Mood Log that was done primarily in role-playing during the session. In other words, write the Positive thoughts, rate the belief, and re-rate the belief in the corresponding negative thought. Use the Daily Mood Log in the future whenever you get upset and start to have negative thoughts again. I also do Relapse Prevention Training following the initial dramatic recovery, and this takes about 30 minutes. I advise the patient that relapse, which I define as one minute or more of feeling crappy, is 100% certain, and that no human being can be happy all the time. We all hit bumps in the road from time to time. When they do relapse, their original negative thoughts will return, and they will need to use the same technique again that worked for them the first time they recovered. In addition, they will have certain predictable thoughts when they relapse, like “this proves that the therapy didn’t rally work,” or “this shows that I really am a hopeless case,” or worthless, etc. I have them record a role-play challenging these thoughts with the Externalization of Voices, and do not discharge them until they can knock all these thoughts out of the park. I tell them to save the recording, and play it if they need it when they relapse. I also tell them that if they can’t handle the relapse, I’ll be glad to give them a tune up any time they need it. I rarely hear from them again, which is sad, actually, since I have developed a fondness for nearly all the patients I’ve ever treated. But I’d rather lose them quickly to recovery, than work with them endlessly because they’re not making progress! People with Relationship Problems recover more slowly than individuals with depression or anxiety for at least three reasons, and can rarely or never be treated effectively in a single two-hour session: The outcome and process resistance to change in people with troubled relationships is typically way more intense. It takes tremendous commitment and practice to get good at the five secrets of effective communication, in the same way that learning to play piano beautifully takes much commitment and practice. Resolving relationship conflicts usually requires the death of the “self” or “ego,” and that can be painful. That’s why the Disarming Technique can be so hard for most people to learn, and many don’t even want to learn it, thinking that self-defense and arguing and fighting back is the best road to travel! * * * Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Yes, Ten Days to Self-Esteem would likely be a deeper dive into the topic of Self-Esteem. It is a ten-step program that can be used in groups or individually in therapy, or as a self-help tool. There is a Leader’s Manual, too, for those who want to develop groups based on it. * * * Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” I was involved with a woman with Borderline Personality Disorder, and it was exhausting! Why was I attracted to her? Thank you for the question, Jay. Most claims about parents and childhood experiences, in my opinion, are just something somebody claimed and highly unlikely to be true if one had a really great data base to test the theory. We don’t really know why people are attracted to each other. Many men do seem attracted to women with Borderline Personality Disorder. Perhaps it’s exciting and dramatic dynamic that they’re attracted to, and perhaps it’s appealing to try to “help” someone who seems wounded. Good research on topics like this would be enormously challenging, and people would just ignore the results if not in line with their own thinking. Our field is not yet very scientific, but is dominated by “cults” and people who believe, and who desperately want to believe, things that are highly unlikely, in my opinion, to be true. I do quite a lot of data analysis using a sophisticated statistical modeling program called AMOS (the Analysis of Moment Structures) created by Dr. James Arbuckle from Temple University in Philadelphia, someone I admire tremendously. This program does something called structural equation modeling. In the typical analysis, the program tells you that your theory cannot possibly be true, based on your data. If you are brave, this can lead to radical changes in how you think and see things, especially if you are not “stuck” in your favored theories. But this type of analysis is not for the faint of heart. All the best, David Here is Jay’s follow-up email: HI Dr. Burns, As you know A LOT of people attribute their present problems (depression / anxiety / relationship conflicts / addictions) to their "abusive" or "toxic" relationship with their parents. It is interesting that it seems some people internalize negative beliefs about themselves based on what their parents said to them on a consistent basis. But it seems you are saying the data does not support that theory. Jay Thanks, Jay, I’m glad you responded again. There may be some truth to those kinds of theories. We know, for example, that abused or feral cats often have trouble with trust. So, we don’t want to trivialize the pain and the horrors that many humans and animals alike endure. At the same time, people are eager to jump onto theories that “sound right” to them and serve their purposes, and most of these theories are not based on sound research. Here are two examples from my own research. I tested, in part, the theory that depression comes from bad relationships, and also that addictions result from emotional problems. I examined the causal relationships between depression on the one hand and troubled vs happy relationships with loved ones on the other hand in several hundred patients during the first 12 weeks of treatment at my clinical in Philadelphia, and published it in top psychology journal for clinical research. (will include link) That was because there were at the time two warring camps—those who said that a lack of loving and satisfying relationships causes depression, and those who said it was the other way around, that depression leads to troubled relationships. And the third group said it worked both ways. My study indicated that although troubled relationships were correlated with depression, there were NO causal links in either direction. Instead, the statistical models strongly hinted that an unobserved, third variable had causal effects on both simultaneously. This is the only paper in the world literature that I am aware of that has tested the causal links between intimacy and depression, but because the results did not satisfy anyone, the paper is rarely or never quoted, and did not seem to influence those who were advocates of one or the other theories. As they say, wrong theories die hard. Here’s the reference: Burns, D. D., Sayers, S. S., & Moras, K. (1994). Intimate Relationships and Depression: Is There a Causal Connection? Journal of Consulting and Clinical Psychology, 62(5): 1033 - 1042. I also looked at the causal links between all kinds of emotional problems and all kinds of addictions in 178 or so patients admitted to the psychiatric inpatient unit of the Stanford Hospital. I was unable to confirm any significant causal links between depression, anxiety, loneliness, anger, and so forth and any kind of addiction (overeating, drugs, alcohol, etc.) The only possible causal link I could find was a small causal link of depression on reducing the tendency to binge or overeat. This was a secondary and unpublished analysis of data I collected in validating my EASY diagnostic system. I don’t mean to encourage insensitivity to suffering or and I don’t want to stop or stifle creative thinking about the causes of depression and anxiety and addictions. I simply want to emphasize that the causes of depression, and most other emotional problems, are still totally unknown. That is a very simple statement, but it seems to me that most folks don’t “get it,” or don’t want to hear it. Maybe we all want to explain things, or blame others, or think of ourselves as “experts,” or perhaps we feel uneasy with thinking that we don’t yet know the causes of most psychiatric problems, like depression and anxiety or troubled relationships. It may be comforting to think we do know the causes of negative feelings or human conflict. This is my thinking only, and I’m often off base! Tell me what you think. David