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

Today’s podcast features a most unusual and incredibly inspiring guest, Dr. Cai Chen. Cai is a fourth-year general psychiatric resident at the University of Texas Health Science Center in Tyler, Texas. He’s also currently enrolled with Mike Christensen’s “Live Online CBT Training Courses for Therapists.” Cai has told me that Mike Christensen is a “friggin’ amazing teacher” and that everyone who is interested in starting their journey in TEAM owes it to themselves to take his class. My first contact with Cai was an email he sent me after listening to Podcast #187 on the live work I did with Dr. Michael Greenwald and Thai-An Truong at the Atlanta intensive about a year ago. Cai wrote: Hi David, Michael, and Thai-An, This podcast episode helped me truly change my life. I thought I had things figured out before, but man! The work you three did that day crystallized my own social anxiety issues and gave me the courage to finally do some very hefty self-disclosure. I was in tears throughout the podcast and well after even waking up in the middle of the night crying, knowing that I had to do the exact same thing that Michael had done. So I finally told all the people I knew on social media that I struggled with social anxiety and that my deepest fear was my negative feelings inconveniencing people, hurting them, and showing how I was being selfish by taking the spotlight. I also told everyone how all of these fears led to a lifetime of loneliness, rejection, and helplessness. I cried writing it all out because it finally felt like I was letting all of that go for the first time in my life. The response I received from so many on social media, including people I hadn't heard from in years, was astonishing and so supportive! My social anxiety was completely shattered! Now I see the truth: that our feelings are an expression of our humanity and the most honest, loving thing to do is to share them with people! I'd be damned if I'm going to tell myself anymore that my negative feelings "inconvenience" or "hurt" people. Screw whether I'm being "selfish"! I finally understand what you mean, David, that the problem was NEVER that I have been inconveniencing, hurtful, or selfish. It's that I'm telling myself that these things about me are WRONG and that I SHOULDN'T be that way. I share my feelings all the time now! The constant feelings of nervousness/unease, OCD, and panic attacks I had before are gone 99% of my days! I feel more human and myself than I've ever felt for the last 20 years. You should call it "re-learning how to be human" therapy! God bless you David, Thai-An, and of course yourself Michael! I'm truly in your debt, Michael. You're my own personal hero and I wish I was there at the intensive to give you a big hug! I'm grateful, honored, overjoyed, and just so happy for the help you've all brought me it's making me tearful again. I love the work you've done and I love you all! I'll remember this for the rest of my life. Regards, Cai Today, Rhonda and I were thrilled to meet with Cai face to face for the first time to get an update on what’s happened since that time. Cai emphasized that his intense feelings of depression, anxiety, crippling shyness and loneliness have vanished because of the intense effort he put in learning and using TEAM-CBT entirely on his own. He described how he first became acquainted with the podcasts. He felt a lack of clinical training in his residency program on how to do psychotherapy, so did a google search for therapy training, and came up with two podcasts, one of which was ours. So, he flipped a coin and the Feeling Good Podcasts won. He listened to the first podcast on measurement and testing, and said he was immediately excited about testing the idea that you could see exactly how effective or ineffective you were in every session with every patient. He was also excited by the idea that rapid changes in depression and anxiety really are possible, and that long term treatment is often not necessary. He describes his determination to use TEAM-CBT in his clinical work, after a tremendous amount of practice based on what he’s been learning in the Feeling Good Podcasts. He stressed: The importance of T = Testing, and how helpful and challenging it was at first because, as I had predicted, he initially got failing scores on the Empathy and Helpfulness scales from nearly all of his patients. But this led to opportunities to deepen his relationships with them while processing their feedback from the previous session. He said that he was initially embarrassed about handing his patients the Brief Mood Survey and asking them to fill it out before and after each session. This was helpful, but very challenging, both from a technical and emotional perspective, since it was painful to have to view his failures. I mentioned that it has been the same for me, and described a recent extreme failure with a patient who was livid with me after a session I had thought was great. But talking it over with that individual subsequently led to a tremendous breakthrough, confirming the idea that “your worst therapeutic failure is often, or always, your greatest therapeutic success in disguise.” Of course, you have to have the willingness and skill to talk it over with your patient in a respectful, non-defensive, and genuine way. My patient’s Achilles heel was perfectionism and a fear of anger. I believe it was helpful to her to see that it was absolutely okay to be angry with me, and to express feelings that she so often avoided, and to see that my failure did not have to be “awful,” but presented genuine opportunities for growth and a deepening of our relationship. Cai also emphasized the value of the Five Secrets of Effective Communication, since these tools showed him HOW to be empathic with his patients. Prior to that, he thought that empathy was something you just kind of acquired spontaneously, on your own. He also said he now realizes the incredible importance of doing your own personal work if you are a therapist. Cai was so determined to learn and to do his own personal healing that he did tons of Daily Mood Logs, every time he was upset in fact. He also did many Relationship Journals to improve his skills with the Five Secrets of Effective Communication, and even role-played with himself! He unearthed many of his own Self-Defeating Beliefs with the use of the Downward Arrow Technique, including Perfectionism and the Achievement and Love Addictions, as well as the Conflict and Anger Phobias, as well as a kind of underlying “worthlessness” schema, thinking of himself as an inherently “useless person.” Cai described his struggles with shyness, described in his email above, and identified with one of my podcasts about a young man I treated for shyness who “froze” with anxiety when in line at a Safeway store and seeing an attractive young lady checking groceries who seemed to be looking at him and smiling. Similarly, Cai froze when seeing a cute young lady and similarly felt “mortified.” He describes how he overcame his own shyness, and how he did the “What-If Technique,” while working on a Daily Mood Log, and discovered his belief that “If I open up to people about my feelings, I’ll just be wasting their time.” He decided he also had to take action, and begin forcing himself to use Self-Disclosure with strangers, as well as all the people he knew on social media, plus patients, and colleagues, telling them about his shyness instead of hiding it. He says that the positive responses he got blew his mind. He can now share his honest, vulnerable feelings with complete strangers in public and talk with them without shame or anxiety, something he never thought would be possible in the last 20 years. He also described using a two-and-a-half-hour TEAM CBT session with a woman with decades of failed treatment for incredibly severe depression, including several series of electroconvulsive therapy that had minimal effects. Althought the shock therapy worked for several months, she relapsed when she remembered why she was depressed and became miserable again). But when he did Positive Reframing, she was astonished to realize for the first time that her symptoms were actually the expressions of what was most awesome and beautiful about her, and when he used the Externalization of Voices during the M = Methods portion of the session, her symptoms not only disappeared completely for the first time, but she became euphoric. He described this personal rule: anytime he becomes upset: He immediately does a Daily Mood Log or Relationship Journal ASAP, and sometimes spends two to three hours a day doing this. He would also stubbornly skip out on meals to finish a session with himself, something he doesn’t recommend other people do! I am in awe of his commitment, not only to defeating his own demons, but also to learning to become, not just another “shrink” who prescribes drugs, but a true “healer.” Of course, Rhonda and I were pretty happy when he described the free assets on feelinggood.com, especially the podcasts, as “freaking amazing!” He mentioned how convinced he is that with dedication, time, the courage to face a lot of pain, and a lot of homework, anyone can learn how to heal themselves and better heal other people through TEAM just with the podcast and other self-learning material. He feels strongly that this is the case even if you don’t have access to any readily available teachers or trainers in your immediate area. At the end of the podcast, to bring his story to life, he shared three of his negative thoughts after seeing a woman’s new relationship status on Facebook. At the time, he previously believed all three thoughts 100%, but now no longer believed them at all. This proves that I’ll never find anyone special. There must be something inherently wrong with me because I haven’t found a lifelong partner. There’s no point in trying anymore because I keep screwing things up. I’m sure that many of our listeners, including maybe you, have had thoughts like this at some time in your life! We demonstrated Externalization of Voices, using his first thought, and Cai blew it out of the water. This was his response: “This one’s a real tear-jerker for me. I dated someone a couple of months back and it was one of the best moments of my life. It didn’t last long, but I really loved her. She wasn’t special, but that’s the exact reason why I loved her.” And then, when thinking back on the women he loved, he said, “none of them were special, but I loved all of them tremendously,” and broke into tears—showing us the beautiful and awesome human being he is. Cai was so inspired by this short session that he went back to his Daily Mood Log and came up with some more killer, emotional responses. For another of his negative thoughts “Everyone else is succeeding more than I could ever hope to”, he responded: “It’s not in my interest to believe in success and accomplishments anymore. To live is to fail because being human means being defective, flawed, and imperfect. We’re all human and we’re all failing fantastically every day. It’s time for me to join the rest of the human race by letting my success and accomplishments die. Luckily there’s not very much there so I don’t think it will be too painful to let it all go.” He mentioned how this brought on a lot of tears as well because it finally felt like he could let go of what he “needed” and still be ok. Hey ladies, I’m going to post his photo with this podcast! Go for it! This incredible young doctor is—believe it or not—available! Cai (Dr. Chen) plans to start his clinical practice in Dallas next summer following his graduation. He plans to be certified in TEAM-CBT, and will join one of our weekly free training TEAM-CBT training groups. If you would like to contact Dr. Chen, you can do so at: fontatlas42@gmail.com or cai.chen@uthct.edu. David  and  Rhonda

Do Negative Thoughts or Hormones Cause Postpartum Depression and Anxiety? And What’s the Best Treatment? TEAM-CBT or Pills? We begin today’s podcast with a lovely endorsement, and an announcement that Rhonda’s new free Wednesday TEAM therapy training group will be open to therapists from around the world and will start on December 2, 2020 at 9 to 11 AM west coast (pacific) time. Rhonda will have many fine trainers working with her, including the incredible Richard Lam, and the magnificent Leigh Harrington, to make your training experience stellar. If you are interested, contact Rhonda right away, as slots will be strictly limited. You can also fill out this form to confirm your interest! Today, Rhonda and I are proud and excited to interview our brilliant and delightful guest, Thai-An Truong, from Oklahoma. Thai-An is an accomplished TEAM Therapist (the first in Oklahoma) and popular TEAM trainer for therapists who want to learn about these new techniques. Thai-An, her husband, and two children on Halloween, the day after this podcast was recorded. Her daughter was born earlier this year. Thai-An’s niche is unusual and extremely interesting—she specializes in the treatment of women with post-partum depression with TEAM therapy, and usually without medications. This is extremely interesting since the world is currently focused on the belief that post-partum depression is a 100% biological disorder that results from hormonal changes, needs treatment with medications, and typically requires a year or more of treatment before improvement can be expected. Of course, this message can unfortunately function as a self-fulfilling prophecy. And is it even valid? No, says Thai-An. Although she sees a role for medications in some women with severe post-partum depression and anxiety, she says that the vast majority of the women she treats recover quickly without drugs. I was so happy to hear this, since my experience has been the same. In fact, Chapter 2 of my new book, Feeling Great, features my treatment of a woman struggling with severe post-partum depression who recovered in a single TEAM therapy session. Thai-An begins by describing her own horrifying and totally unexpected battle with post-partum depression after her first child was born 4 ½ years ago. She had a wonderful pregnancy and was excited about the prospect of giving birth to her daughter, but immediately after delivery, “it suddenly felt like the rug was pulled out from under me.” She went into a state of self-loathing and struggled with extreme depression and anxiety. She says, “I could barely sleep, woke up in a state of panic, and wondered ‘can I feed my baby?’” It got so bad that Thai-An began to think that her family and daughter would be better off without her. She said, “I even asked my mother if she’d be willing to raise her.” I felt incredibly sad to hear that, and I could barely even grasp the intensity of her suffering. The suffering of extreme depression is almost beyond human understanding, especially if you’ve never been there yourself. Thai-An was treated with medications, including antidepressants, but they didn’t help and made her more anxious. Then was told that these side effects are “expected” and advised to “wait it out.” She said, “I saw how devastating post-partum depression is—it robs you of joy.” They told me it was biological. One theme of Thai-An’s depression was her belief that moms are supposed to bonded to their children and loving at every moment, so “I asked myself, ‘did I make a mistake? Am I a monster? Why don’t I feel that way?’” Fortunately, Thai-An recovered after 3 months, and decided she wanted to work with other mothers with similar problems. She now has a thriving practice in Oklahoma. Rhonda asked how other doctors view her work, since Thai-An’s treatment approach—TEAM—is so radically different from current treatments that emphasize biology. Thai-An said the doctors have become extremely supportive when they see fabulous results in the patients they refer to her. Thai-An emphasized several components of TEAM-CBT that have been especially helpful to the women she treats. Positive Reframing. She says that this method is super powerful. Traditionally, woman are told (and think) that they need to “calm down,” but this makes the symptoms worse, especially the anxiety. Positive Reframing, in radical contrast, honors their negative feelings, and the effect is often “mind-blowing.” She says, “It heals a lot of the symptoms” Anxiety is even more common in post-partum depression than depression, including OCD symptoms. For example, many women have horrific intrusive thoughts that their child may suffocate, or that they’ll throw their child down the stairs, or other gruesome scenarios that they try to control and suppress. Of course, that never works and always makes the symptoms worse. Exposure, techniques like Cognitive Flooding—leaning into the fantasies and surrendering to them—can often be rapidly curative, but requires great courage on the part of the therapist, as well as the patient. Sadly, 80% of American mental health professionals avoided Exposure, wrongly thinking it will be “too dangerous” or that the patient is “too fragile.” Therapists like Thai-An, with expertise in Exposure and the courage to use it, are treasures, or “healers,” because they can often cause almost unbelievably rapid recovery and freedom from horrific fears. The Hidden Emotion Model. Nearly all anxious individuals are overly “nice,” and often suppress forbidden negative feelings, like feeling angry or annoyed. Bringing the hidden feelings to conscious awareness, and helping the patient express them, using the Five Secrets of Effective Communication, can also have fantastic and rapid healing effects. I, David, resonated with all of these themes, having seen nearly identical scenarios in many patients I’ve treated with post-partum depression, as well as their husbands or partners. Rhonda and I both share Thai-An’s enormous enthusiasm for TEAM-CBT, and greatly admire her incredible dedication to healing. Thai-An said that although post-partum depression is a bit more common among African-Americans as well as poor and underprivileged populations, it really affects everyone from a wide variety of social and economic backgrounds. No one is immune to this debilitating and demoralizing disorder. Thai-An emphasized that while hormones may play some kind of role, the real and surprising culprit is perfectionism, and the expectation that things should or should not be a particular way. In other words, telling yourself that “I should not feel angry or sad,” and “I should be flooded with love and joy,” can set you up for a painful fall. These are the unrealistic expectations that trigger intense feeling of inadequacy, anxiety, and worthlessness, not only in women with post-partum depression, but all of us. I can attest to that personally! Thai-An emphasized that recovery is not just a psychological phenomenon, but involves a deep and spiritual transformation of the patient. I definitely resonate with this theme. Thai-An attributes her fantastic therapy skills to her many mentors—teachers she’s learned from at the Feeling Good Institute (FGI) in Mt. View, California, including Matthew May, MD, Angela Krumm, PhD, and many others. But she especially wants to honor her hero and mentor, Mike Christensen, who teaches introductory TEAM-CBT classes at the FGI. I want to second that, since I also love and admire Mike, and all of our amazing teachers and colleagues at the FGI. Thai-An’s parents emigrated from Viet-Nam, a culture where psychiatry and psychology are practically unknown. Thai-An was “supposed” to go to medical school, but found psychology classes way more interesting than pre-medical classes. But her mom didn’t understand. She said, “Are you going to sit around and talk to crazy people al day?” Fortunately, Thai-An stuck to her guns and went to graduate school in a mental health field rather than medical school, and the rest is history. We are SO LUCKY to know Thai-An. She is a diminutive and beautiful woman with the brain and heart of a giant! Rhonda and I both feel extremely honored to have her testimony on today’s podcast! If you would like to contact Thai-An for training, please visit TEAMCBTTraining.com. If you are in Oklahoma and looking for treatment, you can contact Thai-An at LastingChangeTherapy.com. Thanks for tuning in today. Next week, it looks like we’ll have another amazing guest, Cai Chen, who will also blow your mind. Warmly, David  and  Rhonda

Today's Ask David features four terrific questions. Kevin asks: Why is the concept of worthwhileness and worthlessness so important to people and their emotional health? Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?” correspond to overgeneralization, or self-blame? I’ve been listening to the early podcasts on the ten positive and negative cognitive distortions. David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? Harvey asks: I don’t see how Positive Reframing actually contributes to the therapy. Kevin asks: Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health? Hi David, I have a quick question about the concept of being a worthwhile human being. Suppose a person believes they are unconditionally worthwhile, what are the implications of this? Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health? Best Regards, Kevin Hi Kevin, Thanks! That’s a very important question. However, it is abstract and philosophical. I have found that philosophical discussions tend to go on endlessly with resolve. In contrast, when someone asks for help with a specific moment when she or he was upset, then I can usually show that person how to change the way she or he is feeling. And when that happens, the person generally suddenly “sees” the solution to some very profound philosophical or spiritual questions. All that being said, I’ll take a crack at it. The goal of TEAM therapy is not to go from thinking that you’re a worthless human being to thinking that you’re a worthwhile human being, but to give up these concepts as nonsensical. Specific activities, talents or thoughts can be more or less worthwhile, but a human being cannot be more or less worthwhile. We can judge specific events, actions, and so forth, but not humans. At least I am not aware of how to validly judge a human being, or a group of humans. We can only judge their actions, attitudes, thoughts, and so forth. Unconditional self-esteem is definitely better than conditional self-esteem, since you don’t have to be perfect or a great achiever or a great anything to be “worthwhile,” but you are still focused on being "worthwhile." I'm not sure what that means, but there is a downside, to my way of thinking. If you think you are worthwhile because you are a human being, does that mean that you are more worthwhile than animals? Lots of people abuse animals, hunt animals, and so forth, which many people find immensely disturbing. These are some of the consequences of thinking that animals are less worthwhile, for example. Not sure that helps, but like your line of questioning! David Kevin follows up: What is the implication then of giving up these concepts at all? I assume that thinking that you have unconditional worthwhileness because you are alive or to drop these concepts entirely have the same emotional implications for people. What are these implications? For example, if I think that worthwhileness and worthlessness are meaningless concepts, so what? What’s the point? What do I gain? Hi Kevin, Let me start by saying, once again, that I am not an evangelist spreading the “gospel,” so to speak. My goal is simply to help people who are struggling with feelings of depression, anxiety, and self-doubt. So, if your way of thinking about things is working for you, there’s no reason to change. But my focus is always on someone who is suffering, and that’s where these concepts can sometimes be important. I can tell you what I gained by giving up the idea that I could be, or needed to be “worthwhile” or “special.” I gained a great deal of joy. It was a lot like escaping from a mental prison. It freed me to find incredible joy in the “ordinary” events of my daily life. It also freed me from fears of “failure” or not being “good enough.” Depression always results from Overgeneralization--you generalize from failing at something specific to thinking you are a failure as a human being. Without Overgeneralization, I think it is safe to say that it is impossible to be depressed. For example, if you measure your worthwhileness based on your achievements and success, you may feel excited when you succeed and devastated or anxious when you fail, or when you are in danger of failing. I'm not sure if this addresses your excellent question! A young woman told herself that she was "unloveable" when she and her boyfriend broke up after two years of going together. Can you see that she thinks she has a "self" that can be "loveable" or "unloveable?" This thought was very disturbing to her, as you might imagine. Relationships do not break up because someone is "unloveable," but because of specific factors or events that drive people apart. Once you zero in on why the relationship failed, or more correctly, why the two of you broke up, then you can pinpoint the causes and learn and grow so you can make your next relationship even better. There are tons of specific reasons why people break up! But if you think that you’re “unloveable,” or tell yourself that the relationship was “a failure,” then you may get stuck in a morass of negative feelings. But it’s not even true that the relationship was a failure.” That’s All-or-Nothing Thinking, since all relationships are a mixture of more or less successful aspects. You could even tell yourself that a “failed” relationship was a partial success, since you successfully learned that this isn’t the person you’re going to spend the rest of your life with. What’s in it for you to give up Overgeneralization and All-or-Nothing Thinking, as well as the concepts of being a “worthwhile” or “worthless” human being? That’s a decision each person can make. There are benefits as well as problems with these ways of thinking. For example, let’s say you’re depressed and think of yourself as “defective.” This is a common negative thought, and it is based on the idea that a human being could be more or less worthwhile, or thinking that your "self" can be judged or rated. So, you could do two Cost-Benefit Analyses. First, you could list the advantages and disadvantages of thinking of yourself as a “defective” human being. Then balance the advantages against the disadvantages on a 100-point scale, assigning the larger number to the list that seems more important or desirable. Second, you could list the advantages and disadvantages of thinking of yourself as a human being with defects, and once again balance the list of advantages against the disadvantages on a 100-point scale. This is just a subtle change in semantics, but the emotional implications can sometimes be pretty powerful. As I mentioned at the top, philosophical debates are just debates. Fun, perhaps, but not terribly useful. I’m more interested in magic, or miracles. That’s what happens at the moment of profound change, which can ONLY happen by focusing on one specific moment when you felt upset and needed help. When you do that, everything becomes radically different, and real change can occur. And at that magic moment of change, the solutions to all of the problems of philosophy will often suddenly become crystal clear. Or, to put it differently, the philosophical debates will suddenly become, without meaning to sound harsh, almost a waste of previous time. Our current semi-feral cat loves my wife, but is only starting to trust me, so I’ve been working at gaining her trust and learning to understand her non-verbal and somewhat complex efforts to communicate. Yesterday she roller over on her back and stretch out her front and back paws to expose her tummy to the max, and she let me pet her tummy for quite a long time, purring loudly the whole time. I don’t care if she’s “worthwhile,” or if I’m “worthwhile,” and have no idea what those terms could even mean. But petting her tummy—now, that’s something that’s REALLY worthwhile! david Hi David, You and Albert Ellis are my heroes. Without your books, I always wonder what path I would have taken in life! Thank you. I had a quick question about self-acceptance. One of the reasons I feel that I’m fully unable to embrace it (and I think this is common) is that I’m afraid that I will lose out on motivation to work hard towards my goals. I think this partially true because my conditional self-esteem has caused me to work hard on a lot of things including CBT! Do you have any good ways to combat this exact notion, that if I accept myself I will simply become complacent and therefore I can’t? Looking forward to Feeling Great! Best Regards, Kevin Hi Kevin, There’s a lot of truth in what you say. Early in my career I also had a tendency to base my self-esteem on my achievements and productivity, both in my research and in my clinical work as well. I did accomplish quite a lot, but things were a bit of a roller coaster. When I thought I was doing well, I felt terrific, but when I thought my research was failing, or when I was stuck with a patient, I got quite anxious and frustrated. These feelings didn’t always foster positive outcomes. Now I no longer feel that my “worthwhileness” as a human being depends on my successes. In fact, I don’t even have the concept anymore. Now, I think my writing skills are very good, especially my skills in explaining complex ideas in fairly simple terms. But I do not think this makes me “more worthwhile.” Sometimes my writing, or my interactions with people, or my jogging, and many other things I do aren’t very good. But I don’t think these problems and flaws make me any less “worthwhile.” Take our little adopted feral cat, Miss Misty, that I mentioned in my last email. Misty does not care how “worthwhile” I am. However, she’s totally delighted if I pet her, let her out in the back yard to explore, or give her a piece of cat candy, or if I play with her. She is enlightened because she judges what I “do,” not what I “am.” Will you become less productive or unmotivated when you give up these concepts of “worthwhileness?” That has not been my experience. I am the busiest and most productive now than at any previous time of my life. I’m now 78, and life is a ball. I have tons of fabulous colleagues to collaborate with and we’re working on all kinds of super-exciting and challenging projects. When we don’t have “selves” that we need to protect, or feelings of “worthwhileness” that we need to defend, we can listen to criticisms and collaborate without feeling threatened, and use the information to improve what we’re doing! Hope that makes sense! david * * * Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?” correspond to overgeneralization, or personalization cognitive distortion? I’ve been listening to the early podcasts on the ten positive and negative cognitive distortions. Hi Vallejo, Rhetorical questions are technically not considered Negative Thoughts because they contain no distortions. However, this question is actually a Hidden Should Statement, and a great example of Other Blame as well. You need to change rhetorical questions into statements, like: “It’s unfair that I’m always the last one to find out about anything. This shouldn’t happen all the time!” And, as you point out, it is also a gigantic Overgeneralization. Thanks, Vallejo! On the podcast, David will talk about some of the rules for generating Negative Thoughts. * * * David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? Dr. Burns, I'm a big fan of your work, and have now finished "Feeling Great" and loved it. I know you approach depression from a clinical background, but do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? It seems like my negative thoughts are automatic, and I have to work to counter them. Maybe, if I have to force myself to think of a few things I really am grateful in my life, instead of only focusing on countering the negative automatic thoughts, it would be beneficial? Also, is there a role for altruistic volunteering in alleviating depression? Thank you. david p Hi David P, Anything that works for you is strongly recommended. I do a lot volunteer teaching, and also treat therapists and students for free, and i enjoy that a great deal! So go for it and let me know if it is effective! I often feel grateful for a lot of things, and people, and animals, like our cat, who "almost" loves me! As for me, I never use non-specific, formulaic approaches that one practices over time, hoping some good will come from it. So I never prescribe meditation, a daily gratitude log, prayer, aerobic exercise, dietary considerations, vitamins, and so forth. You can do these things if you like, but they are not “therapy” to my way of thinking. I only use specific techniques to crush a patient’s unique negative thoughts of dysfunctional ways of communicating with others during conflicts. Therapy is a lot like learning to play the piano, or going to a tennis coach to improve your game. Specific practice is needed, not prayer, gratitude journals, or the like. And my focus is on high speed, total and lasting change right now, if possible. david * * * Harvey asks: I don’t see how Positive Reframing actually contributes to the therapy. Hi Dr Burns: Thank you for this great podcast. I was particularly impressed by and related to the idea of “Beating Up On Yourself.” I think it is so easy to fall into that trap. My question is that I don’t see how the positive reframing aspect of TEAM actually contributes to the therapy. Once you did the reframing with Neil, you didn’t seem to go back to it. So why is that a necessity thing to do? I understand that the positive side of negative thoughts could cause resistance to give up the negative thoughts, but that didn’t seem to be dealt with. Thank you so much for these podcasts and I have just started to read “Feeling Great”. Maybe you go into the positive reframing aspects and benefits more in the new book. Thanks, Harvey. Hi Harvey, The session you are referring to was a while back, but by memory my thinking was that the Positive Reframing was not a particularly powerful tool for Neil, and I think he thought that also. It is not the case that any one tool--and I have created / learned more than 100 methods--will be effective for everyone. That's why it's so great to have a huge palette of tools and techniques, so you can find the path forward for many patients, and not just a few! Some people think that if a technique is not helpful for one patient, then it is no good. Some people also think that one technique, like meditation, or exercise, or medication, should be "the answer" for everyone. My experience is radically different, and it is hard for me to even comprehend how people can get sucked into some of these notions--but they do! Positive Reframing is one of the great breakthroughs in TEAM-CBT, and it opens the door to ultra-rapid recovery. In fact, I usually (but not always) see a complete or near-complete elimination of negative feelings in one extended (two-hour) therapy session. Here are some reason why Positive Reframing can be helpful: When you see that your negative feelings are the expressions of your core values, rather than your defects, this reduces feelings of shame, so you might feel a little better right away. You don’t have to shoot for perfection, or complete recovery, but rather a reduction in your negative feelings. This is pretty sensible, and more realistic and relaxing than shooting for total change. In addition, you are no longer fighting against your negative thoughts and feelings.  Your resistance to change will diminish because you can honor your negative thoughts and feelings, and work to reduce them rather than thinking you have to change completely. You’re in control—the therapist is not trying to “sell you” on something. “Selling” nearly always triggers fairly strong resistance. You may suddenly see the benefits of many of your negative thoughts and feelings, so you no longer feel so “broken” or defective. When you "listen" and finally hear what your negative thoughts and feelings are trying to tell you, the volume and intensity of your negative thoughts and feelings will suddenly diminish, like a balloon with a hole in it. Thanks for listening today! Rhonda and David  

Ask David featuring four terrific Should questions, and more questions about “asinine, stupid, narcissistic, self-serving humans! “ Oliver asks: Can a thought be thought as moral or immoral? Vincent asks: I have suffered from depression for about 3 years and say to myself, "I should have gotten better sooner." Isn't this "should" appropriate? Charles says: Your concept of “no self” shot my anxiety way up and made me feel hopeless. . . . It makes me feel worse than before! Michelle asks: How is your requirement that new patients must agree to not make any suicide attempts for the rest of their lives any different to a “suicide contract” which you mention are not effective? Brian asks: I’ve done a few things that made me feel intensely guilty. . . . The knowledge that I didn’t do what I should have done led to a lot of guilt and shame, and eventually depression. Just wondering your thoughts on this Carrel asks: I'm a Democrat in Texas. How can we use disarming to heal the political rifts in our country? Natasha asks: How do I stop the dark thoughts of wishing harm to come to stupid humans who do asinine, narcissistic, self serving, irresponsible things—like driving massive, loud pickup trucks around the neighborhood, honking incessantly as they wave their 20 ft political flags; or bringing the family for a paddle boat ride in the local pond, taking delight in teaching their human offspring to paddle the boat as quickly as they can to chase after the beautiful, innocent geese and ducks trying earnestly and fearfully to swim to safety. and more.   Dear Dr. Burns, Can a thought be thought as moral or immoral? In many podcasts and articles, you use "Thou Shalt Not Kill" to demonstrate morally should statement, which is one of the 3 valid should statements in English. I'm still somewhat confused about this concept. To tell you where I get stuck, I come up with three thought experiments. Imagine the following situations in which a should statement may come to mind: Situation 1 Lisa stole some money from a grocery store. When arrested by police, Lisa said with tears, "I shouldn't have stolen money. I feel ashamed for what I have done." In this case, it is obvious that "I shouldn't have stolen money" is a morally should statement, and also a legally should statement, because Lisa did something that violates the law and her moral principle. DAVID’S COMMENT: YES, YOU ARE CORRECT. LISA’S STATEMENT CAN BE CLASSIFIED AS A LEGAL SHOULD AND A MORAL SHOULD. Situation 2 One day, Bob went to Walmart to buy a suit. When he was passing by a shelf, a thought appeared in her mind. "What would happen if I steal this suit? I really want it, but I have very little money." When he came back home, he talked to himself," I shouldn't have felt the urges to steal things. And I shouldn’t have thought about stealing the suit." DAVID’S COMMENT: THESE WOULD NOT BE CONSIDERED VALID SHOULD STATEMENTS BY MOST PEOPLE, SINCE WE HAVE FREEDOM OF THOUGHT. HUMAN BEINGS HAVE ALL KINDS OF FANTASIES AND URGES ALL THE TIME—AT LEAST I KNOW THAT I DO! AN URGE ONLY BECOMES IMMORAL OR ILLEGAL WHEN YOU ACT ON IT. HOWEVER, ALTHOUGH I DO NOT THINK THESE ARE VALID SHOULDS, BUT I TRY NOT TO IMPOSE MY VALUES ON OTHERS FOR THE MOST PART. I AM A SHRINK, SO I WORK WITH PEOPLE WHO ARE ASKING FOR HELP. FOR EXAMPLE, PEOPLE WITH OCD OFTEN PUNISH THEMSELVES JUST FOR HAVING “FORBIDDEN” THOUGHTS, FEELINGS, OR URGES. THE FIGHT TO CONTROL THEM IS THE ACTUAL CAUSE OF THE OCD. THE SHOULDS TYPICALLY MAKE THE PROBLEM WORSE, NOT BETTER. SELF-ACCEPTANCE CAN BE ONE OF MANY HELPFUL TREATMENT STRATEGIES. RELIGION CAN SOMETIMES BE A SOURCE OF OPPRESSIVE SHOULDS, ESPECIALLLY THE MORE FUNDAMENTALIST TYPES OF RELIGION. RIGIDITY MAY BE A PARTIALLY INHERITED TRAIT. FOR EXAMPLE, MANY RELIGIONS AROUND THE WORLD PROMOTE THE IDEA THAT HOMOSEXUALITY IS “WRONG” AND THAT PEOPLE “SHOULDN’T” HAVE URGES AND ATTRACTIONS TOWARD PEOPLE OF THE SAME GENDER. THIS IS AN AREA WHERE “SHOULD STATEMENTS” BECOME HIGHLY CONTROVERSIAL, AND ARE OFTEN A SOURCE OF HORRIFIC HATRED AND VIOLENCE, SOMETIMES IN THE NAME OF SOME “HIGHER POWER.” Situation 3 Lucy was buying fruits in a grocery store when she found that a man was taking an apple off the shelf and hiding it in his clothe! Obviously, the man was stealing an apple. Lucy was very angry and said, "the man shouldn't steal things from the store. It's not right!" In this case, Lucy didn't steal apples, the man did. But Lucy made a moral judgement about the man's behavior, not Lucy's behavior. Then is this should statement valid for Lucy? DAVID’S THINKING. TO MY WAY OF THINKING, YES THESE ARE VALID LEGAL SHOULDS AND MORAL SHOULDS, SINCE OUR CIVILIZATION (AND ALL CIVILIZATIONS) HAVE DECIDED THAT STEALING IS ILLEGAL, AND IS ALSO CONSIDERED MORALLY WRONG IN MOST RELIGIONS: “THOU SHALT NOT STEAL” IS, I THINK, ONE OF THE TEN COMMANDMENTS. THE GOAL IS NOT TO CLEAN UP YOUR SPEECH SO THAT YOU NEVER USE SHOULD STATEMENTS THAT DO NOT FIT INTO ONE OF THE THREE VALID CATEGORIES OF LEGAL SHOULDS, MORAL SHOULD, AND LAWS OF THE UNIVERSE SHOULDS. AT LEAST I HAVE NO INTEREST IN THAT. MY GOAL IS TO HELP PEOPLE WHO ARE SUFFERING BECAUSE OF SHOULD STATEMENTS. sincerely Oliver   Hi David, What is it with "shoulds" related to recovery from depression? I suffer from depression for about 3 years and say to myself "I should have gotten better sooner." Isn't this "should" appropriate? Because who really wants to suffer through this agony? Greetings from Geneva. Vincent Hi Vincent, "I wish I had gotten better sooner." This is a correct statement without the "should." This simple shift in language is called the Semantic Technique, and it was developed by Dr. Albert Ellis who kind of gave birth to cognitive therapy in the 1950s, along with Dr. Karen Horney about the same time. Instead of using a should, you use “it would be preferable if” or “I wish X was true.” In addition, it isn't actually true that you "should" have gotten better sooner! The universe does not always conform to our expectations. Just because we want something, it doesn't follow that it "should" happen. I'd love to have a new Tesla sports car, at least in fantasy, but it isn't true that I "should" have one. It would be “great” if you had gotten better sooner, that’s absolutely true. “I should have gotten better sooner.” That’s totally false. In addition, although one might think that no one would "want" depression, my research and new clinical work indicate that resistance is nearly always the key to recovery. In other words, people do cling to depression, anxiety, troubled relationships, and habits and addictions, but don’t realize why they are resisting change. Once you suddenly see why you are resisting, your resistance paradoxically disappears, and recovery is then just a stone’s throw away. You can learn more about this in my new book, Feeling Great, available now on Amazon. Thanks! PS let me know if you like the new book, and if you find it helpful! All the best, David   A new comment on the post "108: Do You Have a "Self?"" is waiting for your approval Author: Charles Dr. Burns, First off I want to say thank you. Your work has been helping me through my anxiety. However, I really struggled with this podcast. The concept of no self shot my anxiety way up and made me feel hopeless. It made me feel almost as if I was not real or that there is nothing worth striving for. I love helping people. But I feel like I don’t have a purpose if I don’t have a self. It makes me feel worse than before. David’s answer. Hi Charles, The “great death” of the self is a challenging concept, and while it is incredibly liberating, lots of people—most, in fact—don’t “get it.” Some get angry. Some struggle with trying to understand what this could possibly mean. And some find the concept very threatening. That’s why I deleted the chapter from my book. In fact, a couple extremely brilliant and interested colleagues totally couldn’t grasp it, and felt frustrated by my writing on the concept. sometimes, ideas are so simple and basic that people cannot grasp them. The Buddha ran into this problem 2500 years ago. People thought he was fantastic, but almost none of his followers experienced the enlightenment he was so excited to teach them. The 20th century philosopher, Ludwig Wittgenstein, ran into the same problem. He solve all the problems of philosophy, but when he was alive, it was rumored that only seven people in the world, including one of his favorite students, Norman Malcolm, could grasp what he was saying. He went in and out of intense depression and loneliness during his life, in part because of his frustration with trying to teach the obvious. In my book, Feeling Great, I teach that there are actually four “Great Deaths” for the patient, corresponding to recovery from depression, anxiety disorders, relationship conflicts, and habits and addictions. There are also four “Great Deaths” for TEAM therapists. Those sections might be helpful for you! In addition, I focus on the fact that people can never judge your “self,” only something specific that you think or do. Depression cannot exist on the specific level, only up in the clouds of abstraction. For example, Overgeneralization is one of the ten cognitive distortions I described in my first book, Feeling Good. When you Overgeneralize, you see a negative event as a never-ending pattern of defeat, and you might also Overgeneralize from some specific flaw or defect to your “self.” You will read about an attractive and vivacious young professional woman who had the thought, “I’m unloveable,” when her boyfriend of two years broke up with her. This is classic depression thinking, and “self” thinking. She thinks she has a “self” that can be loveable or unloveable. But this is simply not true, and it’s not productive, because she’ll spend all her time ruminating and feeling worthless. An alternative is to focus on why the (overall excellent) relationship didn’t work out, and what she can do to change and learn and grow, so as to make the next relationship even better. You can pick up on the details in the chapter on Overgeneralization if you’re interested! As I point out in Feeling Great, the “death of the self” is not like a funeral, it’ like an incredible celebration of life. Death of your old concept of what you are is liberating, and leads to instant rebirth. My teachings cannot make you happy or unhappy. Your thoughts about what I’m saying create all of your feelings, positive or negative. At any rate, thank you for a most important question that most of my audience will definitely related to. As an aside, I lost my “self” years ago, and what a relief that was. Sadly, it comes back to life from time to time, and then I struggle again, until I realize what’s happening. One day, what I’m saying may make sense! In the meantime, please accept my apologies concerning the “self!” If it gives you comfort to believe you have a “self,” no problem. But the “self” is just a concept, and not a “thing” that could exist or not exist. When you lose your precious and protected “self,” you lose nothing, because there was never anything there in the first place! But while you lose nothing, you do inherit the earth, as nearly all great religious leaders—Buddha, Jesus, and others—have taught us. David   Hi Dr. Burns, I’ve just listened to your podcast episode on suicide and found it really interesting and useful but I have a few questions. Firstly, how is your requirement that the patient agree to not make any suicide attempts for the rest of their life any different to a ‘suicide contract’ which you mention are not effective? Also, you talk about doing this assessment at the intake and making non-attempts a condition of therapy. If the patient/client agrees to this, why then do you continue to monitor suicidal thoughts in each session in the BMS? Presumably because the agreement is no guarantee of cessation of thoughts. Surely if you’ve told them it’s a condition of therapy with you to not make any attempts then they’d be likely to not tell you about them even if they occurred, and don’t see how setting the initial ground rule resolves the problem. And lastly, when suicidal thoughts, urges, or fantasies do come again in the BMS how do you handle it then? Do you tell them you’ll end therapy, say “but you promised”? Looking forward to your reply. Thanks, Michelle. Hi Michelle, I have scheduled your email for an upcoming ask david episode, and will use your first name unless you prefer that i use some other name. Here is a brief reply. Most patients with borderline personality disorder will become enraged by the gentle ultimatum at the initial evaluation, and if they decide this is not the type of therapy they want, so be it. The techniques I use will not be effective with patients who continue to threaten suicide. TEAM therapy requires TEAM work. Most, nearly all, patients will "get it" and will decide to continue with the therapy. They can have suicidal thoughts and urges, and we can work on them together in therapy. However, to my way of thinking, it is important that they therapist and patient be protected, in a safe environment. If the patient starts threatening to make a suicide attempt, then they will need another form of more intensive treatment like hospitalization, day care, or intensive outpatient treatment. These are options I cannot personally provide for them. I monitor suicidal urges before and after each session with every patient with no exceptions to protect the patient and to protect myself as well. Thanks! PS the suicide contract is an agreement not to attempt suicide "while we are working together." This is very weak, as the patient can suddenly decide he or she is dropping out of therapy and making a suicide attempt. And this often happens. My contract is more demanding, and intentionally so. Patients must also agree to do psychotherapy homework, too. Some patients want to make the therapist a hostage with suicide threats, which can and so work as a form of manipulation and hostility. Then the therapist is in an almost constant state of agitation, anxiety, and frustration. If I allow a patient to make my life miserable, how can I teach that patient how to be happy? We are all ONE—we go up and down together. If I allow you to make my life miserable, then I am allowing you to make your own life miserable, too. David   Hello David, Thank you so much for everything you do. I’ve listened to all of your podcasts, and read most of your books, and am very grateful for the changes you, Rhonda, Fabrice and the rest of the team have made to my life. I’ve just listened to this episode, and there’s one thing I’m struggling with, which is the concept of the moral should. I’ve done a few things that made me intensely guilty – one in particular was not standing by and supporting a friend who needed people when he was going through a particularly hard time. He was angry and disappointed with me, and, in hindsight, rightly so. He has since forgiven me but I still struggle with it. I feel that supporting him was a moral should. The knowledge that I didn’t do what I should have done led to a lot of guilt and shame, and eventually depression. You say that a moral should is valid; so therefore, I feel that my negative thoughts on this are not misguided but valid – I did something morally wrong and deserved to feel bad for it. Just wondering your thoughts on this. Thanks again, and keep up the good work! Hi Brian, thanks! Would love to include this on an Ask David, using just your first name, or even a fake name if you prefer. A quick response might be to ask how many minutes per day would you like to dedicate to feeling guilty? And for how many days, months, or years? In your spiritual or religious beliefs, is a person supposed to feel intensely guilty forever? Most of us have done things we are ashamed of, or feel guilty about. How much guilt and shame would you recommend for me, for example? And what is the goal of the guilt and shame? And how guilty would you recommend I feel, between 0% and 100%? That's one approach. Another approach would be A = Assessment of Resistance, listing what the guilt shows about you that's positive and awesome, and then asking yourself why in the world you'd want to let go of the guilt, given all the many real positives. Then you might validly decide to “dial it down” to some more acceptable level. For example, if you now feel 90% guilty, perhaps 15% or 20% would be enough. In addition, you could also decide how many minutes of guilt you would recommend. If you now feel guilty about eight hours a day, would 10 minutes be enough? If so, you could schedule your “guilt periods” ahead of time, and then really work hard at feeling guilty during those ten minutes. Then, when you’re done with your “guilt work,” you can return to joyous and loving living! Also, instead of one ten minute daily guilt binge, you could schedule, for example, three guilt binges, each three minutes long, in the morning, at lunch time, and in the evening, like three pills the doctor prescribed! David In reply to Dr. Burns. Hi Dr Burns, Thanks so much for your quick response! I really appreciate your advice; I will dedicate a bit of time today to approaching it the way you say. And also, I’d be delighted if you included it on a podcast! You can use my first name by all means. Thanks again! Brian   Comment from Carrel I'm a Democrat in Texas. How can we use disarming to heal the political rifts in our country? How does one find agreement across that ever-widening divide? Carrel David’s reply Hi Carrel, It’s really tough, for sure! Have you listened to my podcast on this topic? There is a search function on my website. If you type in “political divide,” this podcast will pop right up: “127: How Can We Communicate with Loved Ones on the Opposite Side of the Political Divide?” Let me know what you think! David David emphasizes the value of the search function. Often you can find your questions have already been addressed. In addition, the many podcasts on the Five Secrets of Effective Communication could be invaluable (links), and the emphasis would be on using the Disarming Technique to find some truth in what the other person is proclaiming and arguing for. But first, you have a decision to make, and this is always based on ONE person you may want to interact with. First, ask yourself if you do actually want a better relationship with person X, Y, or Z. There is no rule that says we have to get along better with everyone. I think that Joe Biden is doing a pretty good job of promoting unity, and not diverseness in our country. Hopefully, the forces of love and unity will win out over the forces of hatred and war, but it’s not at all clear what direction our country is heading for. And we’re seeing now that at times the tensions are become so intense, and the hatred so strong, that violence is once again on the increase. In the next Ask David we'll have a really cool session devoted to the intense anger that many of us feel when confronted by human behavior that strikes us as narcissistic, vicious, self-serving, and aggressive. This topic should appeal to lots of people! And we have a wonderful question from a woman who's feeling pretty darn enraged! David and Rhonda  

Last week, you heard part 1 of the live work with Sunny. Today, you will hear the dramatic conclusion of that session. My wonderful co-therapist is Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California. Jill also co-leads our Tuesday training group at Stanford. This session took place between 5 and 7 PM at a recent Tuesday group because we feel that personal healing is a critical part of psychotherapy training. We will begin with a summary of A = Assessment of Resistance. David will summarize  Sunny’s Positive Reframing list, as well as the “turning point” when David challenged Sunny’s first negative thought, telling himself that he shouldn’t be getting anxious again. Once again, the moment he saw that he actually should be getting anxious, and that this was a good thing, and not a bad thing, the dam kind of broke open, and Sunny suddenly saw everything in a radically different perspective. This is one of the core principles and goals of TEAM—helping the patient suddenly see that his or her suffering is not the expression of what’s wrong with you, like a “chemical imbalance” in your brain, but what’s most beautiful and awesome about you, and your core values as a human being. During this phase of the session, Sunny expressed anger about parents who tell their children they SHOULD do X, Y, and Z, and thus sowing the seeds of low self-esteem and the need for approval. We continue and conclude the M = Methods, using: Identify the Distortions The Enhanced Cost-Benefit Analysis (Enhanced CoBA) The Externalization of Voices, with Self-Defense and the Acceptance Paradox The Hidden Emotion Technique The Five Secrets of Effective Communication Final T = Testing. You can see Sunny’s end of session mood ratings on his completed Daily Mood Log, as well as his end of session scores on the Brief Mood Survey and Evaluation of Therapy Session. Here is Sunny’s follow-up email to the Tuesday group: Hi folks. Just want to give you an update of what happened after our group meeting. I was exhausted after our session. But I felt very good - even different than other times when I did self disclosure and deep-down part of me was looking for some validations from others. This time, I came out feeling very confident about myself and my ability to swim without the floating bubbles (approval from others). Most importantly enjoy life now. In fact I didn’t think talking with my mom was necessary because I was not angry with her the next day. Somehow I wasn’t blaming her anymore because I know she changed since then. And I was thankful because I wouldn’t be where I am without that push. But I did chat with her tonight. I told her how I was hurt when I felt a lot of pressure from her when I was young. And that I love her very much and now am happy that I am confident about my own life decision without needing approval from others. And she told me that she is happy that I am happy. And when we were young, she And she will always love me and support me. And she is happy that I am doing whatever I love so I don’t regret in life. And on and on... lots of loving languages that we don’t use together usually :) Net net: it was an awesome chat and we are closer. But as importantly, I wasn’t looking for any validation from her - more like giving her some good news about my personal growth. And I felt more confident and equal but loving when I talked with her. So it’s all good :) I do have an insight on self disclosure. From my experiences, there is a fine line between self disclosure vs approval seeking type of sharing. Both can have similar Immediate results - feeling good and emotional. So make sure our clients are clear of the objective of the self disclosure. And that there is no approval seeking hidden inside - if that’s not the objective. See you all next Tuesday Sunny And here is some of the feedback from members of the Tuesday group: What did you like the least about today’s Tuesday group? Nothing comes to mind Sunny was fabulous! This isn't something I disliked, but a question... I'm trying to figure out how David and Jill are able to get through the process so quickly and yet have it not feel rushed.. I suppose a lot of practice! Also curious about how Sunny will talk to his mom- thinking about doing this with my mother, I'd be worried that she'd feel like I was blaming her for something and become defensive and close down (which she typically does when anyone tries to bring up their feelings or even when they ask about hers), so I'd be curious about the specific details of the 5-secrets approach here Nothing — I loved everything about our session tonight Please describe what you specifically liked about the training? What was the most helpful? Agree with David that the learning which takes place via live personal work may be the most powerful of all. Helpful to review the various steps and methods while also watching the masters weave the art and science of It all together. Thank you to the brave Sunny for sharing this work with us tonight. This Session was also an awesome dose of relapse prevention for myself, as while I have made major strides with approval addiction this year, I still drift in and out of enlightenment, as is expected! I appreciate that Sunny's courage to share his vulnerability. His cultural background and parenting style are very similar to mine. I enjoyed the masterful use of empathy from David and Jill I share Sunny's approval need without being told by a parent, at least not obviously. The 'talking back to distorted thoughts' helped me a lot. Also, watching the flow of the therapy by David and Jill was educational in my interactions in similar situations. I loved seeing the whole process of TEAM being modeled with Sunny. I especially liked the positive reframing and empathy stages the best, but it was all so blow away to experience. I'm so grateful to be able to be a part of this group. I loved watching the whole session unfold. It was a powerful positive reframe and Jill really honed in on the hidden emotion which seemed to really resonate with Sunny. I love the live sessions. It went so deep, and was so moving and beautiful. I appreciate Sunny's courage and authenticity, and the skill of David and Jill. Feeling so grateful to be able to see the live demo of TEAM by David & Jill on Sunny. It feels like watching the very painful but beautiful grief process of letting go of this infamous approval addiction, which I relate to so much as a Chinese woman. Watching how the enhanced CBA is a very magical, powerful & dynamic uncovering tool to address outcome resistance & change his mood rapidly. I loved being able to walk patiently through each step of the therapy. I am frequently amazed at how quickly the work goes once the TEA is managed fully and effectively. I love this stuff! Thanks for allowing me to be an observer and participant in this group. I like seeing the richness of live work. It was uplifting to hear group members share with Sunny how the session affected them and how they think about their parent-child relationships. It's always great to watch a full session. This has been a wonderful session and also a surprise. I see clients and do not get to check emails before we start and was not aware we were heading for another individual work - what a treat! This has been an amazing session. Sunny is a very bright and sensitive guy and admire his eagerness to work though his challenges and open up to the group. I have learned so much from his insights and felt most honored to be an invisible participant in this process. Thank you Sunny! Jill and David you were wonderful! This has been a particularly powerful session. Thank you. It was great to see the shift in thinking and feeling in session. Sunny was so open to talk about his past and his pain; he had been reflecting about his approval addiction for some time. It seemed that through the positive reframing he was able to see his "addiction" from a different perspective. Approval addiction is something I have struggled with myself over the years and I felt so grateful toward Sunny for his vulnerability. Also really appreciated Jill's pausing to address the anger that came up in the Externalization of Voices, and David's teaching point about how important it is for the patient to really "SEE" something during the positive reframing. Loved that Sunny was willing to be truly vulnerable and authentic. I always love seeing the model from start to finish. Session tonight was exceptionally awesome. Thank you, Sunny for your willingness to work on something so painful and deep in front of the whole class. This has been one of my favorite classes. You touched my heart because you were genuine,, honest, and very very humble. Thank you! And thank you to David and Jill for their superb teaching. As always, I learn so much from them when they do live. With immense gratitude – Sara Demonstration by David and Jill. It was such an amazing opportunity for us to witness how T.E.A.M works and get through the process. Approval addiction is something I have wanted to work on myself..... I need to listen to the recording and review! I enjoyed seeing the ease in which the TEAM method was used Jill's way of connecting some dots and inquiring with sunny about his mother’s understanding of his experience. Jills ability to do this always blows my mind because I'm still trying to tap into that deep level of listening. Thank you for sharing Sunny! Love the cultural aspect that was brought in This live session was moving, insightful, and very instructive for me. It gave me insights into my own approval addiction, it moved me to see how Sunny went through his internal conflict throughout the session, and it was beautiful and very instructive to see two master therapists like David and Jill at work. Thank you so much Sunny, David, and Jill! Thank you Sunny, David and Jill. I was moved and touched by the therapy. I like David and Jill asked Sunny his feeling at an appropriate moment during the therapy instead of only at the beginning and the end. For instance, David asked, "You are opened up to us. How are you feeling now?" Jill asked how angry he was when he expressed his feeling of anger to his mom. It is very powerful. I liked how David asked Sunny to communicate with his mom. Although I am learning the Five Secret skills, it is still hard to use them in daily life. I need to practice it. Sunny can be reached at: Sunny Choi, LCSW sunny@bettermoodtherapy.com Better Mood Therapy Thanks for listening today! David and Rhonda

In today’s podcast, we will work on another common Self-Defeating Belief, the Approval Addiction. Here are two definitions: My worthwhileness as human being depends on getting approval. I need approval to feel happy and fulfilled. I thought of calling this podcast “Curing a Case of Siliconitis” because here in Silicon Valley, there is a pronounced tendency for people to measure their self-esteem based on their accomplishments, so today’s program also has some overlap with the Achievement Addiction we featured recently. Of course, you don’t have to live in Silicon Valley to struggle with the Approval and Achievement Addictions. These problems are almost universal throughout the United States as well as the entire world. In fact, for today’s special guest, Sunny Choi, the problem originated in Hong Kong when he was growing up. And although your life may be very different from Sunny’s, you may discover that you, too, sometimes struggle with the need for approval, and the tendency to base your self-esteem on your achievements. So I’m hoping that the healing Sunny experienced might be contagious and end up helping you! I want to thank Sunny for allowing his personal work to be broadcast, raw and unedited, on the podcast. Personal work is absolutely essential to becoming a world-class therapist, because you can’t really heal others until you’ve healed yourself. But sharing your inner struggles, your tears, and your shame, can be extremely frightening, making you totally vulnerable, so Sunny has given all of us an incredible gift! I also want to thank my amazing co-therapist, Dr. Jill Levitt, who helps lead the Tuesday group. She is also the Director of Training at the Feeling Good Institute in Mt. View, California. I love teaching and doing co-therapy with Jill. TEAM therapy does NOT require two therapist, but I love to work with a co-therapist whenever I do live therapy in a teaching situation, as it often makes for a richer and more dynamic session. The session will be broken into two consecutive segments. Today, you will hear the T = Testing and E = Empathy parts at the start of the session. Next week, you will hear the A = Assessment of Resistance and M = Methods parts. At the end of next week’s podcast, Sunny will join us for a follow-up so we can see how he’s been doing since the end of this session. At the beginning of the session, we reviewed Sunny’s scores on the Brief Mood Survey, which indicated minimal feelings of depression, mild anxiety, and just a touch of anger. However, his happiness score was only 22 out of 40, indicating significant unhappiness, and his Relationship Satisfaction score, thinking of his mother, was only 16 out of 30, which is also not very good. However, he said that this score is higher than it’s been, indicating longstanding dissatisfaction with his relationship with his mother. Sunny explained that he’s been seeking and getting approval since he was a small boy. He was the “good golden boy” who always wanted what his mother wanted, and he always got rewarded. In addition, since he was a boy, he always got the best food, and his sister always got the less desirable dinner. In addition, she was a rebel, and often punished and beaten by their mom, which made Sunny feel guilty. At the same time, he was good at getting approval from just about everybody, so lots of people like him. His first frightening step toward independence was coming out as a gay man in his 20s. This was an intensely anxious time in his life. After his family migrated to California, he pursued a career in high tech, which was what his mother wanted, and he was very successful and earned a high salary. But he was unhappy, because it wasn’t what he really wanted to do with his life. He wanted to help people, but because of a lisp in his speech, his mother urged him to pursue engineering, which, of course, he did, and he also graduate from Stanford University, which gave him even more approval and “success.” His second frightening step toward independence was six years ago when he decided to leave high tech to pursue a master’s degree in clinical social work. This was a bit anxiety provoking because he did his master’s work at a program that was adequate, but not at all prestigious. That was about the time he joined my weekly training group at Stanford. Sunny took the TEAM model very seriously, and mastered it, developing superb therapy skills. Following his licensure, he took a job at a local mental health clinic and worked with many immigrants struggling with depression, anxiety, and somatic complaints, and experienced tremendous success, since most of us patients recovered in just a handful of sessions. However, he was anxious and ashamed of his success, since TEAM is so radically different from the more conventional forms of therapy his colleagues at the clinic were using. He feared their disapproval, and always tried to hide or downplay his success. Recently, Sunny took a third frightening step toward independence. He decided to quit his full-time job, and take a half time job with an online startup, so he could have half of his time to do what he wanted, instead of trying to please or impress others. And although this is working out well, and he’s been feeling pretty good, and making progress, at times he gets anxious, and feels like he’s swimming in the ocean without his flotation device to keep him safe. And although he knows rationally that he can swim really well on his own now, at times he descends into spells of anxiety and self-doubt. He even yelled at himself out loud for being “stupid.” He explains: What helped was when I called my Mom and said, “I feel useless if I’m not working full-time,” and started crying. She is now 80, and was accepting, and that helped quite a bit, but in the past I’ve always been surrounded by people who approve of me because of my success. Now I feel lost and lonely, and I’m dealing with anxiety again. Sunny also said he felt frustrated because, once again, he sought and got his mother’s approval. He explained: I feel bad. I’m concerned that I will never get better. I feel sad that I’m stopping myself. My approval is my flotation device. I’m scared and lonely at times. I’m used to someone saying, “You’re doing the right thing.” I feel like I’m not good enough. Right now I want the approval of the Tuesday group, but that will just prolong my addiction. You can see Sunny’s Daily Mood Log here. Next week, Jill and I will work with Sunny on A = Assessment of Resistance and M = Methods! Sunny can be reached at: Sunny Choi, LCSW sunny@bettermoodtherapy.com Better Mood Therapy David and Rhonda

In today’s podcast, we discuss a few of the many differences between Feeling Good, my first book, and my new book, Feeling Great, which was just released. We also discuss some of the differences between the cognitive therapy that I launched in Feeling Good, and the powerful new TEAM therapy that I feature in Feeling Great. I wrote Feeling Great because there’s been a radical and enormous evolution of the treatment methods and theories in the 40 years that have elapsed since I first published Feeling Good in 1980. I now have many more techniques than I had then, and there’s been with a radical development in my understanding of the causes of depression. I also have new ideas about the most effective treatment techniques, based on my clinical experience since I wrote Feeling Good (more than 40,000 hours treating individuals with severe depression and anxiety), as well as fresh insights about what's important, and what's not, based on four decades of my research on how psychotherapy really works. Rhonda asks many questions about the unique features of TEAM including the new T = Testing techniques, the new E = Empathy techniques, the A = Assessment of Resistance techniques, as well as the M = Methods. Rhonda is particularly curious about the four “Great Deaths” of the therapist’s ego in TEAM therapy, which correspond to the four TEAM components of TEAM, as well as the four “Great Deaths” of the patient’s ego, which correspond to recovery from depression, anxiety, relationship problems, and habits and addictions. One of the goals of TEAM is not simply the complete and rapid elimination of the symptoms of depression and anxiety, but the development of personal enlightenment and the experience of great joy and a deeper appreciation of life. Toward the end of the podcast, David tearfully talks about the life of his hero, Ludwig Wittgenstein, who is viewed by many as the greatest philosopher of all time, and David, a philosophy major when he was a student at Amherst College, would definitely agree with this assessment. But Wittgenstein was very lonely, and prone to depression, because very few people understood his ground-breaking contributions when he was still alive. In fact, it was thought that only five or six people in the world “got it.” Part of the problem is that what he was saying was so basic and obvious that most people just could grasp it, or the extraordinarily profound implications of his work. His depression and loneliness, sadly, perhaps also resulted from the fact that he was gay, and living at a time when this was far less acceptable than it is today. He never published anything when he was alive, because when he was depressed, he thought he'd made no meaningful or enduring contributions. However, his remarkable book, Philosophical Investigations was published in 1950, following his death, and was soon regarded as the greatest book in the history of philosophy. Because of that book, David gave up his goal of a career in philosophy, since Wittgenstein wanted all of his students to give up philosophy and do something practical instead. So that’s what I did! My only regret is never having the chance to meet Wittgenstein and tell him, “I got it!” and thank him for his incredible contributions. If you want to learn more, check out the short read by his favorite student, Norman Malcolm, who wrote “Ludwig Wittgenstein: A Memoir.” I cry like a baby every time I read the book, and tears come to my eyes when I even look at the book, which is proudly displayed in my office. If you ever visit me at home, make sure you check out the  book. I feel so fortunate to be able to work with Rhonda and bring my message to so many of you every week. Thank you for your support!  [Note from Rhonda:  I feel extremely honored to work with David and be a part of bringing David's message, and the TEAM therapy model to our listeners!] David and Rhonda

How to Change a Self-Defeating Belief (SDB) (cont'd) Last week, you had the chance to listen to our Tuesday training group at Stanford as we worked on the "Achievement Addiction," Part 1 (Podcast 211). Although we were working with a therapist named Zeina Halim, it turned out that just about everybody in the group had this belief, and perhaps you do, too--thinking that your worthwhileness as a human being depends on your achievements, hard work, and productivity. This belief, which is also known as the Calvinist work ethic (e.g. you are what you do) is actually at the heart of Western Civilization. And while it can trigger intense achievement, it can sometimes also trigger angst, including feelings of depression, anxiety, and endless self-doubt, wondering if you and your achievements are "good enough." In last week's podcast, we played the first half of the Tuesday group's session, featuring the Cost-Benefit Analysis. In today's group, we play the the recording of the last half of the group, featuring these three additional techniques. At the end of today's recording, Zeina joins us and talks about the session, and the techniques that were the most meaningful for her. The Semantic Technique. This involves change at the intellectual level. If you decide that a SDB is not working to your advantage when you do a CBA, you can you modify it so you can keep all the advantages you listed while getting rid of most if not all of the disadvantages. This is a bit of practical personal philosophy exercise with significant emotional implications. The group members came up with a wide variety of alternate beliefs, and I critiqued several of them, pointing out the benefits and pitfalls of each new version. The Feared Fantasy. Here's where change at the gut level begins, and you also can begin to challenge the idea that high achievers really are more worthwhile. We did a version of this technique that I've often demonstrated in my workshops called the "High School Reunion." It is a humor-based technique, but the goal is to make a powerful point at the gut level, so you can (hopefully) suddenly "see" that it is simply not true that people who achieve a great deal really are more worthwhile human beings. The Double Standard Technique. Here's where change at the gut level continues, and you will hear a beautiful example in Zeina's dramatic interaction with Dr. Levitt. Dr. Levitt plays the role of someone trying to figure out if she really is less worthwhile than people who achieve a great deal more. Rhonda and I hope you enjoyed our podcasts on the Achievement Addiction. We'd also like to thank our courageous Zeina for sharing her very personal work with all of us. Live work--and showing how a technique works--is generally far more inspiring and illuminating than simply teaching how a technique works. Please let us know if you'd like more Feeling Good Podcasts like this in the future, with recordings from our weekly training group,  and also if there are additional Self-Defeating Beliefs you'd like us to feature. My new book Feeling Great, is now available on Amazon (see the link below) as a hardbound volume or as an eBook. It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public. Rhonda and David

How to Change a Self-Defeating Belief (SDB) Many of you have expressed an interest in my free Tuesday training group for mental health professionals. Today, you can attend, thanks to the generosity of our group in allowing the group to be recorded on Zoom, and thanks Zeina, the group member who courageously volunteered to have us work on her “Achievement Addiction.” I also want to thank my beloved and brilliant co-teacher, Dr. Jill Levitt, who always adds tremendously to our group, on so many different levels. Last week, we taught the group members how to pinpoint Self-Defeating Beliefs that trigger depression and anxiety, and we promised to show them how to challenge and modify a Self-Defeating Belief in the group you’re about to “attend.” We decided to focus on the Achievement Addiction, which is the belief that your worthwhileness as a human being depends on your achievements and productivity. Perhaps you share this belief! Most people do. Here’s how a Self-Defeating Belief works. Let’s say that you base your self-esteem on your achievements. As long as you think you’re achieving and being successful, we would predict that you’ll feel happy and contented. But we would also predict that you may experience episodes of depression, anxiety, and self-doubt when you fail or fall short of your goals and expectations. That’s when you’ll be most likely to start beating up on yourself with distorted negative thoughts, like “I’m a loser,” or “I shouldn’t have screwed up,” or “I’m not good enough.” So, in short, the combination of an SDB (“My worthwhileness is based on my achievements”) plus a negative event, like a perceived failure, triggers distorted thoughts (like “I’m a failure” or “loser”) which trigger negative feelings, like depression, anxiety, shame, inferiority, or even suicidal thoughts. In addition, cognitive therapists believe that if you modify the SDB, it will not only help you in the here-and-now, but it can also make you less vulnerable to painful mood swings in the future. But how in the world can you do that? If you like, take a look at the list of 23 common Self-Defeating Beliefs and see if you can find any of yours! Zeina said she wanted help with her tendency to base her feelings of happiness and self-esteem on her accomplishments. In the group, we demonstrated four techniques for changing this or any SDB, including: The Cost-Benefit Analysis.  You list the advantages and disadvantages of the belief you want to change. You can find the one we worked on with Zeina during the group if you click this link. If you want a blank one you can work with, you can find one on page 2 of this link. The Semantic Technique. This involves change at the intellectual level. if the SDB is not working to your advantage, could you modify it so you can keep all the advantages you listed while getting rid of most if not all of the disadvantages. This is a bit of practical personal philosophy exercise with significant emotional implications. The Feared Fantasy. Here's where change at the gut level begins, and you also can begin to challenge the idea that high achievers really are more worthwhile. The Double Standard Technique. Here's where change at the gut level continues, and you can hear a beautiful example in Zeina's dramatic interaction with Dr. Levitt. In today's part 1 podcast, we completed the Cost-Benefit Analysis. I would urge you to do your own CBA while you're listening. When you're done, balance the advantages against the disadvantages on a 100 point scale. Put two numbers in the circles at the bottom to show whether the advantages or disadvantages are greater. For example, if the advantages of this belief greatly outweigh the disadvantages, you might put 80 - 20 in the two circles. If the advantages and disadvantages of this belief are about equal, you can put 50 - 50 in the two circles. And if the disadvantages are somewhat greater, you might put 45 - 55 in the two circles. When you do your own weightings, please note that the number advantages or disadvantages is not important--that's because one advantages could outweigh several disadvantages, and vice versa. Instead, look at the lists as a whole and ask yourself how they feel, and how this belief is working for you. In addition--and this is super important--remember that you are NOT evaluation the advantages and disadvantages of achievement. There probably aren't any disadvantages of achievement! Instead, you are evaluating the advantages and disadvantages of basing your self-esteem and feelings of worthwhileness on your achievements and productivity. At the end of the group work with the CBA, I emphasize that the goal of the CBA is simply to find out if you (or in this case Zeina) want to change your SDB. This is a motivational question. If the advantages and disadvantages are about equal (50 - 50), or if the advantages out weight the disadvantages (eg 60 - 40), then there may be no reason to change the belief. But when the disadvantages outweigh the advantages, you can then change the belief so that all the disadvantages diminish or disappear entirely, while at the same time you keep all the advantages. That sounds like a pretty good deal! In next week's podcast, you'll learn how to make this happen with the help of the Semantic Technique, Feared Fantasy, and Double Standard Technique! There are a great many additional techniques for challenging and modifying any SDB as well. The four I listed above are just a kind of “Starter Kit” for SDBs to give you a feel for how some of the techniques work. If you like this podcast, we may focus on other SDBs as well, such as the Approval Addiction, the Love Addiction, and more. Let us know if you’d be interested, and which beliefs interest you the most. We’ve already done a podcast on perfectionism, as well as a popular Live TV program on perfectionism on Facebook that features Jill and me, but there are tons of beliefs we haven’t yet addressed. To make today’s podcast more dynamic, you can do your own Cost-Benefit Analysis while you watch, and make sure you do your own weightings at the bottom, just like the therapists in our Tuesday training group. I think you’ll enjoy it, and it might nudge your thinking a little, too! Please let me know if you've enjoyed "eavesdropping" on my Tuesday training group, and if you'd like more Feeling Good Podcasts like this in the future. Let me know, too, if you'd have an interest in attending a weekly TEAM therapy training group for therapists or for the general public. My new book Feeling Great, is now available on Amazon (see the link below) as a hardbound volume or as an eBook. It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public. Rhonda and David

Corona Cast 8: Live Therapy with Dan. How Could You Treat an “Existential Depression” in the Midst of a Pandemic? Today David and Dr. Jill Levitt feature live work with Dan, a licensed clinical social worker who’s been struggling with an “existential depression” for 15 years, but it has been recently exacerbated by the COVID-19 pandemic. The session took place in one hour and forty minutes on a Tuesday evening on July 23rd, 2020, in David’s and Jill’s Tuesday training group at Stanford. Live personal work is one form of training that is vital to professional growth and learning, so it is extremely beneficial for the person who volunteers for the role of “patient.” At the same time, the live work also provides superb learning for those observing the process, since you can see what is really happening during a T.E.A.M. therapy session. Hopefully, you will learn a great deal as you listen to Dan’s live and uncensored therapy session. Jill and I feel very grateful to Dan for allowing us to publish such an intensely painful and personal experience. You will likely feel grateful to Dan as well! All live therapy sessions tend to be dramatic and illuminating from a variety of perspectives. Today’s session is unique in that the A = Assessment of Resistance was outstanding and unique. The remarkable changes that occurred would not have been possible without outstanding E = Empathy and A = Assessment of Resistance, which were stellar. However, the M = Methods portion of the session was also strong, especially in the use of humor and role-reversals during the Externalization of Voices to blast Dan’s Negative Thoughts out of the water. That portion of the session confirmed by the three basic tenants of cognitive therapy: You FEEL the way you THINK. All of your negative feelings are caused by your thoughts in the here-and-now, and not by the actual events in your life. In other words, the COVID-19 pandemic cannot “cause” anyone to feel depressed or anxious. Depression and anxiety are the world’s oldest cons. When you’re depressed, anxious, or angry, the Negative Thoughts that upset you will not be valid. They’ll be distorted and illogical. Depression and anxiety are the world’s oldest cons. You can see the ten cognitive distortions I first published in my book, Feeling Good, at the bottom of Dan’s Daily Mood Log (link). You can CHANGE the way you FEEL. The very instant you stop believing your distorted thoughts, your feelings will change. Recovery is not a long, drawn-out process that requires weeks, months, years or decades, as so many people believe, including the majority of mental health professionals. Recovery happens in a flash, an unexpected “ah-ha” moment when your perceptions of the world are suddenly transformed. You will witness such an event in today’s session. Now let’s see what actually happened! T = Testing Take a look at Dan’s Brief Mood Survey (BMS) at the start of the session. He was feeling moderate to severe depression, no suicidal impulses, and just a little anxiety and anger. His Happiness score was quite low, only 7 out of 20, paralleling his depression score of 12, and his satisfaction with his relationship with his wife was a perfect 30 out of 30. He indicated he’d been doing a lot of psychotherapy homework. This, by the way, is the latest version of the BMS. We’ll ask him to complete it again at the end of the session to see what changes occurred during the session. Because the BMS asks how Dan is feeling “right now,” it’s like an emotional x-ray machine, allowing therapists to see exactly how much, or how little, a patient is changing at every therapy session. The patient’s scores at the start of the next session also allow the therapist to see exactly what happens between sessions in multiple dimensions. At the end of today’s session, Dan will also fill out the Evaluation of Therapy Session (ETS), and rate Jill and David on Empathy, Helpfulness, and Session Satisfaction, and indicate how willing he is to do psychotherapy homework, whether he had unexpressed negative feelings during the session, and whether he had difficulty filling out any of the survey questions honestly. The BMS and ETS are invaluable tools that have been game-changers in psychotherapy. To my way of thinking, it is difficult, if not impossible, to do good therapy, much less outstanding therapy, without these powerful and extremely accurate tools. They have the potential to radically transform clinical work and have been an important key in the evolution of TEAM. E = Empathy After briefly reviewing Dan’s starting scores on the BMS, Jill and David empathized while reviewing the Daily Mood Log that Dan filled out prior to the start of the session. The upsetting event was sitting at home on a Friday night with nothing to do, since his wife was studying for an upcoming exam. He points out that when he’s busy doing therapy, he generally feels fine, but sometimes when he has nothing specific to do, intense negative feelings suddenly hit him and take all the joy out of life. As you can see, his feelings on his Daily Mood Log are similar to his feelings on the Brief Mood Survey but some are far more intense, since he’s focusing on a moment of angst. If you look at his Negative Thoughts, you will see that they all revolve around a common theme that life has no meaning, since people are suffering and dying all over the world, and since all of us will also die one day. He says, “the good things that happen are just like dust in the wind,” and tells himself that “life is unfair.” Dan explains that in the last couple of years he’s experienced several painful events. He got married, but got divorced after just three months when things did not work out with his wife. But he’d sold his condo, and his practice was not going well, and he could barely pay his bills, so he had to move back home with his mother, who then died of cancer. Then, right after she died, things suddenly took a turn in a far more positive direction. He began dating and found an extremely loving and wonderful woman in 2017, whom he married last October, and his clinical practice began to blossom around the same time, so he and his wife were able to purchase a new home. But still, the Negative Thoughts kept popping unexpectedly into his mind, and they can turn feelings of joy (“Wow! I really came back”) into despair in an instant (“I’ll probably lose everything again, and it makes no difference because I’ll eventually die.") David pointed out this is a little like PTSD, when you’re suddenly reminded of a previous trauma and get overwhelmed by angst. And the frequency and intensity of these sudden despair attacks have increased since the start of the pandemic. Dan gave Jill and David an “A” on empathy after about 30 minutes of listening without trying to “help,” and this was a sign that we could move on to the next portion of the session. A = Assessment of Resistance Jill asked Dan if he wanted help tonight, or needed more time to talk and vent. He said he was ready to roll up his sleeves and get to work. His goal was to reduce or eliminate his negative thoughts and feelings, if that was possible. Jill asked if he’d press a “Magic Button,” if that would cause all of his negative thoughts and feelings to instantly disappear completely, with no effort, and he said he would. Almost everyone says they’d push it—which is completely understandable. When you’re in great pain, we all want relief! Jill indicated that we did have powerful tools, but weren’t convinced it would be such a good idea to use them to eliminate Dan’s feelings, and suggested we might first make a list of indicating: What each negative thought and feeling showed about Dan and his core values that were positive and awesome. How his negative thoughts and feelings might be helping him. Doing this skillfully is an art form, since it is radically different from the inept “cheerleading” so many therapists and family members attempt when a loved one is feeling down. You will hear this process unfolding when you listen to the audio of the session. Notice how Dan’s memories of the death of his older brother when he was just three years old and the recent death of his mother bring tears to his eyes, and help him change the way he thinks about his angst, not as something “bad,” but as something beautiful that honors his mother and his brother who passed away. But this is just the tip of the iceberg, as a long list of positives emerges during this portion of the session, which is designed to melt away subconscious “resistance” to change. The A = Assessment of Resistance is really the secret key that opens the door to the possibility of rapid, profound, and lasting change. David and Jill make it look easy, but it is, in reality, quite challenging to learn, because it goes against the very grain of our human inclination to try to “help.” Instead, Jill and David are assuming the role of Dan’s resistance, and showing him, in a gentle and loving way, that his negative thoughts and feelings are not actually symptoms of a defect or “mental disorder, but are really the manifestation of something positive and beautiful about Dan. David and Jill are selling Dan on the status quo and are still NOT trying to “help.” Paradoxically, this procedure typically has the opposite effect of greatly intensifying the patient’s determination to change. But now, the therapists have put Dan into a confusional state, and bind. On the one hand, he desperately wants to change. He doesn’t want to continue throwing cold water on the cherished positive moments in his life. But at the same time, if he presses the Magic Button, all of the positives will go down the drain along with his negative feelings. This is resolved with the Magic Dial. David and Jill ask Dan if he’d be willing to dial his negative feelings down to some lower level instead of lowering them all the way to zero. You can see his goals for each negative feeling on the “% Goal” column of his Daily Mood Log. M = Methods Now David asks Dan which Negative Thought he wants to work on first. He chooses this one: “It’s pointless in life to strive towards anything, because, in the end, we are all going to die.”  Dan believes this thought 80%. While identifying some of the many distortions in this thought, he comes up with this Positive Thought: “Some things are worth striving for!” This thought is 100% true, and his belief in the Negative Thought suddenly drops to 10%, as you can see on his Daily Mood Log (Daily Mood Log.) Next, he wants to work on this thought, which he believes 60%:  “People are dying in the world right now, so I don’t deserve to relax and have fun.” After identifying five distortions in this thought, he challenges it with this Positive Thought: “Although the deaths of so many people are tragic, it isn’t my fault that people are dying all over the world.” Dan rates his belief in this thought at 100%, and his belief in the Negative Thought drops to zero. Then he decides to work on this thought: “I’ve had so many good things happen in the last several years, but I can’t enjoy them, since it’s inevitable that I’ll lose those things.” He adds, “After all, what goes up, must come down!” After a couple of rounds of Externalization of Voices with Jill, he still couldn’t completely crush this thought, so David steps in to give it a try, with Dan playing the role of the Negative Thoughts and David playing the role of Dan’s Positive Thoughts. David interrupts Dan’s verbalization of this thought with some irreverent Buddhist humor. At that moment, Dan suddenly “gets it,” and the floodgates open up as Dan crushes the thought. Some people have called this “ah-ha” moments the “cognitive click.” It’s like waking up from a trance or nightmare, and the patient suddenly sees the world in a radically new and far more realistic light. Jill and David complete the M = Methods portion of the session by challenging the rest of Dan’s Negative Thoughts using Externalization of Voices, including role-reversals with the Self-Defense Paradigm and the Acceptance Paradox. I think you will find these exchange fascinating, and you will hear the tides coming in and the tides going out as Dan sometimes struggles and then defeats all of his Negative Thoughts. You can review Dan’s end-of-session mood ratings on his Daily Mood Log as well as his end-of-session Brief Mood Survey and his ratings of Jill and David on the Evaluation of Therapy Session. The Necessary and Sufficient Conditions for Emotional Change If you look at Dan's Daily Mood Log at the end of the session , you will see that the belief in each Positive Thought was high, and that his belief in the corresponding Negative Thoughts was drastically reduced. This is exactly why his feeling suddenly changed so dramatically. Cognitive Therapy (including TEAM) is NOT about telling yourself positive things or uttering positive affirmations. Instead, it's about crushing the distorted thoughts that trigger all of your negative feelings. The very moment you stop believing your Negative Thoughts, your feeling will instantly change. At the end of the session, Jill gives Dan a critically important “homework” assignment. Listening to the audio of a session and doing written work with the Daily Mood Log are vitally important aspects of TEAM. What happens between sessions is just as important as what happens within sessions! Thank you for listening today, and a HUGE thanks to Dan! I hope you learned a ton, on many different practical plus philosophical levels, and enjoyed today’s live therapy session! The Tuesday group at Stanford is free to all Bay Area mental health professionals as well as graduate students in some form of mental health training. The only “fees” involve a commitment to consistent attendance and the willingness to use the BMS and ETS with all patients, plus the willingness to do homework between Tuesday groups so you can really learn and master the very challenging TEAM techniques. Rhonda and David