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

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

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

Today’s emotional and inspiring podcast features Mary Stockton, an Level 3 certified TEAM therapist living in Ohio and her daughter, Elizabeth Stockton Perkins, who is 19 years old and a sophomore at Vassar College. They give testament to how the Five Secrets of Effective Communication have transformed their relationship as mother and daughter, as well as their relationships with others. Mary said that the Five Secrets changed her life personally and professionally, and that the tools have been “life-changing.” Mary was first introduced to the Five Secrets of Effective Communication when she attended one of David’s training workshops in 2002 entitled, “And It’s All Your Fault!” However, she did not really dive in and use the techniques until 2017 when she received additional TEAM-CBT training from Rhonda, Jill Levitt, Daniel Mintie, Matt May, and Thai-An Truong. Mary introduced Elizabeth to the Five Secrets when Elizabeth was a junior in high school, and Elizabeth began to use these tools with friends and also in her baby sitting. Mary said it has transformed their relationship, because previously she had been addicted to “helping,” rescuing, advising and problem solving, habits which often prevent closeness in relationships. David pointed out that many if not most mental health professionals, including many reading this at this moment, have been trained in these misguided “helping” methods, and are not even aware of it, or how unhelpful that “helping” can be. The relationship between Mary and Elizabeth is wonderful testament to the power of the Five Secrets. Mary said that using the Five Secrets in their relationship provides them with a wonderful framework that they share and enjoy. Elizabeth said they have zero other-blame or self-blame in their relationship, and that they routinely get a fun, positive charge from the Five Secrets. Elizabeth discussed a distressful situation when Mary responded to her using the Five Secrets and she felt supported, comforted and empowered. She was struggling with negative thoughts and feelings about her body image, telling herself on the one hand that “I should be bird boned and be a size 2 and be super skinny,” while at the same time telling herself, “I should be a strong feminist and not give in to these societal messages about what a woman should be like.” Because her mom relied on the Five Secrets of Effective Communication and other TEAM skills, Elizabeth suddenly found that she could open up about feelings she'd been hiding, and their relationship changed dramatically. Elizabeth suddenly found that she could open up about feelings she’d been hiding out of a sense of shame, and felt love and accepted. She said that “mom was the first person I’d been able to open up with. I felt relief that I didn’t have to defend myself.” Elizabeth cried when she described the gratitude she felt when she had the chance to be open and accepted, especially when she described her concern about being a good role model for two younger friends. They also described how Mary used the TEAM process of Empathy, Positive Reframing, and Methods like the Externalization of Voices and Survey Technique to help Elizabeth escape from the self-critical thoughts that had trapped her. It was a beautiful experience just to witness the joy and love in their relationship. They also described a program on the Five Secrets that they presented for other teens and families. We explored how one might use the Five Secrets when interacting with someone on the other side of the political divide who is angrily proclaiming political views that are sharply different from, and opposed to, your own. This is a huge problem in our country right now, with so much focus on blame, labeling others, and wanting to proclaim and insist on your own “truths.” I have not done this podcast justice in my show notes. You’ll have to listen to “get it.” Mary, her elegant daughter Elizabeth, and the always wonderful and delightful Rhonda really hit it out of the park today. I deeply appreciated being included in this terrific experience, and hope you also enjoyed it! David

In today’s podcast, we focus on a request by Tommy, a podcast fan who asked for a podcast on how TEAM evolved from traditional CBT. So here it is! Hi Dr. Burns, I hope you're doing well! I just recently completed Feeling Great and found it incredibly helpful. I found the technique chart that offered specific techniques for each distortion to be incredibly valuable and I've incorporated it into all my Daily Mood Logs. I've also listened to every podcast and have been already exposed to nearly all of the content within the book, but the book did such an elegant job of simplifying everything and putting it into context. I've already gifted it to several family members and am eagerly awaiting the audio version so I can gift it to my grandfather, a psychodynamic therapist of 30 some odd years who's vision impaired. I think he'll really get a lot out of it! Beyond the well-deserved praise, I'm emailing because I just listened to your post recent podcast episode (222) with Dr. Barovsky and you asked for any suggestions the audience might have concerning future episodes. There were two things that you mentioned that made me think an episode on the evolution of TEAM might be really cool and insightful. You mentioned that TEAM was specifically developed to deal with borderline personality patients that you saw at PENN and you also described an interaction with a stranger in California who approached you that inspired the concept of fractal therapy (at least that's how I understood that interaction). I think it would be incredibly interesting if you gave a sort of chronology of TEAM and what problems some of the core components were intended to solve. Obviously, I wouldn't expect you to go through every technique. But some insight into how you came up with positive reframing, the magic dial, perhaps uncovering techniques, and whatever else you'd be willing to share. Besides being interesting, I think it would be valuable because it would provide greater insight into the TEAM processes through demonstrating how it's overcome some of the obstacles that traditional CBT was unable to overcome. Dr. Mark Noble's chapter in Feeling Great led me to think quite a bit about this, particularly where he described how TEAM is really the ideal therapeutic structure from a neurological standpoint. Certainly you didn't just stumble into TEAM and I for one would find anything you'd be willing to discuss on this topic really interesting! Thank you again for everything you do. Best, Tommy Hi Tommy Here are some historical highlights in my thinking. In the podcast I will describe them and dialogue with Rhonda, but in no particular order. Thanks for the great suggestion, and hope you enjoy the podcast. Rhonda also mentioned how the empathy piece evolved, and we discussed that! Psychotherapy homework: Early research and clinical observations on psychotherapy homework and recovery from depression; how I published research on this topic and decided to make patients accountable. Helping: The man who I called at home twice every time he called me with some emergency one weekend, and my conversation with Dr. Wendy Dryden from England. The beauty of depression: The businessman who thought he was responsible for the death of his stepson. The universal importance of Positive Reframing: The time jill said she wished we’d done positive reframing during her session. Fears of therapists that keep them stuck: My observation through supervising psychology and psychiatry graduate students, as well as teaching workshops, how really hard it is for the vast majority of therapists to give up because of their addiction to helping and their intense fears of making patients accountable. Suddenly understanding “resistance.” The meeting of the Stanford voluntary faculty on teaching, and I mentioned making the concept of “resistance” more understandable for the psychiatric residents. They didn’t seem interested, and then I found the answer in a dream. Creating techniques with more “oomph:” The first method I created, Externalization of Voices, how this was inspired by my experiences in psychodrama marathons when I was a medical student. Giving up on “non-specific” techniques: The elderly depressed man who ran up to 12 miles a day. Therapeutic Empathy: What I learned from Stirling Moorey, and how I set up an empathy training program along with a scale to assess empathy after every therapy session. Rhonda and David

Many of you will recall one of our most popular and amazing podcasts of all, the recording of the live therapy with Michael at the Atlanta intensive last year. In today’s recording, which was recorded for a different purpose, Dr. Michael recalls his entire experience that day, with many teaching points. Although I was AT the Atlanta intensive doing the therapy, with the help of my co-therapist, Thai-An Truong, I was fascinated and enlightened by this interviews because: Michael was incredibly warm, genuine and openness. The summary shows clearly and exactly how TEAM therapy works. He recounts not only his recovery, but also how was unexpectedly catapulted into what, by my understanding, is best described as “enlightenment.” Or something awfully darn close to it! He reminds us that even after one has recovered and experienced “enlightenment,” we are still human and never immune to the occasional return of negative thoughts and feelings of insecurity and self-doubt, which are now, for Michael, short-lived! I just got Rhonda’s response after she listened to this recording for the first time. Here’s what she said: I forgot to tell you that I listened to the 30-minute recording of Michael's reflections and I loved it. I think it would be a great podcast. He did a wonderful job summarizing the work, and how it impacted him at various stages. I liked how he included his skepticism and his awe in recovery. Warmly, Rhonda and David PS Rhonda and I are convinced that successful personal work is a necessary part of therapist training. When you’ve done your own work, you are no longer just a “technician,” but a healer, because you can tell your patients, “I know you feel because I’ve been there myself, and I know how painful and lonely that can be. And I’m really excited to show you the way out of the woods, too, so you can get back to feelings of joy and self-esteem, so you can wake up in the morning and say that’s it’s GREAT to be alive!”

We have not had the chance to do a really good podcast on the Five Secrets of Effective Communication recently, so Rhonda and I jumped at the chance to do a podcast with a local executive we will call “Valentina” who is facing a severe challenge. How can she respond effectively to a ton of her colleagues who responded critically and angrily to one her first emails since being place in a top leadership role at work? They said that her email was harsh and accusatory, and sounded adversarial and provocative, and didn’t give a feeling of partnership or appreciation for all the hard work they were doing. Yikes! That’s pretty tough. And yet, my philosophy—in therapy, in family conflicts, and in work settings as well—is that your worst failure can often be your greatest opportunity in disguise. Is this true? Or just pie in the sky? Rhonda and I do a lot of role-playing and role reversals to (hopefully) show Valentina how to transform a humiliating professional failure into an enormous success. We’ll let you know how it works after we get some feedback from Valentina. We are both deeply indebted to Valentina for her courage in allowing us to talk about a problem that most of us encounter from time to time. I often receive harsh criticism, so I know how anxiety provoking it can be, especially when the criticisms come from authority figures! Valentina was wonderful to work with, and said she felt happiness and a sense of peace at the end of the podcast. It was great to see that! Let us know what you think about today’s podcast, and your own philosophy of how to respond to criticism skillfully and effectively. We alluded to, but did not delve deeply, into the opposite philosophy of arguing, defending yourself, and never apologizing. We’ve seen a lot of that in the past year on the evening news every day. Did the approach we modeled on today’s show seem inspiring and awesome? Or foolish and self-defeating? Thanks for listening! We hope you enjoyed today’s podcast and maybe learned something useful. For more information on the Five Secrets of Effective Communication, you can check out my book, Feeling Good Together, available in paperback on Amazon. Warmly, David and Rhonda

At the start of today’s podcast, we got an update on the Feeling Great app from Jeremy Karmel. We are looking for one or more programmers who might like to join our project. Our goal is to create the first electronic tool that can outperform human therapists, and some super promising preliminary data suggests we may be on the right path to make this happen. We are looking for talented engineers and designers who would share our passion for this incredible dream. If you are interested, contact Jeremy@FeelingGreatapp.com Today we are joined by our beloved and brilliant colleague, Dr. Jill Levitt to ask two questions: Can the “self” be judged? Does the “self” exist? We got quite a bit of positive feedback to a recent Ask David Podcast that included a question about Buddhism, but people said they wanted more on the topic of the “great death” of the self. Bottom line was this: You can judge your own or someone else’s specific thoughts and actions, but you cannot judge your (or somebody else’s) “self.” The question, “does the ‘self’ exist,” is meaningless. The goal of therapy is not to get promoted from the “worthless” to the “worthwhile” category, but to reject these categories as having no meaning. David argues that it is impossible to feel depressed without the distortions of Overgeneralization and Labeling—that where you jump from a specific flaw or problem, like getting rejected by your boyfriend to some abstract label or judgment, like thinking you are “unloveable.” We also used the real-life example of David responding to criticisms that he was too harsh with Steven Hayes on Episode 220. We show how TEAM therapy works, and illustrate several techniques for crushing the Negative Thoughts that lead to the painful negative thoughts that including Overgeneralization and Labeling, including: Empathy Positive Reframing Externalization of Voices Be Specific Acceptance Paradox Feared Fantasy We also focused on the concept of “laughing enlightenment,” a key Buddhist concept, along with the “great death” of the self. When you lose your “self,” you actually lose nothing, because there was nothing there in the first place. This is a kind of cosmic joke. But you inherit the world and gain liberation from your suffering, along with great joy, and of course, sadness as well. We also summarized the thinking of Ludwig Wittgenstein, arguably the greatest philosopher of all time, and how his sudden insight when a soccer ball hit him in the head transformed the history of philosophy. He was an extremely lonely man who had numerous episodes of depression, and never attempted to publish anything when he was alive, because only a handful of students and colleagues could understand what he was trying to say. This was intensely frustrating to him, because his message was so simple, clear, and basic—and yet the great philosophers could not grasp it. The Buddha had the same problem. The book, Philosophical Investigations was published in 1950, right after his death. It is just a series of numbered paragraphs, or brief comments, on different everyday themes, like bricklayers, string, games, and so forth. It is was based on a metal box they found under his bed, which contained notes from his weekly seminars at Cambridge. Many people, including myself, consider it as the greatest book in the history of philosophy, and think of Wittgenstein as the man who killed, or ended, philosophy. According to Wikipedia, the famed British philosopher, Bertrand Russell, described Wittgenstein as "perhaps the most perfect example I have ever known of genius as traditionally conceived; passionate, profound, intense, and dominating." Although Wittgenstein did not focus emotional problems, his solution to all the problems of philosophy is very similar to cognitive therapy. Here is the parallel: You don’t try to solve the classic “free will” problem. Instead, you see through it and give it up as nonsensical, as language that's "out of gear," so to speak. Once you “see this,” and understand why it is true, it is incredibly liberating. But it can be a lonely experience, because you suddenly “see” something super-obvious that seems to be invisible to 99.9% of humans. It's as if you had a "third eye," and could see something incredible that people with only two eyes cannot see. By the same token, when you suddenly “see” that the idea that you have a “self” which could be “superior” or “inferior” is nonsensical, it is also incredibly liberating. This, in fact, is the cognitive therapy version of spiritual “enlightenment.” And that's also one of the goals of the TEAM-CBT that my collegues and I have created. Jill, Rhonda, and David

Podcast 224 Ask David January 11, 2021 Ask David featuring more challenging and interesting questions. Josh asks: What are the most effective types of psychotherapy homework assignments? Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! And Joe asks: Would you say that the secret to overcoming OCD is willpower? Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain? Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks. Clarity asks: Is it too late to be a beta tester for your app? Simon asks: Is there a podcast that you can recommend for general depression, and how to find out what is wrong? Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt! * * * Josh asks: What are the most effective types of psychotherapy homework assignments? Hi David, thanks for all your work. It has been very helpful. You mention That doing homework is essential to recovery from anxiety and depression. Any homework you recommend? I am going to buy a few of your books and have the worksheets from the Neil Sattin podcast. Anything else that will benefit? Josh Hi Josh, It depends on the type of problem you are working on. I can work up an answer, perhaps, if you want to tell me! I did not hear from Josh, but Rhonda and I summarize the best kids of psychotherapy homework for: depression anxiety relationship problems * * * Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! Hi David, I love your work on the podcast. I have not yet found a copy of any of your books in Lahore (where I live), but I have grown to understand your philosophy through your podcasts. Episode 162 disturbed me a little. I suffer from severe OCD and its cousin, depression. And the "high-speed cure" in the title really attracted me. But I had buyer's remorse. Why? Because it does not work like that for most people. The guest on your show, had a few exposures, and BAM, cured. I have tried exposure many many times, and it very minimally helps in lowering the threat of the obsessions. I feel that this was a Magic Pill kind of account, and at the risk of judging a person's pain, I think your guest had a relatively mild (as compared to me) OCD. I would really love it if you could talk about Pure OCD (the type I have), and how it can be resistant to exposure. The intrusive thoughts/obsessions continue to be extremely, EXTREMELY, painful. This "high speed cure" idea seems dismissive of the seriousness of my condition. Please keep up the great work. And I hope to read your books one day. Thanks Hassam (Therapist in training) Thanks Hassam, sometimes, therapy is much harder, as you say! Good point. I often get slammed when I present patients who recover rapidly, especially patients who have had incapacitating symptoms for years or even decades of failed therapy. This is disappointing to me, as my goal is to bring hope to people that rapid and meaningful change IS possible. To be honest, I don’t like it when I get slammed for presenting cases of rapid recovery. Some people think I am a con artist! Yikes! Of course, everyone is different, and some people will be more challenging to treat. One thing I learned when I was in private practice is that you can never tell ahead of time who will recover rapidly and who will take much more time. I’ve had patients I thought would be super easy to treat who responded much slowly than I predicted, and many who I thought would be nearly impossible to treat who responded almost overnight. You’ve mentioned that exposure has been of limited value for you. I totally agree and saw that early in my treatment of anxiety that exposure alone is often quite ineffective. That’s why I argue so strongly that exposure is not a treatment for OCD or for any form of anxiety. It is just one tool among many I use in the treatment of anxiety. I use four very different treatment models with every anxious patient: The Cognitive Model The Motivational Model The Hidden Emotion Model The Behavioral (Exposure) Model Unless you understand and use all four models, the prognosis might be somewhat guarded, as you’ve discovered. In contrast, when you use all four strategies, your chances for success increase tremendously. For example, prior to using Exposure in the episode you listened to, I spent about 25 minutes with Sara using the motivational and cognitive models, which really helped. Focusing on one method alone will often not be terribly effective, especially if you’re looking rapid, complete, and lasting recovery. However, occasionally one method will work, so therapists and patients alike get focused on some single approach they’ve learned, thinking they’ve found “the answer.” There’s a great deal of information on the treatment of anxiety disorders using these four models on my website, www.feelinggood.com. I often urge listeners to use the search function on my website, and everything will be served up to you immediately. You can learn all about these four powerful models. In addition, if you were looking for more techniques, you might want to take a look at my book, When Panic Attacks, which describes 40 potent anti-anxiety techniques. You can order it from Amazon. My psychotherapy eBook, Tools, Not Schools, of Therapy, might also be helpful for therapists who want to learn more about the treatment of depression and anxiety with TEAM. It is an eBook, and order forms are available on my website, www.feelinggood.com, in the resources tab, and also in my store. Thanks for your excellent question! david And Joe asks: Would you say that the secret to overcoming OCD is willpower? In reply to Joe. I use four treatment models in the treatment of all anxiety disorders, including OCD. Certainly, the willingness to use Exposure is required, but Exposure is only one of many helpful methods for OCD. You can search for anxiety treatment on my website, and you’ll find many good podcasts. Also, there is a free anxiety class on my website. My book, When Panic Attacks, is another great resource with more than 40 techniques to combat all forms of anxiety, including OCD. You can find all my books on AMAZON, or on the books page on my website. david * * * Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain? Hi Dr. Burns, It says in your book, When Panic Attacks, p. 49, 3rd paragraph, you said that there's not a shred of evidence that there's any chemical imbalance for any psychiatric disorder. Does that include schizophrenia or bipolar or OCD?  Haldol works for me for schizoaffective....controls dopamine in brain? Ted Hi Ted, There are likely one or more biological factors that contribute to schizophrenia as well as full blown bipolar disorder (with true manic episodes.) We do not yet know what those causes are. However, the brain is not a hydraulic system of chemical balances and imbalances, or perhaps more like a supercomputer. I am not aware of any neuroscientists who believe in the crude “chemical imbalance” theory. We simply don’t know what the causes are. Meds can definitely help with the symptoms of schizophrenia and mania as well. This tells us nothing about causes. Aspirin can help with a headache, but headaches are not due to an “aspirin deficiency” in the brain. Computers often crash, but I’ve never heard of a computer problem that was caused by a “silicon imbalance” in the chips. Hope that helps. Psychotherapy can definitely help with feelings of depression and anxiety, but is not a cure for schizophrenia or mania. I would hate to have to treat any psychiatric problem with drugs alone! I like to treat humans, not “diagnoses,” but it can helpful to be aware of diagnoses like schizophrenia, or schizoaffective, or bipolar I, for example. Hope that is helpful! And just my thinking, too, not “written in stone.” david * * * Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks. Hi Brian, Thanks! One point is that people are often looking for “formulas” or general solutions to buzzwords like “stress.” The key to TEAM is to focus on one specific moment, and to work with it in an individual way, never using non-specific solutions like exercise, meditation, deep breathing, dietary changes, and so forth. But as you can see, this is tough for many people to grasp. The failure to understand the importance of specificity is one of the big problems in our field, and it is a problem for therapists and patients alike. There are no very good solutions in the clouds of abstraction, because we are all unique. I asked Brian for specific examples, and he wrote: “Work pressure, obnoxious bosses, nagging family members, drug addicted family members, and inability to pay bills are a few.” I responded, Thanks, these are all totally unique with different solutions. Perhaps you can focus on one and provide a couple details. david Brian responded, Thanks. Whichever one you think is best. Stressful thoughts. Also how to change stressful thoughts when they're automatic. Hi Brian, There an infinite variety of "stressful thoughts," and they all have unique, non-overlapping solutions. Could you tell me about one thought you had at one specific moment? david During the podcast, I made some additional comments on dealing with stress using TEAM: Stress is a fairly non-specific word for feeling upset or distressed. I like to use and measure specific emotions in my patients, like depression, anxiety, guilt, shame, inadequacy, hopelessness, frustration, anger, and so forth. But for some people, “stressed” may be more acceptable than words like “depression,” which may carry more stigma. However, there is a somewhat specific meaning to stress, which means overwhelmed by having too much to do and not enough time to do it all. This can sometimes result from taking on too much, and having trouble saying no. Reasons for this difficulty being assertive include: Conflict Phobia Excessive Niceness Submissiveness / Pleasing Others Fear of missing out on something cool and exciting to do NY TV story on “stress” and my ten distortions General tools for dealing with patients who feel “stressed out.” Daily Mood Log Relationship Journal Brief Mood Survey You can take a thought on a DML and do a downward arrow—you will typically come to several common Self-Defeating Beliefs, such as Perfectionism Perceived Perfectionism Approval Addiction Submissiveness Worthlessness schema Conflict Phobia / Anger Phobia Superman / Superwoman Specific Tools Positive Reframing “No” Practice * * * Clarity asks: Is it too late to be a beta tester for your app? Hi Clarity, Thanks! You can sign up at www.feelinggood.com/app * * * Simon asks: I have a question for you. I am very depressed at the moment, and I don't know what is wrong, or I have difficult to find out what thought is giving me the down-feeling ☹ Is there a podcast that you can recommend for general depression, and how to find out what is wrong?Thanks for the sooooo great in inspiration. Thanks Simon. I will include your question in an upcoming Ask David, but here’s a start. Focus on one moment you were upset, and tell me how you were feeling and thinking at that specific moment, and record the information on a Daily Mood Log. If you listen to live therapy on the Feeling Good Podcasts, or read one of my books, like Feeling Good or Feeling Great, you will get a step by step introduction to TEAM therapy. Thanks! d PS There is at least one podcast on how to identify your negative thoughts and generate a Daily Mood Log. You can use the search function on the website to find those or podcasts on any topic, but here’s the link since the search function is not working properly at the moment so I’ll have to fix it. (https://feelinggood.com/2018/03/05/078-five-simple-ways-to-boost-your-happiness-5-you-can-change-the-way-you-feel/) PS PS I want to thank Simon for creating time codes for all 50 techniques on podcasts 93 (https://feelinggood.com/2018/06/18/093-fifty-ways-in-fifty-minutes-part-1/) and 94 (https://feelinggood.com/2018/06/25/094-50-methods-in-50-minutes-part-2/) entitled, “Fifty techniques in fifty minutes.” His time codes allow you to find the description of any techniques of interest. * * * Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt! Hi David, I hope this is the right address to which to send an "Ask David." I am a huge fan of your work and cannot thank you enough for making your therapy techniques so accessible. And thank you for taking audience questions! I am in the process of learning TEAM and notice myself getting more skilled, slowly but surely.  There are times I hear you help patients recover in a single session. So far, I have not found myself able to help patients that quickly. I've felt disappointed about this, and it's led to anxiety and self-doubt ("I need to learn TEAM faster so I can help my patients as quickly as possible," "This should be happening quicker."). I am wondering how logical it is for me to expect myself to help patients recover in a single session. Is it reasonable to assume I may have to practice TEAM for some time and go through several training experiences before I can help patients change that quickly? Thank you again!! Stephanie David and Rhonda discuss ways of improving over time and reducing the pressure on yourself if you are a therapist.

The Jealousy Addiction! What Can You Do When Good Things Happen to Bad People? Hi podcast fans! Thanks for your wonderful support in 2020. You helped us hit our three millionth download. I wanted to give a shout out to my fantastic hostess, Dr. Rhonda Barovsky, who has brought magic to the Feeling Good Podcast! This is our first podcast of 2021. It is a really good one, I think. A tremendous amount of work has gone into it, both in the weeks prior to the podcast, as well as in the creation of the detailed show notes for those who want to study and understand exactly how TEAM therapy works for the thorny and almost universal problems of jealousy and anger. Much violence in the world, especially in couples, results from these feelings. I want to thank Bridget for her tremendous courage in giving us all this wonderful gift to kick off the new year! For therapists and therapy students, this show, with the show notes, should be a rich source of learning. David And, I, Rhonda wants to thank Dr. Burns for the incredible contribution he has made to the field of mental health treatment and for the honor of being part of the Feeling Good Podcast! Rhonda Bridget asks: Can you help me with my feelings of intense jealousy? Hello David & Rhonda, I’ve had this issue for a while now, and I’m wondering if others deal with it as well. If I find out that someone I dislike has something good happen in their life, I get extremely upset, frustrated, angry, jealous, & resentful. It will eat away at me, sometimes for weeks. The thing is I’m happy with my life & wouldn’t actually want to trade places with these other people, but it’s like just the fact that they get to be happy when they are a “bad person” & don’t deserve it upsets me. By “bad person” I mean people who are manipulative, liars, cheaters, etc. I’ve always been a person who is big on justice. I don’t want to focus on these other people anymore. I don’t want to care. Any help would be greatly appreciated. Thank you, Bridget David's Comment I was pleased to receive this email, as jealousy IS a big problem, and one I have not focused on specifically in my books or podcasts. I exchanged several emails with Bridget who graciously gave me permission to feature her work in today’s podcast. When people share their vulnerabilities openly, it is a gift to the rest of us, since the teaching and learning potential is great. In addition, most of us feel close to people who open up and share the inner feelings and insecurities that most of us hide. This is an action that requires great courage, and often results in even greater rewards. Bridget is also interesting because some fans have criticized me for featuring mental health professionals when I’m doing personal work. I do that because I’m no longer in private practice, and do not carry liability insurance. When I do personal work with therapists, it is in the context of their training, and is not considered an ongoing therapeutic relationship. But today, I have decided to bring you some really challenging work with someone who is not a therapist, but a married woman who works as a product manager for a high-tech company. Of course, I have disguised her identity. The emotions she is asking for help with, jealousy and anger, are the toughest emotions to challenge, far harder than depression or anxiety. That’s because the thoughts that trigger depression and anxiety involve Self-Blame and self-criticism, so you tend to feel worthless or inferior. Crushing self-critical thoughts leads to relief and joy. But the thoughts that trigger jealousy and anger typically involve Other-Blame and other-criticism, which is far tougher to defeat, because blaming others can be associated with exciting feelings of moral superiority. (You will notice below that I am embedding the PDFs of Bridget's work in the show notes, as opposed to linking to them as I usually do. Let me know which format you prefer. Thanks! david) STEP 1: Record your negative thoughts and feelings at a specific moment Here was my response to Bridget: Thanks, Bridget! On the attached DML, fill out the event, circle and rate emotions, and record and rate belief in negative thoughts. Scan back to me, and then I'll have further instructions. d Hi Dr. Burns, Here is my DML. Thanks! Bridget's DML at the beginning of the intervention. Notice that the belief in the NTs are all high, and the negative feelings are intense. STEP 2: Positive Reframing Hi Bridget, You’re moving fast! Way to go! Great example! Now list answers to these two questions about every category of negative feeling. What does this negative feeling show about you and your core values that’s’ positive and awesome? What are some benefits, or advantages, of this negative feeling? You can also do this with a couple of your negative thoughts. david Hi Dr. Burns, Some of these were difficult to find positives, but I do truly believe everything I wrote. This is Bridget's Positive Reframing Table. The items in caps were suggested by David, and she endorse these as well. Hi “Bridget,” You did great work on Positive Reframing. I have added several more things in caps in the right-hand column. Delete or edit that are not valid or don’t ring true. Would love to see your edited version. Once you are done, use the % Goal column at top of emotions table to do the following. Imagine you had a Magic Button, and if you pressed it, all your negative thoughts and feelings would vanish, and you’d be euphoric with no effort. However, all these benefits and beautiful things about you would go down the drain at the same time. So, answer this question: Why in the world would you want to do that? Then, answer this question for each negative feeling: “Given that there are many genuine benefits of this feeling, would there be some level I could dial this feeling down to if I had a Magic Dial? For example, my unhappiness is at 100%. Would there be some ideal level of unhappiness that would be less painful, but would still allow me to have the benefits and positives associated with this feeling? Would 40% be enough, for example? Or maybe even 20%” If this makes sense, fill in the %Goal column for each negative feeling. Thanks! david STEP 3: Magic Dial Hi Dr. Burns, Thank you! I actually really liked & agreed with everything you added. Those all seem true to me, so I left them on there and did not change it. I put in percentages for my goals on the daily mood log. I think it's good to keep quite a bit of those feelings after seeing the benefits. Bridget's DML with Goal column filled it  STEP 4: Positive Thoughts Hi Bridget, Perfect, and you are moving fast. So cool! Now I want you to choose one thought to work on first. Identify the distortions in it with abbreviations in the Distortion column. Then see if you can generate a positive thought with the help of the attached booklet, which is for your eyes only. Please do not send to anyone!  It is written for therapists but will be great for you, too, hopefully! Please note the Necessary and Sufficient Conditions for an effective and helpful Positive Thought: It has to be 100% true. It has to reduce your belief in the Negative Thought. Reach out if you need help or if something isn’t clear. david Hi Dr. Burns, I was able to reduce the belief in the thought to 50%. Just because she lives in a nice house in a warm location doesn't mean that's guaranteed happiness. There's a lot of factors involved that could change at any moment. Bridget's DML with first Positive Thought. As you can see at the link, she believes the PT 100%, and this reduced her belief in the NT to 50%. Hi Bridget, Well done! If 50% is low enough, we can move on to another thought. Another distortion in the thought is Mind-Reading, since our assumptions about how other people feel are rarely valid. My research has shown that shrinks cannot even know how their patients feel, even at the end of a therapy session. So, we don’t actually know how she feels most of the time, or at any specific time. In addition, you are saying that it’s unfair that people with poor character can have lots of money and nice things, and this is a source of anger. That’s the “should” telling yourself this “should not” happen. It is so EASY and ENTICING to feel this way. And we certainly see lots and lots of ugly, repulsive, mean-spirited people with tons of money and stuff! It’s unfortunate. Albert Ellis used to point out that we may not like certain things, but it’s not true that they “should not” happen. For example, we don’t like the fact that our cats like to capture, play with, and kill little creatures. But it’s not true that they “should not” do that because it’s their nature. For myself, I’d rather hang out with people I like and respect and feel comfortable with, as opposed to these “hot shot” types. I’ve treated some very wealthy narcissistic individuals, one in particular, and it was incredibly unpleasant. I had no longing at all to live his lifestyle—in a mansion in Southern California filled with priceless antiques and stuff—but miserable relationships with other people he was trying to control since it seemed like his only thing—brag and try to manipulate people. I prefer people who are more on the humble side! Just some babbling. If 50 is good enough—since there IS truth in the thought, time to tackle another. You’re doing great! david Hi Dr. Burns, I worked my way through all my negative thoughts, & I ended up surpassing all of my goals for my negative emotions. Some of the thoughts were hard to challenge. I think the "shoulds" do get in the way a lot for me. And I also do a lot of fortune telling I noticed. I did some cognitive flooding and imagined her being hand fed grapes by the pool, her husband telling her how wonderful she is, her saying "I just love my life", and it all seemed so ridiculous then. There's no way that's how the majority of anybody's days are. I feel much better about it now. Let me know if you have any other thoughts. Bridget's completed DML Notice that she believed all of her PTs 100%, and there was a nice reduction in her belief in the NTs, along with a reduction in her negative feelings.  But was this enough? Had we gone far enough. Only Bridget can answer this question! Hi Bridget, This is fantastic, thanks! Can I use all this great work in an Ask David? We might record it Friday, tomorrow. Are you satisfied with where you’re at now? If you want to bring feelings down further, we can attack a couple of the thoughts that are still at 50%, but not necessary. The question will be how many of the negative feelings you want to retain, and it’s cool that you have surpassed your goals! Very cool, and might be helpful to others. let me know if you give permission to use this personal but terrific material in a podcast. Tons of jealousy in the world! David Hi Dr. Burns, Yes, you can definitely use everything we did here. I think it will help others. I think I’m ok with leaving the thoughts at 50% for those 2. Bridget STEP 5: Additional Methods Hi Bridget, While jogging, I realized that I forgot to comment on your creative use of flooding. I had thought of that also as another useful technique, and there you went and did it before I had the chance to suggest it! You are probably the first person in the world to use flooding for jealousy—usually it is for anxiety, as you likely know. I’ve attached a flooding flowsheet if you do more. The goal would be to see if you can work your jealousy up to higher and higher levels, and keep it as high as possible. I also thought of a ton of additional techniques we could use in challenging any of your negative thoughts, like the Individual and Interpersonal Downward Arrow, to get at the core beliefs underneath the jealousy, and lots more cool techniques. But we may not need any more techniques! Like scheduling time each day to make yourself as jealous as possible, say for one minute, or five minutes, or whatever. I was also curious about your prior experiences with this woman. I’m sure there’s a story behind your negative feelings David Hi Dr. Burns, I actually haven't ever met this woman personally. I guess I've seen her as the enemy ever since I started dating my husband. I saw all their old pictures on Facebook & messages between them, & I had this intense rage about it. My husband told me that she had not been faithful to him throughout their entire relationship, but he kept sticking it out with her. So anyways, I had this intense desire to find out more information constantly. I was looking her up online all the time, trying to find out more. It was an obsession at times. At first I thought I just needed to know what it was about her that he liked so much that he was willing to be with her all those years despite everything she had done. Eventually I realized I was doing it to prove to myself that she was not better than me, that her life was not better. But then it's like I was finding out the opposite. I found out about her marrying into that rich family, saw pictures of her and her husband traveling the world together, then buying this big beautiful home. I was filled with jealousy and rage. I thought here she strung my husband along for years and stole his prime years from me, and now she's living it up! Never paying the price. So yeah I suppose that's the long back story behind it. Wow thanks, Bridget, I really appreciate your candor! It all makes sense now. I’m so sorry she has been haunting you and making your life unhappy at times. She sounds, to me, like a pretty unhappy person, bitter and tortured and maybe trying to impress people with her “things.”. Not my kind of folk at any rate! When I was in grammar school, someone asked me if I was going to any Halloween parties, and I said I hadn’t been invited to any. I told my mother, if memory is correct, and she said why don’t I have a Halloween party? So, the next day at school I said if anyone hadn’t been invited to a Halloween party, they can come to my Halloween party. I had an older sister who helped prepare it to be this really neat party, but I didn’t know if anyone would come as I didn’t feel like I was one of the “popular” people. I might have been more of an intellectual nerd or something like that, and I wasn’t very attractive. But I was really happy when practically the whole class came, and we had the best party ever. Ever since then, I think I’ve kind of preferred the “unpopular” people, and to this day it is the same. I have tons of friends I totally love in low places. Anger and jealousy are, to my way of thinking, by far the hardest emotions to get rid of. It can be done, as you’ve shown, but it ain’t always easy. And what you’re doing totally rocks! Kudos! It was hard for me to shake it in the early days of my career. Now, these emotions never bother me, although I am joyfully angry from time to time! And thanks, too, for such rapid responses! I love the humorous imaging you created of her sitting around the pool being fed grapes, exotic wines, and rare chocolates by her dutiful slave husband, and perhaps a couple servants as well! Happy Thanksgiving, and thank you for giving of yourself!! David Hi Dr. Burns, That is a great story. I hope I can one day rid myself of those emotions like you were able to. I really appreciate you taking the time to work with me & spend so much time on this issue. I am just so grateful! I look forward to the podcast. Happy Thanksgiving! Hi Dr. Burns, Thank you! I actually got the idea by using that cheat sheet for the recovery circle from your new book Feeling Great, which by the way I love. It's like the Bible of cognitive therapy. I have so many spots bookmarked and go back to it all the time. I did the Downward Arrow technique, & it helped reduce my beliefs in the thoughts even more. I don't think that I made the wrong choices in life just because I have to work hard to get by. If I had made other choices, then I might never have met my husband or adopted my cats or maybe I would've never even discovered your books and connected with you which changed my life. I was able to reduce my belief in the thought "It’s not fair I have to work so hard just to get by" to 20%. For my other thought "She gets to live this happy life after how she’s manipulated and treated people poorly for years" I also did the Downward Arrow. That made a big difference as well. Just because she is happy doesn't mean that me doing the right thing has been for nothing. I'm glad I can confidently say I believe I'm a good-hearted, caring person. Her happiness will never change that about me. That thought is also now reduced to 20%. I'm feeling pretty dang good right now! I think I will take your advice and continue to do the cognitive flooding a little each day until the thought has no merit anymore. Link to her downward arrow work Hi Bridget, Thanks for all the positive feedback and hard work. I have more ideas, a lot more actually, if you want to push things further at some point, but doesn’t hurt to take a breather when you have climbed to the top of a mountain! Warmly, david Hi Dr. Burns, I’m always open to more ideas to try. Wouldn’t hurt. Maybe I could even get my belief in the thoughts to 0 eventually. * * * I offered to send Bridget a copy of my video, “Overcoming Toxic Shame,” since she was feeling some shame about carrying this burden alone. * * * Hi Dr. Burns, Yes, you are the only person I’ve ever told this to. I definitely fear being judged & rejected in this situation. I feel like I shouldn’t care so much what everyone else is doing in their lives & just focus on my own life. I feel ashamed & embarrassed of my online stalking too. The thing is that when I “play detective” & find out new information about her online I get this sort of high off it. It can be exciting, but then it always just ends up leading to me feeling bad about myself. So, as you can see there are advantages & disadvantages to doing it. I have done online stalking with other people too & told my husband about it when I would find out something upsetting or just interesting information. Sometimes he would make a face & say why would you be looking them up. And then I’d feel ashamed. I just feel like he does not approve of that behavior, & I can’t blame him. If the roles were reversed, it might make me a little suspicious of his intentions. Maybe even a little concerned. I do have a DVD player & would be very interested in seeing that video you mentioned. STEP 6: A New Idea: Is this actually a habit / addiction? Hi “Bridget,” Your video is ready for shipping, and the next mail package pick up at our house will be tomorrow or Wednesday. It will come express mail, so you should get it later this week. I had one other thought. If your habit of checking up on people gives you a high, but also leads to negative feelings, one could view this problem in the context of habits and addictions. You would have to think about that and see if it is valid or not. I don’t know for sure. But if it is, then abstinence might be helpful, too, since continually re-engaging with your checking up on people might keep fueling your feelings of jealousy. So, giving up this habit might be a price you’d have to pay to escape completely from this problem. Again, just speculation. At any rate, two chapters on habits were not included in my new book due to length, but they are available for free on the home page of my website. It offers one unpublished chapter, but there are actually two. If you are interested in this approach, download the chapters and see what you think, and maybe do some of the written exercises like the Triple Paradox, for example, and let me know what you think, too! Sincerely, David Hello Dr. Burns, I read the extra chapters, and they are great. It's too bad they couldn't have been included in the book because I bet they would help so many people. I did all of the exercises & found them very helpful. I especially loved using the decision-making tool for this. I would never think to compare disadvantages of 2 situations like that. I was actually surprised at how much of a "slam dunk" the option of "stop checking up on people entirely" was. I didn't expect that. I want to change because I'm tired of comparing myself & my life to other people. I also don't want to sit around waiting for justice then getting upset when the opposite happens. I spend too much of my free time thinking about these people I don't even like. I'm letting them win by caring. I also don't want to feel like I'm keeping secrets from my husband. The less I know, the better. All signs point to stopping the behavior. I just hope I can do it! Attached are the exercises I did. Would love your thoughts/feedback. Bridget You can link to Bridget's Triple Paradox and work with the Devil's Advocate tool. If you're interested, you can also review her work with the powerful Decision-Making Tool that I created 40 years ago. For more information, you can download the two free unpublished chapters on Habits and Addictions that I omitted from my new book, Feeling Great, due to length. You will find those chapters for free on the homepage of my website, www.feelinggood.com. Hi Bridget, Forgot to write back, I thought all your work was awesome! Incredible. Thanks, and kudos!! Hope you got or soon get the Melanie video. Apology for slowness. We adopted an incredibly 6-year old cat at the Humane Society, but ran into some temporary complications and now all is well. Plan to integrate her with our 3-year old feral cat, Miss Misty, at the end of a week keeping them separated. The new lady is a purring machine! Her owner died, and then she was adopted and returned, so she is terrified that she’s not “good enough” and fearful that we’ll send her back. We are totally in love with her, but had to take her back for a check-up for ring worm as the Humane Society called and said she had an accidental interaction with a ring worm cat. But they didn’t find anything. It was super-traumatic, since we had to put her back in the carrying cage, and she was desperate, thinking we were returning her. It was heart breaking, once of the worst experiences of my life! But now she’s back with us and looking forward to meeting her new “sister,” Miss Misty. Fortunately, she gets along really well with other cats. But we don’t know about Miss Misty! David Hi Dr. Burns, Aww poor kitty! That is so awesome you decided to take in another cat. I love how passionate you are about them. I loved your story of Obie in your book and how you dedicated it to him. I could really identify with it. We took in a feral kitten this past fall, and it went from him running away from us if we were within 10 feet of him outside to him being a permanent inside cat. Just last night he hopped on the couch next to me and laid on me purring while I put my arms around him like a teddy bear. It was so special! I haven't gotten the Melanie video yet, but I will definitely let you know once I receive it and watch it! -Bridget Hi Bridget, Thanks! Congrats on your kitten! Heaven! d Commentary Here are my random comments / observations. Bridget got a really rapid and fairly dramatic response. This was due, in large part, to the fact that she did all of her homework, and she did everything right away. When I worked with individuals when I was I private practice, doing homework was required, not optional. Many people want to just come and talk to their shrink once a week, but, at least in my experience, this has never once been effective. Bridget was motivated. She asked for help, and worked hard to get that help. Motivation is the key to overcoming depression, anxiety, relationship problems, and habits and addictions. Most religions have the concept of “ask and ye shall receive.” Without the asking, there will be little or no “receiving!” Bridget conquered two of the most challenging of all emotions on her own. I did provide some guidance via email comments, but she did the heavy listing. Over time, new insights develop. Therapy and self-help are fluid in this regard. The idea that this problem could be viewed as a habit or addiction suddenly popped into my mind and clicked, and provided another powerful tool for defeating this problem. Rigid formulaic treatment is less effective, but many therapists and many people in general are looking for “formulas” and secrets of overcoming this or that problem. Methods and tools are great, but formulas leave a lot to be desired. I don’t think that Bridget’s response was any slower than when I do live personal work sessions with therapists. It took longer, since we had to exchange a series of emails. But the total contact time was still in the range of an extended (two hour) therapy session. This demonstration may not satisfy the doubters, but it might at least help a little. The effective ingredient is TEAM, applied systematically with warmth and compassion. I am incredibly indebted to Bridget, and hope you also appreciate her brave contribution! It is not easy to bare your soul to the world, but the world deeply appreciates this type of openness, because most of us suffer in secret, adding loneliness to the equation. When you open up, your worst part sometimes gets magically transformed into your best part. It is a little like emotional alchemy, turning your emotional mud into gold! I hope you enjoyed today's podcast, and a got a feel for how a TEAM therapist might treat someone struggling with intense jealousy and anger. These are topics not often discussed in the psychotherapy world, so hopefully this podcast will be a useful contribution to a challenging topic! Rhonda, Bridget, and David

Podcast 222 Ask David December 28, 2020 Ask David featuring five challenging questions. Jay asks: How do you treat individuals with personality disorders using TEAM-CBT? Jeff asks: Can you talk more about the “great death” of the therapist’s “helping” or “rescuing” self? This was really helpful to me! Darkmana asks: Hey David, are there any books about Buddhism you would recommend? I can see you’re a fan of it from Feeling Great! Angela asks: What’s a perfect score on your empathy test? Margaret asks: What can you say to a patient who doesn’t want to push the Magic Button? * * * Jay asks: How do you treat individuals with personality disorders using TEAM-CBT? Dr. Burns Have you considered doing a podcast on using TEAM-CBT or CBT for Borderline, Narcissistic and Histrionic Personality Disorders? The interesting thing is those with personality Disorders seem to blame everyone and everything for their problems but themselves Also, what if anything could individuals do to not get attracted or quickly eject when they encounter these folks. One theory is that folks with abusive or neglectful parents are vulnerable. Because the chaos and drama is familiar. I think many therapists avoid folks with pd no? Particularly patients with Borderline PD. It's interesting in that kids have years of relating to parents with personality disorders. So how would TEAM-CBT help? Just curious what your experience and Rhonda too Jay Rhonda and David talk about how TEAM-CBT developed out of David's treatment of large numbers of individuals with Borderline Personality Disorder, and what some of the treatment strategies are. * * * Jeff asks: Can you talk more about the “great death” of the therapist’s “helping” or “rescuing” self? This was really helpful to me! Hi Dr. Burns, I loved what you've taught on the death of the selves - and recently read the Four Great Deaths of the Therapists Ego in your new book, Feeling Great. One part that I found so helpful was the death of "The Helping, Rescuing Self." I think I've believed that's my purpose. That's why I'm there. I'm there to "help" the client feel better and live a full, rich, meaningful life. That's something I've struggled with - because if I'm not there to help, what am I there for? And if I don't FEEL like I've helped, then I've failed the client. I'd love to hear this concept expanded on. I think many therapists, coaches, etc. would benefit from seeing how they can work with clients without thinking they have to help or rescue them. Thank you, Dr. Burns. P.S. Your new book is a goldmine. Enjoying it immensely. * * * Darkmana asks: Hey David, are there any books about Buddhism you would recommend? I can see you’re a fan of it from Feeling Great? Hi Darkmana, Thank you for your question. I'm sure there are many great books out there, but I have never studied Buddhism or read anything about it. I just sort of make things up! David will tell his Buddhism story when eating in a noodle house with his son Erik. Rhonda has invited the Dalai Lama to appear on a Feeling Good Podcast. It seems like a long shot, but it would be delightful to have the chance to chat with him, as there is so much overlap between Buddhism and TEAM-CBT! I would guess that he likely has a good sense of humor, since humor and laughter can be such great ways of grasping certain ideas and achieving enlightenment. I have heard that the Buddha talked about the “Great Death” of the self. In Feeling Great, I talk about four “great deaths” that correspond to recovery from depression, anxiety, relationship problems, and habits and addictions. I’d love to hear the Dalai Lama’s thoughts about this. There may be large numbers of “Great Deaths,” I suspect. To me, “reincarnation” is something that happens when we are alive, and not something that happens after our bodies die! However, I think most Buddhists might fiercely oppose my thinking in this regard. I think that “literalism” is one of the problems with most organized religions. Stories that are intended to convey wisdom and insight are taken as literally true. * * * Angela asks: What’s a perfect score on your empathy test? Hello David, In the weekly practice group that I host, the question came up today “what does Dr. Burns mean by no less than 20?  Is it the first section titled “Therapeutic Empathy” which is 20 points total, or the entire survey which is 20 questions? Warmest blessings, Angela Poch, RPC-C Hi Angela, Thanks, yes that is correct. 20 on the empathy scale is the lowest passing grade. A score of 19 and below indicate some significant failure in the therapeutic relationship / empathy. Since we are hoping for failure, I try to make failure as easy as possible! That’s part of my “anti-perfectionism” philosophy. I encourage the four “great deaths” of the therapist’s ego, and this is the first of the four deaths. * * * Margaret asks: What can you say to a patient who doesn’t want to push the Magic Button? Hi Dr. Burns, I attended your intensive in Atlanta and am working on my level 3 certification. TEAM CBT has transformed my life personally and transformed my practice professionally. I will be forever grateful to your hard work and dedication in developing this approach. My burning question is about the magic button / magic dial. After the positive reframe, when we ask, " With all these awesome things your negative emotions show about you and all the benefits you get from them, why would you want to press this button?"  Ninety five percent of the time my clients argue for change and that is great. My problem is when they say, "I guess I wouldn't want to press that button."  I feel like I am cheating them by not offering the magic dial. It seems like all or nothing thinking. If you press the magic button, "all" of these positive things will go away. They never get the chance to even learn about the magic dial and then may never get the chance to learn about cognitive distortions and all of the other cool methods you and others have created. My clients always benefit from the positive reframing. How much do they have to argue for change? How critical is this? Maybe I am thinking about this all wrong. I can really use some guidance. Thank You so Much, Margaret McCall I just realized my pun with "Burn"ing question- that was not intentional, lol Hi Margaret, Great question! Will add it to an Ask David. Quick answer: you can agree that it is not a good idea to press the Magic Button,  and ask them what their NTs and feelings show about them that is positive and awesome, and also ask them why they might NOT want to push the Magic Button, and then once again paradox them. All you have to do is say “Good thinking. Let’s list all the really GOOD reasons NOT to press that button.” Then you go right into Positive Reframing, followed by the Magic Dial. Also, if they do not want help, which is often the case with relationship problems as well as habits and addictions, you can just ask if them if there is anything they DO want help with! It is not my job to persuade the patient to work on something. It is the patient’s job to persuade me to help him or her! Rhonda and David