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

Social anxiety has been one of our most popular topics. It seems like lots of people get anxious in social situations. and a great many have even greater difficulties talking to strangers and people they might be interested in dating. When I was in private practice, social anxiety, and “singleness,” were exceptionally common. In fact, 60% of my patients were single—they’d been divorced and didn’t know how to get back into the dating scene, or, they’d never developed romantic relationships in the first place. So today, we offer more tips and help for people who are afflicted with social anxiety. Rhonda and I are very proud and excited to be joined today by a brilliant colleague and expert on social anxiety, Dr. Jacob Towery. Dr. Towery is a Stanford-trained pediatric psychiatrist, and was a student of mine when he was a psychiatric resident, He practices in Palo Alto and helps teach our weekly Tuesday TEAM therapy training group at Stanford. Today (the day we recorded this podcast) was Jacob’s 41st birthday, so Rhonda and I sang a rousing Happy Birthday for Jacob at the start of the podcast! He kindly tolerated our fairly awful but heartfelt rendition of that classic song. Perhaps you could think of it as our own (fairly mild) Shame-Attacking Exercise. As we begin today’s podcast, Rhonda reads a sad but moving email from Davide, who desperately wants to open up and connect with people on a deeper level, but says “these things scare me like hell.” In his email below, he describes his struggles and lists his negative thoughts about talking to people he doesn’t know. He is especially afraid of Self-Disclosure—telling people that he struggles with social anxiety. To his credit, Davide has made significant progress, has worked hard on challenging many of his negative thoughts and self-defeating beliefs, and already has a girlfriend! But he wants to take his progress and growth to a new level. Here’s the email I received from Davide: Hi David! There is no month that I don't listen to your podcast and take some notes. Yes, you can read my email and use my real name as you like! I really think that your methodology is a breakthrough in self-help and coping with emotions. Also, the new technique of positive reframing is very helpful. When I started using it for myself at the beginning of every daily mood log I really noticed a faster improvement. I completely agree with your vision that it would be better if there weren't schools of psychotherapy but tools that work. Your books and works have really changed my life for better and I'm looking forward your next book Feeling Great! In these two years I have done many Daily Mood Log, I have also done every day for a month the Smile and Hello Practice and I got a girlfriend for the first time in my life! I'm still not very good at breaking my negative thoughts though. I often end up with a lengthy, verbose and not so effective positive thought. Sometimes it seems that I understand rationally that a negative thought isn't true, but I don't feel better. Also, my social anxiety is reduced, but not gone. I still have a lot of social anxiety when I'm around people. I understand the Spotlight Fallacy and Brushfire Fallacy at the intellectual level and I'm definitely improved a little, but still today I can't remember a single good conversation with a person that I don’t know and I'm not very comfortable with. I tried to use the Five Secrets but I can't think of anything good to say in real conversations. I want to do some shame-attacking exercises and also disclosure to random people on the street about my social anxiety, but these things scare me like hell and I don't have the courage to do these exercises. I know that these will help, but I feel really really scared and so far, I haven’t mustered up enough courage. I want to leave home (I'm in Italy) for work in another country in Europe next year, but for me social anxiety is a really huge obstacle. This makes me feel a little sad because I see my social anxiety like a prison. These are some of my anxiety thoughts at the idea of disclosure to random people on the street that I want to go to work abroad but I'm too shy and suffer from social anxiety: I will not be able to say what I want to say because of anxiety. I will stumble in words and an inconclusive thing will come out. The other person will think that I'm completely crazy and I will frighten him/her with my behavior. I should never scare other people with my behavior. In the future I will remember all the things that I said wrong and I will beat myself up over and over again. I will waste the other person’s time when I try to talk to them. I should never waste anyone’s time. If I stop a woman, she will think I'm crazy creepy guy who wants to sexually assault her and I will scare her. The other person won't stop to talk to me and will just go their way, pretending I didn't exist. Sorry for this lengthy email. When I read your response I exploded with joy and I decided to write a lot of things. Thank you, Davide Jacob begins with a personal story of his romantic adventure with a woman he’d just met at a Hot Springs. After talking for a while, some good chemistry seemed to develop, so Jacob asked, “Would you like a kiss?” Jacob immediately backed off when she seemed reluctant. Although he felt slightly rejected, they continued to talk and enjoy each other. Then things suddenly took a surprising and exciting turn in the opposite direction! Jacob emphasizes the value and importance of asking for what you want, and recommends getting “enthusiastic verbal consent” before touching. that’s because non-verbal consent can easily be misinterpreted by both people. In contrast, enthusiastic verbal consent is respectful and empowering toward both people. It leads to less mind-reading and a greater chance of being on the same page with the person you are interested in.  Rhonda acknowledges Jacob's tremendous respect for the person he is dating with his emphasis on "enthusiastic verbal consent." Jacob, Rhonda and David also talked about the Burns Rule: People NEVER want what they CAN get, and ONLY want what they CAN’T get,” and how you can use this rule to your advantage if you avoid being pushy or needy. Jacob used the Burns Rule skillfully, and if you listen to the podcast, you will hear the surprising conclusion! We also discussed the power of playfulness, taking risks, and sometimes being silly. In my experience (DB), people struggling with social anxiety are sometimes way too serious, and this can turn people off, particularly if you want to date. I can speak to that from personal experience, as I struggled with five different kinds of social anxiety when I was a young man! With Jacob’s leadership, we illustrated a number of techniques that might be helpful to Davide, and perhaps to you as well, including: The “Consensual Compliment.” This is a safe, non-threatening way of approaching strangers, especially people you might want to get to know better or even date. Essentially, you ask a stranger if they’d be open to receiving a compliment. Jacob and Rhonda demonstrate this technique with role-playing, and explain what to do if the person seems negative or ambivalent, or if the person says yes. I suspect that Jacob created this awesome method. Talk Show Host. This is a great, non-threatening way to make conversation with any stranger in any circumstances. David and Rhonda illustrate it in a role-play. Shame Attacking Exercises. You do something bizarre in public to make a fool of yourself, so you can overcome your fears of looking foolish. Dr. Towery is one of the world’s most creative and funny teachers of this techniques, and I recounted one of his incredible Shame-Attacking Exercises in the Macy’s Department Store near Stanford. Smile and Hello Practice. You force yourself to smile and hello to ten strangers each day. Rejection Practice. Instead of trying to get a date, you try to collect as many rejections as possible, so you can get over your fear of being rejected. I (DB) once skipped medical school classes for two weeks and did rejection practice all day long every day with a young friend, Jeff Evans (aka Spyder). We both had a 100% rejection rate, but it helped us get over our fears. The late psychologist, Dr. Albert Ellis, also emphasized the value of the rejection practice he did in New York when we was a young man. He asked 200 women in a row for a date in one week. They all said no, except for one, but she didn’t show up for the date! But he said this helped me overcome his fears as well, and he ended up with an incredibly rich dating life and even ended up writing an advice column in a men’s magazine for several years. Jacob said that he's experienced many rejections as well, and agrees on the importance of overcoming this fear! Externalization of Voices. You talk back to your Negative Thoughts. Jacob, Rhonda, and David illustrate this powerful method, using the seven Negative Thoughts in Davide’s email. Jacob strongly recommended several other resources, including podcast 197 with Dr. Matthew May as well as several of David’s FB Live videos on flirting, featuring Dr. Angela Krumm (part 1) and (part 2)and Kyle Jones. My book, Intimate Connections, is a bit dated now, but the wisdom and techniques in this book will be invaluable for anyone in the dating scene. Lots of people have told me that they started dating and got married after a long period of loneliness because of that book! Jacob has recently published a book on depression for adolescents and teenagers called “The Antidepressant Book,” which is available on Amazon. If you have or know of a young person who is struggling with depression, this book might be a great gift for him or her! My own new book Feeling Great, was released September 15, and is also available on Amazon (see the link below.) It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public. If you would like to contact Dr. Towery, feel free to visit his website is www.jacobtowerymd.com . Rhonda and David

Last week you heard Part 1 of David’s TEAM Therapy session with Neil Sattin, who became pretty despondent and discouraged right after the first shut down because of the covid-19 pandemic in March of 2020. David and Neil went through the T = Testing and E = Empathy parts of TEAM, and David helped Neil develop a Daily Mood Log so he could record his negative thoughts and feelings at one specific moment at the end of a day when he was feeling like he hadn’t gotten enough work done. Perhaps you’ve had the same problem at times! Today you’ll hear the A = Assessment of Resistance and M = Methods parts of the session. As they begin, David asks Neil the Magic Button and Miracle Cure questions, and Neil says that he definitely does want help and would push the Magic Button to make all of his negative thoughts and feelings on his Daily Mood Log disappear. David cautions against that and suggests Positive Reframing, asking two questions about each negative thought and feeling. What does this thought or feeling show about you that’s positive and awesome? What are some potential benefits, or advantages, of this thought or feeling? Here’s Neil’s list of Positives: My sadness: Shows that I’m ambitious Motivates me to achieve a lot Shows that I have high standards My anxiety: Shows that I’m responsible Keeps me vigilant Fuels me to take action Reminds me that I’m doing important things My guilt: Shows that I have a moral compass My feelings of defectiveness and inadequacy: Show that I want to be a good role model Show that I’m willing to be honest about my flaws Show that I hold myself accountable Show that I’m humble My feelings of being alone show that: I value connections with others Allow me to feel close to people My feelings of embarrassment and humiliation show that: I have high standards and goals I want my life to mean something I value acceptance My discouragement shows that: I have a vision I’m realistic about the many challenges I face and the sheer volume of work I have to do I’m willing to face the truth My frustration shows that: I’ll persevere. I won’t stop and give up. Feeling annoyed and irritated: Shows that I won’t tolerate things that get in my way Gives me energy and determination Feeling overwhelmed: Reminds me that I might be taking on too much Protects me from trying and failing Shows that I’m looking for ways to take care of myself. After listing these positives, Neil used the Magic Dial and indicated that he’d like to dial down his negative feelings to lower levels, rather than getting rid of them entirely, as you can see in the “% Goal” column of his Daily Mood Log. Then they moved on to M = Methods, focusing first on Neil’s Negative Thought (NT): “I’m not capable of getting organized. After identifying a number of distortions in the thought, Neil was able to generate a positive thought that fulfilled the necessary and sufficient conditions for emotional change: The Positive Thought (PT) has to be 100% true. The PT has to drastically lower your belief in the Negative Thought. You can see this on his DML. David and Neil used a variety of techniques, including Externalization of Voices, to challenge the rest of his NTs. Neil re-rated his negative feelings at the end of the session. They all feel to zero except feeling alone, which went from 80 to 5, which was his goal. Rhonda and David

Rhonda begins with a plug for David’s new book, Feeling Great, which will be released on Amazon, on September 15, the day after after this podcast will be published. You can check it out at the link at the bottom of today's show notes. Today and next week you will hear parts 1 and 2 of a live therapy session I (David) did with Neil Sattin, host of his own terrific “Relationship Alive” podcast, which has received 5 million downloads. But as you know, we all sometimes need a little mental tune-up, including therapists. The session you are about to hear occurred on March 23, 2020, when the pandemic shut-down first occurred. Rhonda begins today’s podcast with a moving email from a fan who heard Neil's live therapy session with David on Neil’s Relationship Alive podcast. Then Neil explains how his  work on troubled relationships were born out of his work as a dog trainer, and he saw many similarities with relationship issues! In addition to hosting his popular podcast, Nel does coaching for individuals and troubled couples. Neil explains that, “I’ve always been a person who people have turned to for relationship help. I saw the struggles my parents experienced, and I have experienced my own struggles, and I wanted to figure out how we might use struggles to deepen and improve relationships, so people can thrive and get past those challenging moments. Prior to his personal work with David, Neil sought help from a cognitive therapist, but it wasn’t helpful thought. Neil thought it was too formulaic, a sentiment that David agrees with. Neil prefers working “in the moment,” the way David does therapy. Today, you will hear the T = Testing and E = Empathy portions of Neil’s TEAM therapy session with David, and next week you will hear the A = Assessment of Resistance and M = Methods portions. You can check out the Daily Mood Log that David and Neil filled out at the beginning of session. As you can see, the upsetting event was simply feeling like he hadn’t gotten enough done when evening approached. Perhaps you’ve sometimes felt like that, too! You can also see that Neil had many negative feelings. Most were intense and Neil felt overwhelmed. He was telling himself there was way too much to do, that he was incapable of getting organized, and that he was going to end up unhealthy, weak and broke. These were messages he’d heard from his dad when he was growing up: “You’ve gotta clean your room. . . You’ll never succeed.” Tearfully, Neil says, “I’ve always wanted his blessing. . . but I’ve never gotten it. I wish he could see my role in the world, the impact I’ve been making, and I wish he would admire it! . . . I love him dearly, but there are things I just don’t understand, things that have been the sources of my sadness and anger ” Tune in next week for the exciting conclusion of the session! Rhonda and David

Ask David What do you do when someone won’t stop asking questions? Hello David, It’s been a while since I’ve emailed you, but that’s because I’ve been doing really well thanks to you! I started a new job 3-1/2 months ago, & this woman seemed to take to me right from the start. It was nice at first having someone to talk to etc, but it has quickly turned bad. She sits in the cubicle right next to me. All day long she talks to me asking me questions. What did I do after work? Who was I with? How long was I gone? What did my husband do? And on & on. It feels like she’s interrogating me because the questions never stop. I’m trying to get more vague with my answers hoping if will deter the conversation, but no luck. It really becomes distracting at times & then other times it just feels like she’s being nosy & freaks me out. I just want her to leave me alone! I think this would be a good opportunity to use the 5 secrets of effective communication, but I’m struggling. Could you help? Thank you, Brittany Hi Brittany, Will send to Rhonda for an Ask David. But a simple approach would be to tell her that you admire her and appreciate her interest, but that you sometimes find the questions distracting from doing your work. Perhaps you could sit down with her for lunch or something, and then use your five secrets skills. Using the relationship journal, you could write down one thing she said to you, and exactly what you said next. Then we can see exactly what you are doing that is fueling the problem! I've attached one, and you could send it to us after you have completed Steps 1 and 2. David Thank you for the reply! It really made my day. I attached the relationship journal. It was actually more helpful than I thought it would be for this situation. Once I was able to think of a good example, I realized that maybe my lack of inquiry or showing interest in her is causing her to ask me all these questions. Although if I ask her more about herself, I don't know if it would result in her talking even more? Hard to say. Thanks for your help, and I appreciate your thoughts on my relationship journal. -Brittany Hello, Wanted to give you an update on how it went using the five secrets. First thing Monday morning my coworker started right up with the questions. I used the five secrets & said something similar to what I wrote to you. She apologized for bothering me, & things have been great all week! She actually brought in headphones & has been listening to music now. And there’s no tension or animosity between us which was my fear initially. We still chat here & there & are friendly. Thanks again! -Brittany How can a pastoral counselor get training in TEAM-CBT? Dear Doctor David, I am a pastor from South Africa, married to an Australian, living in Dubai :) I was struggling with mild depression & came across your book "feeling good" and read it & applied all your techniques & it has been life-changing - THANK YOU! What surprised me most was the simplicity and effectiveness of the exercises. I believe that much of what you teach is life skills everyone should have! I wish I was taught these things when I was younger! Over the years I have helped people, from all walks of life - inmates, students, business people, etc., but primarily from a spiritual perspective. I believe I can be more effective and help so many more out there if I learn how to apply your exercises to others. I would love to train in TEAM and learn how to apply these techniques with the people I minister to, but I am not a psychologist or certified as per your requirements. I realize practice and critical feedback is paramount in order to get really good in TEAM. Please advise me on an alternative route. Any help with this regard would be highly appreciated! Thanking you in advance. Yours sincerely, Gareth Noble Hi Pastor Noble, Sure there is a certification program at the Feeling Good Institute. I believe pastoral counselors would be very welcome. They offer many online introductory classes in TEAM-CBT. Check our my free weekly Feeling Good Podcasts, too. I will include your question, with your permission, on an Ask David Podcast. I also offer a free depression class on my website, and about to post an anxiety class too, also free. There are tons of resources, almost all free, on my website, www.feelinggood.com. You can check out my website page from time to time for online workshops. Dr. Angela Krumm angela@feelinggoodinstitute.com is head of the certification program at FGI, which is www.feelinggoodinstitute.com. Angela and I are both PKs (Pastor’s kids)! All the best, David Is love an adult human need? Rhonda said that people in the TEAM certification listserve thought they heard David say that love is not an adult human need. Is this true? David comments on hearing Dr. Beck say that decades ago, in one of Dr. Beck’s weekly training groups at U. Penn, and what he (David) discovered. What’s the best training program to learn TEAM-CBT? David and Rhonda, I hope this note finds you well. I'm writing for a few reasons. The first is to thank you for your podcast and related resources. I found your podcast and started listening at the beginning of COVID-19 (mid-March) because I was feeling acute anxiety. The T.E.A.M. approach and your teaching are such an amazing gifts. The positive reframing in particular is truly life changing and revolutionary for me. Considering what my negative thoughts show about me that's positive and awesome and then finding the cognitive distortions has provided me such relief. I have been so excited about T.E.A.M. therapy that I often discuss it with my husband, friends, and family. I really loved David's comment in the most recent podcast that good therapy isn't evangelizing; rather it's letting the patient define problems and goals within his/her own values. I also liked your comment that doing therapy well is like an artform or a dance- that's such a beautiful sentiment, and I've been able to see the conversational "dances" you perform in the amazing, transformative, empathic live therapy sessions with Michael, Rhonda, Sarah, and others. These sessions have often brought tears to my eyes. This brings me to my second reason for writing. Listening to the podcast has been transformative for me in another way- it's made me seriously consider becoming a therapist myself. I have considered this possibility over the years, but now that I'm familiar with the T.E.A.M therapy approach and can see how helpful it is, I'm excited to explore this path more. I have a B.A. in psychology so I would need additional education- do you have suggestions for masters programs that you think would provide good alignment with the T.E.A.M. approach? I live in Charlottesville, Virginia and have two young children, so a local or online program may be the best bet for me. Thanks in advance for any ideas you may have. All the best to you, Molly Hurt Thanks, Molly. We can read your wonderful email on an Ask David if that is okay with you, but here is the quick answer. In graduate school, you don’t typically learn much that is useful. It is more getting a license to practice, then you learn from mentors, workshops, etc. The FeelingGoodInstitute.com has training and certification programs, including 12 week beginner classes in TEAM that are excellent. The whole area of coaching is emerging now too, and the certification is rather informal. If you get a degree like a masters degree in social work online, and then get licensed to do therapy, that is one approach, but there are many ways to get certified—counselor, psy d degree, marriage and family therapy, and so forth. So in short, I would, personally, find some way—the easiest way—to get certified so you can legally do therapy. But concentrate on learning TEAM as the tool to use. In California, as an aside, anyone can call themselves a “psychotherapist,” but you need the degree and license to call yourself a “psychologist.” Good luck, and thanks again! david Why are should statements considered distortions? Thanks for your quick and helpful reply. It's useful to have a better sense for how to prioritize my time and training. I'm excited to continue to explore T.E.A.M. therapy! And you are welcome to read my email on the podcast, thanks for asking. If I may, one other question for you: how do you recommend someone defeat "should" statements when his/her behaviors aren't healthy or beneficial? For example, "I should not overeat when anxious" or "I should not procrastinate" or "I should not be impatient with my daughter." I understand that saying "should" in these cases adds pressure and can lead to shame, but I don't see the distortion in these statements. In other words, these statements may not be helpful to a patient, but how are they not 100% true? I would appreciate any additional guidance you can offer on what I find to be the most difficult cognitive distortion! Thanks again to both of you for generously sharing your loving and kind approach to helping people deal with their problems and feel better. The impact you're having is profound. I love listening to you empathize with patients- it makes me strive for building an even more loving connection with my husband and daughters, as well as others in my life. Best, Molly Hi Molly, You may want to listen to podcast #205 pm Should Statements. You can also find a lot in my books, like Feeling Good, which you may have already read. There is also a chapter on how to crush should statements in my new book, Feeling Great, which will be released on September 15, 2020. Shoulds are distortions because they are not valid. It is not true that you “should not overeat when anxious.” You SHOULD overeat when anxious because it is very appealing, tasty, and makes you feel better. A correct statement would be, “It would be preferable if I did not overeat when anxious.” This statement removes the shame and pressure, while honoring your goal. There are three correct uses of should: the moral should (thou shalt not kill), the legal should (you should not drive 90 miles an hour because you’ll get a ticket) and the laws of the universe should: this pen should fall to the floor if I drop it because of the force of gravity. But overeating when anxious is not immoral or illegal, and it does not violate the laws of the universe. So it is not a valid use of the word. There is a podcast on this, I think, and you can search for it on my website use the search function. Rhonda and David  

Today, the Cognitive Distortion Starter Kit Focuses on Blame This is the final podcast on the Cognitive Distortion Starter Kit. Today, we focus on techniques to combat Blame. There are two common forms of Blame, and both can be deadly. Self-Blame: You beat up on yourself and blame yourself for things. Self-Blame is nearly always accompanied with self-directed Should Statements: “I really screwed up. I shouldn’t have done that!” Self-Blame triggers depression, worthlessness, and guilt, and sometimes triggers feelings of hopelessness and suicidal urges. Other-Blame: You beat up on others and blame them for the problems in your relationships. Other-Blame is nearly always accompanied with other-directed Should Statements: “He’s such a loser. He shouldn’t have such ridiculous beliefs!” Other-Blame triggers anger and conflict in relationships, and can sometimes trigger rage, violence, and even murder. Rhonda describes going on a bicycle trip with her husband. But when they got to the trailhead, they realized that her husband had put the wrong bicycle for Rhonda on their car. Sadly, the much-anticipated bicycle ride was ruined, and Rhonda began fuming and blaming her husband for having made this mistake. but then she decided to back off and think about her own role in the problem, and soon they were bake in a loving mood again. Unfortunately, for many people, the outcome is different, with escalating arguments and lasting feelings of resentment and indignance. David describes his work with a married woman who blamed herself for sexual difficulties and a history of sexual abuse as a child, who stood in front of a mirror with a razor blade to her neck the night before her first session with David. She was debating, “Should I just slit my throat and get it over with, or should I show up for my session in the morning?” Rhonda presses David for details about the treatment, which had a glorious outcome. David also gives a dramatic example of Other-Blame—a man who shot two obnoxious and aggressive teenage boys with his crossbow during a road rage incident. He shot one of the boys through the heart, and he fell and bled to death. Then he shot the other boy through the spinal column, and that boy survived but ended up paralyzed for life. The man was arrested and given a life sentence in prison. When interviewed by a television reporter and asked if he had any remorse or regrets, the man said, “Regrets! Hell no! That was the greatest accomplishment of my life! I think about constantly and it makes me euphoric. If I had the chance, I’d do the exact same thing again!” And that the huge problem with Other-Blame. Although negative thoughts containing Other-Blame are nearly always extremely distorted, just like the thoughts that cause depression, thoughts with Other-Blame trigger feelings of moral superiority and anger that can be extremely addictive. That’s why anger and relationship conflicts can be way harder to treat than depression and self-blame. One potentially helpful technique is a Blame Cost-Benefit Analysis, listing all the many advantages and benefits of blaming others for your problems and relationship conflicts. Once you’ve seen all the benefits, you can list the disadvantages, and then balance them against each other on a 100-point scale. if the advantages of blame are greater, there’s no reason to change. If you’re interested, you can check out this link to a Blame CBA that my daughter and I prepared. Check it out! David explains how he used this technique to help a physician with chronic, refractory depression and episodic rage attacks in a single therapy session! It’s a great technique to try if you’re feeling unhappy and blaming others for the problems in your relationships with them. Rhonda and I have  enjoyed creating this series for you. If there are other series you’d like to hear, let us know. For example, we could have a series of podcasts on all the different kinds of anxiety, illustrating the most helpful techniques for each one. We could also have a series on all of the different kinds of Self-Defeating Beliefs, like the Spotlight Fallacy, and how to defeat them. Or, if there are techniques you want us to highlight, we'd be more than happy to do that, too! Rhonda and David

Today, the Cognitive Distortion Starter Kit Continues with Should Statements Rhonda begins by reading a beautiful email from one of our listeners, and I give a brief shout out for my new book, Feeling Great, which can be pre-ordered on Amazon now (see below for the link). Thanks to your support, as of today (July 2) it is already the #1 best seller in the Amazon depression AND anxiety categories for impending new books! David and Rhonda briefly summarize the history of Should Statements, starting with the Buddha 2500 years ago, and culminating in the work of Karen Horney and Albert Ellis in the 20th century. They both emphasized that nearly all emotional suffering as well as relationship conflict results from “Shoulds.” David and Rhonda describe the four categories of Should Statements: Shoulds directed against yourself cause depression, anxiety, guilt, and shame. and even lead to suicidal urges. Should directed against others cause anger, and can even lead to violence. Shoulds directed against the world cause frustration. Hidden Shoulds. They also describe the three valid types of Should Statements: Moral Shoulds Legal Shoulds Laws of the Universe Shoulds David and Rhonda provide vignettes illustrating the tremendous emotional damage that can result from “Shoulds” and describe a number of strategies for combating them, including: Positive Reframing the Semantic Technique Socratic Questioning the Acceptance Paradox The final podcast in this series will focus on the two types of Blame: Self-Blame, which nearly always marches hand-in-hand with Self-Directed Shoulds Other-Blame, which nearly always marches hand-in-hand with Other-Directed Shoulds Rhonda and David

Today we feature a brilliant and beloved colleague, Dr. Alex Clarke. At the start of today’s podcast, Alex describes his unexpected journey from psychoanalysis / psychodynamic therapy to TEAM, but discovered that TEAM can actually be viewed as a type of psychoanalytic therapy. In fact, the two fathers of cognitive therapy, Albert Ellis, PhD, and Aaron Beck, MD, began their careers as psychoanalysts. They were simply looking for specific techniques to help their patients develop rapid and tangible change, and not just understanding that unfolds over a period of years. David and Alex discuss some of the surprising overlaps between TEAM and psychodynamic therapy, as well as some of the striking differences. Similarities Changing the Focus: Often there’s tension in the room, especially during therapy sessions. When you bring it to conscious awareness in a kindly way, it will often lead to therapeutic breakthrough. The Relationship Journal: This is a rapid way to highlight the recurring patterns that cause conflicts in intimate relationships. Interpersonal Downward Arrow: This is a high-speed version of psychoanalysis which reveals your “core conflict” in ten minutes, as compared with five years on the analyst’s couch. Hidden Emotion Technique: This is the idea that anxious individuals are overly “nice” and feel they have to suppress certain kinds of positive or negative feelings, which then emerge, in disguised form as some type of anxiety, such as chronic worrying, a phobia, a panic attack, OCD, and so forth. Differences T = Testing techniques: Most analysts are dead set against testing, thinking it will somehow hurt or ruin the “transference.” TEAM therapists are convinced it is difficult, if not impossible, to do good therapy without session by session assessments to track how patients feel, and how they feel about the therapist. E = Empathy training and methods: TEAM therapists get highly accurate and sensitive empathy ratings after every session from every patient. Many therapists get failing grades from most patients at most sessions. The patient’s criticisms are not taken as evidence for the patient’s distortions of the relationships, but rather as valid indicators of the therapist’s actual errors. This information is used to deepen the therapeutic relationship. A = Assessment of resistance: Freud devoted his career to understanding and trying to solve the puzzle of resistance—but his free association on the couch was not terribly effective. TEAM therapists bring subconscious resistance to conscious awareness quickly, and melt it away rapidly with a variety of techniques. This opens the door to the possibility of ultra-rapid recovery. M = Methods: TEAM therapists use more than 100 methods drawn from more than a dozen schools of therapy. The therapist and patient work together collaboratively to solve specific problems, and homework between sessions in mandatory. Alex’s current passions span a broad range of mental health treatment, and as a result, provide lots of great opportunities for fun and collaboration with David, as well as the rest of the TEAM community. Clinical work: Alex sees patients three days per week, using TEAM and occasionally medications if needed. Training / teaching: He teaches with David and several other experienced TEAM therapists at David’s weekly training group at Stanford. The Feeling Great app: Alex is assisting David and Jeremy Karmel in the process of making TEAM Therapy accessible to everyone as an electronic app. The app will include real-life examples bringing the techniques to life along with step-by-step instructions for how to put techniques into action. Putting these powerful psychotherapy ideas and methods in patients’ hands provides an exciting opportunity to accelerate healing and augment therapy, since the tool can be assigned as homework between therapy sessions. Also, when patients get stuck with topics in the app, they can discuss these with their therapists, deepen their understanding, and bring them to life through role-plays, etc. Statistical modeling: With David’s mentoring, Alex is working to learn data analytic and statistical modeling methods that can help investigators explore and understand how effective psychotherapy actually works. Measurement and Search: Alex has joined David’s son, Erik, on the exciting mission of promoting measurement-based and feedback-informed treatment as the standard of care in mental health. They are currently in the final phases of developing and rolling out an electronic system for use by therapists and patients to assess mood before, after, and between therapy sessions in order to assess changes in therapy as well as relapses between sessions. This system will provide unique insights for clinicians as well as patients about what’s helping, what’s not helping. The tool will also have a search-engine celebrating clinicians who commit use measurement consistently in their clinical work and will help patients find clinicians with outstanding skills in the areas where they need help. Alex was born in Seattle and grew up splitting his time between the east and west coast. Alex went to high school and college in North Carolina and played in a band for several years after finishing college. He also worked in restaurants, real estate, audio engineering, and even owned a vending machine business for several years! He’s always been a giant outdoors enthusiast, loving to hike, ski, climb, and surf. When Alex went to medical school, he planned to become an emergency room physician because of his love for adventure and wilderness. During medical school, Alex fell in love with the operating room and almost decided to become a surgery resident. However, during a summer research internship, Alex became increasingly interested in neuroscience and began devouring literature on consciousness and emotion research, as well as the brain-machine interface. When he discovered psychiatry during his clinical rotations, he was sold. Psychotherapy struck him as particularly awe-inspiring and he decided to dedicate himself to its learning and practice. In his final year of medical school, Alex traveled around the country doing rotations at medical centers across the US in an effort to learn how mental healthcare is practiced in different settings and regions. He searched broadly for psychotherapy mentors and feels wildly lucky to have found Dr. David Burns during his residency at Stanford. During residency, Alex trained in several different schools of psychotherapy, including advanced psychodynamic training with the SFCP (San Francisco Center for Psychoanalysis). As he puts it “there are lots of metaphors for human experiences, but all of these schools for some reason feel a need to use their own jargon, which can sometimes be off-putting or confusing.” I, David, would add that I agree with this 200%. For example, there is a concept called “projective identification.” For years I felt intimidated by this term and couldn’t figure out what it meant! Then someone explained it to me, and for a brief moment, I “got it.” But now, I again have no idea what it means! Alex decided that understandable language was important and discovered that Dr. Burns had been developing “common language” for important psychotherapy ideas as well as a framework for understanding how effective treatment works. Alex loved this and decided to join David is his mission of translating essential psychological and philosophical ideas into practical, usable healing techniques. One of things that Alex expresses that he admires most about David is his strength in taking complex ideas and bringing them down to a simple, digestible, human level. I, David, would add that I love working with Alex, and have learned so much from him, both in terms of the numerous technical discoveries and amazing breakthroughs that have evolved in our research, but I have also learned a little about the incredible value of humility and “selflessness” from this kindly gentle giant! I, Rhonda, would liked to add that I also love working with Alex.  I admire his kind soul, his gentle disposition, and his perceptive mind. Rhonda and I feel extremely lucky to be working with Dr. Alex! Rhonda and David Dr. Alex Clarke can be reached at: 650-382-2090, alex@clarkemd.com   Alex is available by video appointment for anyone located anywhere in the state of California.  He provides psychiatric evaluations, TEAM psychotherapy, and medication management for any condition, so don't hesitate to reach out to him by phone or email anytime to discuss evaluation/consultation options or treatment needs.  He is also available to clinicians for TEAM case consultation.   Thank you!!!    

Today, the Cognitive Distortion Starter Kit Continues with Emotional Reasoning Rhonda begins by reading a beautiful emails from a listener who was greatly inspired and helped by the personal work Marilyn Coffee did on several previous podcast. I also give a brief shout out for my new book, Feeling Great, which can be pre-ordered on Amazon now (see below for the link). Rhonda and David begin with a brief overview of Emotional Reasoning. this is a term i coined when I first created the list of ten cognitive distortions in the mid-to late 1970s. There is the definition: Emotional Reasoning is when you reason from how you feel. Here are several examples: “I feel like a loser, so I must really be a loser.” “I feel hopeless, so I must be hopeless.” “I feel anxious, so I must be in danger.” “I feel like a bad therapist, so I must really be one." “I feel judged. This means that people are judging me.” “I feel guilty. This means that I did something bad.” Emotional Reasoning is a distortion because your feelings all result from your thoughts. And if your thoughts are distorted, then your emotions / feelings will not reflect reality. Sometimes, your feelings are no more realistic than the images you see in funhouse mirrors in an amusement park.  This is worth knowing because for decades mental health professionals have promoted the ideas that getting in touch with your feelings is the key to mental health. There's truth in everything, and this is sometimes true. Being open with your feelings can be an important key to intimacy and to genuine relationships with others. But your feelings can also deceive you. For example, the feeling of hopelessness is always based on distortions and is never true. But sometimes believe it so strongly that they attempt suicide as the only escape from their suffering. David and Rhonda discuss examples of emotional reasoning and the techniques that can be helpful, including, but not limited to: The Double Standard Technique The Socratic Method Truth Based Techniques, such as: Examine the Evidence The Experimental Technique The Survey Technique David describes a father who was convinced he was a bad father because he shouted at his sons, and Rhonda describes an aspiring writer she recently treated who felt like she was dull and unimportant prior to a meeting with prospective agents. We are nearing the end of the distortion series, but still have two mega-important distortions to discuss: Should Statements Blame David mentions that Emotional Reasoning is not only important in emotional problems like depression and anxiety, but also in anger and conflict with others, as well as racial and religious bias. You feel like other racial or religious groups are inferior, and you feel superior, so you think you are right! Thank so much for listening. If you like our podcasts, tell your friends, colleagues, and patients about them! This is all volunteer work, so our only marketing budget is your good will. Each month our downloads are increasing, thanks to you, and we will hit three million downloads early next year or late this year. Rhonda and David  

Today, Rhonda and David discuss seven great questions submitted by podcast fans like you! Are depression and anxiety states of self-hypnosis? How do you deal with somatic symptoms in TEAM? Should we forgive Hitler and Stalin? What if a patient feels stuck and unable to identify emotions? Do you still really believe that depression and anxiety, regardless how severe, can be treated even without the use of prescription drugs? Do you have to work on your negative thoughts the moment they appear? What role, from your years of practice, does spirituality have in the psychotherapy? Are depression and anxiety states of self-hypnosis? Hi David, I have two questions after listening to Corona Cast 7: “My Struggle with Covid-19! Is it REALLY True that only Our Thoughts Can Upset Us?” I was struck by thinking of anxiety as the result of hypnotizing ourselves into believing our fears. Can depression by thought of in a similar way, except that we hypnotize ourselves into believing our distorted thoughts about ourselves? How do you deal with somatic symptoms in TEAM? Can you do an episode about how to deal with unpleasant somatic situations, as Michael was experiencing during the recording, that suggest there might be some psychological distress but don't seem to have thoughts associated with them? Thanks! Hi Derek, Another great couple of questions, thanks! Will add these to the next Ask David podcast, but the short story is yes, for sure—both depression and anxiety can be thought of as states of self-hypnosis, or trances, because you believe the messages you give yourself, (eg your negative thoughts) that are not true. I think one could add other positive and negative emotions to the list as well, including anger--believing the other person really IS wrong, bad, inferior, and so forth--as well as mania and narcissism, telling yourself that you really ARE a superior person, etc. This is a hugely important topic, and "emotional reasoning" fuels these trances: I FEEL worthless / inferior, so I must BE worthless / inferior, and so forth. With regard to your second question, you might want to listen to yesterday’s live session with Sarah, (Podcast 193, https://feelinggood.com/category/dr-davids-blogs/feeling-good-podcast/) since it focuses on intense somatic sensations generated by emotions, and you can actually hear the exact moment of recovery, when the physical sensations disappeared. David Should we forgive Hitler and Stalin? Hi Dr. Burns, Do you honestly think what Hitler and Stalin did should be forgiven? Albert Ellis said one should. I disagree! Tom Hi Tom, I only help people with problems they are asking for help with. I am not an evangelist or moral authority! David What if a patient feels stuck and unable to identify emotions? A new comment on the post "Uncovering Self-Defeating Beliefs (SDBs)--For Therapists (and Interested Patients) Only!"/ Hi Dr. Burns, Awesome blog post! Your accessible and kind demeanor shine through clearly. What if a client feels stuck and unable to identify emotions? Holly Do you still really believe that depression and anxiety, regardless how severe can be treated even without the use of prescription drugs? Hi Doctor Burns, My name is Jasmine, and I just started going back to therapy about a year ago. I have really improved, and both my mom AND my therapist recommended you HIGHLY. I’m a millennial and I’m just happy you are still alive! I also wanted to ask, do you still really believe even today that depression and anxiety, regardless how severe can treated even without the use of prescription drugs? I am asking because I just bought about three of your books and want to make sure that your confidence in these theories has not wavered. Sometimes I feel like a lost cause because this is the first time in my life that I am truly dealing with and facing my own problems instead of turning the other cheek. Also, how are you doing, sir? Jasmine Hi Jasmine, Doing great, thanks! The new techniques have added even more power to cognitive therapy. Check out my free Feeling Good Podcasts, free depression class, and more on my website, www.feelinggood.com. All the best, David PS My latest book, Feeling Great, can be pre-ordered on Amazon and will be released in Sept. Check our the link below. Do you have to work on your negative thoughts the moment they appear? Hello David, My name is Shivam, I wanted to ask you a question regarding the double column technique for disputing your thoughts. Do we have to work on that moment(upsetting) immediately as it happens or we can work on it later when we get free time? How often should we do it? Its very effective but consumes a lot of time as I keep writing on and on. Any suggestions? I really appreciate that you reply me back. Thanks for everything. love Shivam. What role, from your years of practice, does spirituality have in the psychotherapy? From: Jerry Souta Subject: spirituality in psychotherapy David: Your seminar today (Psychotherapy Leading Voices) was awesome! What role, from your years of practice, does spirituality have in the psychotherapy? Is there a correlation between spirituality and between feeling good/feeling great? Thank you for time taken in response to my in questions! Blessings! Jerry Souta, Jr. (MSW/LCSW/MDIV) Thanks, Jerry. I will answer this on an Ask David, we will be recording it soon. Your question will be featured on a Feeling Good podcast. The short answer is yes. Deep and rapid change nearly always involves a spiritual dimension, for example, one of the four “Great Deaths” of the self. There’s a whole section on this in my new book, Feeling Great.

Today, Rhonda and David discuss three great questions submitted by podcast fans like you!  This thoughtful question is from our beloved Rhonda! . . . And the answer may surprise you! When something terrible happens, like being raped or having your house burn down, or being a victim of racial discrimination, doesn’t the event itself upset you? Do you really have to have a negative thought before you can feel anger, fear, grief, or worthlessness? Hi David! For example, if our house burned down and we lost everything, or we or someone we loved was raped--doesn't the event affect you directly? Do you really have to have negative thoughts before you can feel sad, depressed, anxious or angry? Do all of our feelings REALLY result from our thoughts?  What about people who have been treated unfairly or been discriminated against because of their race, religion, gender identity, etc.  Aren't their feelings a direct result of their experience  and not just their thoughts? Rhonda What do you do when patients fall in love with you? Hi David and Rhonda, My name is Ben and I live in Maryland. I started listening to the feeling good podcast about 3 years ago when I was in a period of life transition. The podcast has been incredibly helpful to me as I dealt with my childhood trauma, explored my motivations and drives for life, and reoriented my personal relationships and career, away from what I thought I should be doing, toward what I love and deeply want for my life. In part because of the podcast's inspiration, I have decided to pursue a master’s degree in social work, and hope to become a psychotherapist. Thank you for all that you do, and the amazing help you have been to me personally. I do have one question. In one past episode. You mentioned the possibility of using five secrets to defuse the situation when a patient falls in love with the therapist because they feel understood and cared for. This has happened to me a few times when I talk with a friend about their personal difficulties, and they begin to develop feelings for me. I would like to keep these relationships friendships, rather than romantic. I would love to have your advice on how best to both inoculate against and resolve such situations. Thank you again. Ben What can you if your boss is not empathic? Hi Dr. Burns, You guys are always so good at empathy. I’d love to hear one day your method about how to cope when there is lack of empathy, but you still have to keep a relation. For example: when your boss doesn’t empathize with you and his message makes you feel bad, but you still need the job. I had an experience like that and it really hurt the ego. Cheers, David. Have a great day! Andres Hi Andres, One can always learn a lot from one exchange with the boss. What did he say and what, exactly did you say next? Waiting for empathy from others is never something I have recommended! That’s a really long wait! But you CAN discover how you are provoking the very problem you are complaining about if you have the courage. This empowers YOU to change. David Questions on the next Ask David: Are depression and anxiety states of self-hypnosis? How do you deal with somatic symptoms in TEAM? Should we forgive Hitler and Stalin? What if a patient feels stuck and unable to identify emotions? Do you still really believe that depression and anxiety, regardless how severe, can be treated even without the use of prescription drugs? Do you have to work on your negative thoughts the moment they appear? What role, from your years of practice, does spirituality have in the psychotherapy? Rhonda and David