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

My mother won't follow my advice! David and Rhonda are joined in today’s podcast by Alex Clarke, MD, a former student of David’s who is practicing TEAM therapy at the Feeling Good Institute in Mountain View, California, and by Zeina Halim, a TEAM therapist and student in David’s Tuesday Stanford psychotherapy training group. In our last two podcasts (Corona Cast 1 and 2) (links) we focused on the impact of the corona crisis on internal feelings like depression, anxiety, panic, hopelessness, and so forth. In this week's Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example. Zeina was concerned that her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother might get the virus and die. However, Zeina’s mother is very self-reliant and independent, and didn’t take kindly to Zeina’s frequent reminders to do this or do that so as to be safe. They ended up arguing and feeling frustrated with each other. Perhaps you’ve also run into problems with friends and loved ones because of the corona crisis. When people get confined into close quarters, under conditions of intense stress and uncertainty, clashes are almost inevitable. When you’re angry with someone , you’ll nearly always be viewing the other person in a distorted way. For example, you may be telling yourself that s/he “should” not think, feel or behave the way he or she is thinking, feeling, or behaving. Of course, this is a classic other-directed “should statement.” Or you may be telling yourself that the other person is being “stubborn” or “unreasonable” (Labeling; Mind-Reading). Or you may tell yourself that you’re right and the other person is wrong (All-or-Nothing Thinking; Blame). And in most cases, you’ll be telling yourself that the conflict is the other person’s fault and that you’re the innocent victim of his or her bad behavior (Blame.) These are just a few of the cognitive distortions (link) that fuel conflict. But it’s these distorted thoughts, and NOT what the other person is thinking, feeling, or saying, that actually causes your negative feelings. You are making yourself angry--the other person is NOT causing your anger or frustration! You are creating these feelings. And the thoughts that trigger these feeling are wrong thoughts. This can be a VERY hard pill to swallow. You, and not the person you're mad at, are triggering your feelings of frustration and anger. In addition, the thoughts that upset you are not valid. They’re distorted, and just plain WRONG. If you don’t like this message, you might want to stop reading! I get it! It is SO MUCH more rewarding to blame the other person! In today’s podcast, we discuss and illustrate a sophisticated TEAM-CBT technique called "Forced Empathy" (link). Forced Empathy forces you see things from the perspective of someone you’re at odds with. It will ONLY be effective if you want a closer relationship with the person you’re at odds with. If you want to remain in battle--as most people do--then you're welcome to do that. Go for it. If, in contrast, you do want to feel closer and more loving, Forced Empathy can lead to a helpful shift in how you think about the person you’re angry with. When you suddenly see things through the eyes of the person you're angry with, you may suddenly discover that your thoughts about the other person’s motives were not correct. Alex and David describe how the technique works in a step-by-step way, and then illustrate it with a role-play between Zeina and her mother. This is a recreation of the technique they used live in the Stanford Tuesday group a couple weeks before the recording. Forced Empathy proved to be extraordinarily helpful to Zeina, and brought tears to her eyes. Once she saw things from her mother’s perspective, the tone of their interactions suddenly softened, and the tension was replaced by feelings of love and acceptance. Zeina was surprised to discover that, among other things, her mother, while not wanting to die, had no fear of death, but didn’t appreciate being constantly told what to do, or what not to do, and that she loved and admired Zeina tremendously. Zeina also discovered that in the highly unlikely event that her mother did die, she would want to spend her last days or weeks with her Zeina, feeling close, and loving one another, instead of arguing. Is this relevant to you and your friends and loved ones? In today’s podcast, we talk about how you can improve your relationships with friends and loved ones during these challenging times using the Five Secrets of Effective Communication. We emphasized one of the important take home messages in podcast 164 on "How to Help, and How NOT to Help." Sometimes, people just want someone to care about them and listen, without having someone trying to help them or give them advice. Learning to do this can be incredibly freeing, but it’s not easy, because so many of us are addicted to “helping.” If you want some additional help, check out David’s book, Feeling Good Together. Thanks for tuning in, and let us know what you thought about today’s program! Until next time, Rhonda, Alex, Zeina, and David

With the "Shelter in Place" orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual while we are learning to use the new technology. (I apologize for the echo in this week's podcast. It won't be there again-Rhonda) Let us know what you think!  Thank you, David & Rhonda David and Rhonda are joined again in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app. In our first Corona Cast, we promised to present an example of how TEAM-CBT can be helpful for individuals who feel depressed and anxious about the personal impact of the pandemic. Rhonda kick starts today’s session by describing her treatment with a patient we're calling Alice just a few days ago. Alice woke up feeling stressed and having trouble settling in and getting to work. If you click here, you can see how she filled out the first few steps of the Daily Mood Log just before the start of her session with Rhonda. The Upsetting Event was simply waking up and feeling out of sorts. She circled and rated her negative emotions, which were fairly intense, especially the feelings of depression, anxiety, inadequacy, despair, frustration. Her anxiety was only minimal, but she was also feeling tremendously "jittery." Why was Alice feeling so upset? Her feelings didn't result from the corona virus epidemic, but from her thoughts about it. As you can see, she was telling herself: 1.      This could be the new normal. 2.      My life is going to waste. 3.      I should be handling this better. 4.      I could catch the virus and die. 5.      No one is in charge. She strongly believed all of these thoughts except #4, which she only believed 40%. You may recall that in order to feel upset, two things must be true: You must have one or more negative thoughts on your mind. You must strongly believe these thoughts. How are we going to help Alice? In the old days, I would have jumped right in to help Alice challenge her Negative Thoughts, but now we have a far more powerful and systematic approach called TEAM-CBT, as most podcast fans probably already know! These are the four steps of TEAM-CBT: T = Testing. Rhonda tested how Alice was feeling at the start and end of the session. E = Empathy. Rhonda provided warmth and support without trying to "help" or "cheer-lead." A = Assessment of Resistance. This is one of the unique aspects of TEAM-CBT, and it's the secret of ultra-rapid recovery. Rhonda used the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial to bring Alice's "resistance" to change to conscious awareness, then quickly reduced it before trying to "help." M = Methods. Rhonda helped Alice identify the many cognitive distortions in her thoughts. For example, her first Negative Thought, "This could be the new normal," was an example of All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Fortune Telling, and Emotional Reasoning. The goal of the M = Methods phase is to crush the Negative Thoughts that  are upsetting you. Do you know how to do this? You have to come up with a Positive Thought that has two characteristics: It must be 100% true. Positive affirmations and rationalizations and half truths are worthless. Cognitive therapy is based on the Biblical idea the "The truth shall set you free." The Positive Thought must drastically reduce your belief in the Negative Thought you've recorded on your Daily Mood Log, and ideally your belief in it will go all the way to zero. In fact, the very instant you stop believing the Negative Thought, your feelings will change, and often quite dramatically. Rhonda helped Alice challenge her Negative thoughts with a powerful technique called the Externalization of Voices. For example, Alice was telling herself that "I should be handling this better" because she'd been having trouble adjusting to the home isolation and had been procrastinating instead of focusing on her writing, and she was also telling herself that "My life is going to waste," thinking she'd be procrastinating and feeling miserable forever: "The new normal." The Positive Thought that crushed it was, "I have a lot of experience as a self-starter, and I've got eight weeks of free time now to write, which is pretty awesome. In addition, I can give myself a break, instead of putting myself down, and give myself a little to regroup!" After all, there are hundreds of millions of people around the world who are feeling isolated and in distress, and probably most of them aren't being nearly as productive as they usually are, but clearly, that isn't going to go on forever! Instead of putting yourself down, you can give yourself some support and encouragement, in exactly the same way you might talk to a dear friend. Once Alice crushed her Negative Thoughts with strong Positive Thoughts, her feelings suddenly changed. Although the session was only one hour long, Alice experienced incredible improvements in how she felt, thanks to Rhonda's compassion and skillful guidance. Alice's depression went from 95 to 5, and her anxiety dropped from 95 all the way to zero. The rest of her negative feelings dropped to very low levels or zero as well. Did it last? Long-term follow-up isn't possible for such a recent session, but she did call Rhonda the next morning to say that she woke up Feeling Great . . . which is the name of my new book, due for release in September. You can see the cover below! If you want, pre-ordering on Amazon may be available by the time you hear this podcast. In next week's Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example of a young woman named Zeina who felt her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother would get the virus and die. They ended up arguing and feeling frustrated with each other. We will illustrate a sophisticated TEAM-CBT technique called "Forced Empathy" that brought tears to Zeina's eyes, and we'll also talk to you about how you can improve your relationships with friends and loved ones as well during these challenging times. Thanks for tuning in, and let us know what you thought about today’s program! Until next time, Rhonda, Jeremy, and David  

With the "Shelter in Place" orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual until we all get the necessary recording equipment, and learn the new technology.  Please bare with us during this transition.  Thank you, David & Rhonda David and Rhonda are joined in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app, and Dr. Alex Clarke, a former student of David’s who is practicing TEAM therapy / psychiatry at the Feeling Good Institute in Mountain View, California. One of our loyal podcast fans, Phil McCormack, sent a heartwarming email which read, in part: In light of the pandemic taking us into uncharted territories, I thought it might be interesting to hear of some tips from you that would help folks deal with the situation, kind of like the David’s Top Ten Tips podcast but this one focused on the hysteria which is prevalent as I write. I’m sure your fans would appreciate it and it might be a good jump start for your new book and app, both called Feeling Great. I realize you are incredibly busy and don’t expect an answer. And if you want to tell me to screw myself, I can use your techniques to handle that! I responded like this: Thanks, Phil. I’m trying to put together at least two or three podcasts on the coronavirus from a variety of perspectives! Might read you question to kick start the first one we do, if that’s okay. david Phil immediately shot back this email: You’re an animal! I have no idea of where you get all your energy and motivation–obviously your techniques work (drug free!) so that must be part of it! Kudos to you for all your effort. It is so, so much appreciated!! I sincerely hope you someday get the recognition you deserve!!! I think Feeling Great might be your ticket... Hope so. Please feel free to read question and thanks for not telling me to “screw myself!” Really appreciate that! Phil How cool is that! Rhonda and I are planning several podcasts on this important topic including today’s as well as a podcast on how Rhonda used TEAM to help a woman with severe feelings of depression, anxiety, inadequacy, despair and frustration about the current corona crisis in a single session. We are also planning podcasts on how to communicate with friends and loved ones during the crisis, as well as a survey to assess changes in mood (depression, anxiety, anger, relationship satisfaction and happiness) since the corona virus hit, and possibly  more. When the survey is ready, we’ll announce it and send you a link in case you’d like to let us know how you've been feeling, and how your feelings might have changed since the virus hit! Rhonda kick starts today’s session by reading a list of negative thoughts from folks who are freaked out about the corona virus, including these: Negative Thoughts with Probable Cognitive Distortions The world will turn into an apocalypse. I’ll be a carrier and won’t know it and then I'll infect my partner and children who will get really sick. I’m divorced and I think my ex- will try to keep me from my kids. She won’t be as vigilant as I am about keeping our kids healthy. They’ll get sick and infect me. I’m looking for a job right now, but no one will be hiring for a long time and I’ll never get a job. I won’t have enough money to pay my rent and I’ll be evicted from my apartment and end up homeless (or) my business will go out of business. I won't have enough money to have fun for several months. My parents will contract the virus, especially one of my parents who has some chronic health stuff, and get really sick or die. I’m going to get cabin fever. I will lose a sense of self/connection to reality with how surreal everything is. People in my life will die from the virus. * * * Negative Thoughts that are Probably Not Distorted The numbers of infected people are way higher than what's being reported because there's no testing The pandemic is worsening. The pandemic will get much worse than we realize now. Needier populations -- people who have lost work who really need it (restaurant workers, hotel, caterers, production staff, people with no savings, etc) — will suffer. The social fabric is going to break down. Things are going to continue worsening as climate change worsens. I live too far from my parents to help take care of them. Rhonda, Alex, David, and Jeremy begin by discussing several of the basic ideas of TEAM-CBT. We feel the way we think. In other words, the events of this world—like the corona virus—cannot have any effect on how we feel. All of our negative and positive feelings result from our thoughts, or “cognitions.” This idea goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who said that people are disturbed, not by the things that happen, but by our views of them. Some negative feelings are healthy and some or not. Healthy fear is not the same as neurotic anxiety. Healthy sadness is not the same as depression. Healthy remorse is not the same as neurotic anxiety. And so forth. Healthy anger is not the same as unhealthy anger. Healthy negative feelings result from valid negative thoughts, like “We are in danger because of the spread of the corona virus, and we need to be vigilant to protect ourselves and our loved ones.” Unhealthy negative feelings result from distorted negative thoughts, like "The world will turn into an apocalypse." Anxiety, panic, and depression, in contrast, result from distorted negative thoughts, like many of those that Rhonda read. For example, think about this thought: “My parents will die and I may never see them again.” Review the list of  cognitive distortions and see if you can spot some! This thought is likely to be at least somewhat distorted since your parents probably won’t die. For example, in China there have been around 3,300 deaths so far, and the epidemic has finally been slowing in the past few days. Since there are more than a billion people in China, the odds that you or someone in your family will die, while significant, appear to be incredibly low. So while there is clearly some risk, the distortion would be Magnification, Fortune Telling, and Emotional Reasoning, the three distortions that trigger all feelings of anxiety. In addition, you can see your parents right now if you like, using Skype, for example. So, while that thought also contains a grain of truth, it arguably involves Discounting the Positive as well. In spite of these considerations, TEAM therapist don’t try to “fix” or “help” just because someone may have distorted negative thoughts. Trying to help without first addressing therapeutic resistance is the most common error therapists make, and the most common error most people us make. For example, you will hear politicians telling people to “stay CALM,” or trying to encourage people with good news or promises which sometimes don’t seem entirely honest. Instead of jumping in and trying to "help," TEAM-CBT therapists first ask the person who is upset if they are looking for help. Sometimes, people aren't asking for "help" or cheer-leading, they just want someone to listen and provide validation and support. If the person does want help with negative feelings like panic, depression, frustration, loneliness, or inadequacy, we do a little thought experiment and say: "Imagine that we had a Magic Button, and if press it, all your negative feelings will instantly vanish, with no effort, and you'll feel terrific. Will you push the Magic Button?" Most people say they'd gladly push the button! Then we say that while we don't have a Magic Button, we've got some tremendous techniques that could help them reduce or even eliminate their negative feelings, but don't think it would be such a good idea to do that because their negative thoughts and feelings may be expressions of their core values as a human being, and what is most beautiful and awesome about them, and that their may be some important benefits, or advantages of their negative thoughts and feelings. And maybe we should list those before making any decision to press the Magic Button and make everything disappear. If you're upset, you can try this right now. First, circle your negative feelings and estimate how strong each category is, between 0 and 100%. If you click here, you can see an example of this on the Emotions table of the Daily Mood Log of a woman who was upset about the corona virus scare. Then ask these two questions about each feeling: What does this negative feelings show about me and my core values that’s positive and awesome? What are some benefits or advantages of this negative feelings are. How might it help me, or my loved ones? I call this new technique Positive Reframing. In other words, I want to honor your negative thoughts and feelings before we think about changing them! This is called Positive Reframing and it is the key to the incredibly rapid changes we typically see when using TEAM-CBT.  Typically, we come up with a list of a long list of compelling positives. Then I point out that if they push the Magic Button, all those positives will go down the drain, along with their negative feelings. Would they really want to do that? Now you're in a trap, or dilemma. One the one hand, you are suffering and desperately want to feel better. But at the same time, you don't want to lose all of those awesome positives! Fortunately, we can resolve this paradox. Instead of trying to make your negative feelings disappear by pushing the Magic Button, imagine that we had a Magic Dial instead, and you could dial each negative feeling down to a lower level that would allow you to keep all the positives on your list, and still feel better. What would you dial each type of negative feeling down to? For example, if you're feeling 80% panic or 90% depressed or angry about the corona virus, and you could dial each emotion down to a lower level, what would you dial them down to? You can see an example of this if you click here. As you can see, this person has put these new levels in the "% Goal" column of the emotion table. Jeremy provides a touching real life example of this. He feel intense anger because his fiancé, a nurse—is working in a hospital with a shortage of protective masks. He becomes tearful when he realizes that his anger is actually an expression of his intense love for her. The change in how he feels is almost instantaneous, and touching. The group further illustrate this by using Positive Reframing with many of the negative feelings our podcast listeners like you may be having. Jeremy concludes by drawing a critically important distinction between Positive Reframing, which is nearly always helpful, and “cheer leading,” which is rarely or never helpful, and  can actually be downright irritating! This table below highlights some of the critical differences. Is Positive Reframing Just Cheerleading Warmed Over? by David and Jeremy Cheer Leading Positive Reframing You’re trying to cheer someone up to make them feel better. You are highlighting the benefits of NOT changing. You say generally nice things about someone, like “you’re a good person,” or “you’re a survivor,” or “don’t be so hard on yourself.” The positives are not general but embedded within specific negative thoughts and feelings. You don’t acknowledge the validity or beauty of the person’s negative thoughts and emotions. In fact, you’re trying to tell them that they’re wrong to feel upset! This is always preceded by doing superb empathy. Positive Reframing is actually a deeper form of empathy because you’re honoring the patient’s core values. Cheerleading is irritating to almost everybody who’s upset, because you aren’t listening or showing any compassion or respect. The effect is enlightening and leads to feelings of relief, pride, peace, and acceptance. You’re trying to control the other person. You’re telling them how they should think and feel. There’s no acceptance. You’re Sitting with Open Hands. You’re bringing hidden motivations to conscious awareness so they can decide where to steer the ship. Hollow praise sounds dismissive, glib, and insincere. This technique is very difficult and challenging to learn because you have to let go of the idea that you know what’s best for other people. Thanks for tuning in, and let us know what you thought about today’s program! Oh, if you clicked on the two links to the Daily Mood Log of the woman who was intensely upset about the corona virus, and want to find out what happened in her magical TEAM-CBT session with Rhonda, tune in to our next CoronaCast! Until then, Rhonda, Alex, Jeremy, and David

Today, Rhonda and David answer several challenging questions submitted by listeners like you. What schools of therapy are embedded in TEAM? Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither? “Can TEAM-CBT help bipolar patients during the depressed phase?” How do you make Externalization of Voices work? I get stuck! For example, my patient said, "It's unfair that I cannot get a job!" Is there a cure for OCD? 1. What schools of therapy are embedded in TEAM? Dear Dr. Burns, I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy "integrates features and techniques from more than a dozen schools of therapy." I'm aware of many of the CBT techniques you use, but I don't think I've read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques? Madelen Hi Madelen, This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy. Here are some of the schools of therapy that I draw upon TEAM-CBT. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic) Flooding / Experimental technique: behavior therapy (exposure) Externalization of Voices: Gestalt / Psychodrama / Buddhism Acceptance Paradox: Buddhism Self-Defense Paradigm: REBT CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques Identify the distortions / examine the evidence: cognitive therapy Empathy: Rogerian (humanistic) therapy Five Secrets / Forced Empathy: Interpersonal therapy Shame-Attacking Exercises: Humor-based therapy / Buddhism Be Specific / Let’s Define Terms: Semantic Feared Fantasy: Role-Playing / Psychodrama / Exposure One-Minute Drill / Relationship Probe: Couple’s Therapy Time Projection / Memory Rescripting: Hypnotherapy Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy) Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior Storytelling: indirect hypnosis. Positive Reframing: Paradoxical psychotherapy. Hidden emotion technique: psychoanalytic / psychodynamic Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David 2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither? Hello Dr Burns, I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist. I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example? Thank you very much! Audrey Hi Audrey, Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like "I'm a loser" or "my case is hopeless." My research, which I'll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey. david  3. “Can TEAM-CBT help bipolar patients during the depressed phase?” Name: Sarah Comment: Hi, Dr. Burns. I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts. I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before. My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes. For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness. In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease? In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do? I would love to hear your take on it. Thank you so much for your endless work helping people to feel good! Sarah David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment. 4. Externalization of Voices: How do you make it work? I get stuck! "It's unfair that I cannot get a job!" Dear Dr Burns and Rhonda, I've just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes. I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can't find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts. I have a question about Externalization of Voices. In all of the examples you've shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to "win huge". I'm less experienced and find I'm not batting 1000. What do you do when neither you nor the patient have been able to win huge? Many thanks again for all you do, Calvin PS The episode on How to Help and How Not to Help was one of the best yet! Hi Calvin, Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with? All the best, David D. Burns, M.D. Hi David, There have been a couple of examples where we could only get a small win. With the first patient, the thought he was tackling was: "It's not fair that I've worked so hard in life, but I can't get a job." I tried modelling self-defense, along the lines of "I've accomplished a lot given how many challenges I've faced." I also tried suggesting the Acceptance Paradox with something like: "It's true that life's not fair. Who said it should be fair?" This was only a 'small win.' I felt stuck. Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was "I'm going to be chronically tired and no longer able to enjoy life the way I used to." We tried: "Sure, I may be more tired than I used to be, but I'll still be able to enjoy life to some extent." Again, this was a small win, not enough to crush it. Thanks again for your willingness to help! Calvin David’s response Hi Calvin, All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.” Let’s focus on the first thought, "It's not fair that I've worked so hard in life, but I can't get a job." This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts. When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well. The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth. This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.) You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job. If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy. Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques. When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome? For example, My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense. The sadness shows my passion for life, for work, and for being productive. My anger shows that I have a moral compass and value fairness. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve. My anxiety, in other words, is a form of self-love. My anger shows self-respect, since I have a lot to offer and contribute. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed. This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up. Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear. Then you resolve the patient’s dilemma with the Magic Dial. All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices. If you do this skillfully, the Externalization of Voices technique will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too! If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all! Not sure how much training you’ve had in TEAM.  There are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance. There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy. Thanks! David 5. Is there a cure for Obsessive Compulsive Disorder (OCD)? Hi Dr. Burns, I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counseling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too. I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives? Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy. I know you do not reply to personal messages but would really be grateful if you could reply to this mail Looking forward to hearing from you Regards "Betsy" In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story (episode 162) plus lots of additional great resources on OCD, including podcasts 43 - 45 (this page provides links to all the podcasts), and more. Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety. Thanks for listening today, and thanks for all the kind comments and totally awesome questions! David and Rhonda

Today, Rhonda and David talk about how to give potentially hurtful feedback when you sense racial bias in a friend or colleague. She describes an incident in her office where the glass coffee table in her waiting room was found smashed and shattered when her office mate "Steve" (not his real name) arrived Monday morning. Although many people, including the cleaning crew, had used the office over the weekend, Steve asked Rhonda to discuss the broken table with someone who uses her office on the weekends, Kenya.  Kenya is African American, and a highly esteemed professional and beloved friend and colleague of Rhonda's.  Rhonda thought there was implicit bias being played out in this situation but did not know how to discuss it with Steve. But how can she convey these feelings to her office mate, who conveyed the impression that a black man must be the one who broke the table? David suggests one of the advanced communication techniques called "Changing the Focus" discussed and demonstrated in a previous podcast #158.  They illustrate how to apply that method to the current situation, and struggle a bit along the way! David reiterates the story of when he was accused of being racist at a psychotherapy workshop near the Texas / Mexico border, and how his own teachings in that very workshop saved the day for him. He emphasizes that it can be so painful to be accused of racist tendencies, or to discover them in yourself, and that this is another case where the cover-up is far worse than the crime! David and Rhonda

Today, Rhonda and David answer three great questions submitted by listeners like you. I am confused about the terms, negative and positive distortions. Help! “How do you treat an “existential crisis?” Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse?  1. I am confused about the terms, negative and positive distortions. Dear Dr. Burns, I do have one question about terms I have heard on the podcast. The terms that confuse me are "negative distortions" and "positive distortions." I think I understand that they are both "bad" distortions, but the  positive distortions are distortions related to moods or thoughts that are unhealthily high or "up," such as in mania or narcissism. And negative distortions are the ones related to lower mood states/depression. Is this correct? I don't know if it is a brain thing, but even though I think I understand the concepts, my brain still seems to automatically think of positive distortions as good, and so I become quite confused when trying to understand how to fight them or help someone else fight them . . . Thank you again, so much, for all of your hard work on the podcast, as well as your diligence in training therapists in your TEAM model. I am a super-fan of the model already after only a week or so of listening! And the Five Secrets have challenged me to examine my communication abilities much more honestly and helped me in several important interactions already (even as a novice making many mistakes😬). Thank you, thank you, thank you! Please also tell Fabrice and Rhonda many thanks for all of their hard work and excellence as well. They both bring such gifts and refreshing honesty, brilliance  and genuineness to the discussions. I especially admire Rhonda for sharing her personal work. Such powerful and transformative stuff! It gives me hope that someday I might be a fraction as brave to DO that kind of work, much less share it openly with others for their benefit. What a generous as well as brave thing to do! I feel so hopeful and encouraged to know there are therapists like you, Fabrice, and Rhonda helping people to heal from vast amounts of mental and emotional suffering. I can't wait for TEAM to be as commonly known everywhere as CBT is now. Sign me up to volunteer for any promotional efforts if that is ever needed! For now, I will continue to tell everyone, including quite a few other counselor friends, about the podcast and the TEAM model. Sincerely, A new super-fan podcast listener, Holly Miller Hi Holly, Many people are confused, so this is a great question! Rhonda and I will gladly discuss this on our podcast. And thanks for your kind words! david  2. Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse? Hi David and Rhonda, Thank you so much for the podcast. I have been an avid listener since the early days of the podcast, and it has helped me through very difficult times and still is. My question is related to my relationship with my future to be divorcee. She is at times in a hypo mania state due to her bipolar illness (which is diagnosed and treated). Is it possible to use the five secrets of effective communication with someone who is in a state of hypo mania? I feel that agreeing with unreasonable accusations and complains is not helping at all and only causes her to hold to these claims. I know that you usually like to relate to specific correspondence but it is more of a general question. I hope you can give me some guidelines on what works and what doesn’t. Thanks! Al Hi Al, The devil is in the details. Can you provide a specific example of one thing she said, and exactly what you said next, that you need some help with? General questions about the Five Secrets are NEVER productive. Great question, thanks! david David D. Burns, M.D. Hi Dr. Burns, Thanks for the prompt reply. Well, I was asking a general question if it is possible at all to use the 5 Secrets with someone who is totally unreasonable? She would say "You started to be a father when you decided to divorce" referring to the fact that I am claiming for joint custody. The fact of the matter is that she has been going in and out of long depression periods and manic periods and I had to take care of the kids, maintain the house and keep a job (working from home). I would answer that I was there taking care of the kids all the years and now that I decide to break I want to keep my fair share of the time with them. Prior to that she always claimed that I am not a good spouse although I took care of her during all the years and had at times to reduce my workload in order to be available for the kids and her. So, the claims and accusations are always discounting what I did for her and the kids. And she is not accepting the fact that she has been ill and that this had a toll on the family. She says I need to look forward even though these episodes on hypo mania keep repeating. Hope I was specific enough. If you still feel I am vague then it may be that this is not the right forum to ask such questions and may need to get proper consultation. All the best and looking forward to reading the new book. I already started with the free chapter. Al David and Rhonda describe 'mania" and "hypo-mania" model how to find truth in criticisms that seem irrational, exaggerated, untrue, or unfair. They also discuss the tendency to blame others for the problems in our relationships, and why and how that is rarely or never helpful. 3. “How do you treat an “existential crisis?” Good afternoon Dr. Burns, Have you treated anyone that went through an existential crisis before and were you successful? I have a wife that deals with depression and I was in the past able to help her (even though my mind set was "life is awesome. so why or how can you be upset?") I have also dealt with my own anxiety and was able to get myself out of that 10 years ago, using exposure techniques. But I have ran into a bit of a wall here with what I believe is an existential crisis. I've noticed that I am unable to find anything of that subject in any of your topics. Thank you for your time, Dr. Burns. In the podcast, Rhonda and I demonstrate how to respond effectively to someone who is depressed, and why cheer-leading (“life is awesome,” etc.) will generally not be helpful. Hi Arturo, There are no existential crises in California at this time, as the Buddha pointed out more than 2500 years ago. However, specific and real problems exist, and once you identify what’s bugging you and you deal with it you’ll find your “existential crisis” has disappeared. Check out my podcast on the teenage girl who was having an “identity crisis." Our podcast on “How to Help” might also be useful to you! You might also enjoy my book, When Panic Attacks, especially the section on the Hidden Emotion Technique. If you go to my website, you can type any topic in the search box in the right-hand panel of every page, and a lot of useful information, will suddenly pop up. David and Rhonda

In my workshops and weekly training group for community therapists at Stanford, we often include personal work as a part of the training. The personal work can help in several ways: When you’ve successfully done your own personal work, you will feel greater joy and energy in your personal life and in your clinical work as well. You will have a much deeper understanding of how TEAM-CBT actually works. You will be able to deliver faster and deeper therapy to your patients. You’ll be able to tell your patients, “I know how you feel, because I’ve been there myself. And what a joy it’s going to be to show you the way out of the woods, too!” Those who observe the therapy develop a greater understanding of how the fine points of effective therapy. When the person in the “patient” role has a profound change, we all share that joy and feel inspired by the miracles that can often be accomplished in a relatively short period of time. As they say, “seeing is believing.” Rhonda recently surveyed some of our listeners about live therapy we sometimes offer on our podcasts—do you prefer to have the live therapy presented all at once, in an extended, two-hour podcast, or split up over two or more podcasts with expert commentary along the way? Our listeners were split on this. So today we are presenting an actual and dramatic therapy session in its entirely. If you don’t have two hours to listen all at once, you can stop after an hour or so, and then return to the last portion when you have more time. And please let us know what you think of this live therapy podcast format! In today’s session, we are very grateful to Sarah, a certified TEAM-CBT therapist, for allowing us to share her very personal and powerful session with you. Sarah was having intense anxiety during her sessions with patients, and her anxiety was bordering on panic. This is actually not unusual. In my experience, most shrinks struggle with feelings of insecurity from time to time. But when we shrinks experience insecurities, we often feel strong shame as well, telling ourselves that we “should” have it all together because we are supposedly “experts.” I’m no exception! I can remember how anxious I used to feel on Sundays when I was starting out in private practice. I’d tell myself, “Wow, I’m going to have all of these high-powered patients tomorrow, and what if they notice that I don’t actually know what I’m doing half of the time!?” But then, halfway through Monday morning, it would dawn on me that my patients didn’t seem to notice or care about my flaws, and I’d relax! Although Sarah brought a Daily Mood Log to the session, listing all of the negative thoughts that were triggering her anxiety, along with many other intense negative feelings, the session took an unexpected turn in the direction of the Hidden Emotion Model. We’ve done several podcasts on this powerful technique before, and now you have the chance to see how it works first-hand! Instead of challenging Sarah’s negative thoughts, as we usually do, we asked whether there was something bothering Sarah that she wasn’t telling us about, due to her arguably excessive “niceness.” I think you’ll enjoy listening, and you may learn a little, too! My co-therapists for this session included Dr. Rhonda Barovsky, my beloved and brilliant podcast host, as well as Kevin Cornelius, MFT, a fabulous TEAM therapist whom I’ve recently featured in a recent blog! Rhonda and I want to thank you, Sarah, once again, for your tremendous courage and generosity! David and Rhonda

Rhonda and David are joined today by Jeremy Karmel who is working with David on a new Feeling Great app. Rhonda begins by reading several amazing emails from fans whose lives have been changed by the podcasts as well as David’s books, including Jessica, Tim, and Mike. Thank you, everyone, for such kind and thoughtful comments! This great photo of Rhonda is courtesy of Nancy Mueller, a local photographer who kindly took some pics at my home in Los Altos, California. David describes his upcoming book, Feeling Great, which will be released in September of 2020. It will move well beyond his first book, Feeling Good: The New Mood Therapy, all will incorporate all of the latest hi-speed treatment techniques in TEAM-CBT (aka “Feeling Great Therapy.”) David describes his excitement about the team he is working with to publish his latest book, including Linda Jackson at PESI (the publishing company), and Jenessa Jackson, his editor. Jeremy describes why he approached David to develop a Feeling Great app. As a Stanford student, he was depressed and had to drop out of school for semester. Antidepressants and talk therapy had done nothing for him, so he was feeling hopeless. Then Jeremy discovered one of Dr. Burns’ students, Dr. Matthew May, and recovered in just two weeks, which was mind-blowing. Matt was one of the first practitioners in the world to use the new TEAM-CBT, Jeremy felt a tremendous drive to make these powerful new techniques available to people around the world. David and Rhonda, of course, share this goal! In fact, Rhonda has recently gone to Mexico City as well as India to support the sudden and strong emergence of TEAM-CBT in those countries. Rhonda asks Jeremy many questions about the amazing recovery he experienced in his work with Dr. May, and how he’s been doing since. Then Rhonda, Jeremy, and David address a number of intriguing questions about the new app. For example, there is tremendous evidence from research that David’s first book, Feeling Good, has significant antidepressant effects. In fact, many published studies have confirmed that more than 50% of depressed individuals will recover or improve dramatically within four weeks if you just give them a copy of the book. Is it possible that an app that incorporates all the great methods in Feeling Good, plus all the new techniques in TEAM-CBT, could be even more effective? And if so, would this mean that an electronic app could even outperform human therapists as well as antidepressant medications? David says that this has been his dream for more than 40 years, and he thinks this is a definite possibility. Jeremy agrees, since the app, now in creation, has the potential to be far more powerful and systematic than reading a book or even going to a therapist. Rhonda asks: "Are you trying to put human therapists out of business?" David believes that there will always be a place for human therapists, since the person to person support and connection is invaluable and desperately needed. However, the Feeling Great app can actually be a friend of human therapists, just as his book, Feeling Good, has been, working hand in hand with therapists helping to accelerate the recovery of their patients. In addition, the app can bring rapid help and relief to millions of people worldwide who cannot afford therapy, and those who simply cannot find effective therapy. David emphasizes the goal of having an entirely free version of the app for people without resources. Rhonda asks: "Will you be doing research as well as self-help “treatment” with the new app?" The answer to that is absolutely, yes, and the implications for incredible research into the causes and treatments for depression, anxiety and relationship problems are immense, especially if thousands or even tens of thousands of individuals use the Feeling Great app. For example, David has developed many psychological assessment instruments to help therapists and patients alike, but the costs and time required to develop and validate even a single short test can be substantial. In contrast, one might get more than enough data to evaluate a new instrument in just one day, which is mind-boggling. In addition, every time someone uses the app, we will learn more and more about what works, and what does not. This type of analysis is vitally important, but practically impossible, or at the very least arduous and confusing, when working with human therapists, due to the complexity of what’s happening, and the intense bias of therapists and researchers alike. The computer, by way of contrast, does not mind being wrong and moving in different and more promising directions! Rhonda, Jeremy and David will let all of you know when a beta version of the new app, is available, and hopes that many of you will try it out and let us know what you think! David will also let you know when pre-ordering for his new book, Feeling Great will be available as well! David and Rhonda Thanks for listening to today's podcast! David    

Rhonda and David are joined today by Dr. Michael Greenwald, who was in the studio following his recording of last week’s podcast. We address a fascinating question submitted by a podcast fan: Sally asks” “How can I help my depressed husband who is leaving me?” Hello Dr David, My husband is going through severe depression and anxiety. He blames me frequently for all the bad decisions he made, and he says he married the wrong woman. He regrets almost every decision he made and says he made the decision [to marry me] under my pressure. Our marriage of 20 years is almost leading to separation. I don’t want to separate, but I don’t know how I can improve the situation. He doesn’t want to go to any doctor. Do you think if I decide to go to TEAM certified therapist, they can work on me to get him out of his depression? If yes, how many sessions will it take? Sally David, Rhonda and Michael discuss this sad and difficult situation that Sally describes. Feeling loved and cared about is vitally important to nearly all of us, and when an important relationship is threatened, it can be extremely painful. It sounds like Sally's husband may be on the verge of leaving her. David describes a powerful and paradoxical strategy he described in Feeling Good: The New Mood Therapy, that he has often used to help abandoned wives. The approach is the opposite of "chasing," and is based on experimental research on the most effective ways of shaping the behavior of rats! It also sounds like Sally and her husband have some significant difficulties communicating in a loving and supportive way, like nearly all couples who are not getting along, and certainly some couples therapy or consultation might be a useful step. However, the prognosis for couples therapy isn't terribly positive unless both partners are strongly committed to each other, and willing to work on their own problems, as opposed to trying to change or “fix” the other person. We place a strong emphasis on the Five Secrets of Effective Communication, especially the listening skills, when criticized by a patient, family member, colleague, or just about anyone. If Sally committed herself to learning to use these skills—which are NOT easy to learn—she might be able to develop a more loving and satisfying relationship with her husband, whether or not they separate or stay together. David expresses the opinion that her fixation on “helping” or “fixing” him might be misguided, and might actually irritate him and drive him away. Rhonda, Michael and David illustrate David’s “Intimacy Exercise,” which is a way of learning to use the Five Secrets, and they practice with three of the criticisms Sally has heard from her husband: “You pressured me into marrying you.” “You’re to blame for all the bad decisions I’ve made.” “I married the wrong woman.” After each exchange, the person playing Sally’s role receives a grade (A, B, C, etc.) along with a brief analysis of why, followed by role-reversals. These role play demonstrations might be interesting and useful for you, too, because you’ll see how this exercise works, and your eyes will also be opened to just how challenging it can be to respond to a painful criticism in a skillful way, and how mind-blowing it is when you do it right. You will also see that trained mental health professionals often make mistakes when learning these skills, and how you can increase your skills through this type of practice. David emailed Sally with some additional resources that could be helpful to her. Hi Sally, Thank you so much for your question, and for giving us the permission to read and discuss your question on a podcast. We will, however, change your name to protect your identity. For referrals for treatment, you can check the referral page on my website,  or go to the website of the Feeling Good Institute. There may be some excellent therapists in your area, too. I would recommend the recent Feeling Good Podcast on “How to Help, and How NOT to Help.” . The idea is that listening is sometimes far more effective and respectful than trying to “help” someone who is angry with you. Also, the podcasts on the Five Secrets of Effective Communication, starting with #65, could be helpful, along with my book, Feeling Good Together. There’s also search function on almost every page of my website, and if you type in “Five Secrets,” you’ll get a wealth of free resources. Your husband might benefit from my book, Feeling Good: The New Mood Therapy, available on Amazon for less than $10. Research studies indicate that more than 50% of depressed individuals improve substantially within four weeks of being given a copy of this book, with no other treatment. However, the depressed individual must be looking for help, and it’s not clear to me whether the treatment is more your idea, or his idea. You seem to be asking for training in how to treat your husband. Perhaps, instead, you could learn to respond to him more skillfully and effectively using the Five Secrets. Learning how to do psychotherapy requires many years of training, and since he is not asking you for treatment or for help, that plan does not seem likely to be effective, at least based on what I know. In fact, trying to “treat” someone who is clearly annoyed with you runs the danger of creating more tension and anger, but this is not consultation, just general teaching. You would have to consult with a mental health professional for suggestions. Obviously, we cannot treat you or make any meaningful treatment recommendations in this context. But there is no doubt in my mind that there are many things you can do to improve the way you communicate with him and relate to him, if that would interest you. But this would require looking at your own role in the relationship, as well as lots of hard work and practice to learn to use the Five Secrets. Sincerely, David D. Burns, M.D. Thanks for listening to today's podcast! David

In today’s podcast, Rhonda and David are honored to interview Dr. Michael Greenwald, a courageous clinical psychologist who helped make the Atlanta Intensive a truly amazing event. Michael volunteered for the live demonstration to work on his lifelong problem with social anxiety, which seems to be a popular topic these days, and likely a personal problem for many podcast fans. My co-therapist was Thai-An Truong, a highly respected TEAM therapist and TEAM therapy trainer from Oklahoma City. Thai-An also joins today’s podcast via Zoom and dialogues with Michael for the first time since the intensive. The session with Michael was powerful and inspiring, with a good 50% of the audience in tears (of joy) at the end. Michael recorded the session on his cell phone, but the quality was not up to the quality of our podcast recordings, so he agreed to fly up to the “Murietta Studios” from his home in Los Angeles so we could at least describe what happened and share the magic with you. If we can find a way to do some sound enhancement on the cellphone recording of the session, we will likely publish it as a separate mid-week podcast for those who like to hear the incredible therapeutic process unfolding in real time. If you review Michael’s Daily Mood Log at the start of the session, you’ll see that he was feeling depressed, anxious, ashamed, worthless, lonely, self-conscious, discouraged and stuck, and all of these feelings were intense. In addition, he told us that he wasn’t feeling much joy, self-esteem, pleasure or satisfaction in his life. But the strongest feeling was anxiety. He said that coming up on stage to face his fears was an enormous challenge, and that this was the first time he’d ever done something like this. We will do T = Testing again at the end to see what changed, and by how much. We’ll also ask Michael to complete the Empathy and Helpfulness surveys, so we can find out how he experienced Thai-An and David during the session. You may be saddened by the upsetting event Michael recorded at the top of his Daily Mood Log, which was “sitting with my son and trying to make conversation with him.” He said their conversations were always pretty superficial, and that he would typically leave the room after short interactions with his son because he felt so anxious. Here’s an example of a typical exchange. Michael’s son, a graduate student in clinical psychology, was working on his applications to internship programs. Michael: What’s up? Son: I’m working on my applications to internship programs. Michael: That’s good. How’s it going? Are you getting them in on time? Son: Yah, it’s fine. Michael: Are you completing them? Do you want me to look at them? Son: All fine. If you review the negative thoughts on Michael’s Daily Mood Log, you’ll see that he felt like a failure as a father because he did not know how to get close to his son or how to tell him just how much he loved him. He was telling himself things like this: Something is wrong with me because I can’t talk to him. 100% I am failing him as a father. 100% He deserves so much better than me. 100% He must wish he had a different father. 95% And more. I was sad to see that Michael had been beating up on himself pretty badly for years, and I'm pretty sure that the therapists in the audience felt the same way, because it was so clear that he was a tremendously humble, giving and loving father who was totally devoted to his sons. I found myself thinking, "My gosh, I wish I'd been half the father that Michael is!" The E = Empathy phase of the session lasted about 30 minutes. Michael indicated that Thai-An and I had done a good job, and that he felt understood and accepted, so we went on to A = Assessment of Resistance in a step-by-step manner, using these tools: The “Invitation Step” to find out if he was ready to roll up his sleeves and get to work on his social anxiety The “Miracle Cure” question to find out what he hoped would happen in the session The “Magic Button,” to see if he’d want all of his negative thoughts and feelings to disappear suddenly, just by pushing it “Positive Reframing,” asking Michael these two questions about each negative thought or feeling: “What does this negative thought or feeling show about you and your core values that’s positive and awesome?” “What are some benefits, or advantages, of this negative thought or feeling?” At first, these questions didn’t make any sense to Michael, since he was so used to thinking about his negative thoughts and feelings in a negative light, thinking they were “bad” and were the result of some kind of personality defect or mental disorder, like “social anxiety disorder” described in the DSM5. This is also the hardest part of TEAM-CBT for therapists to learn, because it is so anti-intuitive. But as the list of positives grew, Michael began to “get it,” and we could actually see his mood lightening up before our very eyes. It was so cool, and this was the first hint the audience had that something remarkable was afoot. This, for sure, is one of the most powerful and innovative components of TEAM-CBT. The “Pivot Question” and “Magic Dial” Question. Michael decided it wouldn’t be such a great idea to press the Magic Button, since then all of the positives on the Positive Reframing list would go down the drain along with his negative thoughts and feelings. He decided, instead, to dial down his negative feelings to much lower levels that would allow him to feel better without losing any of the positives. You can see this on the “% Goal” column of his DML For example, he decided that it would be desirable to dial his depression down from 85% to 20%, since some sadness was appropriate, given his difficulties getting close to his son. In fact, if his depression disappeared completely, it would be like saying he didn’t really care. Michael decided to dial down the rest of his negative feelings as well in the range of 5% (for discouraged and stuck) to 15% (for anxiety), and 10% for the rest of his negative feelings. This ended the A = Assessment of Resistance phase of the session, and that took about 25 minutes. We then went on to M = Methods, focusing on his negative thoughts, one at a time, and attacking them with a variety of techniques like Identify the Distortions, Externalization of Voices, Acceptance / Self-Defense Paradigms, Examine the Evidence, and the Paradoxical Double Standard Technique. At the end, we went into the audience so Michael could ask participants if they were judging him, and what they thought about him as a father. This is called the Survey Technique, and it is usually pretty threatening to people with social anxiety, or any of us, really! But as you’ll hear in the podcast, the feedback he received was jaw-dropping. Thai-An joined us at the end and dialogued with Michael about the loneliness he’d struggled with, as well as how he could most effectively share his feelings of love and insecurity with his son. His “homework” after the session was to call his son and report back to all of us the next morning! The next morning, Michael reported that he’d had the most phenomenal dialogue ever with his son! He was practically floating on air, and reports that after the intensive, his life has changed dramatically in many ways, including: A terrific relationship with his son. Feelings of true joy, even ecstasy, that he’d never previously experienced or even thought possible. Way better connections with people in general, due to being open and vulnerable for the first time. Greatly improved clinical experiences as a result of using TEAM-CBT in his clinical work. In fact, he is thinking of starting a free weekly TEAM-CBT practice group in the Los Angeles area, and hopefully opening a Feeling Great treatment center somewhere down the line. Make sure you contact Michael if you are interested joining his weekly practice group. (drmichaeldg@gmail.com) You can see his amazing mood scores at the end of the session on his final DML. He also gave us perfect scores on the Empathy and Helpfulness scales, and described his experience as a “transformation.” After the session, he added that he’d seen that people really could improve quickly during other live demonstrations at my workshops, but felt skeptical that a TEAM session could trigger joy, even euphoria, as he’d never actually felt those kinds of feelings. But now, he realized this was actually possible! I would like to thank Michael, as well as my amazing co-therapist, Thai-An Truong. Thai-An is located in Oklahoma City and specializes in treating post-partum depression with TEAM-CBT. She also does one-on-one case consultation as well as awesome online TEAM training for mental health professionals, including free weekly webinars as well as her “TEAM-CBT bootcamp intensives.” If you would like to contact Thai-An, she can be reached at Thai-An Truong thaian@lastingchangetherapy.com. After the show was recorded, I received this amazing email from Michael. I think you'll enjoy it! Dr. Burns, Just some additional thoughts I'd like to mention about the changes I've noticed since the Atlanta therapy demo. The ones you put in the show notes are totally accurate. But the positive changes I've experienced since the demo go way beyond those. I'm not writing this to suggest you include these; I'm great with what you wrote. I only wanted to elaborate a bit on how things have been for me because it's such an incredible change for me. Please feel free to add to the notes, or not, at your discretion. And by the way, we are now two months post-demo and my mood scores remain essentially at zero with high positive feelings. My stress tolerance has increased a great deal. Prior to the demo, when I made a mistake or did something stupid, I would rip into myself with intensely harsh criticism and self-judgment (I think I shared with you about the time I dropped the bottle of Cologne as one example showing the different reactions to myself). Now, when the same sorts of things happen, those harsh voices are absent or merely a whisper, and easily dismissed. So there is no accompanying self-hatred like before. I'm far more outgoing with people in general. I feel closer than ever to my friends and family. I've been more present and available to my friends and family. I'm more open and far less defensive than I've ever been in my life. I feel more positive feelings than ever, and I laugh more than ever. I have more compassion for others as well as for myself. I'm more aware of my emotional world and have more access to my feelings. I'm able to connect more with others in general. The types of situations that would trigger feelings of irritability or anger, no longer do. I'm more able to be available for others, whether in my personal or professional life. I'm closer with my wife, and, honestly, with everyone in my family and social circle. I've been in several social gatherings since the demo, and my levels of anxiety have never been lower, and my level of engagement and participation has never been higher; I'm like a different person. I'm more optimistic and hopeful than before. So I know this is a bit of rambling, but I just wanted to mention these things. As I  had discussed with you during our visit, I've been struck by how far-reaching the benefits of the therapy demo have been for me. We focused on the one moment of one problem on the DML. We blew away those negative thoughts and feelings. That outcome, had it been limited to that specific target, would have been amazing and a total success for me. But as per your model, that was a 'fractal'. And the change in the brain circuits happened with that fractal and the new networks were created, and I feel that they continue to grow. For me, it's truly been the opposite of the drop of ink in the glass of water, discoloring everything, as a distorted thought or belief will do. The therapy demo was the drop of 'clarity' that shined the light on all my distorted thoughts and beliefs at one time. Maybe that's corny, but this is what it feels like to me. So feel free to use or not use any of this as you see fit. I only wanted to mention these things. There's more, but I think this gives the flavor. Thanks again. Love, Michael Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David