The podcast discusses how to help loved ones in difficult situations, emphasizing empathetic listening over giving advice. It explores the challenges of supporting others authentically, the power of effective communication, and the importance of empathy in mental health conversations. Real-life scenarios and therapy anecdotes illustrate the value of compassion and understanding in addressing depression and anxiety.

163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more Can you treat anxiety without meds? How do you interpret dreams? Are negative thoughts cyclical? How can I get over anxiety when selling? How does exposure work? Will you teach on the East Coast again? Hi! We’ve had tons of great questions from listeners like you. Here’s the first: Question #1. TREATING ANXIETY WITHOUT MEDICATIONS Hi Dr. Burns, I would love to talk to you!!! I have been going to a wonderful counselor for several years, and he is the one who recommended your book. My question is how can you overcome anxiety without taking medicine? I have been on a very low dose medicine for years and would love to discontinue but when I try the anxiety seems to come back. Thank you. Lisa Hi Lisa, Thank you for your email! This is one of my favorite topics, since I’ve personally had at least 17 different anxiety disorders that I’ve had to overcome. That’s why I love treating anxiety. Whatever you’ve had, I can say, “I’ve had that too, and I know how it sucks! And I can put you on the road to recovery, too!” Did you read When Panic Attacks, or one of the earlier books? The written exercises would be the way to go, I think. You will find more than 40 methods in that book. Write back if you have questions after reading it. Focus on one specific moment when you are anxious, and do a Daily Mood Log, as illustrated in Chapter 3. You can also listen to the free Feeling Good Podcasts on anxiety. Go to my website, FeelingGood.com, and click on the Podcast tab. There, you’ll find a list of all the podcasts, with links. In the right hand panel of every page, you’ll find the search function. You can type in “anxiety,” or “social anxiety,” and so forth, and all the relevant podcasts and blogs will pop right up. You can also sign up in that same right-hand panel of every page so you’ll receive all the new podcasts, along with the show notes. In addition, withdrawal effects are pretty much inevitable when going off of benzodiazepines, if that is the type of medication you are taking. These are the drugs most often prescribed for anxiety, like Valium, Librium, Ativan, Xanax, and so forth. Typically, the withdrawal, which typically involves insomnia and increased anxiety, take several weeks to wear off. Your medical doctor can guide you in this. I cannot advise you about medications in this forum, so make sure you check with your doctor! David Question #2. How can you interpret dreams? Hello, Dr. Burns. I am terrified that this may be the most boring question you have ever received, but, I’ll press on none the less. I often experience very vivid dreams after listening to your podcasts. In fact, I recently dozed off after listening to one of your podcasts on procrastination (#75) and forgot to turn off my phone. In my dream I was in my childhood house and could hear you talking away in some far corner of the house and I was really getting quite annoyed and angry. I really wanted to find you to tell you to shut up, but I couldn’t get the words out. When I awoke, podcast #77 was playing, which seems to explain some of my unconscious hostility. I struggle with most of my relationships and don’t really want to deal with all the hard work I have to do to improve them. So, there you have it! Thanks for listening to me and all your Herculean efforts on behalf of all those in the struggle to grow. Mike Hi Mike, I explain how dreams function, and give an example with my dream that I had a broken jaw! Question #3. Are Negative Thoughts cyclical? David, I have a question about our strong attraction or inclination to negative thoughts. Are our psychological processes cyclical? People seem to recycle the same negative thoughts for years. Even if we produce a strong alternative thought or reattribution it may not be a default choice the next time. How can we make the alternative/ positive thoughts a conscious choice? Thanks, Rajesh Hi Rajesh: Negative Thoughts are not cyclical for the most part, but are an inherent part of our human nature. The podcast on fractal psychotherapy might be useful, since the same Negative Thoughts will tend to come back over and over throughout your life. And once you have learned how to combat those thoughts, you can use the same techniques to smash the thoughts whenever they pop back into your mind. The written exercises I describe in my books, like the Daily Mood Log, are extremely helpful, even mandatory, in building new brain networks and strengthening them through repeated practice. Bipolar manic-depressive illness is a little different, and it can be quick cyclical. (David will briefly explain this.) Thanks Rajesh for yet another great question! david Question #4. I’m in sales. How do I combat my Negative Thoughts about each person I approach? Hi David, I have been struggling with anxiety for the last 18 months and recently faced up to the fact I have also been suffering from depression. And then I discovered your podcasts. I have been spending a lot of time on the episodes I believe I can benefit from the most. I have found your solutions to be the most beneficial I have come across. Thank you for sharing your ideas and techniques with all of us! A couple of questions—How would you advise constructing a work day to reduce anxiety? I work in sales and feel anxious before every phone call or visit I encounter, and the anxiety can be for reasons that seem to be related solely to each sales encounter on individual basis! And my anxiety will grow as the day goes on. My second point would be, would there be a benefit in monitoring positive thoughts and feelings throughout the day, like happiness and hopefulness, rather than negative feelings? Hi Rudi, I’ve done a lot of sales work, including door-to-door sales when I was young. When I was 8 years old, I sold show tickets door to door. When I was a teenager, I sold Fiesta Chips, Cosmo’s Cock Roach Power, tick powder for dogs, and For Econoline Vans door to door in Phoenix. So, I feel a soft spot in my heart for everyone involved in sales! In fact, I’m still involved in sales! But these days I’m selling happiness, self-esteem, and intimacy. I think it could be useful to do a written Daily Mood Log on the anxiety you feel before one of your calls. I think you will find there are certain themes that are common to each call, such as fears of rejection, disapproval, or failure. Once you’ve dealt with these fears successfully, I think they will help in all of your sales encounters. If you send me a partially filled out Daily Mood Log, perhaps Rhonda and I could provide more specific tips on how to crush your Negative Thoughts. If you listen to Rhonda’s work on performance anxiety, you may find it extremely helpful. In addition, the Five Secrets of Effective Communication are the keys to successful sales. I used to think that you had to sell yourself, or your product, which is rarely true. I learned that the key is to form a warm relationship with your customers. David will explain what he learned from his mother, who sold women’s clothing part-time at a department store in Phoenix. Thanks, Rudi, I hope to hear more. Question #4. Why and how does exposure for anxiety work? Hi Dr. Burns, I am a big fan and believe that you are the greatest living psychologist of our time. I have seen you in person and hear your recent PESI presentation (link). Quick question, when exposure is used to get rid of anxiety, what do you think is the mechanism in the brain? It works paradoxically, instead of strengthening a neuro-network it extinguishes it. Any ideas how. Thanks for your time, and again I have learned so much from you in my over 30-year career, thank you for that also. Sincerely, Dr. Mark Hi Dr. Mark, With your permission, will include this on an upcoming Ask David on my Feeling Good Podcast, but I think you discover a couple things during exposure: When you stop running away and confront the monster, you discover that the monster has no teeth, so you go into enlightenment. This is the basis of Buddhism and the teachings in the Tibetan book of the dead. During exposure, you also discover that after a while the anxiety just kind of wears out, dwindles, and disappears. The brain simply cannot continue creating anxiety for prolonged periods of time, especially when you are doing everything you can to make it as intense as possible. You discover that you can, in fact, endure the anxiety and survive, and that you do not have to “escape” from the feeling of anxiety via avoidance. One other thing that is important is that I treat anxiety with four models, not one: 1. The Motivational Model; 2. The Hidden Emotion model; 3. The Exposure Model; and 4. The Cognitive Model. All play vitally important and unique roles in the treatment of anxiety. Exposure alone is NOT a treatment for anxiety, just one tool among many that can be helpful, and often incredibly helpful, as you’ll see in the upcoming podcast on the treatment of Sara, a woman struggling with severe OCD for more than 20 years. Great question! Hope to catch you in one of my upcoming in-person / online workshops! Thanks, David Mark’s reply and a brief final question Hi Dr. Burns, Yes, of course you have my permission to use my question! Also, I do understand your impressive approach to treatment (not just exposure), and again it is genius. I also love that you see the connection between Buddhism and cognitive restructuring, where as Dr. Beck only went as far back as Socrates and the Greek Stoic philosophers. I don’t know if you ever read the Dhammapada (best translation I found is Eknath Easwaran) as it clearly states that our life is shaped by our mind, and that our feelings follow our thoughts just like a cart follows the ox that pulls it. Thanks again! Will you be coming to the East coast again soon? Hi again, Mark, Yes, I’ll be coming to Atlanta for a four-day intensive in November! Check my workshop tab at www.feelinggood.com for more information. (https://feelinggood.com/workshops/) david David D. Burns, M.D. & Rhonda Barovsky, Psy.D.    

“Yikes! I might get contaminated!” The Treatment of Sara Today we are joined by a woman named Sara, who will be featured in one of the chapters from my new book, Feeling Great. Rhonda begins today’s podcast by reading two heart-warming endorsements from podcast fans. Then we did a brief overview of OCD. OCD consists of two components, obsessions and compulsions. The obsessions are intrusive, anxiety provoking thoughts, like “what if I forgot to turn off the burners on the stove.” Compulsions are rituals that temporarily relieve the anxiety, such as going back into the kitchen repeatedly to make sure that the burners really are turned off. This problem can become more and more severe until the obsessive thoughts and compulsive rituals consume massive amounts of the patient’s time and become crippling. You are probably aware that OCD plagued the life of the billionaire playboy, Howard Hughes, featured in the recent film, “The Aviator.” During the last years of his life, he became totally consumed by concerns about germs, and ended up isolated in the penthouse suite at the top of a hotel in Las Vegas. According to a “psychological autopsy” (https://www.apa.org/monitor/julaug05/hughes) published by the American Psychological Association, Hughes lay naked in bed in darkened hotel rooms in what he considered a germ-free zone. He even wore tissue boxes on his feet to protect them, and burned his clothing if someone near him became ill. Sara, today’s guest, was a victim of the same type of OCD. She describes how her intense fears of germs and contamination came on more than 20 years ago, and the devastating impact of the OCD on her as well as her relationships with friends and family. She also describes her shame about her rituals of constantly washing her hands and desperately trying to avoid contamination. Sara also describes, in vivid detail, her remarkable and inspiring five minute “cure” one evening at David’s Tuesday evening training group at Stanford earlier this year. She had courageously volunteered to be the patient so David could to demonstrate TEAM-CBT with a problem generally thought to be exceptionally challenging and refractory. And although Sara’s dramatic and mind-blowing recovery only took about five minutes, the treatment required a lifetime of courage! Fortunately, one of my students had his cell phone in hand, and made a brief video of the last phase of her treatment at the Tuesday group, which involved putting her hands into a slimy, dirty garbage can right outside the front door of our Behavioral Sciences Building at Stanford and then rubbing her fingers on her face. Check it out! (link) And yes, the effects DID last! Her treatment was many months ago, and she’s been a totally changed person! Following the podcast, Rhonda and I got two beautiful emails from Sara: Wow! What a beautiful day! Thank you, Rhonda and David for the amazing opportunity to share my story! I feel very selfish but I enjoyed every minute of it. You both made me feel so comfortable and welcome. You two are so incredibly AWESOME! You make a superb team! :) And here is the second wonderful email: David, I hope you are feeling better and that you recover from your cold soon, very soon. I wanted to share an afterthought I had a couple of days after we recorded the podcast. I wish I had thought about it before the podcast because this was so much part of my OCD. Anyway, for years (many years) I bought sanitized hand wipes and carried them in my purse, car, briefcase, you name it—I had hand wipes everywhere. I was known for having wipes with me all the time. Not long after the magical treatment of my OCD, I was at the grocery store and proceeded to add three packets of sanitized hand wipes to my basket and I burst into laughter, even though I was by myself! I, then, put them back on the shelf, as I told myself, “I don’t need these anymore!” Since then, I no longer carry them NOR NEED THEM! Funny enough, I have been approached on different occasions by family members and friends saying something like, “You always have wipes, can we have one, please?” I have to say, “Sorry, I don’t carry wipes anymore since I’ve been cured!” What a wonderful feeling that is—not to feel dependent nor a slave to the sink and hand wipes. Not to mention, all the money I am saving by not buying wipes!!! Anyway, I thought I should share that with you and I’m sad I didn’t remember it until after the recording of the podcast. Once again, thank you both for the amazing recording, all your support, and all you do for our Tuesday training group and humanity in general! With Immense Gratitude, Sara Sara Shane is a certified TEAM-CBT therapist practicing in the central valley of California (Stockton). She is multi-lingual and offers intensives—extended, single-session treatment of depression and all of the anxiety disorders. And, here’s something fantastic—although Sara is a superb therapist, her fees are modest, thus bucking the current trend of charging outrageous fees for psychotherapy in California. This is something I really admire and appreciate! If you would like to contact Sara, you can reach her at: 209-476-8867. David and Rhonda

Hearing the Music Behind the Words This podcast again features the music of two beloved colleagues we introduced last week, Brandon Vance, MD and Heather Clague MD. We will be listening to music again this week, but it will be, for the most part, a different kind of music—it’s the music behind the words when someone criticizes you. We will be focusing on the most challenging and important of the Five Secrets of Effective Communication, the Disarming Technique. This week, Brandon and Heather will help Rhonda and David illustrate how to use this technique when you’re under the fire of criticism. But in addition, Brandon and Heather will also sing one more of their extremely beautiful and fun songs, appropriately entitled, “The Five Secrets!” When you use the Disarming Technique, you find the truth in a criticism, even if the criticism seems untrue, unfair, or exaggerated. This technique is based on the Law of Opposites. The essence of the Law of Opposites is that if you genuinely and immediately agree with the criticism that seems untrue, you will put the lie to it, and the critic will stop believing the criticism. This is a remarkable phenomenon that can be enormously helpful in conflicts with patients (if you're a therapist) as well as friends, colleagues, and loved ones. However, it is challenging, because you have to be able to really listen and "hear" the music behind the other person's words. If you use the Disarming Technique, or any of the Five Secrets, in a mechanical way, it will backfire. And I (David) have noticed that even trained mental health professionals can have a tremendous difficulties learning to use the Disarming Technique. Here's an example of POOR technique. Although this is a therapy example, it is equally valid for conflicts between friends and loved ones. Let's say that you're a therapist, and your patient confronts you by saying, "This is the second week in a row that you've been late for my session."   I've seen therapists respond like this: "You're right. I have had emergencies which made me late for your sessions last week and today."  Is this a good example of the Disarming Technique? NO! Can you see why? It's because this therapist is agreeing with the criticism in a literal way, and not hearing the "music" behind the words. What is this patient really saying? He's probably saying that he feels a lack of caring from his therapist, and this may be one of his core conflicts,  thinking that the people he cares about never care about him. So the therapist's "mechanical" answer misses the boat. Here's an improved response that addresses what the patient really said. After each sentence, I'll put the name(s) of the technique(s) I used in the sentence. "Jim, it's painful to hear you say that, because you're right. ("I Feel" Statement; Disarming Technique) I was late and I let you down, and I feel embarrassed. (Disarming; "I Feel" Statement.) I wouldn't be surprised if you're feeling hurt and  annoyed, and maybe even a bit angry with me, and for good reason. (Feeling Empathy) This is particularly uncomfortable, because you've told me that everyone you care about seems to let you down. ("I Feel" Statement; Thought and Feeling Empathy) I care about you and have tremendous respect for you.  (Stroking) Although I was delayed by emergencies last week and this week, the fact is, you had to wait. (Disarming) I will try to correct the problem of getting emergency calls when I'm in the clinic, which definitely is irritating and unfair to you, and I'll gladly offer a free session to compensate the fact that you had to wait. (Disarming Technique, Feeling Empathy) I want to know more about how you've been feeling, and if there have been other times when I've let you down or perhaps said things that seemed uncaring? (Inquiry)" Can you see that this response addresses the music, or feeling, or message behind the words, and not just the words? And can you see the Law of Opposites in action? When this therapist agrees that he has let the patient down, and shows some humility, the patient will probably suddenly feel very cared about. In today's podcast, Brandon, Heather, Rhonda and David play a kind of Disarming Round Robin, taking turns responding to unexpected criticisms, using the Disarming Technique as well as any other communication techniques that may be needed. For example, one of the therapists is attacked by a patient who is a person of color who calls him "one of the rich white privileged people."  You will also hear the immediate grading of each response--was it an A, a B, a C, or a D--along with what worked and what didn't work, followed in some cases by a second try. If you want to learn the Five Secrets, and especially the Disarming Technique, this type of practice will be a must! You can practice with a colleague, or with a friend. But be prepared to check your ego at the door so you can learn from failure, because it will be very challenging for you at first! A neighbor who was helping with the recording, Dave Fribush, said that he really liked the podcast, but was disappointed it was so short--he wanted to hear more examples. So Rhonda and I recorded a  brief supplement two days later, which we will edit in.  Here are the additional criticisms we practiced: Angry friend who feels jealous / betrayed and says: You were hitting on my girlfriend last night! Irate mother, who feels neglected / used, and says: Forget it! I’ll just do it myself! Hurt colleague, who says: You didn’t support me during the meeting! Indignant patient, who tells her therapist: You just called me Jane, but my name is Lisa! If you are serious about learning the Disarming Technique, as well as the other Secrets of Effective Communication, I would strongly urge you to study this list of Common Five Secrets Errors in addition to practicing with a friend. I know I'm asking a lot from you, but we are giving you, or hoping to give you, something precious!  And here are the words to today's featured TEAM-CBT song!  She Used the Five Secrets Lyrics by Heather Clagueto the tune of Blue Velvet by Bernie Wayne and Lee Morris. She used the Five… Secrets Madder than angry, oh was I Pissed and unhappy, I could cry At the start She used the Five Secrets She spoke my words to ‘ empathize She ‘ guessed my feelings, oh she tried  From the heart How could I stay harmed When she so skillfully disarmed How could I want to fight When she asked, did I get it right with With my Five Secrets she told me plainly how she felt Her stroking made my whole heart melt Into tears And I can still hear her Five Secrets In my ears The Five secrets Now I have learned to use them too To give up blame and follow through And face my fears And I practice my Five Secrets With my dears I love the Five Secrets! Conflict fuels intimacy Not about me but about we It’s more sincere! So with the five secrets Let love appear!  More about Brandon and Heather Brandon Vance, MD and Heather Clague, MD are both psychiatrists and certified TEAM-CBT therapists. They practice in Oakland, California. In addition to her brilliant work as a TEAM-CBT psychiatrist and teacher, Heather is a singer and improviser who collaborated in the creation of lyrics for some of Brandon’s songs. She is a member of the performance group, The Berkeley Players, and is the director of Berkeley Improv, a Bay Area school of improv that offers improv acting classes for adults and youth. Heather says, "Improv is a lot like TEAM CBT - full of laughter and enlightenment.  The best moments tend to happen when we throw shame to the wind and let magic arise from the ordinary and let our 'mistakes' become gifts." In addition to his brilliant work as a TEAM-CBT psychiatrist and teacher, Brandon has a musical group that is connected with the Justice Arts Collective at Chabot College in Hayward California. In that group, he works with students to create musical pieces with social justice themes, often in the style of hip hop with Latin beats. Most, if not all of the students have experienced personal trauma and social inequity. Through music, they can share their truths, their hearts and their wealth of experiences with each other and the community, while at the same time working for social change.  Brandon explains that “we form deep connections with each other, and it’s become something of a family . A couple of years ago, we made a music video for our song, ‘From Mt. Tamalpais to Fruitvale Station,’ and actually won first place in the My Hero International Film Festival and in the World Independent Film Festival, as well as awards in many other film festivals.  Check it out! We’re now working on a new video about immigration with our song, 'Bring Down the Wall.'" Brandon has also worked with Amy Specter in the creation of a company called Gameful Mind. He explains that “we wanted playful ways to support adults and kids in developing skills to be and stay emotionally well. So, we made the game TuneIN TuneUP, as well as some other games and playful shirts and such.” David and Rhonda

Introducing Brandon Vance, MD  & Heather Clague, MD This podcast features the music of two beloved colleagues, Brandon Vance, MD and Heather Clague MD. Brandon and Heather are both certified TEAM-CBT psychiatrists practicing in Oakland, California. Brandon is a brilliant multi-instrumentalist and singer / song writer / performer who has transformed his vision of TEAM-CBT into music! Heather is brilliant and fun improv acting teacher and performer who is quick in her mind and on her feet! Brandon and Heather have performed at David’s annual South San Francisco psychotherapy intensive for the past several years, and we are delighted to bring them to you up close and personal today! In today’s podcast, they’ll bring you their songs and amazing personal stories. And what is super cool is that you can follow the words for the music right here in the show notes. Song #1  Heather and Brandon begin with music about a familiar but painful theme for nearly all of us—the feeling of failure, and the belief that we are somehow defective or just “not good enough.” Brandon and Heather are extremely talented and successful individuals, but they are not immune from suffering. During the podcast, they describe their own painful personal experiences with depression, anxiety, shame, and defectiveness. Most therapists, including David, were trained in the psychoanalytic tradition and told that we should NEVER disclose or reveal our own personal feelings or experiences to patients. But we believe that some personal disclosure can be very healing for patients if done with skill and compassion. Most patients want to hear this type of message from a therapist: “I’ve been there myself, and know how much pain you’re in. And I can show you the way out of the woods, so you can experience feelings of joy and self-esteem again. And what a joy that’s going to be!” So, with no further ado, Brandon and Heather perform their first song: The Feel of Failure Lyrics by Heather Clague and Brandon Vance to the tune of “The Sound of Silence” by Paul Simon Hello failure my old friend I’ve come to talk with you again Because my ego softly creeping Infects my thoughts while I am preaching And that vision that was planted in my brain Still remains; becomes the Feel of Failure   Fool, said I, you are so lame Done something wrong to feel this shame Perfect is the way that you should be Self-blame coming like a tsunami Negative thoughts one hundred - percent on my DML I was in hell Suffered the Feel of Failure   My self-esteem had turned to shit I needed the magic button hit Something told me my feelings weren’t lame Began to do a positive reframe Maybe my feelings say something about me that is pretty fly I set the bar high So I have a Feel of Failure   I saw that I was not alone Dared go beyond my comfort zone I took pride in my humility Welcomed my faults as my humanity And in a moment of enlightenment I cried and then I laughed I’d finally grasped The wisdom... of the Feel... of Failure Song #2  The next song is on social anxiety. Brandon explains: “I wanted to introduce this song I wrote with Amy Specter who was on your podcast on August 5th #152 a month or so ago. It’s called, “Negative Thoughts Shut your Piehole Tonight.” And it’s about social anxiety and the idea that when you’re upset, it’s not the event or the other person who’s “making you” feel upset, it’s your own negative thoughts. “Where it gets personal for me is that I was bullied in elementary school by a group of my former friends who made up a story that I was gay - as if that's a bad thing - and then yelled things, tried to get in fights with me, etc., for really the majority of the school year. And I got really down and felt ashamed, and didn’t tell my parents or anyone else about it because of that. But what they did, didn’t make me down - it was my negative thoughts. I wasn’t actually gay, but what was important was that I told myself that I was defective, and people didn’t want to be around me. “The person who I thought was the ringleader was a blonde blue-eyed (as if those are good things) smart, handsome guy who had great social skills and apparent confidence - both seemingly more than I had. In my mind I made him into an evil person just interested in popularity. But he had many good qualities (and was a friend of mine before this). Seeing his good qualities reminds me of the concept of the disarm. “In this song, the singer is anxious about going to a party. She feels envious of Anna, a woman who’s thin (as if that's a good thing) and gets a lot of attention - both because of our culture’s preoccupation with women being thin and also because she has great social skills. So, she feels bad about herself. “But then realizes it’s just her negative thoughts and also sees that her negative thoughts and feelings helpful to her, and represent good things about her. Then she works successfully on changing the way she thinks and feels.”  Negative Thoughts, Shut Your Piehole Tonight!  by Amy Specter and Brandon Vance Tiny Anna, you’ve been getting me down. But I know it’s not you; it’s the negative thoughts doing their doo-doo. And those negative thoughts I can leave behind. That’s right, you can walk right out of my mind. You can shut your pie-hole, though you’ve given me a lot during my days. But, I don’t need you now; you can get up and walk right out of that door - and shut your pie hole on the way!   You’ve been talking since the dawn’s early light you’re an expert, attention getter, you’re quite the sight! Anna please teach me to talk at a party like the talkin' on the tv screen Now I’m gonna say something and it may not be polite! Cause I’ve realized that I’ve got some work to do But this time I’m not going to shut down and stew. My negative thoughts are bothering me much more than Anna Lee so negative thoughts, shut your pie holes tonight. Negative thoughts you’ve served me well and kept me from being in social situation hell Rejection comfortably kept at bay I don’t have to put myself out there I can keep myself at home without judgments to fear they can let me off the hook No effort to change, to learn new things or swim in another lane Negative thoughts you’ve kept me safe But I’m going to try my mind on a different train Maybe I don’t need negative thoughts and their kind to tell me if I can have a good time I can be myself and go at my own pace Even with these tiny negative thoughts flapping their tiny lips in my face Negative thoughts said there’s no room in this world for my kind well that’s just bullshit created by my negative mind I laugh about awkward autocorrects, Weird-Al and farting So why not enjoy, the people, at the party? So negative thoughts shut your pieholes tonight! Negative thoughts you’ve served me well Negative thoughts - farewell! Negative thoughts shut your pie hole tonight Tiny Anna will surely get some attention That may be true And that doesn’t mean I won’t get affection But even if I don’t have things to say, I’ll learn to chit chat the Anna way. So Negative thoughts shut your pieholes tonight, Negative thoughts shut your pieholes tonight. That’s right, negative thoughts shut your pieholes tonight!  Cause I wanna have some FUN!!! Song #3  The last song by Brandon and Heather focuses on the “A” of TEAM therapy, formerly called A = Paradoxical Agenda Setting, and now given the simpler name of A = Assessment of Resistance. We address the patient’s resistance in this very crucial and paradoxical part of TEAM-CBT. When we address resistance up front by arguing for the status quo, the patient paradoxically argues for change, and therapy becomes much easier. After that point, it’s No Resistance No Cry. NO RESISTANCE NO CRY  Lyrics by Amy Specter and Brandon Vance to the tune of “No Woman No Cry.” by Bob Marley. No resistance no cry No resistance no cry No resistance no cry No resistance no cry Next week, Brandon and Heather will return for a second podcast on listening to a very different kind of “music,” the meaning behind the words when people are critical of you. We will discuss and illustrate, once again, the incredibly important Disarming Technique, which is arguably the most important of the Five Secrets of Effective Communication. More about Brandon and Heather In addition to her brilliant work as a TEAM-CBT psychiatrist and teacher, Heather Clague is a singer and improviser who collaborated in the creation of lyrics for some of Brandon’s songs. She is a member of the performance group, The Berkeley Players, and is the director of Berkeley Improv, a Bay Area school of improv that offers improv acting classes for adults and youth. Heather says, "Improv is a lot like TEAM CBT - full of laughter and enlightenment. The best moments tend to happen when we throw shame to the wind and let magic arise from the ordinary and let our 'mistakes' become gifts." Dr. Brandon Vance has a musical group that is connected with the Justice Arts Collective at Chabot College in Hayward California. In that group, he works with students to create musical pieces with social justice themes, often in the style of hip hop with Latin beats. Most, if not all of the students have experienced personal trauma and social inequity. Through music, they can share their truths, their hearts and their wealth of experiences with each other and the community, while at the same time working for social change.  Brandon explains that “we form deep connections with each other, and it’s become something of a family . A couple of years ago, we made a music video for our song, ‘From Mt. Tamalpais to Fruitvale Station,’ and actually won first place in the My Hero International Film Festival and in the World Independent Film Festival, as well as awards in many other film festivals.  Check it out! We’re now working on a new video about immigration with our song, 'Bring Down the Wall.'" Brandon has also worked with Amy Specter in the creation of a company called Gameful Mind. He explains that “we wanted playful ways to support adults and kids in developing skills to be and stay emotionally well. So, we made the game TuneIN TuneUP, as well as some other games and playful shirts and such.” David and Rhonda    

The Secret of a Meaningful Life One of my favorite podcasts of all time, and one of the most frequently downloaded, was the live session with Daisy (podcast #79): “What’s the Secret of a Meaningful Life?” You may recall that Daisy and her husband, Zane, were looking forward with dread to the possibility of childlessness, since their efforts at pregnancy had so far failed, and Daisy was asking if she could possibly have a joyful and meaningful life without children. In today’s podcast we return to the same type of question from the other end of the spectrum. When we age and look back on our lives, and realize that our days are numbered, we may once again, "Have I lived a meaningful life?" Do you know how to answer this question? What, in your opinion, is the secret of a meaningful life? If the answer to this question is important to you, you might enjoy today’s podcast, which features, once again, two beloved friends and colleagues, Dr. Marilyn Coffee and Dr. Matthew May. Matt and I first treated Marilyn for intense depression, anxiety, and anger two years ago at the time of her unexpected and shocking diagnosis of Stage 4 non-smoker’s lung cancer. Marilyn was incredibly depressed and panicky, as you might imagine. If you are interested, you can listen to our initial treatment of Marilyn in podcast #49, “The Dark Night of the Soul.” One of Marilyn's concerns at that time was that she had lost her faith in God and had begun to doubt the existence of an after-life. She was intensely self-critical and ashamed, and was also extremely angry because she began doubting her spiritual teachers and thinking of them as frauds. These doubts were all the more troubling to Marilyn, since she’d been a devout Catholic for her entire life. In fact, she  even has a Master’s Degree in theology, along with several additional Master’s Degrees plus a PhD in clinical psychology! But now she was terrified by the prospect of her own death. During that initial treatment session, Marilyn overcome her fears, depression, and doubts, and ended up in a state of joy, and even laughter. This rapid transformation confirmed the basis of cognitive therapy, that our emotional pain results from our thoughts, and not from what is actually happening to us. And the thoughts that cause depression and anxiety will be distorted and cruel--I've often said that depression and anxiety are the world's oldest cons. Following that session, we were flooded with emails praising Marilyn. Oddly enough, many people said she was their spiritual hero. They said they were stunned and grateful her raw courage, testimony, and honesty. Now, it’s two years later. Sadly, Marilyn has just learned from her doctors that she’s had numerous metastases, and that her lung cancer has spread to the opposite lung, as well as to her bones, brain, liver, and lymph nodes. Marilyn is understandably paralyzed once again by overwhelming feelings of depression, anxiety, shame, hopelessness, and anger. Today’s podcast is based on our most recent session with Marilyn about two weeks ago. I have to warn you that the session may be sobering, and even a bit terrifying, but hopefully you will find it to be inspirational and helpful, because sooner or later, we’ll all have to share the prospect of facing our own inevitable death, and asking ourselves, “Have I had a meaningful life?” We scheduled this follow-up live therapy podcast for three reasons. First, we hoped to provide Marilyn with some relief from the devastating depression that had returned when she learned of her metastases. Second, we wanted to give you, and all of Marilyn’s many fans, an update on what’s happened in the past two years. And third, Marilyn wanted the chance to tell you about some of the positives in her life, since she so often mentions her failures, such as her bouts with alcoholism, and the fact that she never found a loving partner. Every TEAM session begins with T = Testing. You can see her scores on the Brief Mood Survey she filled out just before the session began. (link) All her scores reflect the most severe negative feelings a human being can experience. Marilyn has extraordinarily severe depression, anxiety, and anger, and her positive feelings are totally absent. Marilyn brought a partially completed Daily Mood Log to the session. If you take a look, you'll see all of her intensely Negative Thoughts and devastating feelings about the spread of her cancer.  During the E = Empathy phase, Matt, Rhonda and I gave Marilyn the space she needed to vent and describe her despair and feelings of terror. We did not try to help or cheer her up. Marilyn cried as she described her fear of dying alone, and vividly recalled a friend who died a horrible death from lung cancer 20 years ago. Marilyn says he could barely breathe, and fears a similar horrific fate. Marilyn cries, and confesses that she has not been able to cry up until now. She says she suddenly felt a spiritual presence being around Matt, Rhonda, and David. During the Empathy phase, Matt made many tender comments to Marilyn, shared his own profound sadness, and told Marilyn that joining us today is a gift to him, and to all of us. Matt and I asked Marilyn how we were doing in Empathy, in terms of understanding how she was thinking and feeling, and whether we were providing warmth, acceptance and support. She gave us high grades. When you listen, please notice that we didn’t do anything to try to help Marilyn, or to try to cheer her up. You can hear Matt simply paraphrasing much of what Marilyn had been saying, acknowledging her feelings, and sharing his own feelings of sadness and warmth toward Marilyn. After about 25 minutes of empathy, we moved on to the next phase of the session called A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) We started by asking Marilyn if she wanted any help with the problems she'd been describing, or if she needed more time to talk while we listened and provided support.  She said that she did want help. Since her remaining time was potentially short, she said she didn’t want to spend it in the misery of overwhelming depression, anxiety, worthlessness, shame, loneliness, hopelessness, and rage. Then I asked the Magic Button question—If we had a Magic Dial, and all of her negative thoughts and feelings would instantly disappear, with no effort at all, simply by pressing it, would she press the button? Marilyn immediately said that she WOULD press the button. Almost everybody says this. And it seems obvious. Why would anyone want to feel intense, relentless and overwhelming negative emotions? Matt, Rhonda, and David debated about whether or not the A = Assessment of Resistance would be needed, since it seemed like Marilyn was suffering so much that she would OBVIOUSLY want help. We decided to address the resistance, since whenever we’ve skipped it, we’ve usually regretted it. So just to be safe, we decided to do some Positive Reframing, and asked these two questions about each of the nine categories of intense negative feelings on Marilyn's Daily Mood Log, such as depression, anxiety, guilt, inferiority, loneliness, hopelessness, rage, and so forth. What does this negative feeling show about you and your core values that’s beautiful, positive and even awesome? What are some benefits of this negative feeling? How might it help you? Surprisingly, Marilyn came up with a list of more than 20 positives with some help from Rhonda, Matt and me. You can take a look at her Positive Reframing List. This process seemed to have a profound calming effect on Marilyn, just as it does on most people. I think one reason is that culture / society have trained all of us \to think about our negative feelings as defects, or “mental disorders,” like the many that are listed in the DSM5. Positive Reframing turns all of this upside down, and makes you proud of your negative feelings. Paradoxically, this make it possible for you to get rid of the feelings quickly. We concluded with the Magic Dial, and asked Marilyn what she might want to dial her feelings down to, without getting rid of them completely, since they did have many benefits, and since they also reflected what was most beautiful about her. You can see the result of the Magic Dial on her Daily Mood Log, in the “% Goal” column of her table of negative emotions. For example, she wanted to dial her depression down to 10%, but thought that she'd want to keep the anxiety in the range of 20 - 25. But she said she'd be happy to dial the guilt and shame all the way to zero! After the A = Assessment of Resistance, which seemed to lift her mood considerably, we went on to M = Methods. After easily identifying the distortions in her thoughts, like All-or-Nothing Thinking, Self-Blame, hidden Should Statements, and more, Marilyn was able to challenge and crush her Negative Thoughts pretty quickly using the Paradoxical Double Standard Technique as well as Externalization of Voices. Two strategies seemed important—the Self-Defense Paradigm and the Acceptance Paradox. I emphasized the overlap between the Acceptance Paradox and Marilyn’s Catholic faith. It is the idea that you cannot, and not have to, earn your way to heaven through your good works. Christianity is based on the idea that we are not saved by our achievements or good work, but rather by the grace of God--which is simply the acceptance of our flawed nature. David emphasizes that these ideas are not exclusive to Christianity, but are woven into most if not all religions. During this phase of the session, Marilyn reflected on some of the experiences that she’s proud of, things she would like you to know about, like her trip to Nicaragua to attend seminary at the Franciscan School of Theology. During that time, she worked with the oppressed indigenous people in relocation camps following the bombings, and joined the Witness for Peace group.  She describes this as "one of the most transformative and spiritual experiences of my life." Many of you are probably not familiar with Marilyn's fairly extensive arrest record, which she is equally proud of! She explains: "During the 80s and early 90s, I was arrested several times for political protests, primarily at the Federal Building in San Francisco.  For example, I participated in a major non-violent prayful march at Lawrence Livermore Laboratory.  Several of us were arrested and spent a month in jail (tents on the grounds of Santa Rita Jail.)" Marilyn also wants to know that she was "a damn good therapist." That's something I can attest to, having presented with Marilyn on many occasions, including our empathy workshop at one of the prestigious Evolution of Psychotherapy conferences in Anaheim, California. And still, all of her amazing accomplishments and contributions do not protect her, or any of us, from falling into a black hole of self-doubt and despair from time to time, and when Marilyn falls, the pain she inflicts on herself can be intense. You may notice that the Negative Thoughts on her Daily Mood Log today are very similar to the Negative Thoughts on her Daily Mood Log from two years earlier, during our first session with Marilyn. This confirms the concept of “fractal psychotherapy.” In other words, all of your suffering will be encapsulated in any one brief moment when you are upset. And when you suffer again in the future, it will be that same fractal--the same exact pattern of negative thoughts, distortions and feelings. This is really good news, because the methods that helped you recover initially will be helpful for you when you again fall into the black hole of depression. The goal of TEAM-CBT is NOT eternal happiness--no human being is capable of that! Rather, the goal is to understand and master the tools that will be helpful for you. One important teaching point is that Marilyn’s suffering, once again, does not result from her cancer, but rather from her self-critical thoughts, which are both cruel and distorted. She’s been telling herself that she is not religious enough, that she has lost her faith, and that her life has not been meaningful. Fortunately, these Negative Thoughts can easily be challenged and defeated, as you will hear on the podcast. The entire basis of cognitive therapy is a spiritual idea, that “the truth shall make you free.” Although this is a core Christian teaching from the New Testament (John 8: 32), it is an idea that’s embedded in many religions, including Buddhism, and probably in every religion. Toward the end of the session, Marilyn described inspiring moments when she feels the most spiritual and the most alive. It’s when she notices and profoundly appreciates the simple things in her life, like seeing a sliver of the moon in the evening when walking her dogs, watching a sunset on the beach at Santa Cruz, her first sip of latte in the morning or a bite of a delicious peach! Marilyn also described the intense mourning she feels for people throughout the world who are in poverty or pain. She also grieves for animals who are suffering, and feels devastated by the destruction of our natural resources, such as the rain forests in Brazil. You can see the final T = Testing . As you can see, she met or exceeded her goals for all of her negative feelings. You may be puzzled by the end of session rating for sadness and depression was "50%, but a GOOD 50%!" Sometimes, feelings of sadness and grief, once the distortions have been eliminated, are are the experiences that can wake us up, and provide the profound sense of meaning we are craving in our lives. The highest human experience, perhaps, is the compassion we sometimes feel for ourselves and others who are suffering. In fact, this may be the true meaning of spirituality. I call this feeling, "Sadness as Celebration," and hope to write and talk more about it in a future podcast.  At the end of the session, Marilyn said, “I feel light!” And gave us all big hugs. Will it last? Matt wisely suggests some terrific Relapse Prevention Training that you will hear when you listen to the session. Of course, it will be up to Marilyn--and to all of us--to pick up these tools and use them when we again fall into a black hole. This is also an inherently spiritual idea, and is based on the idea that we have the freedom to chose light or darkness. After the session, Marilyn emailed me and asked if I could include a few additional comments in the show notes. Here’s what she wrote: Greetings David, my dearest friend, Words cannot express my gratitude for you, Matt, & Rhonda - what special gifts you are. I hope the podcast was ok. I am deeply embarrassed because I forgot to express my gratitude and surprise from all the e-mails we received - the compassion and support was/is overwhelming. I hope I can give back! I could never had done this, if I weren’t for you & Matt - and your amazing & compassionate skills. I also forgot to mention that I probably will never get to New York or Ireland because of finances. I take one day at a time and try to be grateful for the small miracles. I go to Stanford next Tuesday. I will definitely be in touch. Thank you again. I also forgot to mention this - which is VERY important is that I am going through this process sober - not avoiding with alcohol. I am going to more meetings & speaking up. Thank you again. I cherish our friendship. With deep gratitude and love. dear friend, Marilyn Thank you, Marilyn, for this incredible gift to all of us! Matt, David, and Rhonda

David and Rhonda are joined again today by David's neighbor, friend, and hiking buddy, Dave Fribush. We appreciate his superb technical skills and thank Dave for his support of our podcasts! Rhonda starts the podcast by reading a question from a podcast fan named Rajesh, who wrote: I have often seen that estranged friends or family members do not talk or resolve a trivial conflict for years because one or both of them have ego issues or have fear of rejection. This problem of unfairness may even exist between a demanding parent and the child, ranging from secretly resenting to not talking at all. They might come face to face in family occasions or professional settings in case of friendship and bear the discomfort, but not attempt to reconcile. They might be suffering deep down emotionally but they refuse to accept that it matters. One or both members might feel they have been treated unfairly and expect apologies. But, both parties are scared to even make the move for the fear of being hurt again or rejected. On a personal level, I have faced such unfairness with a close friend. I see even if you forgive the other party, that element of resentment is still in their somewhere. How do you know you have truly forgiven someone and moved on? Whats the best that can be done at an individual level without involving the other party, at least till the time both are ready to talk it out, if it ever happens.  Once again I thank you for all the selfless Good work you do for people through your knowledge sharing. My sincere best wishes to you and great thanks 🙏. Rajesh I appreciate this question, and it is a great introduction for our podcast on Changing the Focus, one of the three Advanced Secrets of Effective Communication. We recently introduced the three advanced secrets in podcast #126, and you can listen to it for review if you like. Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room. Multiple Choice Empathy. This technique can be transformative when you’re trying to connect with a teenager, friend or loved one who refuses to talk to you. Positive Reframing. This technique can be invaluable when you’re fighting with a colleague, patient, friend or family member, and you’re both feeling frustrated, angry, and upset Today we take a deeper dive into Changing the Focus. This technique can be extremely helpful when you feel tense or awkward in your relationship with someone. For example, you may be arguing endlessly, or there could be some unacknowledged feelings that no one is talking about, like shame, anger, hurt, or resentment. When you use Changing the Focus, you gently point out what's happening, and focus on your feelings, and drawing out the other person's feelings, instead of continuing in the same pattern of arguing or avoidance. Although this technique can be tremendously helpful, it is very challenging, so I have written two memos explaining the technique in greater detail, with examples. One is for therapists and one is for the general public. If you are interested in learning this technique, this would be a great starting place, and it might not hurt to read both memos. In addition, you have to be skillful with the Five Secrets of Effective Communication before trying this technique. That's a lot to ask, I know!  David, Rhonda, and Dave (our new podcast co-host) model how Rajesh might use Changing the Focus with estranged friends or family members. Then Dave Fribush provides a terrific example of how he used the Five Secrets, plus Changing the Focus, in a troubled love relationship, after arguing and resisting for several years. Then I (David) provide an example with a patient I was failing with, and Rhonda provides two tremendous examples--one from her clinical practice, and one involving her sister.  See what you think about our new three-person format! Since our audience consists of therapists as well as the general public, we welcome Dave with open arms and hearts, and feel lucky!  David, Rhonda, and Dave :)

One Student’s Experience In today’s podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it’s a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago. Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher. During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to “sell” this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well. Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT. Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help. But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist’s efforts to “help.” Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to “get it,” and that she also resisted using the Invitation Step it at first, thinking it wasn’t needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn’t know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors! Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients. Finally, I asked her why she wasn’t using the Invitation Step. She told me she was afraid her patients would say, “Yes, I DO want some help with problem X, Y or Z.” And then she might not know how to help them solve whatever problem they had! She said, “As long as I just schmooze with my patients, I know that nothing will change, but they’ll think it’s good therapy!” Fortunately, after we discussed this dilemma, she began using the Invitation Step, along with many other Paradoxical Agenda Setting techniques, and her clinical work improved a ;pt. Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments. I think this is arguably an ethics violation, since therapists’ perceptions of how their patients feel can be wildly inaccurate. I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments. The importance of assessment instruments in clinical work and training was underscored by my experience several days ago with a patient who gave me incredibly poor grades on empathy as well as helpfulness at the end of a free, two-hour phone session. I had sensed the session had not gone especially well, but I didn’t realize just how awful it was until I saw my ratings! The scores on Empathy and Helpfulness were among the worst I’ve received in the past 25 years. This was illuminating, but disturbing, as I’d been trying my best but I had clearly failed my patient in a big way, and he was ticked off! I would not have known just how angry and upset he was if I had not been using the Evaluation of Therapy Session. I had a fairly sleepless night, and emailed him the first thing in the morning to find out what emotions I’d overlooked, and urged him to express his angry feelings toward me. This led to a tremendous and highly gratifying therapeutic breakthrough. Kyle was generous in his praise for the training we do in our Tuesday group, and I feel extremely fortunate to have had the chance to work with Kyle! I am hopeful that the training methods my colleagues and I have been developing over the past 20 years will begin to catch on, but have to admit that I’ve run into fairly strong resistance from many therapists who fight and oppose our new training and treatment methods. By the way, the Tuesday group is totally free for all clinicians in the San Francisco Bay Area, or from anywhere for that matter. We’ve had commuters and visitors from as far as Denver, Portland, and even China. If you want to dramatically improve your therapy skills, and have an interest in some of the new treatment and training methods we’re using, and want free personal work as well, this might be an option for you, and we’d be really happy to have you visit and maybe even join us! David, Rhonda, and Kyle  

Plus, Thomas Szaas, TV Shrinks, and more! David and Rhonda are joined today by David's neighbor, friend, and hiking buddy, Dave Fribush. He has incredible technological skills, and wisdom.  We thank Dave for his support of our podcasts! We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the "Tiger Monastery" in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery. Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us!  Here are the questions for today's program: Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question - I have suffered from panic attacks for years - the past 2 years I've become agoraphobic and don't want to be far away from my house. So, my phobia is now "having panic attacks." Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying. Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide. Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a "study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis." I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student's the results of your research. Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this? If a person is worthwhile but the world thinks they are not worthwhile, isn't this almost as bad as not actually being worthwhile. Don't we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think? Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date! I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours. Robert also asks: My other question is an idea for future podcasts and it is...How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy. Some of the Hollywood therapists people know best are: Judd Hirsch as the shrink in Ordinary People Lorraine Bracco as the shrink in The Sopranos Peter Bogdanovich as the shrink's shrink in The Sopranos Billy Crystal as the shrink in Analyze This! Robin Williams in Good Will Hunting Kelsey Grammer in Frasier I am sure there are many others. These are the ones who quickly came to mind I just found an article about this that might help make the case that what the public sees on TV and in the movies is not really reflective of the therapeutic process or good therapy. Here’s the link: https://www.huffpost.com/entry/therapists-on-the-big-and_b_4263798 Thanks for tuning in! David and Rhonda References for Nathan Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012. Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients' and therapists' shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 - 643.  

The Story of Lorraine and “Anna” In today’s podcast, David and Rhonda interview Dr. Lorraine Wong, a board-certified clinical psychologist, and her patient, “Anna,” who sought treatment recently for depression, anxiety, and self-image / self-esteem issues. But first, David and Rhonda answer a question submitted by Estafonia, a “public image consultant,” who asks about the treatment of a woman who sees herself as “fat.” Estafonia wrote: “Hi Dr. Burns, “I am learning TEAM, CBT and implementing your techniques to help my clients change or improve their self-perception. In most cases, your techniques have been very effective. I am very grateful to you and I will happily join your list of fans! “My question is this—What would be the best method to change someone’s self-image? How can you help people change the idea that they are fat for example? “I have a patient who can't defeat the thought, ‘I am fat.’ We tried the method called Examine the Evidence,” and she has already found 20 people who see her as thin. So, the evidence clearly did not support her belief that she is fat. But this did not help. “We also tried the method called Let’s Define Terms, and we both concluded that she is not fat. But now she tells me, ‘I know I am not fat, but I can't stop thinking about it.’ “We also did the Downward Arrow Technique to probe her deepest fears and Self-Defeating Beliefs, but that didn’t seem to help, either, and she keeps ruminating about being fat. I would greatly appreciate your guidance on how to help her overcome that thought! “Thanks in advance! Estefania” Lorraine, Rhonda, David and Anna quickly diagnose the most likely cause of Estefania’s stuckness—she is trying to “help” her patient without first melting away her patient’s resistance. This is the cause of practically all therapeutic failure, and you’re not really doing TEAM-CBT if you don’t know how to eliminate the patient’s resistance. That’s because most people are ambivalent about change. As the Jesuit mystic, Anthony DeMello, has said: “We yearn for change but cling to the familiar.” Recognizing and modifying this inherent ambivalence is the heart of A = Paradoxical Agenda Setting, but you can also think of the A as standing for “Assessment of Resistance.” How could we melt away this woman’s ambivalence / reluctance to stop bombarding herself with the message, “I’m fat”? It is important to realize that this self-critical thought, and, in fact, all of her negative thoughts and feelings have huge advantages for her, and also indicate some really beautiful and awesome things about her and her core values. For example, telling herself “I’m fat” may motivate her to diet, to exercise, and to make extra sure that she doesn’t get complacent and gain a tremendous amount of weight. In addition, the thought, “I’m fat,” shows that she has high standards, and her high standards have probably motivated her success in many areas of her life. For example, she probably works really hard to stay in good health and in good physical condition. The thought, “I’m fat,” also shows that she’s humble, and on and on and on. And that’s just one negative thought. But this woman probably has many negative thoughts and feelings, like anxiety, shame, inferiority and depression, and they ALL have tremendous advantages, and they ALL reveal what is beautiful and awesome about her and her core values. In addition, the thought may be protecting this patient from things she fears, like intimacy. As long as she tells herself, “I’m fat,” she does have to risk trying to get close, or having sex, or risking rejection. So the thought, in a way, is a form of self-love and self-protection. Once Estafonia and her patient list all these positives, Estafonia could ask her patient, “Given all these advantages and positive qualities, maybe it wouldn’t be such a good idea to stop telling yourself, ‘I’m fat.’ This thought seems to be working for you in a really positive way, and also reflects your core values.” That’s the essence of Paradoxical Agenda Setting. We try, in a genuine way, to honor the patient’s resistance, rather than trying to sell the patient on change. This is very difficult for therapists to learn because of the compulsion to save, help, or rescue the patient. In addition, obsessions (recurring illogical negative thoughts like “I’m fat”) frequently result from the Hidden Emotion phenomenon, and this has to be dealt with skillfully when treating any patient with anxiety. Estafonia’s patient may be upset about something she’s not dealing with in her life, and bringing the hidden problem or feelings to conscious awareness can often be incredibly helpful. For more information, see my book, When Panic Attacks, which you can order from my books page (link). After focusing on Estafonia’s excellent question, David, Rhonda, Lorraine and Anna talk about the emotional challenges that brought Anna to treatment, including severe feelings of depression which came on when Anna returned to the United States after 13 years working abroad. She was also feeling anxious, stuck, angry, and hopeless, and was comforting herself by binging on her three favorite foods. Anna describes previous partial treatment failures, and explains that her previous cognitive therapist had “the empathy of a prison guard,” and contrasts those experiences with her successful experience with Lorraine. In fact, Anna describes the TEAM-CBT she received at the Feeling Good Institute as “cognitive therapy on steroids.” I (David) loved hearing that because this is how I think about TEAM-CBT, too! TEAM really is CBT on steroids! But, I’ve been too embarrassed to describe TEAM-CBT in this way, fearing it might sound crass or unprofessional. Anna and Lorraine explain why the T = Testing and E = Empathy of TEAM were so critical to the success of the therapy. Anna says that Lorraine was, in fact, the first therapist “who really got me, and really understood me!” Anna emphasizes the enormous importance of the A = Paradoxical Agenda Setting (aka Assessment of Resistance) as well. Lorraine helped Anna discover what was beautiful and awesome about all of her negative feelings, including severe depression, shame, anxiety, anger, loneliness, and even hopelessness. She said, “My depression and feelings of loss when I moved showed that I really care about what I do, as well as the people around me.” Anna also said that her anger showed that she was overly nice, out of her love for people, but that she had the right to set boundaries and stick up for herself, and didn’t always have to be a people-pleaser. The Positive Reframing proved to be a positive shock to the system, and Anna’s symptoms started to improve significantly even before starting the M = Methods phase of the TEAM-CBT treatment. The Positive Reframing made it relatively easy for Anna to smash the negative, self-critical thoughts that triggered her depression, anxiety, shame, and hopelessness, and then they moved on to other goals, such as using the Five Secrets of Effective Communication in her interactions with colleagues and friends. Finally, they focused on self-image issues, which brings us back to the question Estafonia had posed at the start of the podcast: How you can help patients with self-image problems and addictions to eating? Anna explained that when she was depressed, she had gained weight because of her addiction to salami (Mmmm!), ice cream (Yummm!), and rice and beans (WOW!) Lorraine used David’s “Devil’s Advocate Technique,” to help Anna challenge the tempting thoughts that always triggered her overeating. Rhonda and I are incredibly grateful to Lorraine (aka Dr. Wong) and “Anna” for this opportunity to bring TEAM to life in a very real and personal way. Thank you, Lorraine and Anna! Dr. Lorraine Wong is a certified Level 4 TEAM-CBT therapist and practices at the Feeling Good Institute in Mountain View, California. She specializes in the treatment of body image concerns and emotional eating, as well as depression and anxiety, with TEAM-CBT. Thanks for tuning in! David and Rhonda