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

in today's podcast, Rhonda and David address eight fascinating questions submitted by fans like you: What's the difference between David's Therapist Toolkit, his eBook (Tools, Not Schools, of Therapy), and the EASY Diagnostic system? Is there a dark side to human nature? Is being "forceful" or confronting patients ever important in therapy? What's the 5-session schizophrenia cure? How do you suddenly switch into "Sitting with Open Hands" during a session? Questions about OCD Questions about racism What if there are more advantages than disadvantages in perfectionism? What's the difference between the Toolkit, the eBook, and the EASY Diagnostic system? I am a Licensed Clinical Social Worker (LCSW) and I am interested in either the Toolkit or the EASY diagnostic tool. It looks like the Toolkit includes quite a few questionnaires so I am wondering if I would need both. I would love to have a comprehensive checklist to give to clients during their initial assessment so I originally looked into the EASY Diagnostic tool. I'm just looking for a little guidance on which one would be the most helpful and if I would actually need both. Thanks so much! Cindy What do you think about the idea that there's a dark side to human nature? Are humans inherently good, as so many mental health professionals seem to believe? It could be entitled, "The Dark Side of Human Nature," or "Is there REALLY a dark side to human nature?" Jeremy Rhonda and David believe that human beings have positive loving impulses and dark violent impulses as well, and that both are an inherent and basic aspect of human nature. They discuss several aspects, including: The example of cats. They are genetically little serial killers. They love to capture and torture rodents, even if they have had a loving childhood. Many people love violent revenge movies and video games. Many people love killing animals, chopping their heads off, and mounting them on the wall, in much the same way that human serial killers get intense excitement from their killing and torturing, and they also keep trophies. David argues that it is important for therapists to recognize and address the dark side—areas where therapists will typically get in trouble due to blindness / denial / rationalization of negative motives, and excessive idealism. Problematic areas for therapists can include: the suicidal patient the violent patient—David describes a woman who was plotting to kill her husband. disability patients with a hidden agenda of remaining disabled. patients who don't want to do their therapy homework people, for the most part, don't get addicted because they're depressed, anxious, or lonely, but because it's really awesome to get plastered / high. Many, and perhaps all humans, like to judge others and feel superior to them, and also enjoy exploiting others, but our denial can be intense. People enjoy bullying people. It makes you feel powerful and generates feelings of excitement. We acknowledge that although the dark side to human nature may be strongly influenced by our genes, the environment we grow up in can also have a strong impact on our thoughts, feelings and impulses. Is being "forceful" or confronting patients ever important in therapy? This is another great question submitted by Jeremy Karmel. David gives many examples of times when it is absolutely necessary to be forceful and confrontational in therapy, but this requires a strong therapeutic relationship with the patient and perfect empathy scores and high levels of trust and mutual respect. Therapeutic examples where forcefulness or confrontation may be important include: Exposure techniques in the treatment of anxiety. The patient will nearly always "wimp out" at the last minute, and here is where the therapist needs to push—but most therapists will back off out of misguided "niceness." Pushing the patient to view his/her own role in a relationship conflict instead of buying into the idea that the patient is the innocent victim of the other person's "badness." The new CAT technique in the Externalization of Voices is yet another example where gentle confrontation can often lead to rapid enlightenment. Another example is use of Changing the Focus, suddenly drawing the patient's attention to "Have you notice what just happened here between us?" This can be helpful when there's an awkward or adversarial or evasive dynamic going on between therapist and patient. Yet another example is the Gentle Ultimatum in dealing with Process Resistance. In all of these examples, many, and likely most therapists don't do well, due to "niceness" and fear of conflict. What's the 5-session schizophrenia cure? Hello David: I recall you saying in one of your trainings given in San Diego a while back that you could "cure Schizophrenia in 5 sessions" using the T.E.A.M. protocol you taught us. Is there a special protocol for this disorder? One of my clients would very much like to know. I hope that this finds you, your family and everyone at the Feeling Good Institute doing well and being healthy. Kind regards, Leslie David explains that he has always insisted that schizophrenia is an organic brain disorder that sadly cannot be cured with drugs or psychotherapy. However, drugs often plan an important role in treatment, and compassionate psychotherapy can also be extremely helpful. The goal is to help the patient develop greater self-esteem and improved relationships with others. He describes the innovative group CBT program he developed at his hospital in Philadelphia which served a large population of homeless individuals as well as individuals suffer from severe schizophrenia. He also points out how easily one can get severely misquoted, and appreciates the chance to set the record straight! How do you suddenly switch into "Sitting with Open Hands" during a session? This is yet another great question from our friend and colleague, Jeremy Karmel. David and Rhonda compare good therapy to dancing, having to often change courses instantly when the patient begins to resist and fight the therapist. Questions about Obsessive Compulsive Disorder (OCD): I hope this a place where I can submit questions for "Ask David." Are there manifestations of OCD that have common links or hidden emotions? Do you hear one person's description of their OCD and immediately have an idea of what might cause it? For example: do a majority of contamination OCD sufferers have a common reason for that specific "type" of OCD? Do sufferers of something deeply distressing like pedophile OCD all have feelings of shame that manifest in that OCD, where the "what if" would result in probably the most shame they could ever feel? David and Rhonda discuss the Hidden Emotion Technique which can be invaluable in the treatment of OCD. Questions about racism Hello David and Rhonda, Thanks for your amazing podcasts, I have listened to a lot already. And thanks Rhonda for bringing this important subject to the table. :) What if "Steve" had said that indeed he is racist and can't stand African Americans or South Americans, what would Rhonda answer to that?! It would become difficult for me to keep a friendship-like relationship with someone who is at the extreme opposite on sensitive subjects. I am open to any point of view, I don't need to be disarmed here. :) David, I'm so looking forward to your Feeling Great book!!! Rhonda and David discuss two opposite strategies for dealing with someone with strong racist tendencies. What if there are more advantages than disadvantages of perfectionism when you do a Cost-Benefit Analysis? This is a question from a user who wishes to remain anonymous. Rhonda and David talk about the fact that perfectionism, like all Self-Defeating Beliefs, has many advantages as well as disadvantages. And if the advantages outweigh the disadvantages, it's working for you, and it's not something the therapist would need to help you with. There's a difference between neurotic and healthy perfectionism. Many of the great historical figures, like Edison, for example, worked relentlessly and would not settle for failure. And we are all the beneficiaries of that type of genius and intense commitment to the healthy pursuit of excellence! Therapy is all about helping people who ask for help. It's not about evangelism! David and Rhonda

Today, the Cognitive Distortion Starter Kit Continues with Magnification and Minimization Rhonda begins by reading two beautiful, inspiring emails from Heather Clague, MD and Dipti Joshi, PhD. Heather and Dipti are dear friends and esteemed colleagues of David and Rhonda. Rhonda and David begin with a brief overview of distortion #6: Magnification and Minimization. Magnification is when you blow things out of proportion. This is common in anxiety and is also called "Catastrophizing." For example, during panics patients often tell themselves—and believe—that they are on the verge of something catastrophic, like a stroke, a sudden, fatal heart attack, or losing their minds and becoming hopelessly psychotic. Minimization is just the opposite. You shrink the importance of something like your good qualities or the things you've accomplished. Minimization is common in depression. Magnification and Minimization almost always play a big role in procrastination as well. For example, you may Magnify the enormity and difficult of the task you've been putting off, and Minimize the value of just getting started on it today, even if you only have a few minutes. I sometimes call this distortion the "binocular trick" because it's like looking through the opposite ends of a binocular, so things either appear much larger or much smaller than they actually are. Techniques that can be especially helpful include Examine the Evidence, the Semantic Technique, Little Steps for Big Feats, the Experimental Technique, the Double Standard Technique, and Externalization of Voices / Acceptance Paradox. Rhonda brings these techniques to life in a description of a depressed man she recently treated who's been divorced for 2 to 3 years, and living alone due to the Shelter in Place orders during the Covid-19 pandemic. Although he's lonely, he's telling himself that he's "too depressed and scattered" to be in a relationship. At the start of the session, he feels: sad, 90% panicky, 50% ashamed, 50% worthless 50% alone, 90% hopeless90% frustrated, 90% upset, 90%. Rhonda describes her skillful and compassionate TEAM treatment of this man, starting with the Magic Button, Positive Reframing, and Magic Dial, followed by Identify the Distortions, the Paradoxical Double Standard Technique, and Externalization of Voices (including the Acceptance Paradox, the Self-Defense Paradigm, and the Counter-Attack Technique, or "Cat") Rhonda brings these techniques to life in a description of a depressed man she recently treated who's been divorced for 2 to 3 years, and living alone due to the Shelter in Place orders during the Covid-19 pandemic. Although he's lonely, he's telling himself that he's "too depressed and scattered" to be in a relationship. At the start of the session, he feels: sad, 90% panicky, 50% ashamed, 50% worthless 50% alone, 90% hopeless90% frustrated, 90% upset, 90%. These techniques were tremendously helpful, and at the end of the session, he no longer believed his negative thoughts about himself and his negative feelings all fell to zero. He recovered, essentially, in one extended (3-hour) TEAM therapy session. David and Rhonda discuss the impact of this type of experience on the therapist as well as the patient. Obviously, the patient feels fantastic, but Rhonda said she also felt "rejuvenated," with much warmth and kindness. I (David) always feel this as well at the end of an amazing session. Rhonda and David

Today, the Cognitive Distortion Starter Kit Continues with Jumping to Conclusions Rhonda opens today's podcast by reading beautiful email comments from Kevin Cornelius and Thai-An Truong. Both are dear friends and colleagues of Rhonda and David. Then Rhonda and David discuss Jumping to Conclusions, which is the fifth cognitive distortion. It's defined as jumping to conclusions that aren't necessary supported by the evidence. There are two common forms: Fortune Telling and Mind-Reading. Fortune-Telling: You tell yourself that bad things are about to happen. There are two common examples: Hopelessness: You tell yourself that things will never change, that you'll never recover, or that your problems will never be solved. David explains why this distortion is impossibly distorted and virtually never true. And yet, when people are depressed, they nearly always fall victim to the belief that things will never change. It's much like being in a hypnotic trance, because you are telling yourself and believing things that can't possibly be true. Anxiety: You make catastrophic predictions that gradually exaggerate any real danger. All anxiety results from this distortion. For example, if you have a fear of flying, you may be telling yourself that the plane could run into turbulence and crash. Anxiety is also a self-induced hypnotic trance, because you are giving yourself and believing highly irrational messages. For example, one of David's graduate students screamed loudly when she saw his meek little kitten, Happy, because she had a cat phobia and was telling herself that cats are extremely violent and dangerous. Mind-Reading: You assume that you know what other people are thinking when you really don't. There are three common examples: Social Anxiety / Shyness: For example, other people are judging you and can see how anxious you are. You may also assume that other people rarely or never get anxious and that they wouldn't be interested in you. Relationship Conflicts: You may tell yourself that the other person only cares about himself/herself and that s/he is intentionally being "unreasonable." You may also do the opposite type of mind-reading and assume that others are quite impressed with you when they're actually turned off or feeling annoyed with you. Anxiety: You make catastrophic predictions that gradually exaggerate any real danger. All anxiety results from this distortion. For example, if you have a fear of flying, you may be telling yourself that the plane could run into turbulence and crash. Anxiety is also a self-induced hypnotic trance, because you are giving yourself and believing highly irrational messages. For example, one of David's graduate students screamed loudly when she saw his meek little kitten, Happy, because she had a cat phobia and was telling herself that cats are extremely violent and dangerous. Depression: You tell yourself that nobody loves you or cares about you. Many of the Truth-Based Techniques can be useful, such as Examine the Evidence, the Experimental Technique, or the Survey Technique. Motivational Techniques like Positive Reframing can be tremendously helpful. And Role-Playing Techniques like Externalization of Voices with the Acceptance Paradox can also be very useful. David and Rhonda play a short audio clip from the treatment of a severely depressed man named Bradley with a history of extreme abuse growing up. He is struggling with feelings of hopelessness, which he rated at 80 (on a scale of 0 to 100) due to these two thoughts: I'm damaged beyond repair so nothing can help. Psychotherapy homework can't possibly help so there's no use trying it. Prior to the audio clip, David and Bradley have done Positive Reframing asking: What do your negative thoughts and feelings show about you and your core values that is beautiful and awesome? What are some advantages, or benefits, of your negative thoughts and feelings? David and Bradley then attack his negative thoughts using a variety of role-playing techniques, with many role reversals. By the end of this approximately 13-minute excerpt, Bradley no longer believes these two thoughts and his feelings of hopelessness have dropped to zero. We are incredibly grateful to "Bradley" for giving us permission to publish this very personal and inspiring audio clip! Thanks for listening! Rhonda and David

On February 24, 2020 we published Podcast 181, "Live Therapy with Sarah: Shrinks are Human, Too!" This was a live session with Sarah, a certified TEAM-CBT therapist, conducted at my Tuesday psychotherapy training group, because Sarah was struggling with intense anxiety, bordering on panic, during therapy sessions with her patients. It was a phenomenal session with outstanding results. The Hidden Emotion technique was the main focus of that session, bringing to conscious awareness some feelings of anger and resentment that she'd been sweeping under the rug. This is a common cause of anxiety. But a month or so after that session, Sarah relapsed in a big way, so I agreed to treat her again during the psychotherapy training group at Stanford, and Dr. Alex Clarke was my co-therapist. This time, we used very different treatment techniques. Once you've recovered, the likelihood of relapse is 100%--that's because no one can be happy all the time. We all hit bumps in the road from time to time, and when you do, your "fractal" will come into prominence again. This means that the same kinds of negative thoughts and feelings will return in an almost identical form. This can give you the chance to defeat them again and strengthen the positive circuits in your brain. That's exactly what happened to Sarah. Approximately one month after the first treatment session, she had a viral infection, and began taking large amounts of Advil to combat the symptoms. This led to severe feelings of nausea, followed by panic. Multiple trips to the doctor failed to reveal any diagnosable cause for her somatic symptoms, aside from the possibility of Advil side effects. However, the discomfort was so severe that she panicked, fearing that she had a more severe medical problem that the doctor had overlooked. She lost 13 pounds over the next two months, and requested an emergency TEAM-CBT session, which Dr. Clarke and I were very happy to provide, since live work almost always make for superb teaching. If you take a look at Sarah's Daily Mood Log, you'll see that the upsetting event was waking up Sunday morning still sick and anxious for the 100th day in a row. She circled nine different categories of negative emotions, and all were intense, with several in the range of 80 to 100. and she had many negative thoughts, including these. Please note that she strongly believe all of these thoughts: Negative Thoughts % Now 1. I should be able to defeat my anxious thinking and reduce my suffering. 95 2. If I can't heal my own anxiety, I'm an inadequate hack of a TEAM-CBT therapist. 95 3. I was strong, confident, vivacious. Now I'm fragile, weak, and self-doubting. 100 4. My anxiety is slowing me down—I should be able to do more and take on more. 100 5. Something serious is wrong with my stomach, but now with Covid-19, I won't be able to get medical intervention and testing. 70 6. I'm not as effective in my clinical work when I'm upset and anxious. 85 7. I might get panicky during a session and screw up. 80 8. I should always do more. 85 After empathizing, I asked Sarah about her goals for the session. She said she wanted greater self-confidence and less anxiety, and said her husband had theorized that if the anxiety disappeared, her somatic symptoms would also go away. But when we did Positive Reframing, Sarah was able to pinpoint more than 20 overwhelming benefits of her intense negative feelings, including many awesome and positive qualities and core values that her negative thoughts and feelings revealed about her. This always seems to be a shocking and pleasant discovery for the patient! At this point, we used the Magic Dial to see what Sarah wanted to dial her negative feelings down to, as you can see here. Then we went on to the Methods portion of the session, using techniques like Identify the Distortions, Externalization of Voices, Acceptance Paradox, and more. We also had to revert back to the Assessment of Resistance once again when Sarah began to fight strenuously against giving up her self-critical internal voice. We did a Cost-Benefit Analysis on the advantages and disadvantages of being self-critical and not accepting her fragileness, weaknesses, and flaws. Once we "sat with open hands" and listed all the reasons for her to continue criticizing herself, she suddenly had a change of heart and really poured herself into crushing her negative thoughts. It was interesting that as she began to blow her negative thoughts away, she suddenly got hungry for the first time in months! If you click here, you can see how she felt at the end of the session. It was a mind-blowing session, with much potential for learning. Rhonda, Dr. Clarke and I hope you enjoy it! Here were some "teaching points I sent to the tuesday group members after the session. This could not have been done in a single session. At least in my hands, a two hour session is massively more cost-effective than a bunch of single sessions. But even then, you have to have a plan and move quickly. Although you all said wonderfully admiring things to our "patient" during the E = Empathy phase of the session, few or none of you used Thought Empathy or Feeling Empathy, which is vitally important. I thought that Fabrizio did a magnificent job with "I Feel" Statements, expressing genuine warmth and compassion. As usual, resistance was the key, and could not have been overcome with efforts to "help" or attempts to use more M = Methods. Learning the dance of reverting instantly to A = Assessment of Resistance is key (revisiting this when the patient resists during M = Methods. But this requires "sensing" that the patient is resisting during Externalization of Voices, for example. You have to kind of "smell" what is happening, and then suddenly change direction. You also have to be able to "see" that the patient is absolutely committed to some underlying schema or belief, like "I should always be strong and vivacious," etc. The Assessment of Resistance cannot just be an intellectual exercise, as it might then revert to "cheer-leading." Emotion and tears are crucial, and amazing work was done by Sarah, our "patient," during the tears. She gave herself compassion at that moment. But tears alone without the structure would not have had nearly the impact. Skillful therapy integrates multiple dimensions at the same time. It cannot be formulaic. It's an art form, based on science, and it is data-driven, based on the patient's ratings at the start and end of the session. During the Externalization of Voices, I would recommend that you NEVER settle for a "big" win. Shoot for huge, and stick with the same thought for as many sessions as necessary to get to "huge." During the role playing I switched back and forth from Ext of Voices to Paradoxical Double Standard and then back frequently, as they both draw on different sources of pretty incredible healing power. As a therapist, I never give in to a patient's feelings of hopelessness, because rapid and dramatic recovery is usually possible. Relapse Prevention Training (RPT) will now be necessary, since NTs always return. RPT only takes about 30 minutes. I apologize for taking over last night, but felt my strongest commitment is to provide relief for the person in the "patient" role. Sometimes what you think of as your worst "flaw" (eg being suddenly weak and fragile and fearful) can be your greatest asset in disguise, once you accept your flaw(s). But we fight against acceptance, thinking that if we beat up on ourselves enough, something wonderful will happen. And, of course, the self-criticism can sometimes reap big dividends. At the same time, I try to remind myself that self-acceptance is the greatest change a human being can make. The goal of therapy is not just feeling somewhat better, but getting to enlightenment and joy. That's what happened tonight! After the session, I received this awesome email from Sarah: Thank you from the bottom of my heart, David, Alex, and all members of our training group who were present tonight. Such beautiful contributions from all, and I appreciate so deeply this 2nd opportunity to do personal work, especially given that we are ALL going through difficulties during this Covid-19 crisis (or in general). I feel so much lighter, even enlightened, ate some pot roast for dinner (What??? I haven't had an appetite for something like that in a LONG time... and find myself looking forward to my sessions with my patients tomorrow). And I also know I'll have moments of relapse, but I really felt like I finally defeated those thoughts and especially the core belief. Stay healthy and safe everyone, I look forward to opportunities in the future when we reunite, to be in support of YOU. Best, Sarah Rhonda, Alex and I want to thank you, Sarah, once again, for your tremendous courage and generosity! David and Rhonda

"I don't matter!" Did you ever feel like you aren't important? Did you ever feel like you don't matter? These thoughts are extremely common and can be extremely painful. I know from my clinical experience over the years, with more than 40,000 hours of therapy with people struggling with mild to extreme depression and anxiety. I know from personal experience as well, because I've been there personally at times! And one of the reasons I love doing therapy is because of the joy of helping someone transform these feelings of inadequacy and tears into feelings of joy and exuberance, and even laughter. Today, my highly esteemed colleague, Matthew May MD, and I, work with our highly esteemed and beloved colleague and podcast host, Rhonda Barovsky, on concerns that emerged when a scheduling difficulty made it difficult for Rhonda to join a podcast recording on "The Phobia Cure" which was going to feature Matt May MD doing live exposure with a colleague named Danielle who has an intense fear of leeches. I suggested that Matt, Danielle and I could do the podcast without Rhonda, to save her from having to commute from her office in Walnut Creek, California to the "Murietta studios" twice in one week. (It's a 90-minute commute in both directions, and sometimes traffic makes it even worse.) When Rhonda read this email, she was flooded with negative emotions, which you can see on pages 1 and 2 of her Daily Mood Log at the start of her session. As you can see she felt down, anxious, ashamed, inadequate, rejected, self-conscious, angry, jealous, and more, and these feeling were intense. Have you ever been suddenly and unexpectedly triggered like that? What triggered Rhonda's feelings? According to the TEAM-CBT treatment model, our negative feelings are not the result of what happens, but how we think about it. So, what were the thoughts that triggered Rhonda's angst? Take a look at the negative thoughts on her Daily Mood Log. As you can see, she was telling herself that She didn't matter and wasn't important. David didn't value her. She shouldn't have such strong negative feelings, like jealousy. The people listening to the podcast (like you, for example) will think she looks like an idiot and will judge her. She shouldn't be taking up time and space on the podcast in the "patient" role again. One of the things I like about the TEAM model is that it gives us a clear blueprint about how to proceed. One of the things I love about Rhonda is her openness, vulnerability, courage, and intense desire to teach and reach out to others, like yourself. And one of the things I admire so intensely about Matt is his tremendous kindness and compassion which are coupled with extraordinary technical skills. I feel very blessed to have Matt and Rhonda as colleagues and friends! In the podcast, we go through the TEAM model, step by step, starting with T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. We encountered some tears, some memories of childhood and tons of laughter as well. During the Assessment of Resistance, we used the Straightforward Invitation, Miracle Cure Question, Positive Reframing, and Magic Dial. To me it is always surprising to see how many positives are embedded in our so-called "negative" feelings and "negative thoughts." Positive Reframing nearly always eliminates resistance and opens the door to rapid change. You can look at Rhonda's Positive Reframing list on page 5 of the attachment. You can also take a look at her Emotion's table when she filled in the Goal column on page 3 of the attachment. The first thought Rhonda wanted to challenge was "I don't matter," and we started with the Downward Arrow Technique to identify the Self-Defeating Beliefs that gave rise to this thought, as you can see on page 4 of the attachment. Rhonda also told a moving story about her father, and how her belief that she was not important may have gotten started. She also told a beautiful story about reconciling with her father eight years before he died. We used several methods to challenge and crush the thought, "I don't matter," including Identify the Distortions, the Double Standard Technique, the Externalization of Voices, the Feared Fantasy, the Acceptance Paradox, and Examine the Evidence to crush this thought. Several role reversals were necessary before Rhonda knocked the ball out of the park. The first negative thought is generally the most difficult to crush. Once Rhonda no longer believed this thought, she could easily challenge and defeat the rest of her negative thoughts as well, resulting in a dramatic transformation in how she was feeling, as you can see on page 3 of the attachment. It seems like when you crush one negative thought, there is a sudden change in the brain, as if the negative circuits get turned off and the positive circuits get turned on. You will have the chance to hear this first hand when you listen to the live session. If you'd like to take a peak at Rhonda's final Daily Mood Log, you'll see how she challenged all the rest of her Negative Thoughts. (David, link to final DML when you get the final version from Rhonda.) To review Rhonda's Evaluation of Therapy Session, click here. Although this podcast was long (roughly two hours), it seemed like very little time had passed because the experience was incredibly engaging and rewarding. Rhonda, Matt and I hope you enjoyed it as well, and hope it gave you some help as well, if you—like the rest of us—have ever struggled with the fear that maybe you don't matter, or aren't important, either. Let us know what you think, and thanks for listening today! Rhonda, Matt, and David PS Following the podcast, Matt and I received this beautiful email from Rhonda: Dear David and Matt: My thanks to you both for an incredibly powerful experience. I am not enough of a poet to describe my experience and gratitude to you both. But you helped me tackle something that has been painful for me for such a long time! I am grateful and humbled by your brilliance and your commitment to me Rhonda

This is the fourth in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Mental Filtering and Discounting the Positive. (This will be the last Episode recorded remotely with poor sound quality. We thank you for your perseverance listening to it, and guarantee better sound quality in the future with our new recording equipment.) Mental Filtering, You focus on something(s) negative, like a mistake you made, and ignore or overlook the positives. This is like the drop of ink that discolors the beaker of water. Discounting the Positive(s). this is an even more spectacular mental error. You insist that the positives about yourself or others don't count. In this way, you can maintain a uniformly and totally negative view of yourself, the world, or other people. David and Rhonda discuss the fact that humans can be very biased in our perceptions of things that are emotionally charged. For example, if you are firmly committed to some belief, you might look for evidence that supports your belief, and discount evidence that contradicts your belief. Similarly, if there is someone you strongly admire, you may selectively focus on the positive things they do or say, and discount or dismiss things they do or say that might be quite offensive. And when you're ticked off at somebody, you probably focus on all the things they do or say that turn you off (mental filtering) and discount the positive things that they do or say. For example, when they say something kind or supportive, you might think, "S/he doesn't mean it," or "isn't being genuine. They're just acting fake." In this way, you convince yourself that he or she really is "bad." When you're depressed or anxious, you'll do this to yourself as well, thus intensifying your negative thoughts and feelings. For example, a teenager with extremely intense depression, strong suicidal urges, and anger told me that human beings were inherently selfish, insensitive, and bad. When I asked her how she'd come to this conclusion, she described seeing some kids in her dormitory who were joking in a cruel, insensitive way about girl with depression, and said that if you're looking for her, you can probably find her sitting on the edge of her dormitory window, meaning that she's probably about to jump. She also described seeing a homeless man on her way her therapy session, and said that no one really cared about him. Of course, these observations were at least partially valid, since human beings certainly DO have the capacity for great self-contentedness, insensitivity, and cruelty. But was she involved in Mental Filtering, and focusing only on the negatives? I asked her if she could think of any times in the past several weeks when someone had been cruel or insensitive to her. She couldn't think of a single instance. David and Rhonda provide additional examples, some personal, of Mental Filtering and Discounting the Positive, and suggest techniques that can be helpful when combating these distortions, including Positive Reframing, Examine the Evidence, the Straightforward Technique, and Double Standard Technique. David tells a moving story that he also told on his Tedx talk in Reno, about an elderly Latvian immigrant who made a suicide attempt because she thought she'd never accomplished anything worthwhile or meaningful. In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Jumping to Conclusions. David D. Burns, MD / Rhonda Barovsky, PsyD

This is the third in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Overgeneralization. There are two common forms of Overgeneralization: You generalize from some specific flaw or failure to your "Self." So, instead of telling yourself that you failed at this or that, you tell yourself that you are "a failure" or "a loser." You generalize from right now to the future, using words like "always" or "never." For example, you may tell yourself, "Trisha (or Jack) rejected me. This always happens! I must be unlovable. I'll be alone forever." Overgeneralization is also one of the most common cognitive distortions, and it causes depression as well as anxiety. I believe it is impossible to feel depressed or hopeless without Overgeneralization. The antidote to Overgeneralization is called "Let's Be Specific." Instead of thinking of your self as a "bad mother" or "bad father," you can focus on the specific thing you did that regret, like shouting at your kids when you were upset. Then you can think of a specific plan to correct this problem, like talking things over with your kids and letting them know that you love them and feel badly that you snapped at them. David and Rhonda also talk about the idea that abstract concepts like "worthless" or "bad" or "worthwhile" or "good" human beings are meaningless. Good and bad thoughts, feelings and behaviors certainly exist, but there is no way to measure or judge the value of a human being. In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Mental Filter and Discounting the Positive. David D. Burns, MD / Rhonda Barovsky, PsyD

Rhonda begins by reading several brief heart-warming endorsements from listeners like you. We are grateful for all of your kind and thoughtful emails endorsing our efforts! Announcement: My upcoming one-day workshop with Dr. Jill Levitt on the "Cognitive Distortion Starter Kit" on May 17, 2020 WILL happen. It will be exciting and entirely online so we hope you can join us from wherever you are. See the write-up below. We are joined in today's podcast by Michael Simpson, who was among the first to contract the Covid-19 virus in New York. Michael was the star of Feeling Good Podcast #169: More on Social Anxiety. The Case for Vulnerability. I have repeatedly pointed out that our feelings do NOT result from what happens—but rather, from our thoughts about what's happening. This idea goes back at least 2,000 years, to the teachings of Epictetus, but people still don't "get it." People still think that negative events can have a direct impact on how you feel. But that belief makes you the victim of forces beyond your control, because we cannot, for the most part, change what happens—there's no way we can snap our fingers and make the Covid-19 virus disappear, but we CAN change the way we think about it. I have also pointed out that the negative thoughts that upset us when we're depressed and anxious will nearly always be distorted and illogical—remember, depression and anxiety are the world's oldest cons! But is this really true? Michael explains that when he contracted the Covid-19 virus on March 12, 2020, his first reaction was not fear, but excitement because he thought, "I'm getting it early, and when I recover, I'll probably have some immunity." But he WAS fearful. Of being intubated? Of a long hospital stay? Of death? No! What were his negative thoughts? Michael was telling himself things like this: People will shun me because I've got the virus. People won't want to hang out with me any more. People will judge me as weak and unappealing. Women won't be interested in me. My friends won't want to talk to me. These thoughts triggered powerful feelings of shame and anxiety. Can you see any of the familiar cognitive distortions in Michael's thoughts? Here are a few of the ones I spotted: Mind-Reading: Thinking you know how others are thinking and feeling without any real evidence: Fortune-Telling: Making frightening predictions that aren't based on any real evidence. Emotional-Reasoning: Reasoning from how you I feel. Michael feels anxious and ashamed, so he thinks others really will judge and reject him. Should Statements: Michael seems to be telling himself that he should be far better than he is to be loved, admired, and accepted by others. Self-Blame: Michael seems to be beating up on himself and telling himself that he's not good enough. Michael describes his decision to start posting his symptoms and insecurities on Instagram as a way of testing his fear which he described as intense. To his surprise and relief, he received something like 150 responses that were overwhelmingly loving and supportive. Michael was so excited by this feedback that he is thinking of starting his own podcast, where his guests will openly discuss vulnerable and personal topics. We look forward to that! I think it could be quite popular because so many people feel lonely and anxious due to hiding how they really feel, and putting up a false front to the world. Michael also expands a bit on David's concept of "fractal psychotherapy." That's the idea that all of our suffering results from one tiny pattern of irrationality that repeats itself over and over in many different situations, and ever single time you get upset—whether it's depression, anxiety, anger—it will be that same fractal flaring up again. Michael said that his fractal is "others will judge me and leave me." Other fractals might be "I'm defective," or "I'm not important," or "I'm inferior to others." The goal of therapy is to give you specific skills that you can use to blast your own fractal every time it's causing problems for you. On a future podcast, (May 25, 2020) we will, in fact, do live therapy with a professional woman you might recognize who had the belief that she wasn't important. So stayed tuned!

This is the second in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions I first published in my book, Feeling Good: The New Mood Therapy. Today, we focus on All-or-Nothing Thinking. that's where you look at the world in black-or-white categories, as if shades of gray do not exist. For example, if you're not a complete success you may tell yourself that you're a complete failure. All-or-Nothing Thinking is one of the most common cognitive distortions, and it causes or contributes to many common forms of emotional distress, including: perfectionism depression Social anxiety-- performance anxiety public speaking anxiety shyness hopelessness and suicidal urges anger, relationship conflicts, and violent urges habits and addictions and more However, this distortion can be also be helpful to you, and may reflect some of your core values. For example, your perfectionism shows that you have high standards, and won't settle for second-best may motivate you to work hard and do excellent work prevents you from glossing over your failures and mistakes intensifies your emotional life, which may feel like a glorious roller coaster ride, with intense ups (when you do well) and equally intense downs (when you fall short.) So, before you can challenge a negative thought with this, or any distortion, you'll have to decide why in the world you'd want to do that, given all the benefits of your negative thoughts and feelings. One of the possible down sides of All-or-Nothing Thinking is that it simply does not map onto reality. There is little in the universe that is 100% or 0%. Most of the time, or even all of the time, we're somewhere between 0% and !00%. For example, this podcast is not incredibly fantastic, or absolutely horrible. It is somewhere in-between, and will hopefully be of some value to you. While it clearly won't solve ALL of your problems, it may be a useful step forward. We describe a number of example of All-or-Nothing Thinking, including a physician who was trying to diet and ended up binging on a half gallon of ice cream, and a suicidal young woman with incredibly severe depression who was involved in self-mutilation. There are many ways of crushing the negative thoughts that contain All-or-Nothing Thinking, including Thinking in Shades of Gray. Although that might sound rather drab in comparison to the drama of All-or-Nothing Thinking, you may discover that the world becomes far more colorful when you learn to think in shades of gray! In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Overgeneralization. David argues that Overgeneralization is arguably the cause of all depression and much anxiety, and that the first person to recognize and solve this dilemma was the Buddha, 2500 years ago. More on that topic next week! David D. Burns, MD / Rhonda Barovsky, PsyD

On April 9, 2020, David and Rhonda did a live TEAM-CBT session with Dr. Taylor Chesney, a former student of David's who is now the head of the Feeling Good Institute of New York City. Her husband, Gregg, is an ER / ICU (Emergency Room / Intensive Care) doctor in New York, and she was terrified he might contract the corona virus and die. Gregg was also terrified, as he had to intubate two of his colleagues who are struggling in the ICU, and recently had trouble breathing. He is working long hours and lives in a separate apartment to protect Taylor and their three young children. The response to that podcast was extremely positive. Here's an email from a therapist in India, Nivedita Singh: Dear Dr Burns, Rhonda and Taylor, Just finished listening to your 4th podcast of the Corona series. What an emotional roller coaster learning and healing journey it's been. Can never ever thank you enough. Living far away in India and watching the Corona story unfold on the international news channels has been overwhelmingly scary for most of us, especially those who have our kids attending different schools in the United States. They share their fears and anxieties or protect us (their parents) by withholding it ... both of which makes us feel helpless and fills us with dread. The podcast today built some amazing perspective. Taylor is a Braveheart to Gregg being a Superhero. The podcast was so pure, had such integrity and absolute raw honesty! It required great courage from Taylor to allow her vulnerability to surface and an equal amount of brilliant skills set by both the therapists to communicate empathy that soothed the right spot not just for Taylor but for everyone of us across the globe who are dealing with the pandemic. When you addressed the distortions you were addressing all of us and our anxieties.The role play method had us confronting our own demons! Yes! All of us on this planet who have families stranded somewhere ... who are battling the virus ... or fighting in the front-lines, felt therapeutically addressed. I personally found myself choking when Taylor did, relaxing when she relaxed and found myself to be gripped by fear when she became vulnerable again. I was on the rollercoaster with her. By the time the podcast drew to an end I could sense my shoulders relaxing ... my breathing getting even and my fists unclenching. Something in the head or somewhere inside of me felt right. I insisted my family and friends listen to the podcast ... and the unanimous feedback was that plenty of pennies dropped for all of us at different times in the podcast. You, Dr Burns and Rhonda made all of us feel less anxious, less fearful and more in control of our emotions; and also compassionate and super, super proud of the Greggs and Taylors of the world. I am extremely grateful to Taylor (who I have met as a beautiful and driven young professional; and I got to see the devoted mum and wife in her) for letting us in to be a part of her journey. Wish her and her family lovely times ahead.This too shall pass ... Stay safe. Take care. Warmly and even more awestruck (by you Dr Burns). Thank you again for giving us TEAM. Nivedita Singh (Your biggest fan this side of the Pacific). One week after the recording of that podcast, Taylor learned that Gregg, has, in fact, been struck by the Covid-19 virus, so her worst fear has become a reality. What do you think happened? Did the monster have no teeth, as David sometimes argues? Listen to this powerful podcast and you will find out! David describes several patients he treated who had intense fears of going bankrupt, who did, in fact, go bankrupt while in treatment. What happened when their worse fears were realized--and why? The cognitive model states that only our thoughts can upset us, and that the thoughts that upset us will be distorted. Depression and anxiety, David argues, are the world's oldest cons. Could the cognitive model be correct in this era where we are fighting something that IS real and IS dangerous? During today's podcast, Rhonda asks Taylor about her romance with Gregg, how they met, what happened on their first date playing frisbee in Central Park, and how their relationship evolved. Taylor recalls the psychodynamic training she received during her graduate work in clinical psychology, which was all about listening without teaching patients to use specific tools to change. Taylor's teachers explained that there was no point in trying to change until you discovered the cause of your problems. Gregg did not agree and urged Taylor to think more about helping her patients change their lives, using specific tools. After all, a medical doctor doesn't just help patients understand why they have pneumonia--the goal is rapid cure whenever possible--understanding the causes doesn't necessarily help or lead to change. In addition, the causes of all psychiatric problems are currently unknown, so the focus on endless talk to understand the causes of depression, anxiety, relationship problems or habits and addictions could even be seen as nonsensical. Taylor had a chance to check this out when she and Gregg moved to California shortly after they were married in 2012. Gregg had a two-year Critical Care fellowship at Stanford, and Taylor joined Dr. Burns TEAM-CBT weekly training group at Stanford to prove that the rapid-change techniques wouldn't work. But they did work. She concluded that TEAM-CBT really IS all it's cracked up to be and fell in love with TEAM. The rest his history. When Taylor and Gregg returned home to New York two years later, she founded the highly acclaimed New York Feeling Good Institute. During today's interview, Taylor is caring for her three beautiful and charming children, but they all want mommy's attention. It's obviously an overwhelming job, on top of her clinical work with patients, and most moms face similar challenges. Taylor provided several tips for moms who may be listening to the show from home during these days of "Shelter in Place" orders, restricting people all around the world to their homes. 1. Emotional Intelligence Training. I try to check in with each child every day to get an emotional read on how they're doing. This varies for each child based on their age. For my 6 year old, we use the Yale Mood Meter since that's what he uses in school. For my 4 year old, I name a few emotions such as happy, angry, sad, and ask her what's a time today she felt any of those. For my 2 year old, I try to find a time where he's thrown a toy or pushed a sibling and mention an emotion he might be feeling such as happy, sad, or angry, and act it out. He often just laughs but it starts to help him develop his emotional intelligence. 2. Scheduling. Every evening I write out our daily schedule for the following day. This helps to keep me organized, but also helps my children know what to expect each day and gives us a flexible guide for the day. This includes things such as meals, brushing teeth, nap time, screen time, social time, exercise, and academics. Certain activities are required, while others are more flexible. Since my kids are just 2, 4, and 6 years old, there are fewer "requirements" but over time I plan to try to push them a little more to stick to the schedule. Since social distancing and being home is something we have not had any practice with, I want to ease into our new schedule. 3. Independent play. I schedule some time for independent play each day. This is a skill I've really been focusing on with each child, and find that it's important for them to learn to play by themselves. Social playing is great, but learning to be alone is important as well! For my 6 year old the goal is 20 mins, for my 2 year old it's 10 mins with minimal help from mommy. We make it a fun game, and they get a small reward if they are able to reach their goal. The rewards could include a hug, high-five, praise, stickers or even a new action figure. I try to switch the types of rewards to keep it fun and interesting, and also so they're not just doing it so that they get X privilege or Y toy. 4. Little Steps for Big Feets. I try to set small, manageable goals each day for each child as well as myself. Sometimes it's something I impose on the kids such as "today each of you will help me with one chore, such as taking the garbage out, cleaning up your toys, washing the table, etc." At other times it's something they want to learn. For example my daughter wants to learn to write her name so for several days her goal was to practice writing her name four times. For me it's usually a small manageable goal related to work or house-cleaning. This is similar to David's principle of "little steps for big feets!" For example, instead of saying I'll clean my entire apartment today, I focus on one small goal that I can attain. Taylor gives an awesome example of how to use the Five Secrets of Effective Communication with small children, especially when they are angry or upset. This is an example every parent might want to emulate! And it's the first example I've heard of how to do this! Thanks for tuning in, and please let us know what you thought about today's program! Rhonda, Taylor, and David