Exploring the challenges of social anxiety, distinguishing avoidant personality disorder from depression, and managing severe anxiety without feeling like you will die. Discussing the impact of anxiety on relationships, therapy options, benefits and drawbacks of shyness, and embracing emotions like sadness for personal growth.

Mission Accomplished! Dear Feeling Good Podcast fans, I am profoundly sad to say goodbye to my beloved friend and terrific podcast host, Dr. Fabrice Nye, who is leaving the podcast to start his own show this spring. I wish him well on his new podcast he'll be releasing soon. I'll share the specifics when they become available so loyal fans can tune in and follow him! What a joyous experience it has been working with Fabrice for the last three years. He proposed the idea of a weekly podcast in the fall of 2016 and we produced episode #001 on October 27 of that year. Together we have been able to share TEAM-CBT with many enthusiastic listeners, and just exceeded more than 70,000 downloads monthly. Please join me in wishing him well! My feelings of profound loss are comforted by welcoming another dear friend and colleague, Dr. Rhonda Barovsky, our new host. Rhonda and I look forward to creating many more fabulous podcasts for all of you. Rhonda received her doctoral degree in Forensic Psychology from the Eisner Institute for Professional Studies in 2013. Throughout her career, she has been a champion of women’s rights and defender of the victims of childhood sexual abuse. Rhonda is the founder of the San Francisco Juvenile Sex Offender Treatment Program and has served as Director of San Francisco Family Court Services. She has also worked at the San Francisco Rape Treatment Center, providing crisis and short-term counseling for adult survivors of sexual assault and their families. Rhonda is a certified TEAM-CBT therapist and esteemed teacher. In her clinical practice, she focuses on TEAM-CBT for adults struggling with depression, anxiety disorders, and relationship problems. She brings warmth, enthusiasm and brilliance to her new role as host of the Feeling Good Podcasts: "I am extremely honored to be invited to host the Feeling Good Podcast with Dr. David Burns. Fabrice Nye has been a visionary, and his shoes will be impossible to fill. I hope to add to the joy and excitement of learning and teaching TEAM-CBT along with David and having lively and productive discussions.” Dr. Rhonda Barovsky Rhonda and I will be posting two surveys shortly on my website, www.FeelingGood.com, to find out more about you. I want to find out if you are a therapist or non-therapist, and what kinds of topics might interest you the most. And unlike some tech giants, we promise to keep your information totally confidential. We don’t sell information; we just want to do the best job we can for therapists and non-therapists alike, for free. If you are a "patient," we want to accelerate your learning and your recovery as well. If you are a "therapist," we want to help you improve you skills and your joy in your clinical work.  I put the words, "patient" and "therapist" in quotes, because the line between the two is very narrow indeed! As "therapists," most of us struggle at times with the same human dilemmas that our patients face. And as we do our own personal work, as therapists, we bring far more healing and compassion to our work with our "patients!" On the show, Fabrice and David share fondest memories of the show, and Rhonda talks about new directions as she becomes the host of the Feeling Good Podcast. Fabrice also gives some hints about his new show, which will be broadcast in French and English. Fabrice will describe and translate new developments in psychology research and relate the findings to our daily lives.  Thank you so much for your awesome support over the past 2 ½ years!

Today’s Ask David questions. Do depression and anxiety result from medical illnesses, like thyroid problems? Do we REALLY create our own interpersonal reality? What if you’re being raped? Are you saying that’s your fault? How can that be? I struggle with anxiety. Why is it a mistake to try to “calm down?” How do you deal with entitlement? I think my patients should do what I tell them to do! After all, I’m a highly trained professional! How do you deal with racism, sexism, and other societal barriers? What if the injustice is real and it isn’t “all in your head?” And here are the longer versions. Fabrice and I hope you enjoy these thoughtful questions submitted by listeners like you! 1. Barbara asks: 1) How are hypothyroidism, depression, anxiety, and bipolar disorder related, and (2) how are heart disease, depression, and anxiety related? 2. Mark asks: I'm one of your most avid listeners to your podcasts. I've listened to most of Feeling Good Podcasts as well as the recordings of your Facebook live broadcasts with Jill. I absolutely love your content and extremely grateful for your insights and the material you put out for free. I've heard you say numerous times how in interpersonal relationship problems we create the poor behavior we see in the other. At what point though, is a threshold crossed and you acknowledge the other in the relationship is creating problems? For example, if your client is being raped by their partner and is being threatened with violence if they dare leave, you wouldn't say to your client you're creating that kind of treatment from your partner. Obviously the above is a very extreme example, but what if its scaled back in terms of severity of abuse, stopping short of physical attacks and threats? Where does a line in the sand get drawn where you acknowledge the client is not creating the problems themselves? I'd deeply appreciate your reply! 3. Angela asks: I was intrigued by your comment in your podcast #88 on Role-Playing Techniques that “trying to calm down is a big mistake. . . then your emotions become your enemies,” but then you said, “that’s a good topic for another podcast.” I hope you do a podcast on that topic!!! I’m eagerly waiting to hear more about that! 4. Julio asks: I’d like to share my experience. I am a therapist and I suffered from, and am still working on, feeling inadequate. I frequently questioned “am I good enough to be a therapist?” “How can I help others if I have issues of my own?” After reading Feeling Good I realized I frequently jump to conclusions, engage in mind reading, and labeling whenever there is some uncertainty with my clients. At times I might even have blamed them when things didn’t go the way I thought they should go. I believe I do that to protect my ego, and I might have developed some cognitive distortions related to entitlement such as “I’m a therapist, people are supposed to do what I say” “I worked too hard and too long and potential employers better give me what I deserve” “Because I practice evidence-based therapy, I’m better than 99% of all therapists.” These entitled thoughts led me to become irate whenever someone didn’t act according to my expectations. I would vacillate between feeling angry and feeling depressed. I guess when I initially emailed Fabrice I was confused as to how my entitlement develops, but now I’m realizing that it comes from the same distortions that can cause depression. I didn’t know that distortions could produce depression and entitlement. I’m curious what you and Fabrice think about this. I thoroughly what you and Fabrice think about this. I thoroughly enjoy your podcast and often find myself re-listening to earlier episodes. 5. Holly asks: “ Burns: I have found tremendous value in your books and podcast. I have noticed that you discuss some emails/letters/etc. on your podcast and I have one I'd like to hear you discuss. What are your thoughts on dealing with racism, sexism, and other societal barriers? For example, it is not uncommon for people with dominant identities (white, male, physically able) to tell women, people of color, or those with physical challenges that their issues are all in their minds and that if they thought differently, then they would have different outcomes. I am an African-American woman and I don't believe this (the statistics on access to education, employment, and justice all suggest otherwise). What are you saying (if anything) in your writing, practice about thoughts related to injustice? Best, Holly So there you have it! Great questions, and keep them coming! Thanks, David and Fabrice

Debbie asks: Can you use TEAM-CBT to help people with medical disorders, such as Parkinsonism or Cancer? Here is the promised link to Stirling Moorey's book on Cognitive Therapy for cancer patients. Here is the link the first episode of live therapy with Marilyn, a woman who was diagnosed with Stage 4 lung cancer a couple days before her session with David and Dr. Matthew May.  You may also want to listen to podcasts 50 to 52 and 59, which also feature David and Matt working with Marilyn. Marilyn described these inspiring podcasts as mind-blowing! Mark asks: How can I help a depressed family member or friend who is passive and doesn’t want to do anything? Paul asks: How can I get over death anxiety? Sune asks: If you're super-shy, does this mean you have “Avoidant Personality Disorder?” What's the difference between garden variety shyness and a personality disorder? Sly asks: “Do you believe in the big five personality traits model? And will your therapy tools change these big five traits? I got a score of 67 on neuroticism, which means I am more prone to anger, depression, anxiety, and vulnerability, and tend to think about things in a pessimistic way. If I do the exercises in your books, and develop a more realistic outlook on myself and others, does it follow that my “personality traits” will get more or less changed?” According to Wikipedia, the “Big Five” are O = Openness to experience, C = Conscientiousness, E = Extraversion, A = Agreeableness, and N = Neuroticism, often represented by the acronym, OCEAN. Here's an important point I forgot to make on the podcast. According to Wikipedia, here's  the definition of "Neuroticism:" People with high neuroticism indexes are at risk for the development and onset of common mental disorders. . .  such as mood disorders, anxiety disorders, and substance use disorder, symptoms of which had traditionally been called neuroses." Can you see that this is a tautology? In other words, they ask you if you tend to have these kinds of symptoms, then they tell you this is "due to" some "trait" you have called "neuroticism." But they are defining "neuroticism" as people who tend to have more of these kinds of symptoms! It's circular reasoning.  I hope you can "see" this! The reason I mention this is they make it sound like they discovered some "trait" you have which causes you to have depression, or anxiety, and so forth. But they haven't! It's just a word game. In fact, scientists don't yet know the causes of any of these problems, and "traits" do not actually "exist."  Haike asks: What if you’ve battled your negative thoughts and self-defeating beliefs and still don’t feel happy? An absence of depression and anxiety does not necessarily mean more joy in life. How can you help people find out where they want to go in life, who they want to be, and what it is that brings them happiness?”

If you’re my patient, and you want help, I will ask you what specific problem you want help with. These are the four most common problems I see: depression, anxiety, relationship conflicts, or habits and addictions. Then I’ll ask you to zero in on one specific moment when you were struggling with that problem. For example, if you want help with depression and low self-esteem, I’ll ask you to describe one moment when you were feeling down. It could be any moment at all—it might even be right now, sitting in my office (or reading this text). Then I’d ask you to tell me exactly what you were thinking and feeling at that moment. You might be telling yourself, “I’m no good. I shouldn’t have screwed up! I’m always doing that! I’ll feel like this forever.” These thoughts actually cause the feelings of depression, shame, inferiority, and hopelessness. In contrast, if you want help with anxiety, I will ask you to identify one specific moment when you were feeling anxious, worried, nervous, frightened or panicky. For example, you might have been feeling shy and insecure at a party, or terrified just before you had to take a test or give a talk at work. Or it might have been a moment when you were having a panic attack and feeling like you were on the verge of passing out or losing control and going crazy. If you’ve been having trouble getting along with a friend or family member, I would ask you to describe one brief interaction you’ve had with the person you’re at odds with, and I’d ask you to write down one specific thing they said to you, end exactly what you said next. For example, a podcast fan told me that his wife said, “You never listen.” He responded by saying, “That’s not true! I’m listening to you right now.” He was puzzled when she got even more upset and then the argument escalated! I recently did a one-day workshop on the treatment of unwanted habits and addictions, like procrastination, overeating, excessive cell phone use, or drinking too much. I encouraged the audience members to focus on one specific moment when they felt tempted to procrastinate, binge, or have a drink, or give in to their habit / addiction, and to write down all the Tempting Thoughts that were going through their minds, like: Oh, that beer looks SO GOOD! I’ve had a hard day, I deserve it. I’ll just take one little sip. That can’t hurt! There’s a good basketball game on TV. It will be way more fun to watch if I enjoy a few beers! In each case—of depression, anxiety, a relationship problem, or a habit / addiction—I focus on one brief and specific moment when my patient was upset and having that problem. There are two reason for this concept of Specificity: When we understand what was happening at that one brief moment, we will understand everything of importance about that problem. As it turns out, all of your suffering will be encapsulated in that one brief example. So, when you understand why you were feeling depressed or panicky or whatever at that specific moment, you will understand everything you need to know about why you get depressed, or panicky, or whatever at any moment of your life. In addition, the moment you learn how to change the way you were thinking, feeling at that one brief moment, you will become enlightened, and you will suddenly grasp the solution to all of your problems. That’s because that one specific problem will simply repeat itself over and over, in slightly different disguises, every time you are depressed, or anxious, or arguing with a friend or family member, or struggling with temptations. So, once you understand the solution to that problem at one specific moment, you will understand the solution to that type of problem at any time in your life. For example, if you were having a conflict with a loved one, you will not only learn how to resolve that conflict at that specific moment, but you will learn how to resolve any conflict you have with that person, or with practically anybody. Fabrice and David link this Specificity concept to the amazing insights of the new branch of “fractal geometry.” Fractal geometry is a revolutionary form of mathematics in which a very simple formula, or shape, gets reproduced an infinite number of times. In the process, it morphs from a simple geometric shape and suddenly becomes a complex picture. For example, it may turn into a stunning green fern, or a gorgeous, multi-colored parrot, or a breathtaking landscape. But if you zero in on the tiniest piece of the picture, it will always look exactly the same—the same simple design that started the process. Similarly, in “fractal psychotherapy,” we zero in on one very brief moment of your life, but the formula—or error—that caused you to become upset at that moment will always be the very same error you make every time you feet inferior or anxious or angry or tempted. And once you’ve changed at that one brief moment, you really will experience enlightenment! And your entire universe will become enlightened as well! Fabrice provides another metaphor, that of a hologram. A hologram is a photograph that allows to display a fully 3-dimensional picture of an object. The hologram works differently from a regular photograph. Citing from Wikipedia, “When a photograph is cut in half, each piece shows half of the scene. When a hologram is cut in half, the whole scene can still be seen in each piece.” This remains true as you fragment the hologram into smaller and smaller pieces. So you could say that your problem is a kind of hologram of all the problems in your life, in a single moment so you can see the pattern that is repeated in many other situations. David provides an example of how this works, using an example provided by a podcast fan we'll call Janine. Janine was convinced that her husband couldn’t deal with feelings because he had “Asperger's / high level autism.” David asked Janine for a brief simple exchange between Janine and her husband. what, exactly, did he say to her, and what exactly, did she say next? That brief moment is all we need to understand her problem; and things suddenly began to look radically different when we examined how she responded to her husband! You can see the first two steps of Janine's Relationship Journal if you can click here. It turned out she was right--someone definitely WASN'T dealing with feelings? But who? You'll see two spiritual principles brought to life in the Relationship Journal. We create our personal reality at every moment of every day. We like to blame others for the problems in our relationships instead of pinpointing our own role in the problem. Intimacy, and enlightenment, require a painful death of the ego, or self. When you "look inward" for the cause of the problem, instead of blaming, you will find the answer you've been looking for--but the answer can sometimes be pretty painful. If you're willing to let your ego, or "self," die, you will receive a pretty awesome reward in heaven. But this heaven occurs when you are still alive! You'll see Rhonda model a more effective response using the Five Secrets of Effective Communication, as well as one of the advanced communication techniques called "Multiple Choice Empathy."  

In this role-reversal of the traditional Feeling Good Podcast, Dr. David Burns and his special guest, Dr. Rhonda Barovsky, interview Dr. Fabrice Nye, your beloved podcast host, on the topic of Mindfulness and Meditation, which are currently popular with the therapeutic community. Fabrice answers questions like these: What’s mindfulness? How does it differ from meditation? What’s the history of mindfulness as well as meditation? Did it originate with the Buddha, or did it date back even earlier? What are some of the goals and potential benefits of mindfulness? Why specific exercises can you do to develop greater mindfulness ? Why is mindfulness helpful? How does it work? Some people meditate in silence for prolonged times, like ten days, for example. What is the goal here? Are there any dangers of meditation? How does mindfulness differ from yoga, relaxation training, and self-hypnosis? Some people seem to love and benefit from meditation, and others find it uninteresting or even annoying. Why is this? What's the difference in these two groups of people? Is it okay not to be interested in meditation, or is something that everyone “should” do? The goal of mindfulness seems to be learning to deal more effectively with stressful thought and feelings. Does it deal with motivation and the resistance to change? TEAM-CBT makes us aware of the incredible importance of resistance, and provides many methods for reducing or eliminating resistance before you try any Method to “help” the patient. Does Mindfulness Meditation deal with resistance, or would it best be viewed as a method that can help individuals who are already strongly motivated to invest time and effort in their personal growth?

You CAN Defeat Shyness! Lately, I've gotten lots of emails from podcast fans who struggle with shyness, which is categorized in DSM5 (The Diagnostic and Statistical Manual of Mental Disorders) as "Social Anxiety Disorder." This is one of my favorite things to treat, since I struggled with practically EVERY type of social anxiety early in my life, so I really know how it feels and how to defeat it. It's incredibly common. In fact, when I give workshops for mental health professionals, I sometimes ask how many of them have struggled with shyness or public speaking anxiety, and nearly all the hands go up. This podcast will be the first of several on this topic, because it's so common and relatively easy to overcome--IF you have the courage! Here the are several different "flavors" of social anxiety recognized by the American Psychiatric Association, including: Shyness Public Speaking Anxiety Performance Anxiety (such as intense anxiety during a musical or athletic performance) Shy Bladder (or Bowel) Syndrome. This is the fear of peeing or pooing in a public restroom, for fear you'll freeze up or make too much noise and others will notice. Test Anxiety One common theme is the fear that others will notice your anxiety or poor performance and judge you. Another common source of suffering is shame of feeling like you are inherently flawed and will be seen as defective or even as insane by others. Sometimes, these fears become so extreme that they can significantly interfere with relationships and leisure-time activities as well as work. Dan is a podcast fan who courageously immigrated to the United States from Iran as a young man. When he arrived in America, he had little education and almost no knowledge of English. He also suffered from an extreme case of acne, which eventually cleared up, but left him with severe social anxiety. In spite of these problems, Dan worked hard, learned English, and became a top student in college and in graduate school as well, and went on to develop an excellent career. But in certain performance situations, such as public speaking or interacting with strangers, he panics and trembles and his heart races; his mouth twitches and his voice gets shaky, and he has thoughts like these: I'm about to lose control over myself. Others will see my symptoms and think I'm mentally insane. In spite of making Herculean efforts to control these symptoms, I have failed. I will never overcome this. I am defective for life. I will lose my job. David and Fabrice remind listeners that they cannot treat anyone through a podcast, and that there are large numbers of treatment techniques that can be extremely helpful in the context of a compassionate and skillful therapeutic relationship. Since Dan is seeing an excellent therapist, they suggest and illustrate five powerful Interpersonal Exposure Techniques that Dan might want to do under the supervision of his therapist, including: The Survey Technique Self-Disclosure The Experimental Technique Shame Attacking Exercises The Feared Fantasy Technique David and Fabrice also discuss how to address patient and therapist fears of using powerful exposure techniques, and how the avoidance of exposure can sabotage the treatment. They describe four techniques David as developed to help therapists with this, including: Dangling the Carrot The Gentle Ultimatum Sitting with Open Hands Fallback Position David describes "Reverse Hypnosis." This is where the patient hypnotizes the therapist into giving up on exposure thinking that it is "too dangerous," or that the patient isn't "ready" or is "too fragile." And speaking of anxiety, listeners might want to consider the upcoming workshop by David and his colleague, Dr. Jill Levitt, on the treatment of anxiety disorders on May 19, 2019. Check it out below! Also, I promised to post my list of 100 Shame Attacking Exercises, so here it is! It's not perfect, so please have low expectations. It does have some value.

Can the Five Secrets of Effective Communication Help Us in this Era of Intensely Polarized Politics? Clearly, the nation is intensely divided, and passions on both sides of the political divide are characterized by hostility, frustration, and mistrust. Can the Five Secrets of Effective Communication help us communicate with colleagues, friends and loved ones who may have radically different political beliefs? Find out on this edition of the Feeling Good Podcast, as the David and Fabrice respond to Eileen, a podcast fan who kindly allowed us to share her intensely painful conflict with her mother with all of you. Eileen’s mother is an ardent Trump fan, and Eileen is an equally ardent anti-Trumper, and there have been plenty of tears on both sides of the aisle! Eileen wrote: “How can you talk to someone with whom you fundamentally disagree? My Mom is a big fan of the current regime (Trump) and I’m horrified by what’s happened in the past two years and what’s coming. It’s hard for me to get past my rage at her. . . intensely distorted and not-reality based beliefs, fed by right-wing media. To be clear, she thinks exactly the same about my beliefs and information sources. I feel so stuck. . . and I would love to repair this relationship with her before she dies.” Can you identify with similar conflicts in your own family or circle of friends? I know that I can, and it’s quite painful. Fabrice and I will give you our take on a new approach to this widespread problem this Sunday! While you're listening, you can take a look at Eileen's Relationship Journal. You may also want to review the Five Secrets of Effective Communication as well as the three advanced communication techniques we discussed in last week's podcast. Let us know what you think after you've listened to the podcast!

Learning to use the Five Secrets skillfully requires strong motivation and lots of practice, but the benefits can be tremendous. The Five Secrets have transformed my clinical work as well as my personal and professional relationships. And they’ve also had a huge impact on my teaching. But there are even more communication techniques that can be immensely helpful. In this podcast, we discuss three advanced techniques: 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. David emphasizes that these techniques may look easy, but they are actually difficult to learn and require lots of practice as well as the mindset of humility, as well as a strong desire to develop a more loving relationships with the person you’re not getting along with. People who are serious about learning can read Feeling Good Together and do the written exercises while you read!

More Great Questions from Listeners Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself “booster shots?” Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do? Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good? Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, “My Mom thinks I should come to see you.” When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do? Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this “Do-Nothingism,” which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can’t do the psychotherapy homework, either! It’s a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve! Jim asks another related question: How about doing a podcast on psychotherapy homework? “What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks.”