Do you have trouble saying "no"? Lots of people do—and it can sometimes get you into trouble. In spite of many best-selling books on assertiveness, like Manuel J. Smith’s classic book, “When I Say No I Feel Guilty,” many people still have trouble saying no. For example, you may have led someone on in a romantic relationship because you were afraid of saying no and breaking the other person’s heart. Or, you feel burned out, because you're always giving, giving, giving because you can’t—or won’t—say no. Or, you may end up hopelessly over committed at work, putting in long hours and feeling secretly used and resentful, because you don't know how to say no. Sound familiar? In this Podcast, Fabrice and David interview Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Jill confesses that she sometimes has trouble saying no—to new referrals when her practice is full, to her family, who she loves tremendously, as well as colleagues who request this or that. David admits he sometimes has similar problems. There are lots of reasons why you may have trouble saying no. Some are negative, but some are actually positive, including: Conflict phobia. You are afraid that if you say no, the other person will get angry and annoyed with you. Fear of disapproval or rejection. You are afraid that if you say no, the other person will judge you, disapprove of you, or reject you. Perceived narcissism. You believe that other people will lash out if you don’t give in to their demands. Submissiveness. You believe that your role in relationships is to make others happy, even at the expense of your own needs and feelings. Joy / Love. Jill confesses that she often says yes to this or that request because she feels it will be fun, or because she doesn’t want to let the other person down. One example would be baking brownies for her sons when she’s exhausted. One consequences would be giving in, but resenting the person she’s saying yes to. Guilt. You may feel that if you say no, it means that you are somehow “bad,” and that it’s your duty to please other people. Achievement addiction. You say yes to almost everything because you think this or that activity will make you more productive and successful. Fabrice, Jill and David discuss many strategies for overcoming this problem, including: Empathy--as a therapist, you always want to start with empathy, without trying to "help." Motivational strategies such as the Paradoxical Cost-Benefit Analysis, Positive Reframing, or even the Straightforward Cost-Benefit Analysis. This is crucial to find out if patients really want to change before using methods to help them become more assertive. Punting. This is a delay strategy that David uses to get himself off the hook when feeling ambivalent about a request. For example, you can say, “I’m really pleased and honored that you’ve invited me to do X. I’m going to check with my schedule and see what might be possible, and I’ll get back to you.” Then, he has a day or two to work up the courage to say “no” in a kindly way. Write down your Negative Thoughts. when you're feeling compelled to say yes because you're feeling anxious or guilty, Ask yourself, "What am I telling myself?" Those thoughts will nearly always be distorted. Then ask yourself how you could challenge and talk back to those thoughts. Fabrice, Jill and David also discuss how to say no effectively and demonstrate this skill in a role-play with Jill that is surprisingly challenging! They also demonstrate the Feared Fantasy, a powerful technique to help patients say no, using Jill’s example. Her worst fear is that if she says no to colleagues, they will: Feel disappointed. Become angry and demanding. Will say they won’t work with her in the future if she says no. Will say they’ll get someone else to do whatever it is, and that Jill will miss out on all the fun. David and Fabrice play the role of colleagues from hell who put demands on Jill to do another podcast and then get upset when she tries to say no. The dialogue is quite entertaining and dynamic, and Jill finds it helpful, though anxiety-provoking. They also describe the importance of giving patients homework to actually say no between sessions to requests that are excessive or inappropriate.

Answers to Great Questions from Listeners Like YOU! Dylan asks: Do you believe in Freud’s “secondary gain,” in which patients resist change because they benefit from their symptoms? Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing? Ismail asks: Should I use the Daily Mood Log just when I’m upset, or at the end of the day, or when? Do I have to stop what I’m doing when I get negative thoughts so I can write them down and work on them? Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas. Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife? Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?  

This is David and Fabrice's top ten list for the worst errors therapists make. 1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists’ perceptions of how their patients feel, or feel about them, are not accurate. TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist’s ego, but has revolutionized clinical practice. In addition, TEAM therapists assess the patient’s perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance. 2. Trying to help, “save,” “rescue” or “reassure” patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be “sold” on anything. When patients are hurting, they want to be heard, not saved. In TEAM we do Paradoxical Agenda Setting before trying to “help.” We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient’s symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that’s positive and awesome, Then we raise the question: “Given all those positives, why in the world would you want to change?” This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago. 3. Reverse Hypnosis. Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy. Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure. Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person’s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy. 4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change. With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session. 5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today! I’ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they’ll still be just as angry, panicky, and they’ll still feel worthless! There is at least one notable exception to this rule. Most anxious patients are exceptionally “nice” and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety. 6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst’s feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst’s feelings are the complete creation of the analyst’s thoughts! And those thoughts will often be distorted and completely misleading. Therapist’s perceptions of how their patients feel are less than 10% accurate if you put it to an empirical test! If you ask patients, “How are you feeling right now,” and you ask therapists the exact same question, “How is your patient feeling right now,” the therapist’s answer will usually be way off base. The only way to find out is to use assessment instruments at the start and end of each session, like I described in the first answer above, on failure to measure. 7. Believing therapists should never express their feelings. I was trained never to reveal how I was feeling. But when you think about, that’s nutty! How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment. 8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. The causes of all psychiatric disorders are unknown. End of discussion. And yet, almost all therapists promote some fraudulent theory about causality. For example, what is the cause of depression? There are lots of theories, but none has been confirmed, and almost all have been disproven. For example, there is no evidence whatsoever that depression results from a “chemical imbalance in the brain,” or from “anger turned inward,” and so forth. Those are just theories that someone made up. I simply tell my patients that we don’t yet know the causes, but have really terrific treatment tools now for rapid recovery. That’s more than enough for the people I treat! 9. Confusing the process of therapy with a good outcome. For example, as a therapist, you could be doing really great job of listening, and give yourself high marks as a therapist because you believe in the importance of empathy, even though your patient is not improving. Therapists have all kinds of things they’ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you’re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you’re not really “helping.” 10. Believing that insight will lead to change. This has only happened once in my career! It was a woman who discovered that she thought she always had to be submissive servant in intimate relationships. Not surprisingly, she always felt burned out and broke up with her partners after a while. She said that the discovery of this pattern when we did the Interpersonal Downward Arrow Technique during our first and only session transformed her life. But usually, much more will be required. That’s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction—I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity! Now, here's the 60 thousand dollar question. Can therapists learn to stop making these errors? In most cases, the answer is NO! It's not so much a problem with intelligence or aptitude, although those are important factors, but it has to do with motivation. Many therapists simply do not want to change, and are committed to what they're already doing, in much the same way that people are committed to their religious beliefs, which they are unwilling to challenge. That's why it is so much easier to train young therapists, whose minds are still open, as well as lay people who do not have so much prior "training" they have to overcome. Well, that's my cynical side coming out, and I apologize! Still, I think I'm right for the most part. Hey, if you liked my rant, I have at least five more common therapeutic errors on my list, so let Fabrice and me know if you'd like to hear about therapist errors in a future podcast. In addition, if you'd like to add to our list of therapist errors, let us know what your "favorite" (or most annoying) therapist error is!  

How can you get rid of Self-Defeating Beliefs? Although any of the 100 + TEAM-CBT methods can be used to modify an SDB, four methods will be highlighted in today's show. Cost-Benefit Analysis Semantic Method Experimental Technique Feared Fantasy For more information on how to change SDBs, you might want to watch the extremely popular David and Jill  FB Live show on Overcoming Perfectionism (recorded on November 11, 2018). What research has been done on SDBs? This topic was not discussed in the show, but individuals with an interest in research might want to read David’s study with Dr. Jackie Persons on the causal connections between depression and SDBs about dependency (attachment) as well as achievement (perfectionism) in several hundred patients in Philadelphia during the first 12 weeks of their treatment at David’s clinic. The study confirmed That both types of SBS were significantly correlated with depression severity at intake and at the 12-week evaluation. In addition, changes in depression were correlated with changes in SDBs. However, a sophisticated statistical analysis with structural equation modeling techniques did not confirm that SDBs had causal effects on depression, or that depression had causal effects on SDBs. Instead, SDBs and feelings of depression appeared to share an unknown common cause. Persons, J. B., Burns, D. D., Perloff, J. M., & Miranda, J. (1993). Relationships between symptoms of depression and anxiety and dysfunctional beliefs about achievement and attachment. Journal of Abnormal Psychology, 101(4): 518 - 524.  

Rajesh asked: Is it possible to change an SDB? Does the mere knowledge of an SDB change it? How long does it take to change an SDB? How do you change SDBs? Nikola asked: Aaron Beck said the SDBs never really go away. They just get activated and deactivated and activated again. Does this mean that depression is an incurable disease that will keep coming back over and over again? What’s the point in battling against a core belief if it cannot be changed? Fabrice and I appreciate your questions--they often give us ideas for shows! In today’s Podcast you'll learn the answers to several questions about Self-Defeating Beliefs. What’s the difference between Self-Defeating Beliefs (SDBs) vs. Cognitive Distortions? The thoughts that contain cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Discounting the Positive, and Self-Blame are distortions of reality, they are the cons that trigger depression and anxiety. When you're upset, these thoughts will flood your mind. These thoughts can be show to be false, and when you crush a distorted negative thought, you'll immediately feel better. Self-Defeating Beliefs are stipulations, values that you've set up for your self. For example, you may base your self-esteem on your accomplishments due to your belief that people who accomplish more are more worthwhile as human beings. SDBs like this cannot actually be shown to be false--they are simply your personal, subjective values, and they are thought to be with you all the time, and not just when you're depressed, anxious, or angry. The question with an SDB is this: What are the advantages and disadvantages of having this value system? How will it help me--what are the benefits--and how might it hurt me? What's the downside? Why are Self-Defeating Beliefs thought to be important? When you challenge and defeat a distorted thought, you feel better in the here-and-now. When you challenge and change an SDB, you change your value system at a deep level. This is thought to make you less vulnerable to painful mood swings and relationship conflicts in the future. What are the different kinds of SDBs? David’s list of 23 Common SDBs is attached. This list is not comprehensive, as there are many more, but the ones on the list are very common. There are several categories of SDBs. Individual SDBs are often “Self-Esteem Equations” Perfectionism Perceived Perfectionism Achievement Addiction Approval Addiction Love Addiction Interpersonal SDBs are expectations of what will happen in certain kinds of relationships, or relationships in general What’s your understanding of the other person’s role in your relationship? What adjectives describe him or her? What’s your understanding of your person’s role in the relationship? What adjectives describe you? How would that kind of relationship feel? What rules connect the two roles? Other kinds of SDBs Anger / conflict cluster Entitlement Truth Blame Anxiety cluster Niceness Conflict Phobia Anger Phobia Emotophobia Submissiveness Spotlight Fallacy Brushfire Fallacy How can you identify your own, or a patient’s, Self-Defeating Beliefs? Look at the list of 23 individual SDBs (easiest). You might want to do that right now. Review the list, and you'll probably find many of your own beliefs! Individual Downward Arrow Interpersonal Downward Arrow  

I recently did two terrific interviews (Podcasts #92 and #111) with Stephanie James on her superb radio show and podcast, The Spark. Today, Fabrice and I are bringing you my third and final interview with Stephanie, as we describe how to convert conflicted relationships into loving, rewarding ones. Stephanie said it was her favorite interview, although all three were really fun for me. Today you will once again hear how dynamic, warm and positive she is! My first interview with Stephanie was on the amazing inner power we all have to change our thoughts, feelings, actions, and lives. We talked about how to transform your automatic negative thoughts and create a more joyful present and a more fulfilling future. My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. We highlighted the amazing new motivation-busting techniques that can lead to extraordinarily rapid recovery. Stephanie also recently interviewed our beloved colleague, Dr. Matthew May, a psychiatrist who is a phenomenal TEAM therapist. Click here if you'd like to take a look and listen. Matt has worked with Fabrice and me on our podcasts--you may remember the amazing and inspiring podcasts featuring live therapy with Marilyn. Stephanie is a outstanding therapist and radio personality from Colorado. It was an honor to be on her show on three occasions. Stephanie is co-authoring a book on how to live a “spark-filled life.” It should be completed soon, so you’ll likely be hearing much more from Stephanie during 2019!

This dynamic interview covers the integration of TEAM-CBT with Christianity as well as Judaism, Buddhism, Hinduism, the Muslim faith, and more. Mike, Fabrice and I describe many areas of overlap, as well as some potential conflicts, between the teachings and methods of TEAM-CBT and religious beliefs. Mike and I suggest that religion and TEAM-CBT are, in fact, attempting to do the exact same things using slightly different language and symbolism. We strongly agree that at the moment of recovery, a person’s religious beliefs are nearly always strengthened and deepened, and never challenged or belittled. Mike, Fabrice and I also discuss topics like religious scrupulosity, religious obsessions, cognitive distortions (John 8:32: “The truth will set you free”), and the so-called “dark night of the soul” described by Christian and Buddhist mystics. We also talk about the spiritual and psychological aspects of enlightenment (e.g. salvation), Should Statements, the Disarming Technique, forgiveness, repentance, the death of the ego, pride vs. humility, and more. If you have an interest in religious or philosophical topics, you will love this podcast! You might also enjoy the podcasts with Marilyn on what to do when you've lost your belief in God and find yourself in darkness and intense suffering! Mike Christensen treats individuals throughout Canada via teletherapy and also offers online training for mental health professionals throughout the world. If you have a question for Mike, or wish to contact him, you can find him at www.FeelingGoodInstitute.com.

Fabrice and I were thrilled to interview our dear friend and colleague, Stephen Pfleiderer, who is the first therapist in the world using TEAM-CBT techniques in the treatment of habits and addictions, including life threatening addictions, like intravenous heroin or meth marijuana alcohol binge eating procrastination smoking internet porn and more Stephen begins with his personal story of excessive beer drinking starting in high school through his junior year in college when he hit a personal crisis, telling himself, "My life sucks. I can't live like this. I'm a loser." He decided to enter a 12-step recovery program, which helped tremendously, and eventually joined David's weekly TEAM training group at Stanford because of his dream of becoming a professional addiction therapist and interventionist.

Rebroadcast of a fabulous interview David did recently for “The Upgrade” Podcast (sponsored by the popular Life Hacker website with hosts Melissa Kirsch and Alice Bradley on a range of topics, including: Why did you write Feeling Good: The New Mood Therapy? Is depression caused by a chemical imbalance in the brain? What’s your experience with electro-convulsive therapy (ECT)? Why did you give up your research career in biological psychiatry? How can you tease out your negative thoughts when you know you're depressed but you just can’t think of any thoughts? How does TEAM-CBT differ from conventional CBT? Can you use TEAM-CBT with severe problems, or is it only for individuals with mild mood disturbances?

1. Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What's the best degree? Should you go to school to become a psychologist,  clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning! 2. Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies. 3.  Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called "somatic" symptoms of depression, like insomnia or changes in appetite. For example, some “experts” would argue that the following are all symptoms of clinical depression: insomnia or the opposite—sleeping too much; increased appetite or the opposite--decreased appetite; loss of interest in sex, or the opposite, sex addiction; loss of interest in work, or the opposite, being a workaholic. How can opposite symptoms be symptoms of depression? Does this make sense? Are these really the symptoms of depression, or simply non-specific symptoms? What are the five key symptoms of real depression? 4. Kevin is a therapist with a simple question: How do I get over my desire to help? 5. Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn’t making any progress in the therapy.