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

What's Bibliotherapy? Hi podcast fans,David and Rhonda discuss and old controversy: Can a self-help book can really help? Or will you need psychotherapy and / or an antidepressant if you are seriously depressed? [gallery ids="60,357,58,54,51,50,42" type="rectangular"]   I (DB) wrote up the following overview of bibliotherapy research prior to today’s recording with Rhonda. I hope you find it interesting! I have to admit that I’ve never had much respect for self-help books. Many of them seem to be written by narcissistic individuals with pretty superficial ideas who mainly want to promote themselves, and this has been my strong bias as well. When I pick one up in a bookstore, I nearly always get immediately turned off. And I get a flood of them in the mail as well, from authors asking for an endorsement. I have a policy of not doing book or product endorsements—it’s the easiest way to say no. And I never thought of my book, Feeling Good: The new Mood Therapy, as a self-help book. My idea was that people receiving cognitive therapy could read it between sessions as a way of speeding up their recovery, so that the therapist could do the individual work and not have to do so much teaching about the basic concepts, like my list of ten cognitive distortions. But at the same time, shortly after the book was released, I began getting letters, and later on emails, from individuals who said they book had actually caused them to recover from pretty severe depression. In fact, over the years, I would guess I’ve received more than ten thousand letters or emails like that, and probably way more than that, maybe even fifty thousand. Still, it had not occurred to me that it might actually be a self-help book, in spite of the fact that lots of the people who wrote me said the book had helped them much more than the treatments they’d received over the years. One day a colleague asked if I’d seen the article about my book in the New York Times. Apparently, Dr. Forrest Scogin, a research psychologist from the University of Alabama Medical Center, had studied the effects of reading a self-help book on patients seeking treatment for moderate to severe depression. In a nutshell, their studies indicated that simply reading Feeling Good may help some patients overcome depression and may help to prevent future relapses as well. This finding was a shock, but was not entirely unexpected due to all the testimonials I’d been received from people who’d read the book. In their first study, Dr. Forest Scogin and his colleagues told patients seeking treatment for depression that they’d be placed on a four-week waiting list before beginning treatment. Half of the patients were given a copy of either my Feeling Good or a self-help book on depression by Dr. Peter Lewinsohn called Up from Depression. The researchers suggested that the patients could read their book while they were waiting for their first appointment with the psychiatrist. The other half of the patients who were placed on the four-week waiting list did not receive a copy a self-help book. Both groups of patients were contacted each week by a research assistant who administered a test to assess the severity of depression. The goal of course was to find out if there were any changes in depression in any of the patients. The results of the study were interesting. Approximately two-thirds of the patients who received one of the self-help books improved or recovered from depression during the four weeks, even though they received no other treatment with drugs or psychotherapy. In fact, they improved to such an extent that most of them did not even need any further treatment. In contrast, the patients who did not receive one of the books failed to improve during the four-week waiting period. As far as I know, this was the first time that the anti-depressant effects of a self-help book had ever been documented in carefully controlled research study published in a scientific journal. Then the researchers did a number of additional experiments. First, they gave a copy of one of the two self-help books to the patients in the second group who had not improved. They asked them to wait four more weeks before beginning treatment, but suggested they read the book during their wait. Two-thirds of them also improved and did not need further treatment. This study was published in the medical journal, Gerontologist. Some critics challenged the study, arguing that the improvement in the patients who received the self-help book might have simply been a placebo effect. In other words, maybe it was just the reading, and the expectation of recovery, that helped, as opposed to the ideas and techniques described in the books. To test this, the investigators studied a new group of patients who were asked to read a “placebo” book while waiting for treatment. The researchers chose a classic book by Victor Frankl called Man’s Search for Meaning. If these patients also improved, it would confirm that the effect of reading on mood was simply a non-specific “placebo” effect. This is incredibly important, because almost any type of intervention can have a placebo effect, so that as many as 35% of patients will improve just because they think they’ll improve. Surprisingly, the patients who read the Victor Frankl book did not improve. This exciting finding indicated that a self-help book can have a specific and fairly strong antidepressant effect, but that the book had to contain sound information that was actually helpful to individuals with depression. Finally, the investigators also did several careful follow-up studies on these patients to find out if the antidepressant effects of Feeling Good and Up from Depression would last. In several additional publications, they reported that these patients did not relapse but maintained their improved moods for periods up to three years, and that they actually continued to improve following their initial Feeling Good “bibliotherapy. However, they did not report that they were happy all the time. But when they hit bumps in the road, most of them picked up the book again, and re-read the sections that had been the most helpful, and then quickly recovered again. It’s great that two thirds of the patients improved so rapidly. This result is at least as good as the effects of antidepressants or treatment with psychotherapy—and it’s far cheaper, and with no side effects either! But at the same time, one third of the patients did NOT improve. And of course, you see the same thing with treatment of depression by a psychiatrist or psychologist. In fact, recent research indicates that only 50% of patients, AT MOST, improve with professional treatment. In my research, I’ve attempted to figure out what’s different about the patients who do not rapidly recover when treated with psychotherapy or Feeling Good bibliotherapy. And I believe I did find out why. To learn about that, you’ll have to listen to the Feeling Good Podcasts or read my new book, Feeling Great, when it comes out. Hopefully fairly soon! I was pretty inspired by the terrific and important research by Forrest Scogin, and want to thank him! If you or your patients would like to read one of my “self-help” books, the following table will show you which books are best for which kinds of problems. The reading list at the end is for individuals who might like to check out the original studies by Dr. Scogin and his colleagues. Thanks! David and Rhonda Book Topic / Problem Feeling Good: The New Mood Therapy Mild to severe depression The Feeling Good Handbook Depression and anxiety When Panic Attacks All anxiety disorders Feeling Good Together Relationship Problems Intimate Connections Dating Problems Ten Days to Self-Esteem This is a simplified ten-step program to overcome depression and boost self-esteem. it is effective individually or in support groups. Bibliotherapy Research Ackerson J, Scogin F, McKendree-Smith N, Lyman RD (1998) Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol 66: 685-690. Floyd M, Rohen N, Shackelford JA, Hubbard KL, Parnell MB, et al. (2006) Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behav Modif 30: 281-294. Floyd M, Scogin F, McKendree-Smith N, Floyd DL, Rokke PD (2004) Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behav Modif 28: 297-318. Jamison C, Scogin F (1995) The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol 63: 644-650. Mains JA, Scogin FR (2003) The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol 59: 237-246. McKendree-Smith NL, Floyd M, Scogin FR (2003) Self-administered treatments for depression: a review. J Clin Psychol 59: 275-288. Scogin F, Floyd M, Jamison C, Ackerson J, Landreville P, et al. (1996) Negative outcomes: what is the evidence on self-administered treatments? J Consult Clin Psychol 64: 1086-1089. Scogin F, Hamblin D, Beutler L (1987) Bibliotherapy for depressed older adults: a self-help alternative. Gerontologist 27: 383-387. Scogin F, Jamison C, Davis N (1990) Two-year follow-up of bibliotherapy for depression in older adults. J Consult Clin Psychol 58: 665-667. Scogin F, Jamison C, Gochneaur K (1989) Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol 57: 403-407. Smith NM, Floyd MR, Jamison CS, and Scogin F (1997) Three-year follow-up of bibliotherapy for depression. J Consult Clin Psychol 65: 324-327.

This is the second of two podcasts on the Story of Sherrie, who experienced some of the symptoms of PTSD after a traumatic event involving her husband. In the first podcast, we played the T, E, and A portions of the session. In this podcast, we will play the M = methods as well as the conclusion of this amazing session.  Dr. Rhonda and I will make some teaching comments on the session as well. If you'd like to see Sherrie's end-of-session Daily Mood Log, click here.  After the session, Sherrie received some notes from others in the audience. Sherrie,  I think what stood out for me in that session was your authenticity. No mask, no defenses. I fell like we can't really appreciate what our clients are doing when they open themselves up to face their fears until we do it honestly ourselves, and you did--in front of all of us! I feel it was a gift you gave us and I thank you! Candice  Here's another note for Sherrie: Sherrie, You Rock--I love you--and never met you before tonight. :)  You cried. You laughed. You said No.  You said Yes.  You woke up! You're a Brave Woman! What a lucky husband you've got! Thank you. A sister, a colleague,  Rita And another. To Sherrie Your session--that was brave! Shows strong commitment to yourself and to the people you work with. You will be more effective stronger, real, fee, and go even deeper with your clients. Mary If you want to send a message to Sherrie, use the comment feature below, and I will be sure to forward your thoughts to her!  When people learn about the incredibly rapid recoveries that I am so often seeing with TEAM, they always ask about whether the effects last,or whether the dramatic changes are just a flash in the pan. Of course, Relapse Prevention Training is critical, as negative thoughts and feelings will tend to come back over and over for all of us. That's just part of the human experience. And if you know how to deal with these occasional "relapses," you don't have to worry about them, because you'll know how to crush the negative thoughts and feelings pretty fast.   At any rate, Sherrie's session was more than three years ago, and here's an email I got from her a couple weeks ago: Hi David. I always enjoy hearing from you! I agree for you to show the video at the summer intensives, I am actually quite proud of it all so have nothing to hide! You can also do it as a podcast, whatever is workable. I have looked at the podcasts you sent and they look wonderful so will certainly listen to what I can over time! Okay, so for an update and thank you for asking.  The year after my cancer, my husband had his heart attack, so that was four years ago. He is, thank G-d, wonderfully healthy. There is no heart damage and he can do everything he wants to do. And he is even getting better at taking his pills, so I don't have to remind him so much. I have a question for you as what you do is not what I can or want to do. I think you said you were 75 when we met in the training. So what I don't get is how do you have the energy to see clients, write books, do podcasts, travel all over and do workshops etc? How do you fit all that in? You must want to! All the best and enjoy spring! Sherrie Thanks for listening! David and Rhonda Oh, my secret is that I am almost always doing what I want to do. Teaching and treating colleagues with TEAM give me tremendous energy, except when I screw up, which is fairly often! But I'm used to making errors by now, and I really love what I do, so I don't think of it as "work," but more like having fun hanging out with friends. It is a bit like when you were a kid and got to go out and play after dinner! That was THE BEST!  

Hi Podcast Fans, There have been many requests for more podcasts on how we would treat trauma, using the TEAM-CBT model. I have done at least 25 workshops on the treatment of trauma in the past several years, and always do a live therapy demonstration at the end of day 1, so people can see with their own eyes how TEAM-CBT actually works. About three years ago, I did a live demonstration with a wonderful woman named Sherrie who was extremely anxious about a traumatic event involving her husband a year earlier. Sherrie kindly and courageous gave me permission to share the audio tract with you. I think you'll really enjoy the session! I want to thank Sherrie for giving us this gift! I also want to thank my co-therapist during the session, Mike Christensen, who is Canada's top expert in TEAM-CBT. Here's our photo at the workshop: While you are listening, you may want to take a look at Sherrie's Daily Mood Log, which describes the trauma, along with her negative thoughts and feelings. We will publish the first half of the session in this podcast, and the end of the session in the next podcast. We'll also include a live, three-year follow-up with Sherrie that we recorded recently. Dr. Rhonda and I will make some teaching comments on the session as well. David and Rhonda

Rhonda, Fabrice and I received a number of thoughtful emails following our recent podcast on mindfulness meditation, which seems to be quite popular these days, but there some push-back from listeners who all did not agree that mindfulness is an effective way of combating negative thoughts and feelings. Email from Jeremy Hi David, I listened to the Feeling Good Podcast on meditation this morning and had some thoughts I wanted to share. For context I've been meditating daily for about 3 months. First - I personally think that if someone is struggling with depression or anxiety, TEAM-CBT is a dramatically faster acting and more powerful tool than mindfulness. I've never seen or heard about someone having a dramatic recovering in just a few hours due to mindfulness. I've never seen the idea of resistance explored in any kind of mindfulness book or article. I also don't really think much of mindfulness as a "method" in the TEAM model, because compared to the other methods for removing negative thoughts it's extremely weak. I imagine that with hundreds of hours of mindfulness practice you might reach a point where it's easier to let go of negative thoughts. (There are a lot of reports like that/) However, it's a very slow way of dealing with negative thoughts compared to externalization of voices etc.  I think for a therapist who knows TEAM to suggest mindfulness as a key practice to their patient is almost negligent, since TEAM is so much more effective. That said, I've sensed a few benefits of mindfulness which is why I've been investing my time in it: - I think you can view meditation as concentration practice, and I've found that meditation increases my ability to concentrate  - You can reach a very calm and relaxed state in meditation where you cease to have thoughts, and this state is extremely pleasurable - I've noticed that mindfulness increase my ability to enjoy experiences, including experiences I might enjoy less if I was having even positive or neutral thoughts. As an example, after about 30 minutes of meditation the other day I went for a walk in the woods and stop for about 10 minutes to look at a ridge. My visual experience was completely immersive and I even started to feel like the trees were breathing with me. It was one of the high points of my week. I suspect that even someone who had no negative thoughts might be flooded with positive but irrelevant thoughts (like a yummy meal they might be headed to eat later) would have enjoyed this scene much less.  I've also run an experiment using the PAS and CBT to remove the motivation to have distracting thoughts. (ie write down the advantages to having distracting thoughts and disadvantages of focusing on the breath, and then talk back to those) I would classify it as a highly successful experiment, after talking back to all the good reasons to think about something besides my breath my focus got dramatically better. I wonder if this technique could be used to either improve meditation or even supplant the need for it. (because it gets rid of distracting thoughts directly, while meditation is basically practice for having fewer distracting thoughts)  Anyway, just thought I would share some thoughts and ideas with you.  Best,  Jeremy Email from Paul Hey, Dr. Burns! I am with you in terms of the skepticism of mindfulness as a panacea. I also am not sure how particularly effective it is even as a tool in the fight against negative thoughts. I personally cannot seem to get anything out of it, but I am trying to make sense out of how so many people can find it useful. Perhaps you could put it like this: Mindfulness is not a specific technique for specific problems, but a general method for psychological health. If you have a specific medical condition, you'll want to get a specific treatment. Sometimes specific conditions can be alleviated by taking care of your health generally (eating healthier, sleeping better, etc.) Still, depending upon the disease, in order to get rid of it, you'll need a specific treatment. However, even when you're not dealing with a specific disease, generally good health practices can lower your chances of getting any diseases and lessen the severity when they do arise. In sum, perhaps the goals of mindfulness and CBT are different. I think that might respect what both you and Fabrice are getting at. I think this goes to answer partly a question I've had about TEAM. To what extent is alleviation of anxiety, depression, etc the final goal? Are there religious, spiritual, or psychological problems that are positive goals beyond relief? In Feeling Good, it sounded like you thought that happiness was just the absence of depression. Is that all there is to say about human flourishing? Or do you methodologically stick within the parameters of your client's value system, asking only "what can I help you with" because you're a psychologist and not a priest, for example? Paul David and Rhonda discuss several important points raised by these listeners, including: Non-specific vs. / specific interventions. David describes an elderly man named Ezekiel who had escaped from Nazi Germany as a teenager, and still felt like a “totally worthless human being” in spite of incredible success in life. He’d start out shining shoes on the streets of New York City) and end up as a wealthy industrialist, but that did nothing to boost his self-esteem. He’d decades of psychotherapy as well, but it was not effective. David encouraged him to jog long distances daily to boost the release of “endorphins” in the brain, but that did not work either. Nor would medication or meditation have worked, either. When you learn why Ezekiel felt like a “worthless human being,” you’ll see exactly why! And you’ll also learn what did work to end decades of suffering and self-doubt. The time required for meditation, not only during sessions, but in between sessions, is considerable. David would prefer his patients use this time for doing specific psychotherapy homework. Formulaic treatment. Life has always been stressful, and people are always looking for some simple “solution” to emotional problems, which seem almost universal. The current wellness fad is a great example of that. So, people promote a healthy diet, daily exercise, daily meditation, daily prayer, relaxation training, deep breathing, expressing gratitude, and a host of other things as the secret of happiness and contentment. These formulas, in my opinion (DB), do not have, and will never have, more than a placebo effect in the treatment of stress. depression, anxiety disorders, relationship problems, and habits and addictions. Sadly, those who are hugely enthusiastic about one of these fads, or formulas, will not want to hear what I just said, as sometimes we just don’t want to have our beliefs challenged. We see this resistance in politics, in religion, and in almost every aspect of our lives. Mindfulness is already a TEAM technique, even without meditation--but not a terribly effective method, in David's clinical experience. However, for certain kinds of recurrent negative thoughts, Self-Monitoring and Reattribution can be helpful. These techniques are similar to Mindfulness Meditation, but are only two of more than 100 Methods David uses in treatment, and they are not for everybody. David gives an example of the intensely anxious eye doctor with OCD who was afraid of going blind, who responded to Self-Monitoring and Response Prevention. There’s nothing wrong with a healthy diet, or meditation, or prayer, or anything that you enjoy, anything that gives you a sense of meaning. But these non-specific approaches should not be confused with specific treatments for depression, anxiety disorders, conflicts in relationships with others, or habits and addictions. Thanks for listening! David and Rhonda

How to Overcome Shyness In a recent podcast, David and Rhonda emphasized the importance of specificity--selecting one specific moment when you want help. This is very true in the treatment of shyness.  Jason, who we introduced in the last podcast, wanted to work on the intense anxiety he felt in the locate grocery store. He thought the woman checking groceries was attractive, but he was terrified about talking to her, or trying to flirt. So he said nothing, and left the store feeling like a failure.  After this humiliating experience, he filled out a Daily Mood Log and listed all the Negative Thoughts and feelings he'd had while waiting to check his groceries. After doing Positive Reframing, he decided on the Negative Though he wanted to work on first: “People will think I’m a self-centered jerk if I try to flirt with her.” David and Jason put this thought in the Recovery Circle and selected more than 20 techniques Jason could use to challenge thought.  On the podcast, David and Rhonda illustrate how to challenge that thought using many of the methods listed on the Recovery Circle, including: Identify the Distortions. They found all ten distortions in this thought. The Straightforward Technique. This technique was not effective, since the Positive Thought Jason came up with was not valid, and it did not reduce his belief in the Negative Thought. However, this technique did reveal something important about Jason—he seems to see the world in an adversarial way, and imagines he is in competition with others who will try to put him down. The Cost-Benefit Analysis. What the are Advantages and Disadvantages of Jason’s Negative Thought? Jason did a remarkable job with this technique, and found it helpful and illuminating. The Individual Downward Arrow Technique. David and Rhonda illustrated how this works, using role-playing. They were able to identify five of Jason’s Self-Defeating Beliefs that are extremely common in Social Anxiety, including: Perfectionism Perceived Perfectionism The Approval Addiction The Spotlight Fallacy The Brushfire Fallacy The Paradoxical Double Standard Technique. What would Jason say to a dear friend who was also struggling with severe shyness? Would he say, “People will think you’re a self-centered jerk if you try to flirt with her.” If not, why not? What would Jason say to a friend? And would he be willing to talk to himself in the same compassionate way? This technique was also very helpful to Jason. Examine the Evidence. What’s the evidence that people will think he’s a self-centered jerk if he tries to flirt with a young lady he’s attracted to? Survey Technique. Have his friends ever struggled with anxiety when they were starting to date? Would they think of him as a “self-centered jerk” if he was more outgoing and flirtatious? This was a homework assignment, to ask his friends. The information he got was a huge surprise. Thinking in Shades of Gray. He thinks he has to sweep her off her feet or he’ll get totally rejected and ostracized by the human race. Is there some easier goal he could shoot for? He’s telling himself that if she shoots him down, it will prove that he’s a “loser.” Are there other reasons why a grocery checker might not respond favorably to a young man who is trying to flirt with her? Feared Fantasy / Acceptance Paradox. David and Rhonda illustrate this amazing technique, with role-reversals. This technique will help Jason crush the Self-Defeating Beliefs that cause his shyness in the first place, like the Approval Addiction. These techniques were extremely helpful to Jason, and all of his negative feelings went down dramatically by the end of his first therapy session. However, he will have to do more work outside the office for homework, using Interpersonal Exposure Techniques to confront his fears of rejection, including: Smile and Hello practice Flirting Training Talk show Host Rejection Practice Self-Disclosure Shame Attacking Exercises These assignments terrified Jason, but he courageously agreed and followed through. He had his share of rejections, as we all do, but had some successes, too, and soon was dating a lot and enjoying it, and his shyness became a thing of the past. The treatment only required four sessions.

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."