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

Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns’ Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.

This is the second podcast on relationship problems. with Dr. Helen Yeni-Komshian. In today's podcast, we address four questions from listeners like you: Our marriage lacks intimacy. What can I do? A podcast fan named David explains that his relationship with his wife is no longer intimate; he complains that they only talk about day to day things on a superficial level. David wants to know if he needs to inject some conflict into the relationship to make it more meaningful or exciting. Why is my wife so critical of me? David wants to know why his wife constantly peppers him and batters him with critical questions, and what he can about it. Why is my friend so critical and dogmatic? Rajesh describes a friend who argues endlessly and accuses Rajesh of being irritating. His friend says, "Anyone would be upset when they try to talk to you!" What's up? Why is this happening? Who's really to blame? Adarah feels lonely and tells her husband what he can do to make her feel loved--but it just doesn't seem to work! Why? And what CAN she do to improve her marriage? I think you will enjoy the lively dialogue between Fabrice, Helen and myself and see us struggling and making some mistakes, too, when we try to model more effective responses based on the Five Secrets of Effective Communication! We also stress, once again, the importance of Interpersonal Decision-Making any time you run into a conflict with a friend, colleague, or loved one. For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.

We have invited Dr. Helen Yeni-Komshian to join Fabrice and me for two consecutive podcasts on questions listeners have asked about troubled relationships. In today's podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to "keep the peace," it just gets worse. His complaints escalate! This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What's the secret of dealing with a whiner or a complainer? Is it even possible. Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You'll LOVE this lively dialogue!

David describes research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain? And what can we do to help patients with physical pain and intense negative emotions? In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?

Today we answer six questions submitted by listeners like you: Harald: How can I find the Show Notes for the Feeling Good Podcasts? Kristin: How do you help patients who obsess about past traumatic events, with intrusive thoughts about a cruel ex-lover or bullying by classmates? These thoughts can feed into the idea that their life is miserable and  they can’t move forward because they feel blocked by these harmful memories. Valentina: How are cognitive distortions, self-defeating beliefs, and feelings of depression transmitted? What you describe in your books seems to describe my mother’s behaviors when I was growing up? Could it be that depression is transmitted by the family? Alicia: How would you treat someone with cyclothymic disorder who cycles between euphoria and suicidal depression? He’s happy now, so how do I get him to fill out the Daily Mood Log? Kathy: I’m a big fan, and I have a question about “bibliotherapy.” What’s the best way to use your books and other materials to help yourself? Matthew: Do you ever use drugs in the treatment of depression? Are medications sometimes necessary or helpful?  

Suicidal thoughts and urges are very common among depressed patients. The vast majority of depressed individuals have thoughts of suicide from time to time, and some struggle with serious suicidal urges. The experts tell us that 10% to 15% of chronically depressed individuals do eventually commit suicide, even if they are receiving treatment for depression. It is hard for me to believe that suicide is that common, but even if it is only 2% or 3%, that’s still very significant, especially if you have a large clinical practice and you treat lots of depressed individuals. Suicide attempts are shocking and devastating for the patient, for the family, and for the therapist as well. The loss of a patient through suicide is the dark side of our profession. The loss of life is a horrible and unnecessary tragedy, since the feelings of hopelessness that trigger suicidal urges are always the result of cognitive distortions; the belief that you are hopeless and cannot improve is never valid. Yet, the depressed patient does not realize this, and sometimes turns to suicide as the only way out of the suffering. Sadly, clinicians' capacity to assess suicidal urges in patients they are treating is very poor, and not significantly different from zero. In this podcast, I describe how you can solve this problem with the use of the EASY Diagnostic System and suicide interview at the initial evaluation, and the use of the Brief Mood Survey at all subsequent sessions, with no exceptions. In this podcast, I focus on two things. First, how can the clinician identify and evaluate a new (or old) patient who is struggling with suicidal thoughts and fantasies and determine if the patient is at risk for a suicide attempt? Second, how can the therapist make the patient accountable and guarantee that the patient will not now, or ever, make a suicide attempt? The “defensive psychotherapy” I recommend will sound unfamiliar to many therapists but can save lives and make your practice far more peaceful and rewarding! The approach to the suicidal patient involves Paradoxical Agenda Setting techniques, including the Gentle Ultimatum and Sitting with Open Hands.

The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest! Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the “inner universe” Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time. The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon. Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective. Dr. Noble also discusses David’s “fractal” theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the “homeostasis” of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse. This is because neurons that “fire together wire together.” In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together. Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well. Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right. Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!

Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about David’s path into the mental health field the difficulties and rejections David faced getting his first book, Feeling Good, published David’s advice to listeners interested in therapy how he approaches perfectionism, depression, and anxiety with patients the joys of a life free from the need to be special— and much more! Lisa's show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa’s most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.

David and Jill do M = Methods, and show Lee how to respond to his wife more skillfully, using the Five Secrets of Effective Communication (link). Like everyone who is trying to learn the Five Secrets, Lee struggles with several blind spots: “I Feel” Statements. Lee has tremendous difficulties sharing his feelings openly, in a respectful manner. He seems indoctrinated with the cultural idea that men should not be vulnerable and express feelings. Lee makes the common error of “problem solving” instead of asking his wife to share more of her feelings. Lee makes another common error of apologizing and using the trite phrase “I’m sorry” instead of encouraging his wife to open up. David discusses the different between dysfunctional and effective apologies. David and Jill do lots of role-play practice with Lee and give him a homework assignment. T = Testing. After the session is over, Lee completes the Brief Mood Survey again. His scores indicated that his feelings of  anxiety and anger have completely disappeared, and he also has a perfect score  Positive Feelings Survey and the Relationship Satisfaction Scale. He also gave David and Jill perfect scores on the Empathy and Helpfulness scales and wrote what he liked the best about the session: “My epiphany came at the moment I realized I had been afraid of emasculating myself and realizing that my vision of what a “man” should be was completely inaccurate.” At the end, Jill reads an emotional email from Lee describing how he relapsed and started arguing with his wife, and then remember to empathize use the Five Secrets instead, with an amazing result!