Is there anything positive about hopelessness or an addiction ? What does it take to be a "worthwhile" human being, or to have a valuable life? In today’s podcast, David and Fabrice address three questions submitted by listeners: Avi asks another great question about the importance of Positive Reframing in TEAM-CBT. But how can we possibly find something positive in the feeling of hopelessness. After all, Dr. Aaron Beck has taught us that it's the worst emotion of all! Avi asks a similar question about an addiction. How can an addiction possibly be a good thing? Eugene asks a tremendous question about a passage in Dr. Burns' book, Feeling Good: The New Mood Therapy, on the topic of what it means to be a worthwhile human being, and what it takes to make a life valuable. Eugene hints that Dr. Burns may have the wrong idea, and asks what he would say to a patient who doesn't "cry uncle!" David and Fabrice love your questions so keep them coming!  

Will people manipulate you if they catch on to the fact that you're using the Five Secrets of Effective Communication? Is it fair to ask depressed patients to do psychotherapy homework between sessions when they're already struggling with a loss of motivation? In today’s podcast, David and Fabrice address two questions submitted by listeners: Robert asks whether it would be a problem if you are using the Five Secrets of Effective Communication (the Disarming Technique, Thought and Feeling Empathy, Inquiry, "I Feel" Statements, and Stroking) with someone who is already familiar with these techniques. Isn't there a danger that they might see through you and  therefore thwart your efforts and manipulate you? Avi asks about the importance of psychotherapy homework in TEAM-CBT. He points out that the loss of motivation is one of the central symptoms of depression, so aren't we in a catch 22 type of situation since patients might not have the strength and perseverance to do their homework? David and Fabrice love your questions so keep them coming!

We address a number of excellent questions submitted by listeners: Are the scales on your Brief Mood Survey reliable and valid? How can I identify my Negative Thoughts when I'm upset but I can’t figure out what I'm thinking and telling myself? I have social anxiety and don’t want to get out of bed. I'd rather just lie in bed and watch Game of Thrones. Help me! What should I do? I saw an article in the paper that claimed that bacteria in the gut cause anxiety. Is this true? If not, what does cause depression and anxiety? Could your tools, like the Cost-Benefit Analysis, help with problems that aren’t necessarily emotional problems? Like what career to pursue, or what college to go to? What should you do if you feel great at the end of a therapy session, and then become severely upset again during the week? How does Dr. Burns deal with resistance from colleagues when he is trying to teach these new TEAM-CBT techniques? Does he run into much resistance? How does he feel about the resistance?

David describes one of the more obscure methods called “Self-Monitoring”. He thinks of it as “Meditation in Daily Life.” The whole idea is to note a negative thought that suddenly pops into your mind, and then to track it, or count it, with some type of counting device, list the wrist counters golfers wear to keep track of their scores, and then to simply let go of the thought and continue with what you were doing, instead of dwelling on the thought and getting distracted and upset. David explains that Self-Monitoring often is not effective, but occasionally it can be life changing for individuals who are struggling with anxiety, depression, or anger. He brings the method to life with the story of an eye doctor with severe OCD who recovered completely because of Self-Monitoring in combination with Response Prevention. He also explains how this technique, along with the Daily Mood Log, was curative for a retired carpenter with severe depression following a stroke. The type of stroke is called “Pseudo Bulbar Palsy,” and the symptoms include uncontrollable sobbing or laughing after the slightest sad or funny event or comment. This case was particularly interesting because the therapist for the carpenter was one of David’s students, a clinical psychologist who had raised the question, “How could cognitive therapy possibly help someone if his or her depression is caused by a chemical imbalance in the brain?” And in this instance, since we know the carpenter’s depression was caused by thousands of microscopic hemorrhages in the deep structures of his brain, how could any kind of psychotherapy possibly help?”

This podcast was recorded eight weeks after the initial session with Marilyn. As you may recall, Marilyn became severely depressed when she discovered that she had Stage 4 Lung cancer. In spite of that horrific and real trauma, she completely overcame her negative feelings in the first session, which was broken down into a series of three consecutive podcasts, with commentaries as the session unfolded. Sadly, Marilyn experienced severe pain in her left rib cage from a metastasis from her lung cancer roughly two months later. This physical relapse triggered an understandable emotional relapse as well, with an understandable return of severe depression, anxiety and anger, so Marilyn agreed to record another podcast to illustrate how a tune-up works following the initial treatment. I would like to point out that the Relapse Prevention Training was critically important, so that Marilyn would know that relapses are a certainty, and that they can be dealt with effectively using the same techniques that worked the first time. This message is important so that the patient does not feel broadsided when the negative feelings return. Some patients have the false expectation that they'll be happy forever after they've recovered. But no one is entitled to be happy all the time! If the therapist and patient know how to deal with a relapse, and have practiced ahead of time, it will still be painful, but the patient and therapist will know what to do to make sure the patient can recover from the relapse quickly, instead of getting caught in another length episode of depression or anxiety. The entire session has been included in this single podcast. That’s why we’ve offered this as a bonus session between our weekly podcasts. You will need nearly two hours to listen to it, but I think you will find it’s a great investment of your time.

David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn. Marilyn experienced a severe depression relapse eight weeks after her initial session with Matt and David, because of a painful metastasis to her rib cage which frightened and demoralized her. She graciously agreed to come in for a tune-up with David and Matt which will be published as a special podcast within the next week or so. You will not want to miss this session! David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT. David stresses the difference between specific and non-specific therapeutic techniques. He also discusses the distressing but exciting fact that few or no therapies have proven to be much more effective than placebos in the treatment of depression, and why this is the case. Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby. David concedes that if he’d thought of using Cognitive Flooding initially, it likely would have been effective. He also argues that Exposure and Response Prevention are not treatments for OCD, or for any anxiety disorder, but are simply tools one can use in treatment. David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. These models are discussed in detail on previous podcasts.

David emphasizes that the goal of the RJ is not simply to learn how to transform troubled, adversarial relationships into loving ones, but also how to achieve Interpersonal Enlightenment, which is the empowering but shocking realization that we are creating our own interpersonal reality—for better or worse—at every moment of every day! And although the reward of the RJ is greater love and joy in your daily living, the price is steep—it requires the death of the ego, which the Buddhists have called “the Great Death!” Together, David and Fabrice walk you through the five steps in the RJ, using real examples of individuals David has worked with in his workshops for the general public or for mental health professionals. One vignette involves a woman who complained bitterly that her husband had been relentlessly critical of her for 25 years. She said she came to the workshop because she wanted to know why men are like that. She found out why her husband was so critical, but the answer was not the one she expected! The other vignette involved a minister’s wife who complained that her husband was overly “nice” and unable to deal with negative feelings. As a result, she said their marriage was superficial and lacking in intimacy. She discovered precisely why their relationship was superficial—but it wasn’t exactly the answer she was looking for!

Bob, a psychiatric resident named was treating a divorced woman who complained bitterly about her ex, and constantly argued with him whenever he came to visit with the children. Their relationship was clearly acrimonious, so Bob asked the woman if she wanted some help with the way she was communicating with her ex. She bristled and said that she was an attorney and that she could communicate just fine, thank you! Bob’s error was the same that many therapists make—of thinking that people with troubled relationships want help. Clearly, Bob’s patient was not asking for help. She just wanted Bob to agree that her ex was a bum! In many cases, and perhaps most, individuals who aren’t getting along with someone—such as their spouse, sibling, parent, colleague, or friend—aren’t really asking for help. They just want to vent and persuade you to buy into their negative view of the person they aren’t getting along with. They just want you to know what a loser the other person is! So how do we help people with troubled relationships? David emphasizes that empathy is always the first step. You try to see the world through the eyes of the patient without jumping in to try to “help.” Empathy, of course, is the "E" of TEAM therapy. Once the person feels understood and supported, the next step is called Agenda Setting. That’s the A of TEAM. One of the most important tools in Agenda Setting for individuals with troubled relationships is to first ask, “Is this relationship conflict something you want help with?” In many cases, the patient will say no, so you can ask if there’s something else he or she wants to work on. In the language of TEAM, this is called “Sitting with Open Hands.” The therapist has to let go of his or her attachment to “helping.” This is difficult for many therapists, due to the therapist’s compulsive urges to help. If the patient does want help, the next step is called Interpersonal Decision-Making. You ask what kind of help the patient wants, and make it clear that the patient has three choices. To leave the relationship. To improve the relationship. To stay in the relationship and behave in a way that will guarantee that the relationship will remain miserable. David emphasizes that the last choice is by far the most popular. The second most popular choice is the decision to leave the relationship. And occasionally, you’ll find a person who wants help improving the relationship. As you can see, Interpersonal Decision-Making is simply a more sophisticated way of asking the patient if she or he wants help! If the answer is still yes, the next Agenda Setting step is the Blame Cost-Benefit Analysis (CBA). You can ask the patient something along these lines: “Who, in your opinion, is more to blame for the problems in the relationship? You? Or the other person? And who, in your opinion, is the bigger jerk? You? Or the other person?” At least 80% of the time, the patient will say, “the other person!” You may feel the same way if you’re in a conflict with someone right now. However, blame is the most formidable barrier to intimacy, so before we can continue with the treatment, this issue must be skillfully addressed, or the treatment will probably fail. David and Fabrice guide the listener in doing a written Blame CBA, listing the advantages and disadvantages of blaming others for the problems in our relationships with them. They encourage you to pause the recording and to the written exercise during the podcast, but warn you not to do it if you are driving! Then they discuss how to process the results of the Blame CBA. If you would like to see a completed Cost-Benefit Analysis, click here. As you can see, the weightings at the bottom have not been filled out, so you can do that for yourself if you like. Make sure you put two numbers that add up to 100 in the two circles. Put the larger number in the circle under the column that feels more desirable. For example, if the advantages of blame greatly outweigh the disadvantages, you might put a 70 in the circle on the left and a 30 in the circle on the right. If the patient concludes that the disadvantages outweigh the advantages, you can proceed to the M = Methods phase of the TEAM therapy session, which involves the Relationship Journal (RF). This is a powerful tool that David has designed to create interpersonal enlightenment and the death of the ego. David and Fabrice will discuss and illustrate the RJ in the next podcast.

David describes the three assumptions of the Interpersonal TEAM Therapy: We cause the very relationship problems we are complaining about, but don’t realize this, so we blame the other person and feel like victims of his or her“badness.” David describes a man who endlessly complained about his wife during therapy sessions--she didn't like having sex with him, she spend money behind his back, and never bragged about him when they were out to dinner with friends. He had even taken notes for years on all the “bad” things his wife had been doing every day throughout their marriage, but overlooked the many hurtful and self-centered things he was doing to break her heart every single day. We do not want to have to look at our own role in any relationship conflict because it is too painful to have to confront our “shadow,” to use a Jungian concept, and because we want to do our dirty work in the dark. So we will deny our role and angrily punish anyone who tries to shed light on our role in the problem. David describes a severely depressed woman who complained that she was the victim of "loneliness in marriage," a concept she'd just read about in a popular women's magazine. She explained that her husband would not and could not express his feelings, and felt that he was to blame for their marital problems as well as the severe depression and loneliness she’d been struggling with for 25 years. And yet, in a therapy session when he tried to express his feelings, she exploded angrily and told him to shut the F__ up! When Doctor Burns asked her to reflect on what had happened in the session with her husband, she angrily threatened to fire him if he ever brought up the topic again! The first two principles paint a dark picture of human nature. The third principle is more optimistic—namely, that we have far more power to heal a troubled relationship than we realize, and this can often happen quickly, but there’s a stiff price to be paid.  First, we have to be willing to stop blaming the other person so we can examine and pinpoint our own role in the conflict. Second, we have to focus all of our energy on changing ourselves, rather than trying to change the other person. This can be extremely liberating and joyful, but it involves the exceedingly painful death of the ego. The Buddhists have called this type of enlightenment “the Great Death.’ In the next podcast, David and Fabrice will show you how to transform your own troubled relationships into loving ones--if that's what you want to do!

First in a series of podcasts on how to transform troubled relationships into loving ones—if that's what you want to do! David begins with the story of how he got into working with troubled couples as well as individuals with troubled relationships shortly after his first book, Feeling Good, was published. Because cognitive therapy was beginning to generate excitement worldwide as the first drug-free treatment for depression, everyone thought it might also be effective for other kinds of problems, including troubled relationships. And there were fairly good reasons to suspect that cognitive therapy might be helpful. When you’re in conflict with a loved one, friend, colleague or stranger who you can't get along with, you’ve probably noticed that you will usually have negative thoughts like these running through your brain: It’s all his fault. (Blame, All-or-Nothing Thinking) She’s a jerk. (Labeling, Should Statement, Mental Filter, Hidden Should Statement) He’ll never change! (Fortune Telling, All-or-Nothing thinking, Discounting the Positive, Emotional Reasoning) All she cares about his herself. (Mind-Reading, Discounting the Positive, Mental Filter, Over generalization) I’m right and he’s wrong about this! (Blame, All-or-Nothing Thinking) She shouldn’t be like that. (Should Statement, Blame) Sound familiar? And as you can see, these thoughts contain all the same kinds of cognitive distortions that depressed individuals have, as I've indicated in parentheses. If you're familiar with the cognitive distortions, you may be able to pinpoint even more than the ones I've listed. The only difference is that when you're in conflict with someone, the distortions will usually be directed at the person you’re not getting along with, rather than yourself. Although these thoughts will usually be distorted, you may not realize this (or even care) when you're upset. You'll probably be convinced that the person you're mad at really is a jerk, or really is to blame, or really is wrong. In addition, these thoughts will tend to function as self-fulfilling prophecies. For example, if you think someone is a self-centered jerk, you will usually treat him or her in a hostile or unfriendly way, and then he or she will get defensive and hostile, and will look like a jerk. Then you'll tell yourself, "See, I was right about him (or her)!" David got excited about these insights and wrote a draft of a book called Couple in Conflicts, Couples in Love, and sent it to his editor in New York to see what she thought. The new book was about how to modify the distorted thoughts and self-defeating beliefs that trigger and magnify relationship problems. David's editor called the next day with an offer of a large advance, exclaiming excitedly that the book was sure to be a #1 best seller. David was ecstatic, and set out to edit the book for publication. In the meantime, he was using the new approach with troubled couples as well as individuals with relationship conflicts. But after six months of repeated treatment failures, he concluded that cognitive therapy was not at all effective in the treatment of relationship problems. The approach sounded great on paper, but it didn't work in the real world. David sadly returned the advance to his publisher and cancelled the contract. He promised that if he could figure out why cognitive therapy didn't work for troubled relationships, and if he could find a better treatment method, he’d write another book. Figuring it out took 25 years or research and clinical experience, and the name of the book he eventually did publish is called Feeling Good Together, now available on Amazon.com. David and Fabrice then discuss some of the most popular theories about the causes of relationship problems: The skill deficit theory: We want loving relationships, but don’t have the communication and negotiation skills to get close to the people we’re not getting along with. The barrier theory: We want loving relationships, but something gets in the way, such as unrealistic expectations or distorted thoughts about the person we’re not getting along with. Other barrier theories include the idea that women are from Venus and men are from Mars popularized by John Gray, Deborah Tannen, and others. According to this theory, women use language to express feelings, and men use language to solve problems, so they both end up frustrated and not understanding one another. Another popular theory is the idea that we project childhood conflicts with our parents onto others, and thus recreate the same dysfunctional patterns repeatedly in every new relationship. The self-esteem theory: You can’t develop loving relationships with others if you don’t know how to love yourself. The motivational theory: We have troubled relationships because we WANT them! David emphasizes that the first three theories are all very optimistic--they all are based on the idea that human beings are basically good and want loving, peaceful, joyous relationships. But something gets in the way, such as a barrier of some type, or the lack of communication skills, or the lack of self-esteem. And they are all very hopeful, since we can teach people better skills, or remove the barriers to intimacy, or help people develop better self-esteem. David also emphasizes that these theories have only two problems. First, the theories that they're based on are false. Second, the treatments that have evolved from these theories are not effective. David and Fabrice describe research on the validity (or total lack of validity) for these theories as well as the effectiveness (or lack of effectiveness) of the treatment techniques and schools of therapy that have evolved from these theories. David then discusses the motivational theory which is much less optimistic about human nature, and emphasizes that humans have competing positive and negative motives. In the next podcast, they will discuss the basics assumptions of the new treatment approach David has created for relationship problems, based on the motivational theory.