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

David addresses a question submitted by a listener after he heard the introductory podcasts on the Five Secrets of Effective Communication. He questioned the value of the Disarming Technique, and protested that every time he "turned the other cheek" he simply ended up with two sore cheeks! A great question, and David and Fabrice share their thinking. Many people, including therapists, are afraid of the Disarming Technique, thinking that something terrible will happen if they agree with someone who is criticizing them. They emphasize the value of questions submitted by you, the listeners, and also suggest giving specific examples when they are having trouble using the Five Secrets. Specifically, if you write down exactly what the other person said to you, and exactly what you said next, David and Fabrice will gladly analyze the interaction and show you what errors you made that caused a bad outcome, as well as how to correct those errors! David and Fabrice then discuss Thought and Feeling Empathy, the second of the Five Secrets of Effective Communication. The definition of Thought Empathy is repeating or paraphrasing what the other person is saying, so he or she will see that you listened and got the message. Feeling Empathy, in contrast, involves acknowledging how the other person is likely to be feeling, given what he or she just said. You can often follow this with Inquiry, asking if you got it right, and inviting the other person to tell you more about what he or she is thinking. Although David does not like formulas, they can sometimes help you get started. So here's the formula: Thought Empathy: Let me see if I got what you just said. You told me that A, B, and C. (A, B, and C would be what the person said to you, using his or her words.) Feeling Empathy: Given what you just said, I can imagine you might be feeling X, Y, and Z. (X, Y, and Z would be words from the Feeling Words list.) Inquiry: Did I get that right? Can you tell me more about what you've been thinking and feeling? These techniques are invaluable in therapy, and go back to the pioneering work of Karl Rodgers, who argued that therapist empathy is the necessary and sufficient condition for personality change. Although subsequent research did not confirm this idea, there is still little argument that empathy is absolutely necessary for good therapeutic work. In addition, skillful empathy is for everyone, and can greatly enhance your relationships with family members, friends, and colleagues, and strangers as well. For example, if you have a family member or friend who is feeling anxious, down, angry, or depressed, the skillful use of Thought and Empathy will almost always be far more effective than trying to help, rescue, or "fix" that person.   David brings Thought and Feeling Empathy to life with an example of a patient who criticizes his therapist, and then asks listeners, including you, to pause the podcast briefly so you can write down, from memory, what the patient just said. Most therapists who try this end up "forgetting" or editing out important portions of what the patient said. This irritates the other person, because you clearly did not "get it," and his or her attack or complaining will usually escalate. David and Fabrice discuss common errors therapists and general public make when trying to use Thought and Feeling Empathy. The most common error involves using the techniques in a robot-like manner, parroting back the other person's statements repeatedly, without using "I Feel" Statements. They illustrate this error with a humorous example. Other common errors when using Thought and Feeling Empathy include: Helping Rescuing Giving advice Correcting distortions Making interpretations Failing to acknowledge the other person's anger   David encourages listeners (that includes you!) to try using Thought and Feeling Empathy three times each day, even in superficial interactions with people in any setting, such as the grocery store, and give examples of how to do this. Although this will not be the deepest application of these techniques, the practice will give you a clear understanding of how these techniques actually work. David and Fabrice end this podcast with a powerful example of Thought and Feeling Empathy during an actual therapy session in David's weekly psychotherapy training group. The "patient" in the therapy is a TEAM-CBT therapist named Rhonda who became depressed and anxious after receiving some critical therapy from a participant in a therapy group she was teaching. Even if you are not a therapist, you can perhaps identify with the "ouch" we all feel when we are criticized by someone, and it hits a vulnerable spot. This is an almost universal human concern. It is so easy to feel hurt, depressed, ashamed, anxious, inadequate, and perhaps even a bit angry! David invited one of the therapists in the group to empathize with Rhonda, as a part of his training, but he ended up with a less than stellar grade. David, Fabrice and Rhonda explain the errors he made--which actually made her feel worse. Making errors is totally okay in a training and learning situation, as well as in real therapy sessions--as long as you get feedback and try to correct your errors with humility. This can actually deepen the therapeutic relationship. David then asked Dr. Jill Levitt to try to model empathy again, and to address Rhonda's concerns. Jill hits the ball out of the park and gets an A+ on empathy. David and Fabrice explain why her intervention was so effective, and why the Five Secrets have to come from the heart if they are to be maximally effective. Jill is a master therapist and co-teaches the weekly TEAM-CBT training group, along with David and Dr. Helen Yeni-Komshian. If you would like to hear more of Jill's fabulous empathy work, make sure you listen to the live therapy podcasts with Mark, the physician who felt like a failure as a father! Next week, Helen returns for the remaining Podcasts on the Five Secrets!  

David, Helen and Fabrice focus on the Disarming Technique, which is the first of the Five Secrets of Effective Communication. The definition of the Disarming Technique is finding truth in what the other person is saying, even if it seems blatantly wrong, or illogical, or exaggerated. And it's based on the Law of Opposites.  

Is there someone in your life who just  won't listen? won't open up? always has to be right? always has to get his or her way? doesn't seem to understand how you feel? doesn't seem to care? is relentlessly critical? whines and complains endlessly, but always ignores your attempts to help? Would you like greater intimacy and respect, and more rewarding relationships with the people you care about? If so, this podcast series on the Five Secrets of Effective Communication will be right up your alley. Although the Five Secrets have been introduced in previous podcasts, David and Fabrice will bring them to life with clear explanations and vignettes, and will give you homework assignments so you can practice them, one at a time, between podcasts. In the first two Five Secrets podcasts, David and Fabrice will be joined by Helen Yeni-Komshian, MD. Helen was David's student during her psychiatric residency training at Stanford roughly 15 years ago, and she now teaches David's at weekly psychotherapy training group at Stanford, and is on the adjunct faculty there. David, Helen, and Fabrice begin with a brief definition of each of the Five Secrets of Effective Communication. They emphasize the importance of intense desire if you really want to learn and master these techniques. They compare the Five Secrets to the notes on a musical instrument. Lots of dedication and practice will be necessary if you hope to use them skillfully and effectively in your relationships with the people you care about. The goal is to help you develop greater  satisfaction in your interactions with others and to resolve conflicts and arguments with others. Helen emphasizes that these techniques must be applied in a genuine fashion if they are to be effective. If they are used simply as techniques to manipulate another person, they will not be effective. David mentions that the Five Secrets exist on two levels. One the one hand, they are sophisticated and powerful psychological techniques that can change your life and your relationships with others. But on the other hand, they are profound spiritual techniques that require the death of the ego. And they also require us to relearn our usual knee-jerk habits of arguing, blaming, and defending ourselves when we're at odds with another person. These podcasts will be for mental health professionals and for the general public. We will give vignettes illustrating challenging therapeutic logjams that were resolved with the skillful use of the Five Secrets, as well as examples  how you can use the Five Secretes with loved ones, friends, colleagues, customers, and even aggressive or irritating strangers. The Five Secrets require lots of hard work and practice, in much the same way that learning to play a musical instrument will require lots of practice. In addition, when you practice you may initially find them difficult to use, and you may experience some failures. David, Helen, and Fabrice emphasize the spirit of "joyful failure" or "learning through failure," and urge you to check your ego at the door, since the rewards of the learning can be immense.  

How would you treat excessive worrying? a listener asks. David describes a new patient who had struggled with 53 years of failed therapy for excessive, relentless worrying, and describes how she was "totally and irreversibly cured" in just two therapy sessions, which was the "good news." The Hidden Emotion Technique was the key to her remarkably rapid recovery. David explains that the "even better news" was that her relentless worrying would come back over and over in the future, and that this was actually a really good thing! David also emphasizes the importance of using all the four models, along with a Daily Mood Log, when treating any form of anxiety: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. To learn more about how these four powerful treatment models work, you can listen to Podcasts 022 through #028. The DSM5 is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is used to assign diagnoses to patients. David critiques the DSM5  diagnostic criteria for "Generalized Anxiety Disorder" (GAD) and emphasizes that while worrying exists, and can easily be treated in most cases, the "mental disorder" called Generalized Anxiety Disorder does not exist, and is simply a fantasy made up by the psychiatrists who have created the DSM. Soon, David and Fabrice will launch a series of five podcasts on the Five Secrets of Effective Communication, focusing on one technique each week. Say tuned, because these podcasts could change your life and show you the road to more loving and satisfying relationships with friends, patients, colleagues, and family members--and "enemies" as well!  

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.