Fabrice begins with another question on OCD—if you successfully extinguish the symptoms with Exposure and Response prevention, would they just resurface in some other form, such as worrying, or some other anxiety disorder. David agrees, and describes the solution to this problem. Then David describes his treatment of a pregnant woman with OCD who was afraid her baby would be switched at the hospital so that she’d end up with the wrong baby. Although she rationally recognized that this fear was irrational, she could not shake it from her mind, and obsessed about it constantly. After trying more than 30 CBT techniques that did not work, David used the What-If Technique to pinpoint her deepest fear, which turned out to be quite shocking, to say the least. He then encouraged her, with some reluctance, to confront this fear using Cognitive Flooding. After describing the surprising outcome, David and Fabrice discuss the fact that 75% of American therapists are afraid to use Exposure Techniques because of the fear that the patient is too fragile, or they will re-traumatize the patient. David reminds us that this is “reverse hypnosis,” where the patient hypnotizes the therapist into believing something that is not true. If the patient is successful, and the therapist agrees not to use Exposure, the prognosis for effective treatment is quite poor. David gives an example of a therapist who was afraid to ask an OCD patient to drink one ounce of coca cola—something the patient feared would drive him into insanity!

David describes his treatment of a physician with OCD who was tortured by the fear that he would impulsively throw his newborn baby over the railing of his second-floor apartment. He also describes a psychologist with OCD who washed her hands more than 50 times a day for fear of contamination. In addition, she spent hours every day making sure that nothing in her house was arranged in groups of three—including furniture, table settings, decorative objects, magazines on tables, and so forth. Arrangements in groups of 2 were okay, as were groups of 4, 5 or more objects. Why was she so obsessed? What were the hidden emotions that fueled these obsessions and compulsions? David and Fabrice will give you the chance to pause the recording on three occasions to jot down your hypotheses before they give you the answers. It won't be important to get it "right," but it is highly desirable to take a stab at it. This podcast will be of interest to you if you or a loved one is struggling with OCD, or any form of anxiety, including phobias, panic attacks, chronic worrying, and so forth. That's because the hidden emotion phenomenon, or excessive “niceness,” may be a the root of your fears as well. Bringing those feelings to conscious awareness will often lead to sudden relief, or even a complete elimination of your symptoms. In the next Feeling Good Podcast, David and Fabrice will describe dramatic examples of exposure and response prevention in the treatment of OCD, including a woman who was tortured by the fear that she’d received the wrong baby at the hospital after her first child was born. What causes these bizarre symptoms, and what’s the most effective treatment? Stayed tuned and you’ll find out!

Listeners submitted questions on OCD (Obsessive-Compulsive Disorder): Is it an organic illness? Are drugs necessary in the treatment? What’s the best book to read if you want to heal yourself? What’s the prognosis? Drs. Nye and Burns begin by explaining OCD and answering the questions. David emphasizes the importance of using four treatment models when working with OCD—the cognitive model, the motivational model, the exposure model, and the hidden emotion model if you are hoping for a rapid and complete elimination of symptoms. Treatment that focus on only one treatment method, such as exposure and response prevention, may have only limited success. He describes his treatment of a medical student named Ralph with classic OCD. Ralph was frequently plagued by the fear he was dying of AIDS; then he’d get so anxious that he’d go to the emergency room and insist on having a blood test for HIV. These always came out negative, and this brought temporary relief, but within a few days Ralph would be worrying about AIDS again and feeling the overwhelming compulsion to get yet another blood test. The case was especially curious because Ralph was engaged and faithful to his fiancé, so there was no rational reason for him to think he had become infected with the HIV virus. However, he’d tell himself, “Maybe I drew blood on a patient with AIDS and then pricked myself with the needle, and then forgot. And how can I know that this didn’t happen?” This are extremely typical of the kind of obsessions that plague OCD patients. Ralph would torture himself with these thoughts until he succumbed to the urge to get another blood test for AIDS. Although years of conventional psychotherapy had failed this patient, the Hidden Emotion Technique led to an incredible recovery in just a few minutes during a therapy session. You will find this true story inspiring and amazing! And David provides an even more amazing 40-year follow up report! In the next Feeling Good Podcast, David and Fabrice will describe more examples of patients with severe OCD who experienced dramatic relief because of David’s Hidden Emotion Technique. This technique can be helpful for all anxiety disorders, and not just OCD. However, David emphasizes that this is just one of many techniques he uses in the treatment of anxious patients. He cautions therapists against thinking three is just ONE best technique for any anxiety disorder, including OCD. See link to podcast #027: Scared Stiff — The Hidden Emotion Model.

The late Dr. Albert Ellis developed a technique to help individuals struggling with shyness. It’s called Shame-Attacking Exercises. Essentially, you do something bizarre in public to overcome your fear of making a fool of yourself; and you will probably discover that the world doesn’t come to end. When used skillfully, this method can be incredibly liberating. However, there are several ethical considerations. First, before therapists can ask their patients to do Shame Attacking Exercises, therapists have to do Shame-Attacking Exercises themselves! David explains his first, terrifying Shame-Attacking Exercise in a Chinese restaurant in New York after giving a talk at a workshop sponsored by Dr. Ellis. In addition, therapists have to be careful in the way they use Shame Attacking Exercises, and who they use them with. You have to have an excellent therapeutic alliance with your patient, and the patient has to trust you. In addition, the exercises have to be in an appropriate location—for example, it would be disrespectful to do them in a hospital. And you have to be careful that the Shame Attacking Exercises is not aggressive or frightening to other people. He also describes how Shame-Attacking Exercises helped a man and a woman he treated who were both afraid to flirt with people they were attracted to, and in both cases, he had to push fairly hard since the patients put up stiff resistance to the idea. TEAM-CBT includes many powerful techniques, and while they have the potential to bring about rapid and often fantastic change, they also have the potential to hurt if not used skillfully and appropriately. Any listeners who are interested in using these techniques should first consult with a mental health professional to make sure the techniques are appropriate and likely to be helpful to you. All that being said, you will (we hope) LOVE this podcast! In upcoming podcasts, David and Fabrice will address questions on OCD (Obsessive-Compulsive Disorder) submitted by several listeners. Is OCD an organic illness? Are drugs necessary in the treatment? What’s the prognosis? David will describe powerful, drug-free treatment methods based on the four models he uses to treat all anxiety disorders: the Motivational, Cognitive, Exposure, and Hidden Emotion Models.

The third uncovering technique is called the “What-If” Technique, developed by the late Dr. Albert Ellis. The What-If Technique can will help you identify a terrifying fantasy under the surface that fuels your fears. David brings this technique to life with an inspiring story of a woman from San Francisco suffering from more than 10 years of mild depression and paralyzing Agoraphobia—the intense fear of leaving home alone. You may be surprised when you discover the Negative Thoughts that triggered her fear of leaving her apartment alone, as well as the core fantasy at the root of her Agoraphobia. David and Fabrice also discuss the dramatic techniques that helped her completely defeat her fears and overcome her depression. Below, we have included a PowerPoint presentation for you so that you can follow along when David and Fabrice do the What-If Technique together on the podcast. In the next podcast, David and Fabrice will discuss Shame-Attacking Exercises. This is a powerful and bizarre exposure technique that can helpful in the treatment of shyness--but there’s a hook. Therapists must be willing to do Shame Attacking Exercises themselves before they can ask patients to do them! And that can be intimidating!  

The Roles and the Rules—Psychoanalysis at Warp Speed! Most of us run into conflicts with other people from time to time, or even frequently. In this podcast, you will discover precisely why this happens, and how you to change the beliefs that get you into trouble, if that’s what you want to do. Psychoanalysts sometimes help people discover what they call “core conflicts.” According to the highly regarded psychoanalytic researcher Lester Luborsky, PhD, an example of a core conflict might be, “My needs will never be met in my relationships with others.” If you believe this, it will tend to function as a self-fulfilling prophecy, so you’ll constantly feel hurt, lonely, and rejected, and perhaps resentful when you try to get close to others. And you probably won’t realize you’re creating your own painful interpersonal reality. You’ll think that this is just the way it is. Once you bring the painful system to conscious awareness, you can use a variety of powerful techniques to change your expectations and beliefs so you can enjoy far greater satisfaction and intimacy in your relationships with others. David and Fabrice will illustrate a powerful, high-speed method that to bring your own Interpersonal Self-Defeating Beliefs to conscious awareness. David has called it the Interpersonal Downward Arrow Technique. David and Fabrice will revisit the same clinical example from the last Podcast—the psychologist named Harold who felt devastated when his favorite patient unexpectedly committed suicide, but in this podcast they will examine how Harold sets up his relationships with his colleagues in a way that causes him to feel lonely, anxious, and resentful. You can use the Interpersonal Downward Arrow Technique to identify anybody's Self-Defeating Beliefs in five to seven minutes, as opposed to spending five years or more free-associating on an analyst’s couch to get the same information. Not a bad deal! During the podcast, you may want to download and print “The Rules and the Roles” form that David and Fabrice will be using during the podcast. There will be an exercise for you to do while you are listening. But don’t do the written exercise if you’re listening while driving in your car! In the next podcast, David and Fabrice will discuss a third powerful uncovering technique developed by the late Dr. Albert Ellis, a former psychoanalyst from New York who is considered the "Grandfather of Cognitive Therapy." It’s called the “What-If Technique," and Dr. Burns will bring it to life with an inspiring and dramatic story of a woman from San Francisco who had been suffering from years of mild depression and severe Agoraphobia—the intense fear of leaving home alone. So stay tuned! And feel free to comment below or ask questions. Fabrice and I greatly appreciate your feedback and guidance! If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients! Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.  

What are the root causes of depression? Anxiety? Relationship problems? In this, and the next two podcasts, you will discover the answer! Cognitive Therapists believe that negative thoughts, or cognitions, can exist on two different levels. When you’re upset, you’ll have Automatic Negative Thoughts (ANTs) in the here and now, and they’ll usually be something like this: Depression: You may be telling yourself that you’re a loser, or a failure, or that you’ll be miserable forever. Anxiety: You’re probably telling yourself that you’re in danger, and that something terrible is about to happen. “When I get up to give my talk at my church group, my mind will probably go blank and I’ll make a total fool of myself!” Relationship conflicts: You may be telling yourself that someone you’re ticked off at is a self-centered jerk who only cares about himself or herself and shouldn’t be that way! Individual Downward Arrow But why do we get these ANTs in the first place? Cognitive therapists believe that Self-Defeating Beliefs, and other deeper structures in the brain, make us vulnerable to painful mood swings and conflicted relationships with the people we care about. To help you pinpoint your own Self-Defeating Beliefs, David has created two uncovering techniques called the Individual Downward Arrow and the Interpersonal Downward Arrow, and Albert Ellis, the noted New York psychologist, created a third called the “What-If” Technique. In today’s podcast, Drs. Burns and Nye illustrate the Individual Downward Arrow technique, using as an example a psychologist named Harold who was understandably devastated when his patient unexpectedly committed suicide. You can follow along on this PowerPoint presentation starting with Harold’s Daily Mood Log with David and Fabrice while they illustrate the Individual Downward Arrow technique. [office src="https://onedrive.live.com/embed?cid=4C33CD5BBD389DD2&resid=4C33CD5BBD389DD2%21158&authkey=AMjeMe-n6Qmswxc&em=2&wdAr=1.3333333333333333"] Once they come to the “bottom of the barrel,” they will ask you to pause the recording, and see if you can pinpoint five or six or more of Harold’s Self-Defeating Beliefs, using the list of 23 Common Self-Defeating Beliefs. David emphasizes that we create our own emotional and interpersonal reality at every moment of every day, but we aren’t aware of this, so we often feel like victims of forces beyond our control. We are really talking about emotional and interpersonal enlightenment, and the uncovering techniques will make this ancient Buddhist concept more understandable for you. If you’d like more tips on precisely how to do the Individual Downward Arrow Technique, you can read David’s recent Feeling Good Blog on this topic! In our next Feeling Good Podcast, David and Fabrice will illustrate the Interpersonal Downward Arrow Technique, which will allow you to complete a course of psychoanalysis in just 5 to 7 minutes, rather than the 5 to 7 years free associating on the couch. It is truly psychoanalysis at warp speed, and is pretty amazing! And when you change the beliefs that trigger interpersonal conflicts, you can change them and enjoy greater satisfaction in your relationships with the people you care about. But sometimes, that requires a little bit of courage! And in the third Feeling Good Podcast on the uncovering techniques, David and Fabrice will illustrate Dr. Albert Ellis' famous "What-If Technique." If you struggle with any type of anxiety, including fears and phobias, this technique can help you uncover the feared fantasy at the root of your fears, so you can challenge the monster and attain freedom from the fears that hold you back!  

A listener named Daisy describes her despair at being unable to have a baby, despite intensive efforts at a fertility clinic. She gets well-meaning messages from friends, family and support groups that she really needs a baby in order to feel truly happy and fulfilled, and these messages make her feel anxious and depressed. But she wonders whether this is really true. Does she really need a baby to feel happy? In fact, we we get all kinds of messages from society that we need certain things in order to feel worthwhile, including: Achievement / Success / Wealth Intelligence Perfection Love Approval Popularity Good looks Are these things really needs? Listen to today’s podcast and you may be surprised by the answer! In the next three podcasts, David and Fabrice will discuss three powerful uncovering techniques that can help you pinpoint the Self-Defeating Beliefs that may be at the root of your own unhappiness and anxiety. These include the Individual Downward Arrow Technique, the Interpersonal Downward Arrow Technique, and the What-If Technique. After that, David and Fabrice will also describe some powerful techniques to help you change the way you think and feel!

“My problems are real! The world really IS screwed up! And that’s not a distortion. So what can I do about my severe depression and anxiety?” David and Fabrice discuss two questions submitted by Feeling Good Podcast listeners. #1. Shari writes: “I read your book Feeling Good and now I am reading your book When Panic Attacks--thanks to April's podcast with you. I still struggle but recently our current political situation and environmental research about our negative impact on earth—has triggered severe anxiety and depression again. The problem is that I don't think my thoughts are distorted—it certainly seems logical to assume that life on earth is threatened. So I am not sure how to do this. How can I make progress with my mental and emotional health while being aware of situations around the world? Any advice or thoughts would be deeply appreciated.” This is a wonderful note, and I’m sure that huge numbers of people feel the same way, in varying degrees. So how can we attend to our own emotional well-being in the face of genuine adversity? Dr. Burns discusses this from the perspective of Paradoxical Agenda Setting, which is the key component of TEAM-CBT, and emphasizes the most common therapeutic error of all—jumping in to try to help, without seeing all the really GOOD reasons for the patient NOT to change. From this perspective, Shari’s question becomes the most important question in all of psychiatry and psychotherapy—how do we help patients who may not want to change? #2. After listening to the A = Agenda Setting portion of the live therapy with Mark, Paul submitted this question: “Hi David, Thanks to you, Fabrice and Jill for this episode - as with the previous episodes with Mark, this has really helped in bringing the TEAM approach to life. As I have been using your books in the past few years to self-treat feelings of anxiety and depression, I was very keen to hear how the new agenda setting step works. I am wondering what your thoughts are on how effectively the "A" step can be carried out by a patient on his/her own (i.e. without someone else verbalizing the reasons not to change / playing the part of the patient's sub-conscious)? Do you have any tips? I think I heard Mark say something to the effect that, on his own, he wouldn't have thought of all the positives that you came up with in the session. Thanks again for sharing these great tools and techniques - looking forward to the "M" step soon. Paul” This was another terrific question on a topic of great importance. David explains that it is actually easier for patients to learn to use Positive Reframing and the other Paradoxical Agenda Setting techniques than for therapists to learn them. Because of his excitement over this prospect, David has just begun a new book which will show depressed and anxious individuals exactly how to do this on their own in a step-by-step manner. He is optimistic that the new TEAM-CBT techniques, in book form, may be even more helpful to patients than his first book, Feeling Good: The New Mood Therapy. Research studies indicate that 65% of patients with moderate to severe depression improve substantially within four weeks of receiving a copy of Feeling Good, even without any other treatment. Dr. Burns is hopeful that his new book will provide the answers for the 35% who were not helped by Feeling Good. So the answer is yes, I think many individuals WILL be able to do the “A” step on their own, and I am hopeful the positive impact will be great! If you would be interested in David's new book, please indicate this in the Survey attached to this podcast. David and Fabrice have exciting plans for upcoming podcasts. They will be addressing these two questions in one or two podcasts: Is it possible to measure our “worthwhileness” or “worthlessness” as human beings? Do we even have a “self”? These two questions have been discussed by experts for thousands of years, going all the way back to the Buddha, and most recently by the incredible Austrian philosopher, Ludwig Wittgenstein. And although the answers are tremendously simple, people can’t seem to “get it.” The issues are not simply philosophical, but eminently practical, since most depression and anxiety result from the perception that one is “worthless,” or “inferior,” or simply “not good enough.” In addition, David and Fabrice are hoping to create a second live therapy session broken into smaller podcast chunks, but featuring David and a totally awesome former student and now highly esteemed colleague, Matthew May, MD. For the past ten years, David has been telling workshop audiences that Matt is one of the finest therapists in the world. So this is an event you won’t want to miss! Click here to listen to Fabrice being interviewed on Dr. Carmen Roman's podcast.

A blog reader made a fairly strong and impassioned comment that sometimes asking the patient to examine ways she or he may be contributing to the problem may be a mistake when the patient really IS a victim, and cautioned against blaming the victim. David’s goal is never to blame patients, but rather to empower you. David and Fabrice begin by discussing the fact that sometimes people vacillate between other-blame (it’s all his/her fault) and self-blame (it’s all my fault), and emphasize that neither approach is helpful. If you blame the other person, the problem escalates and may turn to violence, but if, instead, you blame yourself, you’ll probably end up feeling worthless, guilty, unlovable, and depressed. So what’s the solution to this dilemma? Dr. Burns encourages patients to use the Five Secrets of Effective Communication and make a radical change in the way they communicate with others, along the lines of EAR. E stands for Empathy, A stands for Assertiveness, and R stands for Respect. You can examine each of the Five Secrets if you CLICK HERE. David gives five compelling examples of how to deal with people who REALLY ARE violent and abuse, including a raging psychiatric patient who was threatening the staff and on the verge of exploding, a serial killer who kidnapped a social worker who had attended one of David’s communication workshops, some drunken, abusive teenagers in a huge jeep who threatened David, an insulting, demoralizing, critical boss who put down everyone who worked with him. He includes with the story of a Lutheran minister,  Dietrich Bonhoeffer, who was imprisoned and mistreated by the Nazis during world war two. This is a controversial topic that David included in the podcasts somewhat reluctantly, so give a listen and tell us what you think! Right now the world seems to be spiraling into greater and greater hostilities. Does David have a point? Or is he way off base?