David answers these questions: How do you deal with a patient (or friend) who is boring? How do you deal with a patient (or friend) you don’t like? How do you get patients to do their psychotherapy homework? How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide. How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely. How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.  

The cognitive model of anxiety is based on three powerful ideas: Anxiety always results from negative thought (NTs) that involve the prediction of danger. For example, if you have public speaking anxiety, you are probably telling yourself something like this: “I just know I’m going to blow it. My voice will tremble. People will know I’m anxious. My mind will go blank. I’ll mumble and make a total fool of myself.” Or, if you struggle with panic attacks, you probably have thoughts like this: “I think I’m about to die. I can’t breathe properly. I’m about to pass out!” Or, “I’m about to lose control and go crazy.” The NTs that trigger anxiety are always distorted and illogical. In contrast, valid NTs cause healthy fear. When you put the lie to the distorted NTs, the anxiety will disappear. This can sometimes happen in an instant. Dr. Burns describes his treatment of a woman named Terry who had suffered from ten years of incapacitating panic attacks and severe depression prior to contacting Dr. Burns. During each panic attack, Terry would experience tightness in her chest and tingling skin and tell herself she was about to pass out, suffocate, or die of a heart attack. Multiple emergency room visits, medical tests, and reassurances from doctors did not help. In addition, years of medication and psychotherapy were not at all helpful. After trying a number of cognitive techniques that did not help, Dr. Burns persuaded her to let him induce an actual panic attack during an office visit so he could use the Experimental Technique, which is arguably the most powerful technique ever developed for the treatment of anxiety, and he televised the session. What happened next will blow your mind! In the next podcast, Drs. Burns and Nye will describe the Exposure Model of treatment, and Dr. Burns will describe his personal struggles with his fear of blood during medical school.

There are 4 powerful treatment models for anxiety, including The Cognitive Model The Exposure Model The Motivational Model The Hidden Emotion Model Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger.  And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover. Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients. Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever. Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out! In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.  

David and Fabrice answer these questions: What is anxiety? How does it differ from depression? Do anxiety and depression always go hand in hand? How does anxiety differ from healthy fear? What are the most common forms of anxiety? How common is anxiety? Anxiety, like depression, has been called the world’s oldest con. That’s because you are always fooling yourself, and buying into negative thoughts that aren’t true, when you’re feeling anxious and insecure. Dr. Burns highlights the most common cognitive distortions that trigger anxiety, and discusses the powerful role of shame in anxiety. In the next several podcasts, Dr. Burns will describe powerful, fast-acting, drug-free treatment methods that can help you defeat every type of anxiety, Including Chronic worrying Phobias Social anxiety Public speaking anxiety Shyness OCD (Obsessive-Compulsive Disorder) PTSD (Post-Traumatic Stress Disorder) Panic attacks Agoraphobia BDD (Body Dysmorphic Disorder) So stay tuned!

A listener with OCD is plagued with intrusive and shameful sexual fantasies. David discusses his treatment strategies for a young man from Argentina who was struggling with forbidden fantasies of Jesus having sex with the Virgin Mary in all positions of the Kama Sutra, but the harder he tried to control them, the more intense and tantalizing they became. Being a good Catholic lad, he was terrified and tearful he would burn in hell if he didn’t overcome this problem. If you’ve ever struggled with shameful sexual fantasies, you might be intrigued by this fascinating discussion of Cognitive Flooding, therapeutic resistance, and the Hidden Emotion Technique!

Discussion of recent startling and disturbing research studies by Dr. Irving Kirsch and others that suggest that the chemicals called “antidepressants” may, in reality, have few or no true antidepressant effects above and beyond their placebo effects. Dr. Burns illustrates the placebo effect with a thought experiment, and explains why it is so confusing to researchers and the general public alike. In addition, David and Fabrice discuss additional troubling research by Dr. David Healey and others that indicates that the chemicals called “antidepressants” appear to cause a doubling or tripling of the likelihood that a depressed individual will commit suicide or become actively suicidal, as compared with depressed individuals treated with placebos. David concludes with a discussion emphasizing that the needs of marketing are in conflict with the needs of sciences, and proposes some solutions to this serious problem. Dr. Burns emphasizes that he is only providing his interpretation of some extremely controversial studies, based on his research training and clinical experience. He urges listeners to do their own research and critical thinking on this disturbing topic, and emphasizes that many may come to different conclusions.

Can the EAR techniques help a listener deal more effectively with a defiant, oppositional child. Dr. Burns reveals a fantastically helpful secret that he and his wife stumbled across in raising their own children. If you have ever struggled in your attempts to deal with an oppositional child or adolescent, you will find this podcast enlightening!

David and Fabrice address this question submitted by a listener: Dear Dr. Burns, I read Feeling Good twenty years ago. It was a wonderful relief and help to me. Your book has helped me live a better and balanced life. The best part was passing the knowledge on to my daughter. I thought I read a wonderful description of how to handle death anxiety in the book. I was describing it to a friend, but could' find it in the book. Is it in another book? Your reply would be considered an act of generosity. Thank you! Mary Existential Therapists believe that the fear of death is universal and is at the root of most emotional problems. Dr. Burns argues that the fear of death is actually quite rare, but does occasionally occur and is extremely treatable. In this podcast, David’s describes his quick, three-part “cure” for the fear of death. Oddly, every patient he treated in this way insisted at the end of the session that it didn’t help. And even stranger is the fact that 100% of them returned the next week and announced that they actually had been cured and were, in fact, no longer afraid of death!

David answers a challenging question posed by a listener: Dear Dr. David: In your Feeling Good Handbook, you suggest that the reader just allows himself or herself to be an ordinary person instead of trying to be perfect. Contrary to your opinion in the book, you're an outstanding therapist in reality. You’ve studied in one of the world’s top colleges, you’re well-educated with a doctor degree, and successful in your career and life. How can I believe your claim? I'm quite confused! Sincerely, XXX David first distinguishes perfectionism from the healthy pursuit of excellence, and then describes a painful incident when he was a Stanford medical student. One afternoon, he attended an afternoon Gestalt encounter group at the home of a friend and mentor in Palo Alto. During the group he was ripped to shreds by the other participants. At the end of the group, the other participants seemed elated, but he felt intensely humiliated, ashamed, and discouraged. This led to an unexpected interaction with his mentor that helped to change his life. David also discusses his clinical work years later with a depressed and anxious professional who had never experienced even one minute of happiness in spite of a life of fabulous success and achievements. At the end, David and Fabrice promise a future podcast on this topic: “Self-Esteem: What is it? How do I get it? How can I get rid of it once I’ve got it?” 

David and Fabrice are joined by Lisa Kelley, a certified TEAM-CBT therapist and former journalist from Littleton, Colorado. Lisa interviews David about an interview / blog David has just published on this website. Lisa begins by asking how people responded to a survey on David’s website asking this controversial question: “Do you believe that a depressed individual could experience a complete elimination of symptoms in a single, two-hour therapy session?” More than 5,000 individuals completed the survey and most were extremely skeptical. David states that ten years ago, he would have felt exactly the same way, and would have dismissed anyone making such a claim as a con artist. However, he has now changed his mind and believes that sometimes it is possible. David explains that he has done more than 50 live demonstrations in workshops and other teaching settings with individuals who are struggling with severe feelings of depression, anxiety, shame and anger. Many of these individuals who volunteer to be the patient have experienced horrific personal traumas. This gives David the opportunity to demonstrate how TEAM-CBT works with someone who is really suffering, and not just a role-playing demonstration. Usually, these live demonstrations are the highlight of a workshop because they are intensely emotional and real. Surprisingly, in the vast majority of these sessions, the individuals who were in the patient role experienced a complete, or near-complete, elimination of symptoms in roughly two hours. David emphasizes that while we would not expect this to generalize to a clinical practice situation, it does seem to suggest significant improvements, or even breakthroughs, in psychotherapy. Many of the new developments have to do with helping patients overcome their resistance to change. Although David makes these techniques look easy, they are challenging to learn, and require a radically new and different way of thinking about why patients sometimes resist change and fight the therapist. Lisa, Fabrice, and David explain exactly how the new techniques work, using as an example an Asian-American woman who had experienced decades of domestic violence and rape.