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

The Dark Night of the Soul (Part 1) The first live therapy podcasts with Mark (the man who felt like a failure as a father: podcasts 29 – 35) were enormously popular, and many people have asked for more. David and Fabrice were delighted with your responses, so the next three podcasts will feature a therapy session with Marilyn by David and his highly-esteemed colleague and co-therapist, Dr. Matthew May. These three podcasts will include the entire session plus commentary the session unfolds. We are extremely grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will touch your heart, inspire you, and give you courage in facing any problems and traumas that you may be struggling with. According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel. Fifty years ago, this notion gave rise to a new, exciting, drug-free treatment for depression called “cognitive therapy,” which was based on this basic notion: When you CHANGE the way you THINK, you can CHANGE the way You FEEL—quickly, and without drugs. That’s why I wrote my first book, Feeling Good: The New Mood Therapy, because I was so excited about this notion and the powerful new “cognitive therapy” that was rapidly emerging. The idea behind cognitive therapy is simple. When you’re upset, you’ve probably noticed that your mind will be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings. In addition, you’re probably not aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In Feeling Good, I said that depression and anxiety are the world’s oldest cons, because you’re telling yourself things that simply are not true. In that book, I listed the ten cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings. In the years since I first published Feeling Good, my list of cognitive distortions has gone worldwide, and is used by enormous numbers of mental health professionals in the treatment of individuals struggling with depression and anxiety. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events or circumstances external events is enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel. But a lot of people don’t buy, or understand, this notion which seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers your negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real. Would you agree? I know that’s what I used to think! The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating. As the session with begins, Marilyn explains that she was recently diagnosed with Stage 4 (terminal) lung cancer, which came as a total shock, especially since she’d never smoked. As Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session, they learn that Marilyn has been struggling with extreme levels of depression, anxiety, shame, loneliness, hopelessness, demoralization, and anger, to mention just a few of her negative feelings. If you’d like, you can review a pdf of the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative thoughts focus on several themes, including Her fears of cancer, pain, and death. Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, feeling that she’s not spiritual enough, and thinking that she’s perhaps been duped by religions. Her feelings of incompleteness at never having had a truly loving life partner. Her feelings of self-criticism, beating up on herself for excessive drinking during her life. Click here for Marilyn's Brief Mood Survey, pre-session. Click here for Marilyn's Daily Mood Log. The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, and will include the Miracle Cure Question, the Magic Button, the stunning Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, including Identify the Distortions, the Paradoxical Double Standard Technique, Externalization of Voices, and Acceptance Paradox, end of session testing, and wrap-up. Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a deeply spiritual person who suddenly finds herself without hope and totally lost, we have called part one, The Dark Night of the Soul.

A reader ask how to handle relapses following recovery from depression. David emphasizes the importance of this question, since there is a 100% probably that every patient will relapse following recovery. And if the patient has not been properly prepared, the relapses can be disastrous. But on the other hand, if the patient has been prepared, the relapses do not have to be problematic. What is a relapse? David defines a relapse as one minute or more of feeling crappy. Given that definition, we all relapse pretty much every day. However, some people can pop out of a bad mood really quickly, while others can get stuck in these “relapses” for weeks, months, or even years. David describes the Relapse Prevention Training (RPT) techniques he has developed, but cautions that RPT does not make sense until the patient has experienced a complete elimination of symptoms. If the patient is being treated for depression, that means that the score the depression test has fallen all the way to zero (no symptoms whatsoever) and that the patients feel joy and self-esteem. There are four keys to David’s RPT, including: The patient must be informed that relapse is an absolute certainty. The question is not “will this patient relapse” but rather, “when will this patient relapse?” Patients have to know that the therapy technique that worked for them the first time they recovered will always work for them. It might be the Cost-Benefit analysis, Pleasure-Predicting Sheet, Acceptance Paradox, Double Standard Technique, Five Secrets of Effective Communication, Hidden Emotion Technique, or Experimental Technique, or simply recording their negative thoughts on the Daily Mood Log and identifying the distortions in them. Patients need to identify and modify the Self-Defeating Beliefs (SDBs) that triggered their depression and anxiety in the first place, such as Perfectionism, Perceived Perfectionism, or the Achievement, Love or Approval Addictions. In several previous podcasts, David and Fabrice have described the Uncovering Techniques that can be used to quickly pinpoint any patient’s SDBs. Patients need to write down and challenge the Negative Thoughts that will inevitably emerge at the time they relapse, such as “This relapse proves I’m hopeless after all,” or “This relapse proves the therapy didn’t work,” etc. David and Fabrice illustrate step #4 using a powerful technique called Externalization of Voices. David has patients record this role play procedure on a cell phone or other recording device so they can play it and listen if needed during an actual relapse. David explains that he used this approach with every patient he discharged, and encouraged them all to come back anytime they had a relapse that they couldn’t handle. In spite of having more than 35,000 therapy sessions with individuals with severe depression and anxiety, David says that he can count on two hands the number who every returned for “tune-ups” following termination of therapy, and in most of those cases, the patients were able to recover once again in just or two sessions. In the next Feeling Good Podcast, David and his highly esteemed colleague, Dr. Matthew May, will begin their live work with Marilyn, a severely depressed colleague who is facing “The Dark Night of the Soul.” Fabrice, as usual, will narrate and elicit enlightening commentaries on the therapeutic strategies that David and Matt are using as the session with Marilyn unfolds.

The title of David's TEAM-CBT eBook for therapists is Tools, Not Schools, of Therapy. David explains that the field of psychotherapy is dominated by numerous schools of therapy that compete like religions, or even cults, each claiming to have the answer to emotional suffering. So you’ve got the psychodynamic school, and the psychoanalytic school, the Adlerian school, the Beckian cognitive therapy school, the Jungian school, and tons more, including EMDR, behavior therapy, humanistic therapy, ACT, TMT, EMT, and so forth. Wikipedia lists more than 50 major schools of psychotherapy, but there are way more than that, as new schools emerge almost on a weekly basis. David describes several conversations with the late Dr. Albert Ellis, who argued that most schools of therapy were started by narcissistic and emotionally disturbed individuals. Ellis claimed that most were self-promoting, dishonest individuals who claimed to know the true “causes” of emotional distress and insisted they had the “best” treatment methods. And yet, research almost never supports these claims. David, who is a medical doctor, points out that we don’t have competing schools of medicine. Can you imagine what it would be like if we did? Let’s say you broke your leg, and went to a doctor who prescribes penicillin. You ask why he’s prescribing penicillin for a broken leg, and he explains that he’s a member of the penicillin school. He says he always prescribes penicillin—it’s good for whatever ails you! That would be like an Alice in Wonderland world. And yet, that’s precisely how psychiatry and psychotherapy are currently set up. If you’re depressed and you go to a psychiatrist, you’ll be treated with pills. If you go to a psychoanalytic therapist, you’ll get psychoanalysis. Or if you go to a practitioner of EMDR, TFT, or Rational Emotive Therapy (RET), you’ll get EMDR, TFT, or RET. David argues that this just doesn’t make sense. David argues that the fields needs to move from competing schools of therapy to a new, science-based, data-driven psychotherapy. He emphasizes that we’ve learned a lot from most of the schools of therapy, and that many have provided us with valuable insights about human nature as well as some useful treatment techniques. But now it’s time to move on, leaving all the schools of therapy behind. David acknowledges that this message may seem harsh or upsetting to some listeners, and apologizes for that ahead of time. David and Fabrice also discuss the spiritual basis of effective psychotherapy, and David describes the reaction of his father, a Lutheran minister, on the day that David was born, as well as a tip his mother gave him when he was in third grade. In the next Feeling Good Podcast, David and Fabrice will describe Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient knows what to do, the relapse doesn’t have to be a problem.

The Beatles tell us that all we need really need is love, and in her famous song, “People,” Barbara Streisand proclaims that “People who need people are the luckiest people in the world.” But is this really true? Fabrice asks David whether love is a human need? David describes hearing Dr. Aaron Beck proclaim that love is not an adult human need, and feeling shocked, during one of Dr. Beck’s cognitive therapy seminars in the 1970s. Although initially skeptical, David did a number of experiments to test this belief, and came to a startling conclusion. David describes the impact of needing love on his depressed and anxious patients, including lonely individuals who were constantly being rejected in the dating scene. You’ll find this podcast provocative, controversial, and hopefully interesting. We’ll also include a survey you can complete below, indicating your thoughts about this topic! In the next Feeling Good Podcast, David and Fabrice will discuss Tools, Not Schools, the title of David’s TEAM-CBT eBook for therapists, and the following podcast will discuss Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient is prepared and knows what to do ahead of time, the relapse, while often painful and disturbing, doesn’t have to be a significant problem.

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.