Featuring Matthew May, MD Today, Part 1. The Inner Bully Next week, Part 2. The Outer Bully There are two types of dialogues that can get us in trouble. The first is your “Inner Dialogue.” Your Inner Dialogue sometimes consists of negative thoughts and perceptions of yourself and the world, which are often dominated by the familiar cognitive distortions that trigger internal mood problems, like depression, anxiety, guilt, shame, inadequacy, loneliness, hopelessness, and more. Examples would be “I’m a failure because . . . “ or “I should be better than I am,” or “I’m really going to blow it when I give my talk, and a myriad of variations on these themes. Your Inner Dialogue often consists of mean-spirited things you say to yourself, much like the schoolyard bully who intimidates younger, weaker children. The only difference is that you are doing this to yourself, often without noticing or realizing  what that voice inside your brain is up to. When you challenge and crush these distorted perceptions, you can CHANGE the way you FEEL. Your Outer Dialogue consists of the things you say when you have with interactions with other people, and this can be especially important when you’re dealing with others who are critical of you, or even threatening you with violence.  The strategies are quite different from the strategies you might use to challenge and defeat your Inner bully. Today, Rhonda, Matt and I will demonstrate various strategies for defeating the Inner Bully. Next week, in Part 2, we will demonstrate strategies for defeating the Outer Bully! Those strategies, in extreme cases, might even save your life one day, as you’ll see next week. Rhonda starts the podcast by reading an awesome comment by certified TEAM-CBT therapist Dan Prine, who commented in a kindly way on podcast 334, where we interviewed Michael Yapko on hypnosis. Then we focus on multiple techniques to challenge two negative thoughts with a variety of strategies. The first negative thought is one we’ve seen on a number of occasions from women who had abortions as teenagers, and then experienced extreme depression and guilt later in life because of their thought, “I’m a bad person because I murdered my baby.” Using role-playing, we illustrated E = Empathy, using the Five Secrets of Effective Communication, followed by A = the Assessment of Resistance, using the Magic Button, Positive Reframing, and Magic Dial, followed by M = Methods. Methods included Examine the Evidence, the Double Standard Technique, the Externalization of Voices (with Self-Defense, the Acceptance Paradox, and the CAT, or Counter-/Attack Technique, along with the Socratic Technique, and more. Then we focused on a thought familiar to Rhonda during moments of insecurity and self-doubt: “I don’t matter!” This thought has plagued Rhonda since she was a child. She recalled her father often saying, “c"Who are you? You don't matter!" She told herself, “he’s saying that because I don’t matter.” Even the memory causes great pain and agitation. Of course, on some level, her father’s comments never had any effect on her. Only your thoughts can cause you to feel one way or another. But this was devastating to Rhonda because she believed what her father said, which is understandable, and those thoughts caused the pain. We again illustrated many approaches to challenging this thought, but one of the techniques that was most helpful was the CAT. During the Externalization of Voices, the Positive Rhonda said this to her Inner Bully: “I’m not going to listen to you anymore! I’ve had enough of your BS!” Thank you for listening today. Remember to tune in to the Outer Bully next week! Rhonda, Matt, and David

Sexual Abuse / Emotional Eating Personal Work with Orly, Part 2 of 2 Last week, you heard the first half of our live session on Emotional Eating, featuring Orly. Today, you will hear the second half and exciting conclusion and follow-up on that therapy session. A = Assessment of Resistance (previously called Paradoxical Agenda Setting) Orly did want help, but there were a number of directions / conceptualizations we could have pursued, including: Working on the distorted negative thoughts that were triggering intense negative feelings and robbing Orly of self-esteem. This would involve the use of the Daily Mood Log. Working on relationship conflicts with the Relationship Journal. Working on the addiction to binging, using the Habit and Addiction Log and the Triple Paradox if you click HERE. Exposure work to help Orly overcome her Emotophobia. That’s a term I coined that means “fear of strong emotions.” Orly shared a number of additional negative thoughts: I need to take care of myself because in truth I really am unlovable. I’m not entitled to feel traumatized because he did not hurt me. If I get excited or upset, and I don’t eat, I might go crazy. If I feel strong emotions, I’ll end up rejected and alone. Orly said she already had the tools for working on her negative thoughts and her relationship problems, but really wanted help with #3 and #4. So we first worked with her Triple Paradox that she brought to the session. This is a key tool in working with any habit or addiction, and Orly did an amazing job with it. You’ will enjoy that portion of the session and learn a great deal if you pay close attention. M = Methods We did a little work with Orly’s tempting thoughts from her Habit and Addiction log (click here to review.) Orly was extremely effective in challenging the tempting thoughts. Thanks to Jill’s brilliant guidance, we next decided to focus on cognitive flooding (exposure,) and gave Orly the assignment of scheduling one hour every evening for the next three weeks experiencing negative feelings and simply tolerating them, refusing to give in to the urge to binge.’ We also made her accountable, asking her to record her moods during each flooding session and to send a report the Tuesday group  the following morning. Either “Mission Accomplished” or “I stubbornly refused.” T = End of Session Testing You can click to see Orly’s Brief Mood Survey and Evaluation of Therapy Session at the end of the session. As you can see, she reported significant improvements in all of her feelings, and gave Jill and David perfect scores on the Empathy and Helpfulness Scales, as well as the other therapy process scales. Group Q and A After live work, we spent 30 minutes responding to questions and comments from the group participants. If you like, you can review just a few of the many comments in the feedback from the training group. Absolutely superb training! Thank you, Orly for the gift of your amazing personal work. And, thank you David and Jill for another magnificent teaching and healing session. I love the interplay between David and Jill. I loved Jill's empathy. I was so happy to get to know Orly better, and felt so close to her after the session. I was touched by her candor and disclosing about her abuse and life experiences. Unbelievable session, more like a miracle. A lifelong deep emotional issue to flow towards resolution in a couple of hours happens only in TEAM therapy. This was so very real; Orly was so open and insightful and vulnerable. Jill's identification of the choice point as to what to work on, and specifically, the option to focus on emotophobia--the anxiety around feeling intense emotions--and hence, exposure/flooding as treatment, struck me as so great, so much deeper than I'd initially expected. Jill's explanation that she focusses on the thoughts that drive the behavior in the HAL encapsulates it well. I loved the focus on feeling more. Recently, I read an article that stated CBT encourages clients to feel less and I didn't agree that was true at all. Tonight's session supported the sense of doubt I had. I thought the flooding concept was extremely helpful. Follow-Up Today, we recorded a live follow-up with Orly and Jill. Orly is doing great, and was very inspired. Jill made some (as usual) brilliant teaching points as well. If you like, you can also review one of her evening Emotional Eating Flooding sessions. Thanks again for listening! See you all next week. Warmly, Rhonda, Jill, Orly, and David

Sexual Abuse / Emotional Eating Personal Work with Orly, Part 1 of 2 In today’s podcast, you will hear the first of a two part series on Emotional Eating, featuring Orly, an Israeli psychologist who experienced sexual abuse at age 6 when she was a “skinny little girl.” After that, she began devouring her grandmother’s delicious cookies, and suddenly gained a great deal of weight. She continued binging for more than 50 years whenever she was excited or upset. This led to a pattern of dramatic swings in weight of 100 pounds or more over and over again. And now, Orly has decided she wants to end this pattern. My dear colleague, Dr. Jill Levitt, will be my co-therapist in this single, 2 hour-session that was conducted in front of my TEAM-CBT Tuesday training group at Stanford. Part of therapist training involves doing your own personal work, although this is not a requirement, it is recommended. That’s because the patient experience gives you a much deeper appreciation for how the therapy works. Rhonda, Jill and I want to thank Orly for permission to publish her highly personal work, and hope you find it immensely educational—so you can see exactly how TEAM-CBT works in real time with real people—and inspirational as well. Nearly all of us are pretty flawed in one way or another or many, and learning how to accept our flawed selves and celebrate is one of the deeper goals of the therapy. Today, we will cover the T = Testing and E = Empathy phases of the treatment. Next week, you will hear the exciting conclusion of our work with Orly, as well as the follow-up. Will she really be able to resolve a severe problem that has defied a solution for more than 50 years in a single TEAM therapy session? Let’s check it out! Part 1 of the personal work with Orly T = Testing At the start of the session, we reviewed Orly’s scores on the Brief Mood Survey that she completed just prior to her session. She scored only 3 out of 20 on the depression test (minimal), zero on suicidal thoughts and urges, 5 out of 20 on anxiety (mild), and 2 out of 20 on anger (minimal.) Her happiness score was 16 out of 20 (very happy with a little room for improvement), and her relationship score with her daughter was 18 out of 30, indicating lots of room for improvement. She indicated she'd done a great deal of homework in preparation for the session. You can also see her scores on nine mood dimensions if you take a look at her molestation Daily Mood Log. As you can see, her scores were quite high, and you can also review many of her negative thoughts when she was growing up. For example, at age 8 she told herself, “I am the fattest kid here. I will never be beautiful or desirable.” You can also see her Habit and Addiction Log (HAL) just prior to binging after a backpacking trip if you look HERE. Once again, you can see that all of her negative feelings were intense, and rated in the range of 90 to 100. You can also see her tempting thoughts, like “I can afford it since I spent so many calories during the hike.” E = Empathy David and Jill empathized while Orly told her graphic story of sexual abuse from a young man while growing up on a farm in Israel around the time of the “Six Day War” in 1967. She explained that he had been like an “older brother,” and she didn’t quite understand what had happened, since there was no Hebrew word for sexual abuse, and the subject was never discussed in public or with children. As she grew up, she learned to be independent, and felt like she was “different” and never really fit in. She developed a strong connection with nature and with spiritual values, and served as a park ranger during her military service in Israel. After her military service and an undergraduate degree from the Hebrew University, she set out to backpack in South America for a year and then settled in Los Angeles. She was married, and had a daughter who she considers her most important relationship, However, it was a troubled marriage and Orly and her husband were divorced when her daughter was 6. For quite a while, her daughter “blamed me for the divorce and for many  other things.” Eventually, she settled down in the United States and decided to become a psychologist after going to therapy, which was “the only diet I had never tried.” In 2020 she got some medical help from her doctor and started hiking extreme distances and heights, and lost a tremendous amount of weight. Nonetheless, she still finds herself “eating her feelings” and engaged in binge eating every once in a while. She also joined our Tuesday training group at Stanford, and said that it made an enormous impact on her life and on her clinical practice, and began at times to think, “Maybe there’s NOT something wrong with me.” She said the group made her an effective therapist and “I got to liking myself just a little bit!” She said the group also helped her tremendously with relationships. I believe she was referring to the five Secrets of Effective Communication that we have demonstrated so often in our podcasts as well as other tools such as the Relationship Journal She shared she was feeling terrified and had a number of negative thoughts during our session, since she was really hopeful that she could finally end her Emotional Eating. Her thoughts included: I don’t belong. 70% Something is wrong with me. 70% What I do is not good enough. 60% Now that I’m more than 60 years old, most of my life is over. 60% If I don’t get over my emotional eating, I’ll never feel normal. If I fail to solve my addiction, I’ll fail in my most important existential tasks. That would mean I’m a failure. That would mean that didn’t make a positive impact on the world. Jill empathized, using Thought Empathy, Feeling Empathy, and warmth, and then we asked, “What’s our grade? How good a job have we done in understanding how you think, how you’re feeling, and accepting you?” She gave us an A, meaning it was time to get on to the next phase of the session. Orly also shared that she never told her parents about the abuse, and never felt really close to her mother, who had her and two boys, all within 19 months. She said, “I was a problem for her, and always challenged her. Orly told friends about the abuse, but not her folks because she was desperately afraid they might not empathize or support her. She added, “Deep down, I fear that I am not really lovable, and that it might be too late for me.” I would add that feelings of hopelessness are so common in all of our patients, and this is what makes our work so challenging for us and painful for our patients—and also so rewarding when we can provide genuine, rapid, and profound relief. But will that really be possible for Orly? Next week we will set the agenda for the session and select some methods that might be helpful for Orly. End of Part 1 Thanks again for listening! Warmly, Rhonda, Jill, Orly, and David

Good Grief—Featuring Mike Christensen     Mikes' beloved friend, Kris Yip, word-ranked bicyclist who suddenly and tragically died. Mikes' beloved dog and best friend, Josie, who died the day before the podcast was recorded In today’s podcast we feature one of our favorite people, Mike Christensen. Mike is a Certified Level 5 Master TEAM CBT Therapist and Trainer, and is the Director Feeling Good Institute, Canada. Mike is a Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors and holds a Master of Arts in Counselling Psychology degree. His diverse background in business, community organizations, and family support roles has provided Mike with a wide array of experience in leadership, administration, parenting training, and team building. He provides advanced level online training with the Feeling Good Institute for therapists around the world and is currently co-authoring a book with Maor Katz on Deliberate Practice of TEAM-CBT. Mike specializes in treating depression and anxiety, with experience and training in addictions, PTSD, and relationship challenges. Today, Mike comes to us today with a personal issue, grief and loss. The day before the recording Mike’s beloved dog, Josie, died, and this came on the heels of the death of one his best friends, Kris Yip, a month earlier. Kris had died suddenly and unexpectedly at the age of 47. Kris was 7 or 8 years younger than Mike, and appeared to be the perfect example of health and fitness, so his loss was an unexpected and devastating punch in the gut. Mike explained that Kris was a celebrity in the bicycling community. He was the Canadian national champion and war ranked 59th in the world. However, he was humble and never promoted himself. Instead, he always focused on others, encouraging even those who were just beginners. Mike has also been a competitive bicyclist, and Kris had invited Mike to join an online racing team consisting of four friends who got together daily on stationary bikes linked by videos on the internet so they could talk while biking. In January of 2023, while riding, Kris’s heart suddenly stopped. A friend of Kris called Mike to say, “Kris is gone!” This was devastating to Mike, who said: “He was the fittest of our group. The impact was profound.” He had trouble sleeping and was in disbelief. He said, “It felt surreal. It felt like something is wrong. He told himself, “I should be able to keep it together without falling apart.” Mike also told himself that Kris, was too young to go, and missed him tremendously. Mike thought of Kris’s mom, and how much she was suffering, so he spent a week with Kris’ family and friends in Prince George. Which was where Mike was born, and his brother and his other biking buddies live.  He said, “We cried together and were together.” He explained, “Whenever I got on my bike to ride, Kris was always there. He’d always say, ‘Let’s ride.’ I miss his voice.” He also said that during his rides, you could see Kris’ face on the video feed, and he was always struggling, digging deep, suffering, but loving it! Mike said that all of his losses, including his sister, his son, and Kris,  were actually double losses, because “I lost not only what had been, but what was to come in the future, and didn’t.” Mike said, “Kris was so humble, so I want to brag for him. He always cared and made all of us feel so encourage and inspired!” Mike mentioned some of the positives he saw in the pain of grief: It honors the depth of the love and the depth of our relationship with Kris. Our grief has motivated us to cherish our riding group and to cling together even more closely. Tears can be the purest form of love. Tears allow us to keep the other person alive in our hearts and minds. I mentioned how I talk to three people I’ve lost every day when I do my “slogging:” my beloved cat Obie, and two dear colleagues I’ve lost, Ann Hantz in Philadelphia and Marilyn Coffy from Oakland. Mike described how touched he was when visiting Kris’ family, and how his mom had arranged all of Kris’ bicycles in the garage, ready to be ridden, with all of his racing jerseys on display. Mike confessed that also felt angry and often thought: “You bugger. It  should have been someone else!” Mike has endured many tragic losses in his life, including the devastating death of his older sister when he was just 15, and the tragic loss of his son, Graeme Michael, who died shortly before birth. Mike reminded us about the various conceptualizations we use in TEAM-CBT, which can include individual mood problems (like depression or anxiety), personal relationship problems, habits and addictions, and “non-problems.” A non-problem refers to people who do not have distorted negative thoughts or problems that need to be solved—they just have strong and appropriate negative feelings, and the job of the therapist is simple: resist trying to “help,” and instead use the Five Secrets of Effective Communication to listen and give the grieving person the chance to vent and expression their feelings. With this in mind, Mike described the support he received from colleagues at the Feeling Good Institute, including one who told him to make sure he was feeling sad! He greatly appreciated this! In my clinical experience, “non-problems” were actually rare, but there were several patients who only needed to vent and receive support. one of my favorite chapters In my first book, Feeling Good, was Chapter 3. entitled Sadness is not Depression. I described my experience as a medical student with a terminally ill elderly man in the Stanford Hospital who reminded me of my grandfather. His extended family had gathered around the bedside as he was slipping into a coma from liver failure due to metastatic kidney cancer, and asked “Would it be okay for you to remove his catheter? It was a bit uncomfortable for him, and we’re not sure if he still needs it.” I was very inexperienced and asked at the nursing station if it would be okay to remove it, and if so, how would I do it. They said he was, in fact, dying, and would not last much longer, and explained how to remove the catheter. I pulled the curtain around his bed, and did that and told the family, with tears in my eyes, “He can still hear you, but not for much longer, so it’s time to tell him how much you love him and say goodbye.” Tears were flowing down my cheeks and they began to cry as well, and began saying good bye. I went to the room where the medical students and resident make their notes, and wept. The family later told the department chairman how much they appreciated what I did for them. I was a pretty terrible medical student, and for the most part had a bad attitude, but that was on moment I still feel very proud of. There are several differences between sadness and depression. First, the thoughts that trigger depression, like “I’m defective. There must be something wrong with me,” are distorted. Depression, as I’ve often said, is the world’s oldest con. In contrast, Mike’s thoughts, like the thoughts that trigger healthy grief, are not distorted, like “I miss Kris. I admired him and loved him, and he made a tremendous difference in my life, and the lives of all who knew him.” Second, depression can go on and on endlessly. I’ve had patients who told me that they’d never had even one happy moment in their entire lives. Healthy grief, in contrast, only needs to be accepted and expressed, and runs its course naturally, If grief is extended, or impairing the person’s life, then it’s a certainty that distorted thoughts are present and preventing the person from healthy grieving. In this case, treatment can be enormously helpful. Finally, depression robs us of joy, hope, and productivity. Life often seems meaningless and worthless. Grief, in contrast, though painful, enriches us and provides us with a deeper level of meaning and gratitude for life. Rhonda and I are very sad for Mike’s many losses, now and in the past as well. But we are both grateful to have him as a friend, and cherish him tremendously. Thank you, Mike, for letting us in today! Warmly, Mike, Rhonda and David Following the session, I emailed Mike to ask a couple questions about peoples’ names, and also find out if we might have perhaps let him down during the podcast, not given him enough space to grieve, and so forth. When I get worried about things like that, I have found that checking it out usually beats “Mind-Reading” by a pretty huge margin. Here’s the wonderful email that Mike sent. It will give you a deeper view of his inner warmth and depth. Hi David, Thank you for your kind words. I experienced our time together as deeply moving and came out of it with a renewed sense of purpose in the sadness. I guess my hope was that we might be able to illustrate and share the value in empathy and the positive reframe in our grief work. That was enhanced to a new level for me with the way you guided me to explore some aspects I had missed. I wouldn't change a thing about it. It also opened up the way in which your stories and the journey we go on with clients can provide healing for others. I am so grateful that you were willing to take that time to revisit them. Our son's name was Graeme Michael. He was in between our oldest (Thomas now 25) and our middle daughter (Janae now 22). We (my wife Janna and I) never had the opportunity to hear his voice or see him smile. We were informed that it was a chord accident. Janna knew something was wrong and an ultrasound confirmed that she would have to deliver him knowing he was already gone. The first time we held him was also the last. Whenever people ask me how many children I have I say 3 (Thomas, Janae & Caelyn -19  & you will meet soon)  but in my mind it is always 4. Thank you for asking. My wife Janna is a nurse and the director of a pregnancy outreach program. She has been blessed with the opportunity to work with at-risk pregnant moms and young families for 17 years and our experience has brought incredible connection and support to so many (I also worked there for 7 years part time with the young dads). While we would never wish our journey on anyone, the suffering of loss has given us insight, motivation, inspiration, understanding and opportunities that we would never have without it. The sadness has deep purpose and meaning and continues to be an expression of our love for Graeme and all the young families we meet. Mike

Amy and her "fab fiancé," Randy Kolin! Secrets of Flirting, Sex Appeal and True Love! Today Rhonda and David interview Amy Berner, who has fallen in love and has quite a story to tell! Today is Valentine’s Day (we recorded this on February 14, 2023), so we thought a love story would be a ray of joy for all of you, whether you are in a loving relationship or still looking for one! But first, Rhonda and David briefly interview Jeremy Karmel, the co-CEO of David’s Feeling Good App. Jeremy tells his dramatic personal story that led to the creation of the app, and solicits for people who might want to join us for beta testing, which has gotten very busy of late. David also present some amazing data from a small, four-week beta test in December involving around 45 beta testers. The findings appeared to indicate that beta users experience far greater warmth and understanding from the app than from the people in their lives, which is on the sad side, since at the time users applied for the app, they only estimated 55% (on a scale from 0 to 100) warmth and understanding from the people in their lives, and roughly 85% from the digital “David” they interacted with in the app. We’ll see if those amazing findings hold up in two larger replication studies now in progress. If you think you might be interested in being a beta tester, please sign up at www.feelinggood.com/app. Rhonda also gave an endorsement for the upcoming second World Congress on TEAM-CBT in Warsaw, Poland this year, March 30-April 2, 2023. It sounds exciting. I will be there is a variety of capacities including conducting a personal session with Jill Levitt, PhD. Please check it out! And, as usual, she read a compelling comment from one of our regulars, Irish Brain, who wrote: “Another amazing podcast for the collection!” Amy Berner is a licensed marriage and family therapist who works with adults and teens online in California. She loves helping her clients heal from heartache, depression, and anxiety. You can find her at the FeelingGreatTherapyCenter.com. Amy’s love story started at a women’s group that Rhonda was also in more than a year ago. It turns out that Rhonda is quite the match-maker, and has arranged dates for large numbers of her friends and colleagues, including Amy. However, Amy was feeling insecure, as so many of us might, before this date. To help her, Rhonda suggested the Feared Fantasy Exercise, and asked Amy to list some of the things she was afraid her blind date might be thinking, but not saying, when they met. When you do the FF, one person plays the role of the “Date from Hell” who not only thinks these awful things about you, but gets right up in your face and says them. This list of awful things the Date from Hell might say included: “I’m just doing Rhonda a favor in dating you.” “You look a lot older than your picture!” “I haven’t gotten over my last relationship yet.” “You’re not smart enough.” “You’re just not very interesting.” We demonstrated the FF on the podcast, and Amy knocked them out of the park, using humor plus the Acceptance Paradox. She said that when they’d done that at the women’s group, in greatly reduced Amy’s fear and trepidation prior to their first date. Amy said she was also greatly helped by being in my small practice group the following Tuesday at our weekly psychotherapy training group. We were working on the “Interpersonal Downward Arrow,” a technique I developed that quickly illuminates the roles people play in problematic relationships. Amy discovered that she was playing the role of the inadequate, inferior, insecure person, and this was illuminating. One bad thing about this role is that it quickly becomes a self-fulfilling prophecy because if you see yourself as inferior, you will chase, and come across as insecure, and that will cause the other person, in most cases, to reject you. David suggested a technique he described in his book, Intimate Connections (which you can see below). called the Queen Bee Phenomenon. Instead of playing the insecure role, you give yourself all kinds of positive messages about how sexy and awesome and desirable you are. Once you get into that mind-set, this mind-set can also act as a self-fulfilling prophecy. That’s because of the Burns Rule, which states that in any relationship, especially at the start, one person will be the pursued, and the other person will be the pursuer. The pursued person has all the power, and the pursuer is usually rejected. So why not utilize the Queen Bee Phenomenon and let the guys chase you? This idea was transformative for our wonderful Amy, who is now happily, giddily, engaged, and she tell her story today with her typical wit, humor, and charm. She emphasized another important concept from Intimate Connections. Self-love has to come first. Once you chose to love and like yourself, your fear of being alone disappears, and you discover that you can be incredibly happy when you’re alone. Then, you will no longer “need” men; and as a result, men will need and chase you. That’s another expression of the Burns Rule which states: Men (all people actually) ONLY want what they CAN’T get, and NEVER want what they CAN get. So, if you don’t “need” other people, they will have to chase you! And that’s what happened! Rhonda, Amy, and David also reviewed the principles of effective flirting. 1, Be playful, and not heavy or serious. 2. Have fun. 3. Give playful, specific compliments. Amy has developed a game called “Flirty Dice” which helped her and many others. It is suitable for anyone 14 years or older and can be obtained at the Feeling Great Therapy Center. At the same time that her love life zoomed into orbit, her clinical practice did the same. This is common—when you become a source of joy, others just naturally are attracted to you. Kind of like human magnetism. Amy sees people virtually from all over California. She practices TEAM-CBT and specializes in the treatment of depression and anxiety, and of course, dating and relationship issues. So, if you want to give your love-life a kick-start, or recovery from rejection, contact her at babyfreud@gmail.com Thanks for listening today! Last month, (January 2023), we broke our one month download record (>182,000 downloads), so thank you for that. We will surpass 6 million downloads shortly. Rhonda, Amy, and David

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2 Mariusz and his wondaful family. Last week, you heard Part 1 of the personal work that Rhonda and I did with Dr. Mariusz Wirga, which included initial T = Testing and E = Empathy. Today, you'll hear the conclusion of our work, including the Assessment of Resistance, Methods, final Testing and follow-up. I am repeating this darling photo Mariusz's beloved cat, with his tail strait up, showing pride and love for Mariusz! Orangina at her favorite scratching post, with tail straight in the air to show pride and love for Mariusz!  A = Assessment of Resistance Once we empathized, we issued a Straightforward Invitation, asking Mariusz if he needed more time to talk and have us listen, or was ready to focus on the problem and see what we might do to help. Mariusz wanted to get to work, and said his goal for the session was to reduce his perfectionism, but when I asked the Magic Button question, he said he would not press it, even if the Magic Button would bring about a sudden and dramatic elimination of all of his negative thoughts and feelings. So, together, we listed the many positives and advantages of his negative thoughts and feelings, including: My anxiety keeps me on my toes. My feelings of inadequacy keep me humble. My hopelessness protects me from disappointment in the session with Rhonda and David isn’t effective. My hopelessness and loneliness show how much I care. My hopelessness shows how helpless I feel to free myself from the many pressures and heavy weights I have been carrying for many years. My negative thoughts and feelings show how much I care for others, including my wife and kids. My suffering with depression and anxiety increases my compassion and understanding of my patients who are suffering and frightened. My anxiety protects me from danger. My anxiety is motivating. My self-criticisms show that I have high standards. My loneliness shows that I welcome intimacy and close relationships. My sadness shows that I am realistic and willing to look at the dark side of life. As you likely know, this process is called Positive Reframing, which is looking at the positive side of things that appear to be negative. Effective Positive Reframing isn’t just listing positives from a list or book, like Feeling Great,  It’s suddenly “seeing” something that you hadn’t previously realized, and having an “ah-ha” moment. So, I asked Mariusz if he could see any additional positives in his fairly intense feelings of sadness and depression. To help him, I primed the pump a little bit by pointing out that sadness and depression are the feelings you have when you’ve lost something or someone your really cared about, or when you notice that something incredibly important is missing from you life. At this point, Mariusz became tearful and said he’d been very lonely as a child. Saying this gave him a “choking pain.” But he said he always turned away from his pain, and distracted himself, with work and activities. He said “I was an obedient child, and I was an only child. Both of my parents worked. “You say something is missing. I think what is missing is life I’m too busy. I’m always distracting myself. But I’m afraid that if I slow down, I won’t be able to pay my bills. I believe that 95%. Then I’ll be a burden. I’ll lose the respect of my family.” At the end of the Positive Reframing, he set his goals for the session, which you can see if you click on his Daily Mood Log again. As you can see, he did not seem to want to reduce his feelings to super low levels, which was surprising to me. M = Methods Rhonda suggested we could do a Feared Fantasy and asked what he thoughts others would think about him, but never dare to say, if he did slow down and they judged him. They’d think: You’re unreliable. We won’t include you anymore. We hate you. We reject you. We’ll tell the world about you. And his worst core fear was ending up in a homeless camp. We did role reversals using the Feared Fantasy Technique until he hit the ball out of the park, and did the same using the Externalization of Voices to defeat the negative thoughts on his Daily Mood Log. When you listen to the session, you’ll see that there was a lot of tenderness at this point, and we discussed our love for cats, and what we can learn from them—the joys of being average and loved and loving your life. We gave Mariusz several homework assignments: Finish your Daily Mood Log in writing, completing the Positive Thoughts and make sure you’ve crushed all of you negative thoughts. Experiment with being open and vulnerable with loved ones (wife and family) as well as colleagues. Practice saying no to colleagues who make requests on your time, and cut down on activities that are not cost-effective. T = End of Session Testing You can find Mariusz final Daily Mood Log if you click HERE, and his end of Session Brief Mood Survey if you click HERE, and his Patient’s Report of Therapy Session if you click HERE. David, add three links when you get documents. Rhonda and I wish to thank you, Mariusz, for a brave and touching session! You gave me the chance to process some of my own perfectionism, and to express my gratitude once again for the stray cats that my wife and I have adopted who have taught me so much about love, acceptance, and the simple things in life! Follow-Up I emailed Mariusz to find out what happened when he decided to become more open and vulnerable with wife, patients, and colleagues. He wrote back: Right before the Eureka moment, there is this state of dense confusion. So I was hesitant about where to go, but there was no visible path to choose yet. It feels like your brain is not getting it. It feels dense, also in an intellectual way. Like your brain stops working. It is quite dark and heavy. And then suddenly, the tears come and things become clear and light (in the sense of brightness and lifted weight). And that you all for listening today! Last month, January, was our biggest month so far, with more than 182 thousand downloads of Feeling Good Podcasts, and this is due, in large part, to your support of our efforts and sharing the show with friends and colleagues who might benefit from it! Thanks again, Mariusz! You are shooting into orbit! I'm SO proud of you and happy for you, and grateful to have had the chance to get to know you on a deeper and more human level, and to share a little of myself with you, too! Several days later, he sent me three addition al Negative Thoughts for his Daily Mood Log. They are touching, take a look at how he challenged and smashed them! Warmly, Rhonda, Mariusz, and David

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 1 Mariusz and his wondaful family. In today’s episode, Rhonda and I do live TEAM-CBT with Psychiatrist Mariusz Wirga, MD, who has struggled with perfectionism his entire life. Our training philosophy for TEAM-CBT involves doing your own personal work for a variety of reasons, including: 1. When you sit in the patient’s seat, you develop a radically different perception of the value of the various components of TEAM, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. 2. When you experience your own recovery, or “enlightenment,” you have a crystal clear vision of what’s actually involved in rapid, effective treatment. 3. You will be able to tell your patients, “I understand how you feel because I’ve been there myself, and it will be my pleasure to show you the path out of the woods.” This message makes a highly beneficial impact on most patients. Bio sketch, by Rhonda Among his many other accomplishments, Mariusz organized the highly successful first world congress for TEAM-CBT in Warsaw, Poland in 2022. He is planning a second four-day TEAM-CBT intensive in Warsaw from March 30 to April 2, 2023. If you are interested in attending, you can learn more at www.teamcbt.eu or www.teamcbt.pl. Mariusz says, " "For the first time ever we will teach a parallel track for business and corporate applications of TEAM CBT at the 4-Day Warsaw Intensive (www.teamcbt.eu & www.teamcbt.pl). It will be taught by our singular Dr. Leigh Harrington, with Polish psychologist and TEAM CBT therapist Patrycja Sawicka-Sikora. In 2023, there will also be major TEAM-CBT conferences in Bristol, UK (August 14-17, 2023, www.feelinggood.uk.com ) and Mexico City (November 6-9, 2023, www.teamcbt.mx )" In today's podcast we will listen to the Testing and Empathy portions of his session. Next week, you will hear the Assessment of Resistance and Methods and exciting conclusion of his session. T = Testing We began by reviewing Mariusz’s scores on the pre-session Brief Mood Survey, which you can review. We will, of course, ask him to take this test at the end of the session, so we can see how effective or ineffective we were in helping him change the way he’s thinking and feeling. Mariusz's beloved cat, Orangina, played a featured role in his session with Rhonda and David! E = Empathy We discussed his anxiety which had spiked in apprehension of today’s live session. He had several negative thoughts that we elicited with a brief Downward Arrow Technique. The percents indicate how strongly he believed each one. I will be talking about private issues, and people will think less of me. 70% Then people will be less likely to want to see me for therapy. 50% My patients might be disappointed in me. 50% This could affect me financially, and I won’t be able to pay the bills, and my daughter’s wedding is coming up. 50% (Mariusz, my estimate on % belief.) If that happens, my wife and kids will turn against me. (Need % belief that you had at the time, Mariusz.) My also reviewed the Daily Mood Log that Mariusz prepared prior to today’s session. Feel free to review it. As you can see, he woke up in the middle of the night and remembered that he’d forgotten to send a form he promised to send to a patient whom he’d seen two days earlier. You can also see that his negative feelings were very elevated, ranging from 60% to 85% for loneliness, embarrassment, sadness, inadequacy, frustration and anger,  to 100% for guilt, shame, and anxiety. If you review his DML, you will also see that he’d recorded 10 self-critical thoughts, and many of them were Should and Shouldn’t Statements. For example, “I should have sent her the homework. I shouldn’t have made such a basic therapy error.” He also identified the many distortions in each thought. All-or-Nothing Thinking, which is the mother of perfectionism, was present in most of them. Other common distortions included Should Statements, Overgeneralization, Magnification, and Self-Blame, to name just a few. Mariusz’s belief in all of his negative thoughts was high. You may recall the two requirements for feeling upset: 1. Your mind has to be filled with negative thoughts. 2. You have to believe those thoughts. Mariusz also described his extremely busy and demanding schedule, including the groups he runs in the hospital for cancer patients, his clinical practice, research, teaching, organizing large international TEAM-CBT conferences, and more. His hectic schedule means he always has to be moving fast, so mistakes and slip ups are fairly common. That’s when he beats up o himself, gets anxious, and has trouble sleeping, which compounds everything. He also beats up on himself and feels guilty for falling behind in some of his commitments. Rhonda and I empathized, using the Five Secrets of Effective Communication, and then Rhonda asked him to grade our empathy. He gave us an A+. Orangina at her favorite scratching post, the one that Mariusz got for her, with her tail straight in the air to show pride and love for Mariusz! This ends Part 1 of the work with Mariusz. Next week, you'll hear the exciting conclusion of his session. Warmly, Rhonda, Mariusz, and David

What IS Hypnosis? Transcending Old Myths Today, Rhonda and I interview Dr. Michael Yapko, a clinical psychologist and expert in clinical applications of hypnosis. Michael D. Yapko, Ph.D. is a clinical psychologist residing near San Diego, California. He is internationally recognized for his groundbreaking work in applying clinical hypnosis, especially in the active treatment of depression. He has taught in more than 30 countries across six continents, and all over the United States. He has been a vocal critic of the medical model of depression and instead advocates for a social perspective, suggesting the problem is less in your biochemistry and more in your circumstances and perspectives. His YouTube lecture on “How to Recover from Depression” has now been viewed nearly 5 million times. Dr. Yapko is the author of 16 books, including his newest book for professionals called Process-Oriented Hypnosis, and his classic hypnosis text, Trancework (5th edition). His popular general audience books  include Depression is Contagious and Breaking the Patterns of Depression. His works have been translated into 10 languages. He is also the Chief Content Advisor for MindsetHealth, a digital hypnotherapy mental health app. More information about Dr. Yapko’s work is available on his website: www.yapko.com. On the personal side, Dr. Yapko is happily married to his wife, Diane, a pediatric speech-language pathologist. Together, they enjoy hiking in the Great Outdoors in their spare time. Michael’s first experience with hypnosis was as an undergraduate psychology student at the University of Michigan. He went to a clinical course on the topic of hypnosis which featured a live hypnosis demonstration. The demonstration subject was a woman who was suffering with intense chronic leg pain following a traumatic auto accident three years earlier. The relentless pain had disabled her and greatly impacted her life on many levels. Michael said he listened to her sad story in skeptical awe, unable to imagine what the hypnotist could possibly say to someone suffering so much that would be helpful to her. He was deeply absorbed in observing every nuance of the interaction wondering what help hypnosis might offer in such dramatic circumstances. The initial phase of the interaction was simply a series of suggestions for relaxing and focusing her attention. He gradually offered suggestions to visualize the pain as a dark, viscous liquid that could flow down her leg, out of her foot, into her shoe, and then spill out onto the floor as a “harmless puddle of pain.” And it was gooey! After re-alerting her from hypnosis, she became tearful and reported that she was pain-free for the first time in almost three years! The change in her appearance was both obvious and deeply impressive. Observing this dramatic demonstration of hypnosis for reducing chronic pain was a transformative experience for Dr. Yapko. He literally thought in that moment that hypnosis had remarkable potentials and that he would dedicate himself to learning all he could about the intricacies of hypnosis and its merits in a wide array of clinical interventions. The demonstration blew Dr. Yapko’s young mind and led to a 50-year career practicing, studying, writing about, and teaching clinical hypnosis to health care professionals worldwide. Although he has recently retired from active clinical practice, he continues to offer trainings and says his fascination with hypnosis is just as strong as ever today. There are a number of striking areas of overlap between Michael’s use of methods of clinical hypnosis and traditional Cognitive Therapy. For example, he routinely uses the Experimental Technique, and gives experiential homework assignments to help patients “see” or discover something that they have not previously seen or realized that would be helpful to them. This can be important when treating patients who hold rigid beliefs that can become the basis for emotional distress. However, the types of experiential experiments Michael suggests are sometimes more ambiguous in their purpose, and are sometimes more paradoxical, but all are designed to lead the patients to a shift in their mindset. In one example, Michael described a severely depressed woman who felt like a victim and constantly compared herself to others she actually knew very little, if anything, about. Then she felt terrible about herself because she was convinced that everyone else was happy and had beautiful, problem-free, ideal lives and she didn’t. She had developed unrealistic perceptions of other people on the basis of little or no actual data. These thoughts made her miserable and she was convinced she was the only one who had been singled out for misery. Of course, we can see many of the familiar cognitive distortions, including Mind-Reading, which is assuming, without evidence, that we know how other people are thinking and feeling or how their lives are going. For most people, this process is so reflexive and unconscious they don’t realize what they’re doing. As Michael said, “too often people think things and then make the mistake of believing themselves.” To her detriment, this woman had never tested her assumptions about others. Michael’s view was similar to that of cognitive therapists, that there would need to be a change in her way of reaching unfounded conclusions if she was going to feel better about herself and her life. But what kind of experiment, or exercise, could he assign to help her discover that her thinking WASN’T always correct ? Telling her to “stop doing that!” would not likely help her. Instead, Michael did a hypnosis session with her and oriented her to the idea that forming interpretations or conclusions without evidence is a reliable path to making mistakes that can be costly. Then Michael gave her an easy assignment that had the potential to make obvious how readily she formed conclusions without any evidence. He encouraged her to go on a hike in a state park near San Diego. The trail he wanted her to go on is called the Azalea Springs Trail, an easy three mile walk. The trail’s name suggests a beautiful trail with flowers and flowing springs and sounds like an awesome, inspiring experience. But in reality, the hiking trail goes through barren desert brush, eventually leading to a clearing. In the center of the clearing, there’s a rusty pipe sticking up out of the soil with a small amount of water dripping out. A sign attached to the pipe reads, “Azalea Springs.” All the expectations of an abundance of beautiful azaleas and a lovely flowing spring naturally exploded in only a moment! When she read the sign and realized how far off her expectations were from the reality, she suddenly “got it” and burst out laughing. She learned in a powerfully memorable way that our expectations are not always the way things are. Subsequently, having absorbed that powerful learning, she regularly caught herself making assumptions about others and using them to build them up and tear herself down. This hurtful pattern changed dramatically, giving rise to a much happier and more satisfying life. Michael also uses the Survey Technique, which is common in TEAM therapy. He described a shy man who desperately wanted to be married and fantasized living in domestic bliss in a house with a picket fence. But he was convinced that no woman would ever be interested in him because he’d been hospitalized for two weeks for depression 15 years earlier. Again, he was rigidly fixated on this unfortunate idea, which he believed to be absolutely true. Michael first conducted a hypnosis session that introduced the idea that “someone can be very sure…and very wrong.” Hypnosis often makes it possible to loosen the hold of unhelpful ideas and shift to a more useful perspective. This is because people in hypnosis process information differently than when in their usual frame of awareness. Having a rational conversation with someone is quite different than guiding someone through a hypnotic experience which can create possibilities that rational conversation alone simply can’t. Hypnosis is all about focus and Michael describes how people’s problems are often problems of focus: they focus on what’s wrong and miss what’s right, or they focus on the unchangeable past and miss positive future possibilities. Those of you who are familiar with CBT or TEAM may recognize these distortions as Mental Filtering and Discounting the Positive. It’s important to appreciate that hypnosis is NOT the therapy. Rather, it’s a vehicle for delivering therapeutic ideas and perspectives at a deeper level that can give rise to more adaptive automatic responses. Following hypnosis Michael gave his patient the assignment to generate a series of general questions that he’d be interested in hearing women answer. Michael included the following question as number 7 on his 10 question survey: “Would you consider dating, getting involved with, and even marrying a man if you knew he’d been hospitalized for two weeks for depression 15 years ago?”  Michael then convinced him to go to the local mall and randomly stop women and ask them to respond to some survey questions he was researching. He could tell a number of women that he was conducting a brief survey and would appreciate getting their opinions. Although he got many varying opinions, he was shocked to discover that the vast majority of women said it would NOT be an issue. He had built his misery around a belief that had no bearing on how women actually felt. Once again, although Michael emphasizes the value of hypnosis, his  therapy techniques have some overlap with Cognitive Therapy. He promotes the idea that the shifts in both physiology and cognition that take place during hypnosis can provide a multi-dimensional foundation for amplifying the effects of virtually any type of psychotherapy. In fact, in his classic text on hypnosis, Trancework (5th edition), Michael cites numerous studies that show that hypnosis can enhance therapeutic outcomes for Cognitive Therapy. And why not? After all, every therapy utilizes suggestions in one form or another! Michael emphasizes the importance of psychotherapy homework between sessions which is also key in TEAM therapy as well as Cognitive Therapy. He will not give patients the room to “skip” or “forget” to do their homework assignments and uses hypnosis to build their curiosity and willingness to explore new possibilities by carrying out assignments. He described different factions in the world of hypnosis. Just as there are different approaches to psychotherapy, there are also differing views about the nature of hypnosis. For example, some experts promote the idea that hypnosis is an intrapersonal (within the person) phenomenon, a “fixed” or unchanging trait the person may have. They use “suggestibility tests” to assess whether and how responsive the patient might be to hypnosis. Michael and other experts view hypnosis differently, seeing it not as a fixed trait a person does or doesn’t have, but rather as a product of many different factors, including the patient’s expectations, the context in which it is being applied, the purpose for which it is being applied, and the quality of the therapeutic relationship that involves empathy and trust. He also believes that almost everyone has the capacity for hypnosis, but different people clearly have different aptitudes, or innate skills, for experiencing various aspects of hypnosis. For example, some people may have a greater capacity for pain reduction or elimination, while others may have a greater capacity for vivid visual imagination and fantasy, and so forth. Hypnosis provides an opportunity for people to discover their hidden strengths and talents. Can you imagine what it does for someone’s self-image, Michael asks, when they discover through hypnosis that they have untapped abilities they can use to handle a situation skillfully that previously had overwhelmed them? In fact, this is what draws Michael to hypnosis: the way it can empower people to discover and use more of their untapped innate resources. This is the exact opposite of the unfortunate myth perpetuated through hypnosis stage shows and Hollywood productions that somehow hypnosis diminishes people’s sense of control. That’s very important, so I’ll repeat it. The myth-based view is that hypnosis makes people obedient to the powerful hypnotist, who is often painted as a Svengali type of character. But in reality, hypnosis can be used to help make people more powerful, more autonomous, and more independent. Just the opposite! Michael has authored 16 books, including nine on the clinical applications of hypnosis. His latest book, entitled, Process-Oriented Hypnosis: Focusing on the Forest, Not the Trees, focuses on how, and not why, people generate their own problems and can be obtained at Amazon. Thanks so much for listening! And thanks so much, Michael, for sharing your wealth of experience and giving us the latest scoop on clinical hypnosis! Warmly, Rhonda, Michael, and David

Ask David: Featuring Matt May, MD What causes anxiety? Is recovery permanent? What if the cognitive distortions aren't helpful? Do hormones cause anxiety and depression? What's the role of vitamins and nutrition? How do Exposure and Response Prevention work? And many more answers to your questions! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below. But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is! Hi Dr. Burns: I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it! "I’ve replaced my copy close to ten times, as I keep lending it to friends who never give it back." https://girlboss.com/blogs/read/feeling-good-david-burns-review Have a great day! Rob Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well. When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous. David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time! What if your client/patient understands the Cognitive Distortions but doesn’t believe them to be true? David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that’s triggering your anxiety or depression, you will almost instantly feel relief. And here’s the precise answer to your question. When someone says, “I understand the distortions but it doesn’t help,” they still believe their negative thoughts. Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist’s efforts to “help.” Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person’s nutrition? Could it be that vitamins that are lacking? David's Answer.  First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings. In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother’s negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared! People want to “biologize” emotional problems, and I started out as a “biological psychiatrist” and researcher, but found the biological explanations to be erroneous and unhelpful. Could you please give a brief overview about Exposure with Response Prevention for OCD treatment.  Thank you! David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth. END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST The answers to the questions below were written by Dr. Burns but not discussed on the Podcast. Questions can I ask to overcome the Cognitive Distortion “jumping to conclusions”? That is the toughest for me. David’s Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common forms of Jumping to Conclusions. Feelings of hopelessness always result from Fortune Telling. All forms of anxiety always result from Fortune Telling as well. Social Anxiety typically includes Mind-Reading, and Mind-Reading is almost universal in relationship conflicts. In addition, I never treat a distortion, an emotion, a diagnosis, or a problem. I treat human beings systematically, using the T E A M algorithm. Matt’s Answer. There are many methods in TEAM that can be applied in the form of a question. These methods and how they are carried out, depends on the circumstances and the specific thoughts a person is having. Below are some examples of negative thoughts (NT’s) and the types of questions that might help overcome them. (NT): ‘Something really bad is going to happen’  (Be Specific Technique): ‘Like what? What’s going to happen?’  NT: ‘I’ll fail my biology test’  What-If Technique: ‘What if I failed my biology test, why would I be worried about that? (write down any new thoughts) What if those things happened, too, what then? (write down any new thoughts) What’s the absolute worst thing that could happen? (write this down).  Measurement: How certain am I, that these things will happen? On a scale from 0 – 100%, how likely are each of these predictions, in the form of negative thoughts, to occur?  Socratic Outcome Resistance: What do each of these negative thoughts say about my values that I can feel proud of? (write these down) What is appropriate about how I’m feeling and thinking? (write these down) What are the advantages of having these thoughts? (write these down). What would I be afraid of, if I didn’t have this thought? (write these down)  Pivot Question: Given the many positive values related to worrying, the advantages of doing so, the disadvantages of a carefree existence and the many reasons why my worry is appropriate, why would I change this?  Forgetful Clone (Double-Standard Amnestic Technique for Outcome Resistance): What would you say, to a dear friend, in an identical situation, when they asked these questions: ‘I’m really worried about failing my biology test, would you be willing to help me? (if ‘yes’, then continue) … Don’t I need to keep worrying? Won’t that protect me from failing? Don’t I need to worry, so that I’m highly motivated to succeed? Don’t I need to worry, so I avoid making mistakes? Don’t I need to worry, to maximize my rate of learning new material? Won’t I get lured into a false sense of security, if I stop worrying? Won’t I jinx it, if I get too confident? What would you recommend to me? How much do you think I should worry? I am prepared to do so … would it be helpful for me to go into a sustained panic, at this time?’  Cost-Benefit Analysis: Is worrying about failure worth the price? How would you weigh the advantages of worrying about failure against the disadvantages? What are the pro’s and con’s? How would you divide 100 points, to reflect the power of these two arguments?  Examine the Evidence, Motivational: What evidence is there that worrying improves academic performance, concentration and learning? What evidence is there that worrying worsens academic performance, concentration and learning? Magic Dial Question: ‘‘Should I remain maximally worried, at all times, forever? (If not, keep going) ’What amount of worry is best, for me, in this moment?’, ‘How about future moments? How frequently do I need to worry and for how long?’  Process Resistance for Activity Scheduling, Worry Breaks/Cognitive Flooding, Self-Monitoring/Response Prevention: ‘Would it be alright to ignore my worry most of the time and only focus on it during scheduled times? Let’s say I could learn how to be extremely calm and focused most of the day, without worry … would I be willing to worry as intensely as possible, for ten minutes, three times per day, to achieve this? When my worry comes up at other times, would I be willing to observe and record that event, then return to the task on my schedule?  Socratic Questioning: Am I absolutely certain that this thought is true, that I will fail? How do I know that I will fail? What specific questions will be on the Biology test that I will get wrong? What number grade will I get? A 60? 58? 39?’, ‘Would I bet money on my getting precisely that grade? Why not?’.  Examine the Evidence (cognitive): ‘What evidence is there that I will fail? What evidence is there that I will pass?  Reattribution: Let’s say that I fail. Would that be entirely my fault? Are there any other factors, outside my control, that might have contributed to this outcome? My genetics, for example? Or the nature of the world, into which I was born? Did I choose my genetics? Did I choose the world into which I was born, when I was born, my parents, teachers, etc.? Could any of these factors have played any role in the outcomes in my life?  Other examples of Inquiry-based methods, using different NT’s:  Negative Thought: ‘People will be angry and judge me, if I fail’  Interpersonal Downward Arrow: ‘What kind of people are they, if they judge me and look down on me, when I fail? How would I feel towards those types of people? Is it possible I feel angry? How do I express that feeling? What ‘rule’ am I following, in my relationships?’  Outcome Resistance: What’s good about me, for feeling anxious, rather than angry? What are the advantages of keeping my feelings inside? What would I be afraid of, if I expressed my feelings?  Process Resistance, 5-Secrets: Would I be willing to spend the time to learn the skills required to express my feelings, including anger, to people, in a way that made them feel good?  Negative Thought: ‘I’ll get sick and die’  Be Specific: ‘When? What time of day will that occur? What illness is going to kill me?’  Negative Thought: ‘I’ll lose my mind, crack up and go crazy’  Examine the Evidence: Has that ever happened to me? When was the last time? When you are working with clients, how do you handle it when they can challenge their thoughts very convincingly using a variety of techniques, state that they can see the logic in their restructured thought BUT they are still experiencing heightened anxiety and state that this hasn’t helped them? David’s Answer. They still have a strong belief in their negative thoughts. It is 100% untrue that they have “challenged them very convincingly.” Here’s an example. Let’s say you have an intense fear of glass elevators. You will say, “I can see that they are unsafe, but I am still terrified of going in one.” The moment you get on the elevator your belief that you are in danger will suddenly skyrocket to 100%. In other words, you still believe your negative thoughts. Of course, it is nearly always easy to overcome phobias, including an elevator phobia. As stated above, I use four models in treating every anxious patient. Simplistic formulas are just that—Simplistic! Treating humans is not like changing the oil in your car! Matt’s Answer: I am hard pressed to add anything of value to David’s awesome response, above. I might just reiterate that the Cognitive model, challenging the logic behind negative, anxiety-producing thoughts, is the least powerful of the approaches we have to anxiety. It is necessary, but almost always insufficient. Exposure, motivational methods and Hidden emotion are the real heavy-hitters. Until trying these, it is likely that the negative thoughts can be disproven ‘intellectually’ but not at the emotional level. How do you work with clients who state they are anxious all the time, experience strong somatic symptoms (body sensations) and cannot identify specific thoughts. They don’t catastrophize these somatic symptoms but really, really dislike them and want them gone! David’s Answer. I just ask them to make up some negative thoughts. That works well. For example, they may have the belief that the anxiety must be avoided because it may never disappear, or may believe that they are on the verge of going crazy, and so forth. Matt’s Answer, Anxiety can cause people’s brains to shut down, experiencing the ‘deer in the headlights’ phenomenon. Try to identify just one upsetting thought, then use the ‘what-if’ technique to expand on that. You’ll be off and running! How do you do techniques with a person who has active suicidal thoughts? David’s Answer. I don’t “do techniques.” I find out if they’re actively suicidal and in danger. If I know for certain that the person is safe, I treat them like human beings, with T E A M. I’m not a formula person. Each person will be different, and will respond to different methods. My books and podcasts are chock full of examples of actively suicidal people who responded. Matt’s Answer. I let them know that I don’t have the skill to help them unless I know they’re safe. If I’m worried for their safety, I’ll be afraid to use aggressive methods that may be required for them to recover. I’d need them to convince me of their safety before agreeing to work with them. If they can do so, I offer TEAM. If not, I ask if they’re willing to escalate the level of their care, e.g. to meet with me while hospitalized in a safe setting. I don’t work with patients who are at risk of harming themselves because I don’t believe in my ability to be helpful to them. Is it really okay to keep continuing the experimental technique when the patient does not want to continue? And, what if the therapist is not confident and something goes wrong in this situation? David’s Answer. I would need a specific example, but you are right that 75% or so of therapists are afraid of exposure and will not use it, fearing that something will “go wrong!” Matt’s Answer. It’s important to identify the resistance before initiating the method of exposure and to talk it through. Why would they not want to continue? What are they afraid of, if they get really anxious, during exposure? Write this down. Then, surrender, acknowledging that these are some excellent reasons to avoid exposure, in which case we can’t help them with their anxiety. Perhaps there’s something else they want help with? If they can convince you, and themselves, that exposure is precisely what they want to do, and they’re willing to keep doing it, even if it makes them very anxious, it’s appropriate to push a bit, in the moment of their doing exposure, to bolster them and help them through the rough patch. That said, I always give my patients a way out, if they don’t want to continue. That’s their choice, I just want them to be aware of the consequences, including a worsening of their anxiety. When doing experimental method, or the exposure method for example with who has sweating issue, how do you handle the hyper-vigilance he would have with people around, especially if someone actually laughed at him? David’s Answer. I would use the Feared Fantasy Technique, and Self-Disclosure. I would likely go with the patient into the real world to do these things, and have done so on hundreds of occasions. How would you work with someone who suffers from  Selective/Situational Mutism? David’s Answer. I have not run into that in my clinical practice. But 100% of the time, I would want to know what the patient’s agenda is. I would also want to know if there are powerful motivational factors that need to be addressed, looking at the whole person rather than the symptom. How different are Team CBT treatments for teens as compared to adults? David’s Answer. My experience is limited, but I would say no difference, really. I have loved working with teens, even though my main focus was on adults. When working with little kids, I think you need to incorporate play and games, although the basic concepts are the same. For example, you can do Externalization of Voices with puppets, the “Bad, Mean Self” and the “Positive, Loving Self,” or some such. We have featured shrinks who work with kids on many times on our podcasts. Thanks for joining us today! Matt, Rhonda, and David

Ask David: Featuring Matt May, MD How can I help my son? Is rapid recovery just "First Aid?" Do early "attachment wounds" cause anxiety? What's the Hidden Emotion Model? Are anxious people overly "nice?" And more! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below. Guillermo asks: How can I get close to my 11 year old son? Hi, Dr Burns Thank you for all the knowledge you share through your books and your podcasts. “the way you think creates the way you feel” has changed the way i view life. I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said “just throw it away” and i raised my voice and said “I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?” (I was rude and loud) To which, he got startled and teary eyed and said “no”. And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him. I later came to his room and apologized for my behavior and gave him a hug. I said “im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me” and i gave him a hug. That same night I heard podcast 278 or 279 and you said “the road to enlightenment is a lonely one, my friend” when responding to someone asking about the other person in a relationship. I thought, damn that’s true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize. I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this? Thank you again for all you do, Guillermo David’s answer: I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?" In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing! Warmly, david ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required? David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any “first aid” problem! Matt’s Answer: I agree with a lot of this.  While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to ‘relapse’, at some point in the future.  Educating people about this is important and part of ‘Relapse Prevention’.  Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences.  As the Buddhists say, ‘we all drift in and out of enlightenment’.  Relapses, the ‘drifting in-and-out’ is a sign of a healthy brain.  Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts.  While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you’ll occasionally go back to old habits in thinking.  So, achieving optimal mental health requires an ongoing practice with the methodology.  Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place.  If it was Exposure, you’ll have to keep on doing that.  If it was talking back to your negative thoughts, then you’ll have to do that, occasionally, etc.  This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection.  Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery.  That is to say, ‘Enlightenment’ is not a ‘perfect’ mental state but an acceptance of an imperfect one.  If this seems distasteful, Enlightenment may not be what you’re after!  For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery.  You’ll still need Relapse Prevention, including a commitment to continue to practice on an ongoing basis.  This leads to a higher level of recovery, in which you become your own ‘best therapist’.  Another place where I agree with you is that one might achieve (imperfect) recovery from anxiety and depression, and even take on the responsibility of maintaining these results, and yet still not be satisfied with some other aspects of life.  It’s possible (in fact likely) for any given person to suffer, not only from mood problems, like anxiety and depression, but from other types of problems, like unwanted habits or addictions, or relationship problems.  TEAM contains methodologies that address these concerns as well.  ‘Recovery’ from these conditions is the same as for mood problems, in that recovery will be imperfect and impermanent and require practice to sustain.  What type of practice that might be depends on the individual and we can’t predict, in advance, what types of exercises will be effective, for a particular person.  In fact, there’s a danger in assuming we know what will be effective and closing our minds to alternative approaches.  It’s a common error, for therapists, to pick up one tool and use that, regardless of results, rather than trying new approaches.  This is kind of like having a hammer in your hand, and seeing all your patients as nails!  I like how David says it: ‘Treat people, not conditions’.  So, I think I agree with what you’re saying, in that it requires trial-and-error with multiple methodologies to achieve initial recoveries, as well as ongoing practice to achieve optimal results.  I also feel compelled to observe the tendency for certain dangerous and wrong ideas to persist in our culture, kind of like ‘Urban Legends’ or ‘Mythology’.  One example is the revolution that occurred in medicine when people realized that pathogens, like viruses and bacteria, cause disease.  It had previously been thought that disease states were caused by an imbalance of the ‘Four Humours’, blood, bile, phelgm and calor (heat).  The treatment, for pretty much anything that ailed you, back then, was leeches and blood-letting, in hopes of restoring the balance of these ‘humours’.  A revolution in our understanding of disease occurred with the invention of the microscope.  It was now possible to visualize microscopic organisms, like bacteria, that we now know, after many experiments, are responsible for disease states. This allowed us to develop medications, like Penicillin, that kill bacteria and lead to rapid recoveries from infections, like pneumonia and immunizations that prevent infection.  Despite undeniable scientific evidence, people are prone to believing the old mythology, keeping the wrong and outdated model alive.  For example, many people are afraid, on a cold day, because they think that exposure to cold temperatures will lead to having a disease, which is even called a ‘cold’.  Meanwhile, we know, scientifically, that it’s not cold temperatures or an imbalance of any ‘humour’, that is causing colds, flus, and pneumonia.  It is microorganisms, like viruses and bacteria.  If you don’t want to get a cold, it’s better to sanitize your hands and wear a mask, than to bundle up on a cold day.  Instead of bloodletting and leeches, try vaccines and antibiotics.  Of course, people also make up new mythologies, around these, much to their detriment and at great cost to society.  My advice would be to listen to develop a skeptical mind and read the scientific literature.  Or, try to understand Neil DeGrasse Tyson, when he says, ‘Science is True, whether you believe it, or not’.  A similar revolution in our understanding has occurred in the field of Mental Health.  Like seeing bacteria, for the first time, after the invention of the microscope, we are returning to the understanding (which ancient Greek and Buddhist philosophers noted, as well) that it is our negative thinking that causes our suffering, more than our circumstances.  We know, now, that psychoanalysis is not required, to optimize mental health, any more than bloodletting or leeches is required to treat Pneumonia.  Thanks to Dr. David Burns, there is now a rapid, highly effective and medication-free treatment for depression and anxiety, called TEAM. Is the Hidden Emotion Model suitable for anxiety caused by early attachment wounds? David's answer. These big words are out of my pay scale, although they certainly sound erudite! In fact, the cause of anxiety is totally unknown, so when you say “caused by” we are in different universes! But the simple answer is yes, in 75% of cases, anxiety is helped greatly by the Hidden Emotion Model. Thanks! Matt’s Answer:  The Hidden Emotion model would always be on my list of methods to try, for an individual who wanted help reducing their anxiety.  That said, it’s better to select methods based on an individual’s specific negative thoughts rather than the presence or absence of trauma in childhood.  In fact, the assumption that we know the cause of anxiety is problematic because it may lead to a kind of therapeutic ‘tunnel-vision’ and delayed recovery, as time is wasted, trying the same approach, repeatedly, expecting different results. For example, assuming that ‘early attachment wounds’ are the ‘cause’ of anxiety may trigger the false belief that the most effective treatment would be many years, even decades, of Psychoanalysis.  This has been disproven, scientifically, yet it lingers in our minds, as a kind of mythology, passed down from our past.  Rather than subjecting our patients to decades on the couch, talking about their childhoods, it’s far more effective to ‘fail our way to success’, using multiple methods and measuring outcomes after each one, to discover what is actually effective for them.  Once you find the method(s) that are helpful, these will continue to be helpful, for that individual, throughout their lifespan, and it’s just a matter of practice. Another question about the Hidden Emotion model: when do you consider it “niceness” in anxious people and when is it the fear/anxiety to upset others due to the anxiety? David's answer. That can happen, but not usually in my experience. The “niceness” typically results from automatic suppression of uncomfortable feelings and problems. When they hidden problem or feeling is brought to conscious awareness, in most cases the anxious individual deals with it or expresses the feelings, and that’s when the anxiety typically disappears completely. As a part of my anxiety disorder, at times, I feel flat, emotionless and disconnected from everything around me. How do you treat that? David's answer. I use T E A M, not formulas! I do not treat symptoms, I teat humans. Matt’s Answer:  You could start with a Daily Mood Log, writing down the details of what was happening, in one specific moment in time, when you felt this way.  Include what you were thinking and feeling, including ‘flat’, ‘emotionless’ and ‘disconnected’.  For example, let’s imagine you had thoughts like, ‘nothing will ever change’, ‘this is pointless’, ‘I’ll never feel better’ and/or, ‘I shouldn’t be feeling so disconnected and flat’ or ‘I should be more in-touch with my emotions’ and/or ‘I need to be more up-beat’ or ‘people will reject me if I’m not more enthusiastic’.  You’d have to identify your particular thoughts, these are just guesses. After this, you could decide what, if anything you wanted to change.  If some change is desired, you might imagine a ‘magic button’ that would achieve that change, without any effort on your part.  For example, the button might eliminate all the upsetting feelings on your Daily Mood Log.  However, everything else in your life would remain the same.  Can you identify any reasons NOT to press that button?  Are there any positive values you have, related to these thoughts?  Would there be any down-side to pressing that button?  This represents your ‘Outcome Resistance’.  Typically, there will be many pieces of resistance that would need to be acknowledged or addressed before methods will be effective in helping you.  You can read in one of David’s many excellent books, like ‘Feeling Great’ and ‘When Panic Attacks’ how to make the most of this approach and what the next steps are. Thanks for listening today. MANY more cool questions on the best treatment techniques for anxiety next week. Matt, Rhonda, and David