In this Podcast, David and Fabrice describe four powerful treatment models for anxiety, including
- The Cognitive Model
- The Exposure Model
- The Motivational Model
- The Hidden Emotion Model
Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger. And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover.
Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.
Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever.
Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out!
In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.
What happens when exposure doesn’t make anxiety go away? When you work a job and experience anxiety every day, despite feeling it & going to work every day for years. When being around people feels terrfying (like being around tigers & bears terrifying) no matter how often you’re with them and around them.
Many people will post anonymously, because who we are in this instance is irrelevant; asking our questions is what’s important to us for this moment.
A good and important question. In the podcasts on anxiety, and in my book, When Panic Attacks, you’ll see that I use more than 50 methods in treating anxiety or any kind of emotional distress, along with four completely different treatment models specifically for anxiety–the motivational, cognitive, exposure, and hidden emotion models. That’s because there is no “one size fits all” in the treatment of depression, anxiety, relationship problems, or habits and addictions. In addition, intentional exposure is radically different from the accidental exposure anxious individuals experience when bumping into a situation that makes them anxious.
Posting anonymously is A-OKAY!
I don’t ever throw techniques at problems, like being anxious around people, since that rarely ever works, as you’ve so wisely pointed out. I always work systematically, using TEAM, and of course it is vitally important to pinpoint and write down the Negative Thoughts that trigger the anxiety, or anger, or shame, or whatever the negative emotion happens to be. You can read about how to do this in any of my books, such as the Feeling Good Handbook, or When Panic Attacks, which both have a great deal of information and methods on how to overcome any kind of anxiety, including social anxiety.
I don’t get how that’s funny at all.
It sounds rather mean
Hi sherry, thanks for the email! I don’t know what you’re referring to, as the podcast was a long while back, but you are absolutely right that humor can be a two edged sword and can sometimes hurt feelings, something that is super important. So easy to be insensitive or even cruel when using humor! That has happened to me several times when I was using humor, and the realization was shocking! 90% of the time, humor brings people closer together and helps to trigger enlightenment. But if someone is raw, and especially if something feels angry or hurt, it’s not the time for humor. David
Dr.d – I believe Sherry is probably referencing the case study when the patient went to the gym to step on cracks and was notified that his aunt died. Dr,ed
Can’t recall who “sherry is” but you are right about the case study! Where did you hear about it? I heard about it in a half day workshop on exposure given by some expert from London. d
Your matted is truly amazing it helped me very much and it even helped me to help others!
Thanks for your kind comments! Warmly, david
I was pretty uncomfortable when you were laughing as well
Thanks, but I don’t get the flow, and don’t know what you’re referring to. Apologies. david
What do you do when you’re older (58) and you’re anxiety is your life is over because it’s just too late to fix things?
Thanks, Lisa. Sounds like a good time to read When Panic Attacks or my new book, Feeling Great! All the best, david
Thank you for the prompt response, Dr. Burns. I’ve been listening to the podcasts on both and trying to decide which book to start with. I think maybe Feeling Great because I fall in the treatment resistant category but then I think maybe When Panic Attacks. Both at the same time seem overwhelming. Any suggestions on which to start first?
BTW, I wish all 11 of the psychologists and 5 psychiatrists over the years I’ve seen would have taken the post visits tests. I feel like psychiatrists today just skate – 15 minutes, here’s a script, bye.
If resistant, try Feeling Great! Good luck, keep me posted~ d
I have a performance anxiety, and have had for many decades. When I play music and “no one is watching”, I can do pretty well. Even soar sometimes. As soon as I’m aware of someone, probably a very kind and generous soul looking in my direction, I can feel a Buster Keaton train wreck coming at me. sometimes I can skate by, sometimes not.
These days of covid and zoom gatherings, I’ve been continuing to wage the battle. Only now, it is a new beast. No longer able hide in the corner of a restaurant, it’s now complete focus from the Hollywood squares collection of a myriad of people, known and unknown. The “vibe”, the ambiance, is gone. It’s more sterile and uncertain. Impossible to gauge the audience.
Again, I can feel it coming. I can hear the train a’coming, like the song says… I know it’s there and I can even be somewhat detached about it. I can tell myself “I’ve got this” and think to myself that I can be sanguine about it, and any little stumbles will pass, but this whole other reality starts barreling down the track and I crash and burn on things I ordinarily feel comfortable with. And afterwards, when the spotlight moves on I can step away, I feel awful and resolve to work twice as hard before next time. I know I don’t have to “work harder”, I know I just need to not overthink, I need to angst less.
I “know” that… but it’s really like I sit and watch something else take control away from me. But I feel like I have to keep doing it, because… it’s the only way I know how to attack it. But wow. I can be hard on me.
I’ve started your e-mail anxiety course and am excited about it. Getting the books, and hoping soon I can quit wrestling with myself sometime soon!
Good luck, and thanks for your thoughtful and accurate description. Fortunately, total solutions DO exist! I got rid of the last of my 17 anxiety disorders, camera phobia, just two years ago. Wife calling me for dinner, have to run! Warmly, david
Hi, Dr. Burns. Thanks for the podcast. I am a PhD student. All the time I feel an urge to study. I fear that I shall not be able to do good work in my PhD if I don’t do work all the time and hence I work all the time. At any moment if I am not studying I feel a certain kind of fear. Can it be considered OCD?
Traditional, shrinks have viewed negative feelings and behavioral issues as the expression of something that’s “wrong” with you that needs to be “fixed” with drugs, therapy and so forth. In TEAM-CBT, we would view your “excessive” studying as an expression of what’s right with you, and if you still wanted to modify this, that could be done fairly easily once we spell out all the positives in the way you’re thinking, feeling, and behaving.
For example, you have wonderfully high standards and a terrific work ethic.
We need more people like you to make the important breakthroughs in psychology!
I am not terribly enthusiastic about labeling human problems as “mental disorders,” the way DSM does. And it’s not even a problem unless you decide that it’s something you want help with!
All the best, david
Hi Dr. Burns, thank you for everything you do, it’s life-changing. Just wanted to point out that I think you missed saying clearly what the treatment is in the Motivational model here. It would be great if I could have that information.
You can read my latest book, Feeling Great. Thanks, david