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Corona Cast 2: Is this the “New Normal?”

Corona Cast 2: Is this the “New Normal?”

With the “Shelter in Place” orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual while we are learning to use the new technology.  Let us know what you think!  Thank you, David & Rhonda

David and Rhonda are joined again in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app. In our first Corona Cast, we promised to present an example of how TEAM-CBT can be helpful for individuals who feel depressed and anxious about the personal impact of the pandemic.

Rhonda kick starts today’s session by describing her treatment with a patient we’re calling Alice just a few days ago. Alice woke up feeling stressed and having trouble settling in and getting to work. If you click here, you can see how she filled out the first few steps of the Daily Mood Log just before the start of her session with Rhonda.

The Upsetting Event was simply waking up and feeling out of sorts. She circled and rated her negative emotions, which were fairly intense, especially the feelings of depression, anxiety, inadequacy, despair, frustration. Her anxiety was only minimal, but she was also feeling tremendously “jittery.”

Why was Alice feeling so upset? Her feelings didn’t result from the corona virus epidemic, but from her thoughts about it. As you can see, she was telling herself:

1.      This could be the new normal.
2.      My life is going to waste.
3.      I should be handling this better.
4.      I could catch the virus and die.
5.      No one is in charge.

She strongly believed all of these thoughts except #4, which she only believed 40%. You may recall that in order to feel upset, two things must be true:

  1. You must have one or more negative thoughts on your mind.
  2. You must strongly believe these thoughts.

How are we going to help Alice? In the old days, I would have jumped right in to help Alice challenge her Negative Thoughts, but now we have a far more powerful and systematic approach called TEAM-CBT, as most podcast fans probably already know!

These are the four steps of TEAM-CBT:

T = Testing. Rhonda tested how Alice was feeling at the start and end of the session.

E = Empathy. Rhonda provided warmth and support without trying to “help” or “cheer-lead.”

A = Assessment of Resistance. This is one of the unique aspects of TEAM-CBT, and it’s the secret of ultra-rapid recovery. Rhonda used the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial to bring Alice’s “resistance” to change to conscious awareness, then quickly reduced it before trying to “help.”

M = Methods. Rhonda helped Alice identify the many cognitive distortions in her thoughts. For example, her first Negative Thought, “This could be the new normal,” was an example of All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Fortune Telling, and Emotional Reasoning.

The goal of the M = Methods phase is to crush the Negative Thoughts that  are upsetting you. Do you know how to do this? You have to come up with a Positive Thought that has two characteristics:

  1. It must be 100% true. Positive affirmations and rationalizations and half truths are worthless. Cognitive therapy is based on the Biblical idea the “The truth shall set you free.”
  2. The Positive Thought must drastically reduce your belief in the Negative Thought you’ve recorded on your Daily Mood Log, and ideally your belief in it will go all the way to zero.

In fact, the very instant you stop believing the Negative Thought, your feelings will change, and often quite dramatically.

Rhonda helped Alice challenge her Negative thoughts with a powerful technique called the Externalization of Voices. For example, Alice was telling herself that “I should be handling this better” because she’d been having trouble adjusting to the home isolation and had been procrastinating instead of focusing on her writing, and she was also telling herself that “My life is going to waste,” thinking she’d be procrastinating and feeling miserable forever: “The new normal.”

The Positive Thought that crushed it was, “I have a lot of experience as a self-starter, and I’ve got eight weeks of free time now to write, which is pretty awesome. In addition, I can give myself a break, instead of putting myself down, and give myself a little to regroup!”

After all, there are hundreds of millions of people around the world who are feeling isolated and in distress, and probably most of them aren’t being nearly as productive as they usually are, but clearly, that isn’t going to go on forever! Instead of putting yourself down, you can give yourself some support and encouragement, in exactly the same way you might talk to a dear friend.

Once Alice crushed her Negative Thoughts with strong Positive Thoughts, her feelings suddenly changed. Although the session was only one hour long, Alice experienced incredible improvements in how she felt, thanks to Rhonda’s compassion and skillful guidance. Alice’s depression went from 95 to 5, and her anxiety dropped from 95 all the way to zero. The rest of her negative feelings dropped to very low levels or zero as well.

Did it last? Long-term follow-up isn’t possible for such a recent session, but she did call Rhonda the next morning to say that she woke up Feeling Great . . . which is the name of my new book, due for release in September. You can see the cover below! If you want, pre-ordering on Amazon may be available by the time you hear this podcast.

In next week’s Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example of a young woman named Zeina who felt her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother would get the virus and die.

They ended up arguing and feeling frustrated with each other. We will illustrate a sophisticated TEAM-CBT technique called “Forced Empathy” that brought tears to Zeina’s eyes, and we’ll also talk to you about how you can improve your relationships with friends and loved ones as well during these challenging times.

Thanks for tuning in, and let us know what you thought about today’s program!

Until next time,

Rhonda, Jeremy, and David

 

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and specializes in TEAM-CBT for depression, anxiety, and relationship problems. She can be reached at rbarovsky@aol.com.

Today’s featured photo is courtesy of Nancy Mueller photograpy in Los Altos California.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

* * *

IMPORTANT ANNOUNCEMENT

FREE TEAM THERAPY FOR HEALTHCARE WORKERS

Health care workers face incredibly challenging times, having to fight a potentially fatal epidemic without adequate supplies or protection. The TEAM therapy community is now offering free TEAM-CBT treatment for 100 health care workers in San Mateo and Santa Clara counties. For more information, please contact the Feeling Good Foundation.

* * *

This is the cover of my new book, Feeling Great. It will be released in September of 2020, but you will soon be able to pre-order it on Amazon, possibly by the time you read this! 
CoverFeelingGreat1

Need Training or CE Credits?

Check Out these Awesome Upcoming Workshops!

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

Corona Survey: How are You Feeling Now?

Corona Survey: How are You Feeling Now?

Dear friend / colleague,

Along with a colleague, Dr. Diane Schiano, I am conducting a brief survey to find out how people are feeling now in comparison with how they were feeling prior to the corona pandemic. It is an informal survey, not a strictly scientific study, but it could provide some interesting and useful information that I’ll report in a future Feeling Good Podcast as well as a blog.

Are you feeling more depressed, anxious, discouraged, or angry because of the pandemic? Have you experienced a drop in happiness or satisfaction in your relationships with friends and loved ones?

And if so, how large are the changes?

If you’re interested in participating, fill out our survey anonymously at this link, and stay tuned in for the results! Your data will be pooled with the data from many other individuals, and no personal identifying information about you will be solicited or stored.

https://www.surveymonkey.com/r/CVS-1

Thanks!

David Burns, MD

Corona Cast 2: Is this the “New Normal?”

Corona Cast 1: Honoring Your Angst!

With the “Shelter in Place” orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual until we all get the necessary recording equipment, and learn the new technology.  Please bare with us during this transition.  Thank you, David & Rhonda

David and Rhonda are joined in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app, and Dr. Alex Clarke, a former student of David’s who is practicing TEAM therapy / psychiatry at the Feeling Good Institute in Mountain View, California.

One of our loyal podcast fans, Phil McCormack, sent a heartwarming email which read, in part:

In light of the pandemic taking us into uncharted territories, I thought it might be interesting to hear of some tips from you that would help folks deal with the situation, kind of like the David’s Top Ten Tips podcast but this one focused on the hysteria which is prevalent as I write. I’m sure your fans would appreciate it and it might be a good jump start for your new book and app, both called Feeling Great.

I realize you are incredibly busy and don’t expect an answer. And if you want to tell me to screw myself, I can use your techniques to handle that!

I responded like this:

Thanks, Phil. I’m trying to put together at least two or three podcasts on the coronavirus from a variety of perspectives! Might read you question to kick start the first one we do, if that’s okay. david

Phil immediately shot back this email:

You’re an animal! I have no idea of where you get all your energy and motivation–obviously your techniques work (drug free!) so that must be part of it!

Kudos to you for all your effort. It is so, so much appreciated!! I sincerely hope you someday get the recognition you deserve!!! I think Feeling Great might be your ticket… Hope so.

Please feel free to read question and thanks for not telling me to “screw myself!” Really appreciate that!

Phil

How cool is that!

Rhonda and I are planning several podcasts on this important topic including today’s as well as a podcast on how Rhonda used TEAM to help a woman with severe feelings of depression, anxiety, inadequacy, despair and frustration about the current corona crisis in a single session.

We are also planning podcasts on how to communicate with friends and loved ones during the crisis, as well as a survey to assess changes in mood (depression, anxiety, anger, relationship satisfaction and happiness) since the corona virus hit, and possibly  more. When the survey is ready, we’ll announce it and send you a link in case you’d like to let us know how you’ve been feeling, and how your feelings might have changed since the virus hit!

Rhonda kick starts today’s session by reading a list of negative thoughts from folks who are freaked out about the corona virus, including these:

Negative Thoughts with Probable Cognitive Distortions

  • The world will turn into an apocalypse.
  • I’ll be a carrier and won’t know it and then I’ll infect my partner and children who will get really sick.
  • I’m divorced and I think my ex- will try to keep me from my kids. She won’t be as vigilant as I am about keeping our kids healthy. They’ll get sick and infect me.
  • I’m looking for a job right now, but no one will be hiring for a long time and I’ll never get a job.
  • I won’t have enough money to pay my rent and I’ll be evicted from my apartment and end up homeless (or) my business will go out of business.
  • I won’t have enough money to have fun for several months.
  • My parents will contract the virus, especially one of my parents who has some chronic health stuff, and get really sick or die.
  • I’m going to get cabin fever.
  • I will lose a sense of self/connection to reality with how surreal everything is.
  • People in my life will die from the virus.

* * *

Negative Thoughts that are Probably Not Distorted

  • The numbers of infected people are way higher than what’s being reported because there’s no testing
  • The pandemic is worsening.
  • The pandemic will get much worse than we realize now.
  • Needier populations — people who have lost work who really need it (restaurant workers, hotel, caterers, production staff, people with no savings, etc) — will suffer.
  • The social fabric is going to break down.
  • Things are going to continue worsening as climate change worsens.
  • I live too far from my parents to help take care of them.

Rhonda, Alex, David, and Jeremy begin by discussing several of the basic ideas of TEAM-CBT.

  1. We feel the way we think. In other words, the events of this world—like the corona virus—cannot have any effect on how we feel. All of our negative and positive feelings result from our thoughts, or “cognitions.” This idea goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who said that people are disturbed, not by the things that happen, but by our views of them.
  2. Some negative feelings are healthy and some or not. Healthy fear is not the same as neurotic anxiety. Healthy sadness is not the same as depression. Healthy remorse is not the same as neurotic anxiety. And so forth. Healthy anger is not the same as unhealthy anger.
  3. Healthy negative feelings result from valid negative thoughts, like “We are in danger because of the spread of the corona virus, and we need to be vigilant to protect ourselves and our loved ones.” Unhealthy negative feelings result from distorted negative thoughts, like “The world will turn into an apocalypse.”

Anxiety, panic, and depression, in contrast, result from distorted negative thoughts, like many of those that Rhonda read. For example, think about this thought: “My parents will die and I may never see them again.” Review the list of  cognitive distortions and see if you can spot some!

This thought is likely to be at least somewhat distorted since your parents probably won’t die. For example, in China there have been around 3,300 deaths so far, and the epidemic has finally been slowing in the past few days. Since there are more than a billion people in China, the odds that you or someone in your family will die, while significant, appear to be incredibly low. So while there is clearly some risk, the distortion would be Magnification, Fortune Telling, and Emotional Reasoning, the three distortions that trigger all feelings of anxiety. In addition, you can see your parents right now if you like, using Skype, for example. So, while that thought also contains a grain of truth, it arguably involves Discounting the Positive as well.

  1. In spite of these considerations, TEAM therapist don’t try to “fix” or “help” just because someone may have distorted negative thoughts. Trying to help without first addressing therapeutic resistance is the most common error therapists make, and the most common error most people us make. For example, you will hear politicians telling people to “stay CALM,” or trying to encourage people with good news or promises which sometimes don’t seem entirely honest.
  1. Instead of jumping in and trying to “help,” TEAM-CBT therapists first ask the person who is upset if they are looking for help. Sometimes, people aren’t asking for “help” or cheer-leading, they just want someone to listen and provide validation and support.

If the person does want help with negative feelings like panic, depression, frustration, loneliness, or inadequacy, we do a little thought experiment and say: “Imagine that we had a Magic Button, and if press it, all your negative feelings will instantly vanish, with no effort, and you’ll feel terrific. Will you push the Magic Button?”

Magic Button

Most people say they’d gladly push the button!

Then we say that while we don’t have a Magic Button, we’ve got some tremendous techniques that could help them reduce or even eliminate their negative feelings, but don’t think it would be such a good idea to do that because their negative thoughts and feelings may be expressions of their core values as a human being, and what is most beautiful and awesome about them, and that their may be some important benefits, or advantages of their negative thoughts and feelings. And maybe we should list those before making any decision to press the Magic Button and make everything disappear.

If you’re upset, you can try this right now. First, circle your negative feelings and estimate how strong each category is, between 0 and 100%. If you click here, you can see an example of this on the Emotions table of the Daily Mood Log of a woman who was upset about the corona virus scare.

Then ask these two questions about each feeling:

  1. What does this negative feelings show about me and my core values that’s positive and awesome?
  2. What are some benefits or advantages of this negative feelings are. How might it help me, or my loved ones?

I call this new technique Positive Reframing. In other words, I want to honor your negative thoughts and feelings before we think about changing them! This is called Positive Reframing and it is the key to the incredibly rapid changes we typically see when using TEAM-CBT. 

Typically, we come up with a list of a long list of compelling positives. Then I point out that if they push the Magic Button, all those positives will go down the drain, along with their negative feelings. Would they really want to do that?

Now you’re in a trap, or dilemma. One the one hand, you are suffering and desperately want to feel better. But at the same time, you don’t want to lose all of those awesome positives!

Fortunately, we can resolve this paradox. Instead of trying to make your negative feelings disappear by pushing the Magic Button, imagine that we had a Magic Dial instead, and you could dial each negative feeling down to a lower level that would allow you to keep all the positives on your list, and still feel better. What would you dial each type of negative feeling down to? For example, if you’re feeling 80% panic or 90% depressed or angry about the corona virus, and you could dial each emotion down to a lower level, what would you dial them down to?

Magic Dial

You can see an example of this if you click here. As you can see, this person has put these new levels in the “% Goal” column of the emotion table.

Jeremy provides a touching real life example of this. He feel intense anger because his fiancé, a nurse—is working in a hospital with a shortage of protective masks. He becomes tearful when he realizes that his anger is actually an expression of his intense love for her. The change in how he feels is almost instantaneous, and touching.

The group further illustrate this by using Positive Reframing with many of the negative feelings our podcast listeners like you may be having.

Jeremy concludes by drawing a critically important distinction between Positive Reframing, which is nearly always helpful, and “cheer leading,” which is rarely or never helpful, and  can actually be downright irritating!

This table below highlights some of the critical differences.

Is Positive Reframing Just Cheerleading Warmed Over?

by David and Jeremy

Cheer Leading Positive Reframing
You’re trying to cheer someone up to make them feel better. You are highlighting the benefits of NOT changing.
You say generally nice things about someone, like “you’re a good person,” or “you’re a survivor,” or “don’t be so hard on yourself.” The positives are not general but embedded within specific negative thoughts and feelings.
You don’t acknowledge the validity or beauty of the person’s negative thoughts and emotions. In fact, you’re trying to tell them that they’re wrong to feel upset! This is always preceded by doing superb empathy. Positive Reframing is actually a deeper form of empathy because you’re honoring the patient’s core values.
Cheerleading is irritating to almost everybody who’s upset, because you aren’t listening or showing any compassion or respect. The effect is enlightening and leads to feelings of relief, pride, peace, and acceptance.
You’re trying to control the other person. You’re telling them how they should think and feel. There’s no acceptance. You’re Sitting with Open Hands. You’re bringing hidden motivations to conscious awareness so they can decide where to steer the ship.
Hollow praise sounds dismissive, glib, and insincere. This technique is very difficult and challenging to learn because you have to let go of the idea that you know what’s best for other people.

Thanks for tuning in, and let us know what you thought about today’s program!

Oh, if you clicked on the two links to the Daily Mood Log of the woman who was intensely upset about the corona virus, and want to find out what happened in her magical TEAM-CBT session with Rhonda, tune in to our next CoronaCast!

Until then,

Rhonda, Alex, Jeremy, and David

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and specializes in TEAM-CBT for depression, anxiety, and relationship problems. She can be reached at rbarovsky@aol.com. Dr. Alex Clarke practices in Mountain View, California and can be reached at alex@clarkemd.com or by phone: 650-382-1145

 

Today’s featured photo is courtesy of Nancy Mueller photograpy in Los Altos California.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

 

* * *

This is the cover of my new book, Feeling Great. It will be released in September of 2020, but you will soon be able to pre-order it on Amazon, possibly by the time you read this! 
CoverFeelingGreat1

Need Training or CE Credits?

Check Out these Awesome Upcoming Workshops!

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

Corona Cast 2: Is this the “New Normal?”

184: Ask David: What Comes First? Negative Thoughts or Feelings? Solving the Chicken vs. the Egg Problem, and More!

Today, Rhonda and David answer several challenging questions submitted by listeners like you.

  1. What schools of therapy are embedded in TEAM?
  2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?
  3. “Can TEAM-CBT help bipolar patients during the depressed phase?”
  4. How do you make Externalization of Voices work? I get stuck! For example, my patient said, “It’s unfair that I cannot get a job!”
  5. Is there a cure for OCD?

1. What schools of therapy are embedded in TEAM?

Dear Dr. Burns,

I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy “integrates features and techniques from more than a dozen schools of therapy.” I’m aware of many of the CBT techniques you use, but I don’t think I’ve read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques?

Madelen

Hi Madelen,

This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy.

Here are some of the schools of therapy that I draw upon TEAM-CBT.

      1. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic)
      2. Flooding / Experimental technique: behavior therapy (exposure)
      3. Externalization of Voices: Gestalt / Psychodrama / Buddhism
      4. Acceptance Paradox: Buddhism
      5. Self-Defense Paradigm: REBT
      6. CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques
      7. Identify the distortions / examine the evidence: cognitive therapy
      8. Empathy: Rogerian (humanistic) therapy
      9. Five Secrets / Forced Empathy: Interpersonal therapy
      10. Shame-Attacking Exercises: Humor-based therapy / Buddhism
      11. Be Specific / Let’s Define Terms: Semantic
      12. Feared Fantasy: Role-Playing / Psychodrama / Exposure
      13. One-Minute Drill / Relationship Probe: Couple’s Therapy
      14. Time Projection / Memory Rescripting: Hypnotherapy
      15. Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy)
      16. Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy
      17. Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior
      18. Storytelling: indirect hypnosis.
      19. Positive Reframing: Paradoxical psychotherapy.
      20. Hidden emotion technique: psychoanalytic / psychodynamic
  1. Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David

2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?

Hello Dr Burns,

I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist.

I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example?

Thank you very much!

Audrey

Hi Audrey,

Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like “I’m a loser” or “my case is hopeless.” My research, which I’ll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey.

david 

3. “Can TEAM-CBT help bipolar patients during the depressed phase?”

Name: Sarah

Comment: Hi, Dr. Burns.

I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts.

I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before.

My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes.

For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness.

In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease?

In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do?

I would love to hear your take on it. Thank you so much for your endless work helping people to feel good!

Sarah

David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment.

4. Externalization of Voices: How do you make it work? I get stuck! “It’s unfair that I cannot get a job!”

Dear Dr Burns and Rhonda,

I’ve just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes.

I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can’t find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts.

I have a question about Externalization of Voices. In all of the examples you’ve shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to “win huge”. I’m less experienced and find I’m not batting 1000. What do you do when neither you nor the patient have been able to win huge?

Many thanks again for all you do,

Calvin

PS The episode on How to Help and How Not to Help was one of the best yet!

Hi Calvin,

Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with?

All the best,

David D. Burns, M.D.

Hi David,

There have been a couple of examples where we could only get a small win.

With the first patient, the thought he was tackling was: “It’s not fair that I’ve worked so hard in life, but I can’t get a job.”

I tried modelling self-defense, along the lines of “I’ve accomplished a lot given how many challenges I’ve faced.” I also tried suggesting the Acceptance Paradox with something like: “It’s true that life’s not fair. Who said it should be fair?” This was only a ‘small win.’ I felt stuck.

Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was “I’m going to be chronically tired and no longer able to enjoy life the way I used to.” We tried: “Sure, I may be more tired than I used to be, but I’ll still be able to enjoy life to some extent.” Again, this was a small win, not enough to crush it.

Thanks again for your willingness to help!

Calvin

David’s response

Hi Calvin,

All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.”

Let’s focus on the first thought, “It’s not fair that I’ve worked so hard in life, but I can’t get a job.”

This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts.

When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well.

The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth.

This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.)

You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job.

If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy.

Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques.

When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome?

For example,

      1. My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense.
      2. The sadness shows my passion for life, for work, and for being productive.
      3. My anger shows that I have a moral compass and value fairness.
      4. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve.
      5. My anxiety, in other words, is a form of self-love.
      6. My anger shows self-respect, since I have a lot to offer and contribute.
      7. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed.

This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up.

Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear.

Then you resolve the patient’s dilemma with the Magic Dial.

All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices.

If you do this skillfully, the Ext of Voices will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too!

If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all!

Not sure how much training you’ve had in TEAM. Rhonda and I can discuss these two examples when she returns from India in a month or so, but there are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance.

There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy.

Thanks!

David

5. Is there a cure for OCD?

Hi Dr. Burns,

I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counselling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too.

I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives?

Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy.

I know you do not reply to personal messages but would really be grateful if you could reply to this mail

Looking forward to hearing from you

Regards

“Betsy”

In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story plus lots of additional great resources on OCD, including podcasts 43 – 45 (this page provides links to all the podcasts), and more.

Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety.

Thanks for listening today, and thanks for all the kind comments and totally awesome questions!

David and Rhonda

Subscribe

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Level 4 Certified TEAM-CBT Therapist and Trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

 

Coming up in 2020

I will present two workshops at the upcoming

Psychotherapy Networker Conference!

Saturday, March 21, 2020
Feeling Great—A New, High-Speed
Treatment for Depression

Sunday, March 22, 2020
Overcoming Magical Thinking with the Anxious Client—
A Paradoxical Approach

Plus, my new book, Feeling Great,
will be officially announced with banners and such!

CoverFeelingGreat1

* * *

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

183: Tough Conversations about Racial Bias. Yikes! Do We HAVE TO Talk about This?

183: Tough Conversations about Racial Bias. Yikes! Do We HAVE TO Talk about This?

Today, Rhonda and David talk about how to give potentially hurtful feedback when you sense racial bias in a friend or colleague. She describes an incident in her office where the glass coffee table in her waiting room was found smashed and shattered when her office mate “Steve” (not his real name) arrived Monday morning. Although many people, including the cleaning crew, had used the office over the weekend, Steve asked Rhonda to discuss the broken table with someone who uses her office on the weekends, Kenya, about it.  Kenya is African American, and a highly esteemed professional and beloved friend and colleague of Rhonda’s.  Rhonda thought there was implicit bias being played out in this situation but did not know how to discuss it with Steve.

But how can she convey these feelings to her office mate, who conveyed the impression that a black man must be the one who broke the table?

David suggests one of the advanced communication techniques called “Changing the Focus” discussed and demonstrated in a previous podcast #158.  They illustrate how to apply that method to the current situation, and struggle a bit along the way!

David reiterates the story of when he was accused of being racist at a psychotherapy workshop near the Texas / Mexico border, and how his own teachings in that very workshop saved the day for him. He emphasizes that it can be so painful to be accused of racist tendencies, or to discover them in yourself, and that this is another case where the cover-up is far worse than the crime!

David and Rhonda

Subscribe

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Level 4 Certified TEAM-CBT Therapist and Trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

 

Coming up in 2020

I will present two workshops at the upcoming

Psychotherapy Networker Conference!

 

Saturday, March 21, 2020
Feeling Great—A New, High-Speed
Treatment for Depression

Sunday, March 22, 2020
Overcoming Magical Thinking with the Anxious Client—
A Paradoxical Approach

Plus, my new book, Feeling Great,
will be officially announced with banners and such!

CoverFeelingGreat1

* * *

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety, OCD,
PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with
Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA