Feeling Good about Poker

You might enjoy a humorous but serious link from a poker player who was helped by reading about the Approval Addiction in my book, Feeling Good. To check it out, CLICK HERE. Apparently, the link has gotten considerable spin in the poker world. Who knows, reading Feeling Good might lead you to riches playing poker! Not my goal when I wrote it, but I’ll take it! david

Pioneers of Cognitive Therapy

Hi web visitors,

Dr. Robert Schachter, from New York, recently interviewed with for his series on the Pioneers of Cognitive Therapy, sponsored by the Association for Behavioral and Cognitive Therapies (ABCT.org).  I was very honored to be included, and have great respect for Dr. Schachter. The interview provides a nice overview of  TEAM-CBT and explains the thinking that lead to its development. If you’d like to check it out, CLICK HERE!

Thanks!

david

Questions from a thoughtful listener

The following is an email I received from Dan Prine, a therapist receiving TEAM-CBT training from Dr. Maor Katz at the Feeling Good Institute in Mt. View, California. Dan had several questions about my recent podcast on single-session therapy with Fabrice Nye and Lisa Kelley.

Good morning David,

As I continue to learn and study the TEAM approach to CBT, I find it challenging and see it as so complex that it will present itself as a career long learning process. I have attended several of your intensive workshops, am currently involved in 2 web based programs and am receiving 1:1 supervision with Dr. Katz. I have several questions / thoughts I would like to get your thoughts on.

  • In the 1999 introduction to your workbook, “Ten Days To Self Esteem,” your referred to patients with schizophrenia and to those experiencing hallucinations who were treated at your hospital in Philadelphia (page 8). Most of the rest of your introduction has a focus on depression and anxiety. Perhaps you were referring to improvement in psychotic individuals who also were experiencing depression. If not, I am interested in knowing if your workbook was found to be helpful with symptoms of psychotic disorders without concurrent depression.
  • There was recently a challenge to your copyright policy on the list serve. [David’s explanation: Several therapists were rather forcefully asking permission to distribute the assessment tests and treatment tools from my Therapist’s Toolkit electronically. This would put me at great risk for online piracy, which is a huge problem for me already, and also risks violating HIPAA laws about sending confidential patient information electronically, with potentially huge fines, including jail time. I responded in strong language that this was not going to work for me.]
  • Dan Prine continues: I 100% understand and agree with all your arguments to maintain status quo. Based on the writer’s response, I think he now also agrees with your stance. It is refreshing in your books when you describe your humanness and talk about when you decide to back up, rethink your response and employ the Five Secrets to get a more productive result. You were “right” and your approach to the writer’s thoughts seem to have changed his perspective. I wonder if upon reflection you would convey the same message in a more gentle way. Just wondering.
  • In response to your recent post and podcast about the 2 hour “miracles” we see in your workshops, I am wondering if think a clinician in a private practice, offering a 2 or 3 hour initial sessions, could achieve the same results you have experienced so frequently?
  • Do you administer the EZ Diagnostic survey and /or the BMS before and after your demonstrations?
  • Could the following, in addition to the TEAM CBT, be responsible, at least in part, for the rapid changes you are seeing in your clinical demonstrations in workshops?
  1. Since your workshops are for therapists, your volunteers are psychologically-minded and reasonably high functioning—could this be a factor?
  2. Could there be a placebo effect, since the “patients” are receiving treatment from an expert?
  3. Could increased motivation play a role, since they are willingness to volunteer for personal work in front of a live audience, which takes courage and determination?
  4. Could your empathy and acceptance of them as humans be a contributing factor?
  5. How important is it that you melt away their resistance during the live session?

If these factors play a major role in the improvements you have been experiencing, do you really believe that we, as private practice therapists, could ever achieve the same kinds of phenomenal results in 2 hour therapy sessions? I do acknowledge you made it clear none of us could ever expect these purported results consistently, no matter how skilled.

Thanks in advance for any response you might offer.

And as I have mentioned before, thank you for your kindness, perseverance and pioneering efforts you offer in promoting therapists worldwide to help the many who suffer from mental illness and their distortions.

dan prine

If you’d like to read my response to Dan Prine’s thoughtful questions, and the email exchanges that followed, CLICK HERE. I really enjoyed the correspondence with Dan (aka Danny) and hope you enjoy it as well!

Should Statements: Is there a moral / ethical dimension?

Hi Website visitors,

I got an interesting email from a brilliant colleague, Rabbi Joel Zeff, who joined one of the Sunday hikes a year or so ago. He asked about the ethical implications of one of the ten cognitive distortions: Should Statements. This is a cool topic, and I hope you enjoy the exchange! Feel free to comment, too, as usual!

David

Dear Dr. Burns,

You might remember me from one of the Sunday morning walks. (I am the rabbi being trained by Leigh Harrington.) I am most pleased to report that I completed the TEAM-CBT Level One training in November. Leigh was absolutely marvelous and I look forward to continuing my training with this powerful approach towards healing.

Meanwhile I have returned to Israel and am completing my dissertation for the doctorate in pastoral counseling from the San Francisco Theological Seminary (Presbyterian), an affiliate of the Graduate Theological Union in Berkeley. I recently posted the following inquiry, for my dissertation work, on the TEAM listserv and wonder if you would consider addressing it (many thanks!):

Dear Friends,

I am currently working on a doctoral dissertation in pastoral counseling. I am creating a source book for Jewish pastoral counseling which presents examples of cognitive re-framing found in the Jewish mystical thinking of Rabbi Abraham Isaac Kook, the Chief Rabbi of Israel during the “Pre-State” period of the British Mandate (died in 1935).

My point of reference is the wonderful TEAM training I received from Dr. Leigh Harrington (thank you so much Leigh!). As part of my writing, I want to address the interface of ethics and cognitive distortions. One gets the impression that cognitive distortions are not defined by ethical considerations. The primary criteria seems to me whether or not the cognition is firmly rooted in reality and to what extent it is helpful in living a relatively happy and productive life.

Do ethical considerations play a role in defining a “distortion” and/or impact on the course of therapy?

This question was particularly accentuated with regards to “Should Statements.” Ethics would posit that people “should,” for ethical reasons, behave in certain ways. Why should we not expect certain standards of conduct, on ethical grounds? I can understand why we might work on not becoming overly emotionally reactive, but that is not the same as saying “why should he/she behave otherwise?”.

I would very much appreciate your thoughts on this, as well, any references to writing on this particular issue that I could incorporate into the dissertation.

If you are able to address the issue, might I have permission to quote you referenced as “in private correspondence?”

Many thanks,

Joel Zeff,

Hi Rabbi Joel,

Good to hear from you! I still have vivid memories of the Sunday hike you joined not long ago!

In my writings (books, blogs, etc.) and teachings (workshops, podcasts) and therapy work, I have always emphasized that there are three valid uses of the word, “should”—the legal should, the laws of the universe should, and the moral / ethical should.

  • Legal should: You should not drive at 100 miles per hour because you’ll get a ticket.
  • Laws of universe should: If I drop this pen, it should fall to the floor due to the law of gravity.
  • Moral / ethical should: “Thou shalt not kill,” which is straight from the Ten Commandments.

Other uses of the word, “should,” are generally not valid, and they can be painful, too. When you say something like this–“I should be a better teacher (or therapist, or Dad, etc.),” or “I shouldn’t be so screwed up,” or “I shouldn’t have made that investment,” or “I shouldn’t be so shy,”—these are not valid uses of the word, should.

Let’s say you have a fear of bridges, like a psychologist I once treated. She told herself that she “shouldn’t” have this fear, and therefore was “screwed up,” and “shouldn’t be screwed i[.” Is this a valid use of “should?”

Well, it is not illegal to be “screwed up,” or to have a fear of bridges. Also, having a fear of bridges does not violate any of the laws of the universe. Nor is it immoral or unethical to have a fear of bridges. For example, you don’t see , “Thou shalt not fear bridges,” listed in the Ten Commandments, or in any of the holy texts from any religion.

If you look up the word, “should” in one of those huge dictionaries, you will see that it’s origin traces back to the Anglo-Saxon word, “scolde.” So, essentially, you are scolding yourself for having some flaw or shortcoming when you use the word, “should.”

You can combat these painful types of self-criticisms in many ways, but one of the easiest is the Semantic Method—you simply substitute gentler language, such as “I would like to be a better teacher” (or therapist, or Dad, or whatever). Then you can focus on the specifics of what you are doing in your teaching, for example, that’s effective, or ineffective, and make a plan for improvement, if needed.

But in a clinical situation, other methods will almost always be needed, especially Paradoxical Agenda Setting techniques, along with empathy and all the rest of the TEAM-CBT treatment techniques. There are numerous techniques that can be used to combat these dysfunctional uses of “Should Statements.” For example, you can say, “It would be great if I could get over my fear of bridges,” and then you can use a variety of techniques to overcome your fear of bridges, if that is your goal. But that is radically different from beating up on yourself.

Should Statements will generally double your trouble. First, you have some flaw, and second, you are filled with self-hatred because you are telling yourself that you “should not” have that flaw. Then you may feel ashamed and defective, or inferior, or even hopeless.

Shoulds directed toward others cause anger, but are equally irrational. Other directed “shoulds” are usually combined with other-directed blame, and are sometimes difficult to combat. That’s because anger and blame usually make people feel morally superior to others—for example, the blame may be directed at certain religious, political, or ethnic groups, and you may enjoy feeling morally superior to the group or the person you are angry with.

The late Albert Ellis, PhD, humorously called this “shoulding on yourself” (or others.) He also called it the “shouldy” approach to life. He tried to show the “shoulding” patient why these statements are irrational, using the technique called Examine the Evidence. He often said things like, “Where is it written that you shouldn’t have this or that problem?” Or “where is it written that your spouse should be different from the way s/he is?” He often made these statements with considerable force and charisma. Those who remember seeing him when he was still alive will know exactly what I mean!

Some people could see his point, and bought it, while others simply could not “see” it, and got turned off by Ellis. That’s why I’ve developed motivational approaches, like Paradoxical Agenda Setting, that therapists can used before trying to modify the patient’s negative thoughts. You can use techniques like Paradoxical Cost-Benefit Analysis and Sitting with Open Hands, for example. This protects the therapist from having to “sell” something to a reluctant “customer,” and greatly boosts therapeutic effectiveness..

There is no conflict I have ever detected between any form of spirituality, religion, or ethics and good, effective therapy. In my experience, individuals who have resolved and recovered from depression, anxiety, relationship problems, or habits and addictions frequently become more spiritual, and have a deeper understanding of spiritual / mystical / theological / philosophical concepts at the moment of recovery, although that probably sounds vague and maybe goofy. That would have to be the topic of another conversation.

I wrote an article on Should Statements that I might publish on my website at some point.

Albert Ellis was one of the first individuals who taught about the problems with Should Statements, back in the 1950s. He pointed out the three valid uses of shoulds that I listed above. The idea that there are valid uses of shoulds, including Moral Shoulds, is an old and well established concept that is embedded in all of the cognitive therapies.

The feminist psychiatrist, Karen Horney, wrote about the “Tyranny of the Shoulds” in the 1950s as well. My mother was struggling with some depression then, and found the books of Karen Horney to be helpful. I was just a kid at the time. I’m still a kid, but more of an old kid now!

Good luck with your dissertation. I’m sure it will be thought provoking, and interesting to many people!

Hope you can come on a hike again one day!

David

Can Depression Really Be Treated in a Single, Two-Hour Therapy Session?

Hi, I hope you will find my latest blog interesting! It is based on an interview with Lisa Kelley, a TEAM-CBT therapist and former journalist, and is intended for therapists and for the general public alike, although a few sections may seem somewhat technical.

I’ve been running a survey on this site about whether single-session treatment for depression and anxiety is possible, and the vast majority of you have indicated the very idea is somewhere between unrealistic and absurd. Ten years ago I would have agreed with you, and written off anyone who made such a claim as a con artist.

For my latest thinking on this highly controversial topic, you can click here.  You’ll also learn the secrets of melting away therapeutic resistance using the latest TEAM-CBT techniques. Make sure you provide your feedback and ideas about this, too, as our understanding is evolving, and you can be a part of that process!

Comments and Questions from Visitors like You!

Is Feeling Good still relevant?

Comment: Dr. Burns, You’re the man!

My C.B.T. suggested your ‘Feeling Good’ book as a good read and when I noticed that it was written before I was born… I thought ‘surely this can be of no use to me – the theories and practices are outdated, archaic and will not be useful.’

Boy was I wrong! I want to personally thank you for your candor and the humorous nature in which the book is written. It has been tremendously helpful in my journey toward ‘feeling good’ and I can’t thank you enough for taking the time to create a product that has the power to fundamentally transform the way in which we think, if we so choose.  I reference it often, sometimes daily, when times are tough and I am feeling overwhelmed by Life.

– Mike W

David: Thanks, Mike! I greatly appreciate your kind comment!

Feeling Good Together is a goldmine!”

Comment: Dr. Burns,

I just wanted to send you a brief note about how much I appreciate your books (I own Feeling Good, The Feeling Good Handbook, Ten Days to Self-Esteem, and Feeling Good Together) and other materials (such as your recent podcasts, which I’ve been following with great interest). I have never (to my knowledge) suffered from clinical depression or anxiety, but I have had many loved ones close to me who have, and so your books have helped me understand it better and hopefully help them, too. In addition, by learning about cognitive behavioral techniques and the thought distortions we all have, it has helped me keep my own moods in check. And Feeling Good Together is a goldmine! The first time I read it I didn’t do the the exercises (I know–shame on me!), but now I’m reading it a second time and diligently doing the exercises. I believe already it has helped me greatly with my relationships, and I’ve recommended it to others.

I really liked your recent podcasts on the TEAM model. The idea about overcoming resistance is quite helpful. I am not a therapist, and I realize that the successful utilization of these techniques requires a good deal of skill and training; nonetheless, I hope that by learning about them I may become somewhat better at interacting with people in the course of my life. Thank you.

EP

David: Thanks, EP! Fabrice and I really appreciate the support!

“Is there a Chinese Feeling Good?”

Comment: I am trying to help a Chinese person who is struggling with automatic thoughts. there is a language barrier. It would be so much easier if I could hand her a book written in Mandarin. Are your books printed in Chinese, and how do I locate one?

Patti

Patti, here is a response from my dear colleague and former student, Sunny Choi, who was born in Hong Kong:

Hi, Patty.  The name of feeling good in Chinese is 好心情手册

You can google that and find places you can get it.  For example:

http://www.yesasia.com/global/%E5%A5%BD%E5%BF%83%E6%83%85%E6%89%8B%E5%86%8C-i-%E6%83%85%E7%BB%AA%E4%BC%9A%E4%BC%A4%E4%BA%BA/1004820220-0-0-0-zh_CN/info.html

Sunny

Catch-22?

Dr. Burns,

I’m confused. You say that anger is irrational and illogical, but you’ve also said that anxiety occurs because people don’t allow themselves to feel angry. This sounds like a catch-22; if people reason away angry feelings, because they know feeling this way is irrational, then they’ll feel anxious and uptight. Either people feel angry, or they’ll feel anxious—and yet you’re saying feeling either way is irrational??

Anonymous

Hi Anonymous,

Thanks for your question. You clearly think about things deeply!

First of all, let’s distinguish healthy from unhealthy emotions / feelings. In my book, Feeling Good Handbook, I have a chapter on the differences between the two. Healthy anger differs from unhealthy anger in many respects, and the presence or absence of cognitive distortions is one important criterion. Another criterion would be the desire to attack with your anger vs. the desire to share your anger respectfully.

By the same token, healthy fear differs from unhealthy or neurotic anxiety, with similar criteria. Unhealthy or neurotic anxiety always results from distorted thoughts. For example, individuals with panic attacks often tell themselves, “I’m about to die,” or “I’m about to go crazy,” but these thoughts are rarely or never valid for individuals experiencing panic attacks. So the anxiety results from distorted thoughts and not from reality. In contrast, if one is in a war zone, the thought, “My life is in danger,” would be valid and would help to keep you safe. So that is healthy fear, and you don’t need to treat it with pills or psychotherapy!

So now let’s focus on unhealthy anxiety, and what causes it. In my book, When Panic Attacks, I mention that any forbidden or unexpressed feeling can trigger anxiety in individuals who are overly “nice.” It could be anger, loneliness, wanting something that you think you are not supposed to want, anything. So when you are upset, you may sweep your feelings under the rug, but you don’t realize that you’re doing this. Then the feelings may resurface, disguised as any form of anxiety.

For example, I used to treat first-year students at the University of Pennsylvania law school. They freaked out in class, and went to the dean saying they thought they had to drop out of law school because of their anxiety. But in most cases, it turned out they really didn’t want to be in law school. They were there simply because their parents had suggested it, or because they were top college students but weren’t clear about what career they wanted to pursue. But they were so “nice” that they thought they weren’t allowed to do what they wanted. They felt they “should” do what their parents wanted, or what they thought their mentors at the law school wanted them to do.

When this emerged during the treatment, then most of them were able to say, “I don’t like the model of becoming a wealthy wall street attorney that is promoted at the law school. I don’t want that kind of life or career.” This brought about immediate and complete relief for most of them. And surprisingly, instead of dropping out of law school, most decided to stay in law school, but to pursue the kinds of careers that really appealed to them. One decided he wanted to represent athletes and movie stars in Hollywood. Another decided she wanted to move to Israel and to legal work on the Palestine / Israeli conflict. Yet another decided he wanted to settle down in a small town in the Midwest and have a humble, general law practice.

So as you can see, the repressed or suppressed emotion can be anything, and not just anger. There is nothing wrong with having healthy negative emotions, including anger. In fact, I call the fear of negative emotions “emotophobia,” and it is very common among individuals struggling with any type of anxiety. I love treating anxiety for many reasons, and one of the reasons is that when you recover, you discover it is okay to be human, and to have all kinds of positive and negative emotions, and to express them.

I wasn’t clear from your excellent question if you were looking for help with your question, or simply registering a protest of some type. I know you signed it as “Anonymous,” and you gave a phony email address (anon@anonymous.com.)

Some individuals in our field, therapists and the general public alike, have strong feelings about things, and that is okay. But I wondered from the tone of your email, and from your reluctance to use even your first name, if you were perhaps turned off by my work, and possibly were trying to catch me in a contradiction, but I am probably way off-base. You can let me know with another anonymous email if you like. At any rate, I often contradict myself, as many things I teach can be seen from a variety of perspectives, and can be difficult to explain clearly. Things are not always “this way” or “that way.”

Finally, it is possible to express one’s feelings in a respectful, caring way, and to be free of anxiety as well. But it is hard for most anxious individuals to do this, because the tendency to sweep your feelings under the rug is so automatic, and you may not even realize that you are doing this. So when you start to get anxious, you may not even realize what you are upset about, and instead began to ruminate or feel anxious about something. Bringing those hidden feelings to conscious awareness and expressing them can be a potent anti-anxiety strategy for many anxious individuals. However, it is only one of about 40 treatment methods I use in treating anxiety.

Sincerely, Doctor David

A massive THANK YOU!

Comment: Hey David, I’m not sure if this will get to you, but just in case it does – I want to say a massive THANK YOU for your work and your book, Feeling Good.
A few years ago the book helped me out in a big way. I was flicking through it just today and I realized that you have no idea how huge and positive the impact on my life has been.

So that’s it, a big thank you from the bottom of my heart! YD
Response: Thanks, YD! I deeply appreciate your warm comment. When I wrote Feeling Good, years ago, I hoped it would connect with at least some depressed individuals, but had no idea that it would really be effective! This is so cool!

All the best, David

Another thoughtful THANK YOU!

Comment: Dear Dr. Burns;
I have been feeling depressed and anxious for the past couple of months because of some unfortunate events in my life and a counselor suggested reading “feeling good” to me. Today is the second day I am reading your book and I am only half way through the second chapter but I just felt the need to thank you and let you know how helpful your book is for me. It even helps me to get through my panic attacks which are mostly accompanied by shortness of breath but as I am writing to you right now I absolutely overcame my last panic attack by just reading “feeling good.” You make the world a better place.

Gratefully Yours, A

Dear A. I appreciate your comment and I’m so happy that Feeling Good has been helpful to you. You might also enjoy a more recent book of mine, When Panic Attacks, which should be right up your alley! Thank your counselor also! Coincidentally, I am teaching a group of residents at Stanford tonight (leaving in a few minutes), and plan to show a video of a woman who had a panic attack right in my office during a session. She was convinced she was about to suffocate or die! I used a treatment technique described in When Panic Attacks called the Experimental Technique. Essentially, I had her test her belief she was about to die of a heart attack by doing strenuous aerobic exercises during the panic attack. After several minutes of running in place and doing jumping jacks, she said, “I wonder if i could do this if I was having a heart attack?”

I said, “Is this what you see in the emergency rooms of hospitals? Patients with massive heart attacks standing next to the gurneys doing jumping jacks?”

She suddenly saw that her negative thought, “I’m about to die,” could not possibly be valid and burst into uncontrollable laughter. That ended ten years of extreme depression and panic, and she’s been good to go ever since!

Panic attacks, like depression and other forms of anxiety, result from distorted, misleading thoughts. The very moment you see that your negative thought is not valid, you will feel better. But making that happen is often quite challenging. That’s why there are so many techniques described in my books, so you can find the one that works for you!

Sincerely, David

The Spiritual vs. the Material World

Hi David!
I come from China. My psychological consultant hinted me that I am somewhat living a Platonic Life. And she pointed out a law of the real world–no material life, no spiritual life. In other words, she is meaning that spiritual life is based on material life. She suggested that I should earn money to live on my own feet and support my family, instead of burying myself in my inner world.

Do you agree with this opinion about material life and spiritual life?

Confused, ZL, from China

Hi ZL,

Thanks for your email inquiry. I am not an expert in spiritual affairs, and I don’t have much information about your specific circumstances, either. But for what it’s worth, I think there could be a couple of different ways to think about what your psychological consultant said. First, although our spiritual values and beliefs can be extremely important, there probably is probably some considerable wisdom in living in the real world as well.

At the same time, as a psychiatrist, I don’t see it as my role to tell people what they should or should not be doing, and I try hard not to give advice. Instead, I see my role as helping people with problems they are asking for help with. Then we work together as a team to find solutions, and this is usually effective and also very rewarding.

I am pleased that my book Feeling Good, has been published in China, and I think one or two of my other books have been published in China as well. If you can obtain a copy of Feeling Good, you will find methods that have helped many millions of individuals overcome depression and anxiety and develop greater self-esteem and happiness. But I’m not sure that these are problems you are struggling with!

I have noticed that when individuals suddenly recover from depression, and begin to feel great joy, they often develop a much deeper appreciation and understanding of their own spiritual beliefs. But my focus is quite practical, helping folks change the way they think and feel in the here-and-now. And this may be similar to the thinking of your consultant, wanting to deal with practical issues first, and spiritual issues second.

I wish you the best, and thank you deeply for your excellent question. I wish I could have given you a better answer!

Warmly, David Burns, MD

We are in Europe and want  T.E.A.M. Therapy training!

Comment: Dear Dr. Burns,

My sister and I read your book: When Panic Attacks. We were thrilled about the methods in the book. Since we are two psychology students, living in Switzerland and interested to learn more about your methods, we wanted to ask if you give any workshops for psychology students in Europe? We would love to take part in one of your workshops to get to know the method firsthand. In case we would want to become C.B.T. / TEAM psychotherapists, where could we do the studies? Do any Universities work with that method? If you have any Information, how we could proceed, we would really appreciate it.

Thank you in advance for any help.

Jacqueline & Nathalie

Dear Jacqueline and Nathalie,

Thanks for your question. If you check my website, feelinggood.com, you’ll find a list of superb weekly online training groups.

Also, you might want to order my eBook, Tools, Not Schools, of Therapy. You’ll find order forms here on the website as well. If you join an online group, this book is required reading. It is an interactive text with exercises you can do while you read.

You can also go to the website, http://www.feelinggoodinstitute.com, and look into their certification program for TEAM Therapy. There are various levels of certification, and it is fairly easy to become certified at Level 1. There are several additional levels too, as your skills develop.

If you start the training, you might want to consider a trip to the US in the summer for my four day intensive at the South SF training center. It is the best!

Finally, if you pursue this journey, at some point when you are well trained, you might want to start your own weekly training group in Switzerland! That would be cool.

Good luck and best wises,

David Burns, MD