089: Ask David: How fast can I taper off my psychiatric medications?

089: Ask David: How fast can I taper off my psychiatric medications?

“How fast can I taper off my psychiatric medications?”

In this podcast, David and Fabrice answer five intriguing questions submitted by listeners:

  1. Joshua: How can I cope with panic attacks during job interviews?
  2. Dan: I feel traumatized by criticisms from my boss at work. what can I do?
  3. Susan: How fast can you taper off of anti-anxiety drugs and antidepressants?
  4. Ross: What if a patient who’s been the victim of trauma or abuse asks for a male therapist? Isn’t this a form of avoidance? Should patients be matched to therapists based on gender? Isn’t it best to avoid the situations that trigger you?
  5. Sumit: I think I have “endogenous depression.” Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression?

If you have a question, make sure you email david and we will try to answer your question on an upcoming Ask David Podcast!

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!

Subscribe

At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.

Coming in June! One of my best two-day workshops ever!

Register Now!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”

A two-day workshop Sponsored by Jack Hirose & Associates

June 4 -5, 2018 Calgary, Canada

 June 6 – 7, 2018 Winnipeg, Canada

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

 

 

No Live FB Broadcast on May 20, 2018

No Live FB Broadcast on May 20, 2018

Intimacy Training, Part 2, will be on May 27th, 2018, at 3 PM

Tomorrow, Dr. Jill Levitt and I will be doing our full day workshop so we won’t be able to do a live FB Broadcast. Next week we will continue our series on intimacy, and will discuss and illustrate how to give critical feedback to friends, family members, and colleagues, including how and when to express anger respectfully.

Although we are sold out in person for our live workshop on May 20, you can still join on line. Here are the details!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

 

 

 

088: Role-Play Techniques —Feared Fantasy Revisited

088: Role-Play Techniques —Feared Fantasy Revisited

088: Feared Fantasy, Part 2, and the Anti-Brushfire Technique*

Hi everybody!

Fabrice and I are thrilled to share this podcast with you, which I think you will really enjoy! We decided to include a second podcast on the Feared Fantasy Technique since it is so dynamic and powerful. We will also demonstrate the “Anti-Brushfire Technique,” which is another useful role-playing technique for individuals who fear disapproval.

We are joined tonight by two members of my weekly Stanford training group for Bay Area mental health professionals, Alisha Beal and Werner Spitzbaden. Both have brought along lists of some of their negative thoughts, which are based on real concerns.

Alisha has just completed our 12-week introductory “newbies” training group in TEAM-CBT. That group will merge with our “advanced” group next week, and she is feeling anxious and insecure for two reasons:

  1. She is concerned that people in the advanced group will think she’s not up to speed, and she’s worried that she will make a fool or herself when she has to practice techniques and get feedback from her colleague or answers questions in the class.
  2. Alisha blushes easily and is concerned that people will think she isn’t very bright and doesn’t know any anything when they see her blushing.

These concerns feel very real, and trigger fairly strong feelings of anxiety! Her negative thoughts included these:

  1. I’ll mess up.
  2. They’ll think I didn’t learn anything.
  3. I’ll blush and they’ll know I don’t know what I’m doing.
  4. I’ll make a fool of myself.
  5. David will realize that he wasted time and people when he created the introductory training group.

Werner’s concerns are similar. He has been in the advanced group for many months and has been doing a tremendous job of learning TEAM-CBT. However, he hasn’t work as a therapist for several years, but has been doing administrative work for a prominent California health delivery system. Werner is excited about the new TEAM-CBT skills he’s been developing, and wants to get back into clinical work. He has just accepted a part time position at the Feeling Good Institute in Mt. View, California.

This is great, but Werner is worried that his therapy skills won’t be good enough, and he’s afraid that the other staff members may judge him. He’s telling himself:

  1. I won’t succeed.
  2. I should know so much more than I do!
  3. I won’t do a good job!!
  4. I’ll develop a bad reputation, and no one will want to work with me.
  5. They’ll judge me and think that I’m not competent.

As you can see, although the details of his situation are quite different from Alisha’s, the underlying fears are similar.

And perhaps you’ve had similar fears and insecurities at times as well! Have you? I know that I’ve often felt that way! And that’s one of the reasons I find the techniques in this podcast so incredibly helpful and fascinating!

As you listen to the podcast, you will see what happens when Alicia and Werner both enter into an Alice and Wonderland Nightmare World where they will confront the monster they fear the most. I think you will find the results interesting, powerful, and entertaining, as they both suddenly achieve what the Buddhists have called “laughing enlightenment” for 2500 years!

* Copyright © 2018 by David D. Burns, MD

 

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!

Subscribe

At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.

Some Cool Upcoming Workshops

 

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

 

 

Intimacy Training, Part 1, on Mother’s Day!

Intimacy Training, Part 1, on Mother’s Day!

Happy Mother’s Day!

Watch the FB Live Broadcast
on Sunday, May 13th, 2018, at 3 PM (Pacific Time)–

Intimacy Training, Part 1: How to Handle Criticism

Hi all!

First, Happy Mother’s Day to all of our wonderful mothers! We love you and appreciate all that you do, both for your families, and also in your professional work as well! I hope you are pampered and loved on this Mother’s Day, and every day!

On this Mother’s Day, Jill, Mike and I will launch the first of several Facebook Sunday broadcasts on Intimacy Training. You will learn how to improve your relationships with family, friends, patients, colleagues and strangers, and also how to attract a mate if you are single and lonely.

How to Enhance Intimacy

The first show, on Mother’s Day, will focus on how to deal with criticism, using the Five Secrets of Effective Communication, especially the totally amazing Disarming Technique. We will demonstrate how to respond skillfully to the most extreme criticisms therapists might hear from angry, dissatisfied patients. We will also show you how you can respond skillfully to criticisms you might hear from friends or family members.

If you plan to attend live, you can type in a criticism you have had trouble responding to effectively, and we will demonstrate how to respond, using role-playing. But please limit the criticisms to one sentence, such as:

  • You never listen!
  • You don’t really care about me!
  • Why do you have to be SO controlling?
  • You always have to be right!
  • You’re a jerk!
  • You’re not helping me!
  • This is all your fault!

Future FB Broadcasts will focus on other common relationship problems, such as how to GIVE criticisms and express angry feelings constructively.

Your textbook for the broadcasts on enhancing intimacy will be my book, Feeling Good Together, which you can purchase at Amazon.com. Make sure you do the written exercises while you read!

How to Find Love

There’s another important aspect of Intimacy Training: How can you find someone to love in the first place? When I was in private practice, more than 50% of my patients were not involved in a loving relationship. Some had been divorced, and did not know how to get back into the dating scene, and others had never been comfortable or successful with the dating scene, and had never found someone to love.

We’ll cover the ins and outs of dating, with a focus on hustling, flirting and making connections, including topics such as:

  • how to deal with people who give you the run-around
  • how to avoid chasing and getting dumped
  • how to make people chase you
  • how to make the first “move” with someone you’re attracted to
  • how to flirt
  • how to handle rejection.

I will be joined by a number of guest experts on these broadcasts on how to play the dating game to win. They will include the incredible Kyle Jones, a doctoral student at Palo Alto University, and the amazing Angela Krumm, PhD, the director of the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, California, as well as others.

Your textbook for these shows will be my book, Intimate Connections, which you can order at Amazon.com. Many people have approached me at workshops to say, “Dr. Burns, because of your book, Intimate Connections, I’m now married!” If you’re feeling lonely, this might just be the book for you!

So whether you are alone and looking for someone to date, or troubled by a conflict with someone you care about, we will have TONS of cool methods to share with you!

Hope to see you this Sunday!

PS There will be NO FB SHOW on May 20th, since that will be my full day workshop with Jill Levitt, PhD! See below!

David

Some Cool Upcoming Workshops

Coming next Sunday, May 20th! Act fast if you want to register!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live! Click here for registration information.

There are no spots left for the live workshop in Palo Alto, but we still have room for you to join us online. Mike Christensen and others will be available to help those who join online with the small group exercises in “virtual” rooms. In this workshop, you’ll have the chance to personal work, so you can boost your own feelings of confidence and self-esteem while at the same time learning tons of new tools that will greatly boost your clinical effectiveness!

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well! And I’ll do a live demonstration at each location, to add some drama, illumination, and inspiration. Should be exciting! Hope you can join us!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

Enjoy David’s Fabulous Canadian Summer Intensive!*

Enjoy David’s Fabulous Canadian Summer Intensive!*

Coming in July! My annual Canadian summer intensive!

“Advanced Cognitive Therapy for
Depression and Anxiety Disorders”

Whistler, BC, Canada
July 3 – 6, 2018

This brief video will explain why you should attend!

For workshop description / registration details, click–Jack Hirose & Associates Inc.
Phone: 604.924.0296, Toll-free: 1.800.456.5424

You’ll LOVE this workshop and you’ll learn TONS of helpful techniques to treat depression, anxiety disorders, and habits and addictions.

You’ll have your evenings free to enjoy the beautiful Whistler countryside, and I will likely offer optional evening hikes as well, with opportunities for personal work and consultation.

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

Mike Christensen and several others will be joining me at Whistler to help out with supervision of the small group exercises. Mike and I will also be doing a live therapy demonstration with an audience volunteer on the morning of day 2. Mike is a tremendous teacher and therapist, and a highly esteemed friend and colleague.

I hope you can join us in Whistler!

Attend David’s Scared Stiff Workshop!*

Attend David’s Scared Stiff Workshop!*

 

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”

Two locations–
June 4 -5, 2018 Calgary, Canada  and  June 6 – 7, 2018 Winnipeg, Canada

Watch this brief video and I’ll tell you why you should attend!

Click this link for registration information: Jack Hirose & Associates

You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety:

  • Generalized Anxiety
  • OCD
  • PTSD
  • Phobias
  • Social Anxiety
  • Agoraphobia
  • Panic Disorder
  • and more

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. Mike and I will also be doing a live therapy demonstration with an audience volunteer on the evening of day 1. This promises to be a highlight of the workshop!

 

Intimacy Training–David, Jill & Mike Start Exciting FB Live Series on Sunday!

Intimacy Training–David, Jill & Mike Start Exciting FB Live Series on Sunday!

Watch Jill, Mike and David on the FB Live Broadcast
on Sunday, May 13th, 2018, at 3 PM (Pacific Time) as they discuss–
Intimacy Training, Part 1: How to Handle Criticism

Hi all!

This Sunday, Mother’s Day, Jill, Mike and I will launch a new live Facebook series on Intimacy Training. This exciting series will include a number of topics on how to deepen loving relationships with family, friends, and colleagues. And the very first show will focus on how to transform criticism in closeness, using the Five Secrets of Effective Communication. If you have been criticized recently, attend live and you will be able to ask us to model how to respond more effectively!

But that’s not all! We will also have one or more FB Broadcasts on hustling, flirting and dating. I will have a number of guest experts, including (hopefully) the incredible Kyle Jones, a doctoral student at Palo Alto University, the amazing Angela Krumm, PhD, the director of the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, California, and more experts in the dating game.

So whether you are lonely and looking for someone to date, or whether you are troubled by an existing but frustrating interaction with someone you care about, we will have TONS of cool things to share with you!

Hope to see you this Sunday!

PS There will be NO FB SHOW on May 20th, since that will be my full day workshop with Jill! See below!

David

Some Cool Upcoming Workshops

Coming in May! Act fast if you want to join us!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live! Click here for registration information.

There are no spots left for the live workshop in Palo Alto, but we still have room for you to join us online. Mike Christensen and others will be available to help those who join online with the small group exercises in “virtual” rooms. In this workshop, you’ll have the chance to personal work, so you can boost your own feelings of confidence and self-esteem while at the same time learning tons of new tools that will greatly boost your clinical effectiveness!

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well! And I’ll do a live demonstration at each location, to add some drama, illumination, and inspiration. Should be exciting! Hope you can join us!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

087: Role-Play Techniques (Part 5) — The Devil’s Advocate Technique

087: Role-Play Techniques (Part 5) — The Devil’s Advocate Technique

In today’s podcast, we will illustrate the Devil’s Advocate Technique, another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as:

  • Drug or alcohol abuse
  • Overeating / binge eating
  • Shopping addiction
  • Internet addiction
  • And procrastination, which is our problem for today.

David and Fabrice are joined by Sara Shane, a member of David’s Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.

Sara explains that she has a small clinical practice in the central valley of California working with children but would like to expand her practice to include teenagers and adults, so she can use the exciting TEAM-CBT skills she’s been learning in the Tuesday group over the past year. In addition, Sara is bilingual, so this would open up the possibility that many Spanish speaking individuals could have the opportunity for treatment with TEAM-CBT.

But to do that, Sara would have to start marketing her practice, but she’s been procrastinating. She never seems to get around to it, and always places the wants and needs of others in her family above her own.

David asks her what it is she’d have to do. She says she wants to put together a brochure describing her work so she could send it to people on her mailing list who might send her some referrals. David ask her to list the first few steps of her task, limiting what she would have to do to just to get started, something requiring only about 5 minutes.

Here are the first steps, and time required for each:

  1. Sit down at the computer and turn it on. (30 seconds)
  2. Open a blank document in MS Word. (30 seconds)
  3. Jot down a few names for my practice, even if they aren’t especially good (since they can be revised later). (4 to 5 minutes)
  4. Add my contact information. (1 minute).

So, the total time required would be six minutes or so. David asks if she’d be will to do it tomorrow morning from 9 AM to 9:06 AM. She said she’d actually like to start tonight, but it is already 9 PM and she still has a two-hour drive home. So she agrees to do it first thing in the morning instead. She also agrees to send an email to Fabrice and David and the Tuesday group at 9:06 with one of two messages: “Mission Accomplished” or “I stubbornly refused.”

Now we’re ready for the Devil’s Advocate Technique. David and Fabrice will play the role of the Devil who tempts Sara to procrastinate, using the actual thoughts Sara has when she’s procrastinating. They include:

  1. I’ll do it later.
  2. There’s always tomorrow.
  3. I don’t have any appointments tomorrow, so I can start to work on the marketing materials then.
  4. I have to take Mom to her doctor’s appointment now, so I can work on the marketing materials later.
  5. Right now, I just need some rest and relaxation, some time for myself.

David begins and tells Sara, “Oh, you can do it later. There’s no reason for you to have to do it now!”

Sara’s response is decent, but not super-strong. You’ll hear on the audio that it’s a bit half-hearted, and not overwhelmingly convincing. And if she can’t crush the tempting thought during the session, she definitely won’t be able to resist it when she’s home alone.

Instead of giving Sara some tips on how to improve it—which David says the therapist should never do when working with someone with a habit or addiction—David suggests that maybe the problem of procrastination perhaps isn’t something Sara wants to work on right now.

This is called Sitting with Open Hands, and it’s far more powerful than trying to “help.” Trying to help a patient who’s struggling with a habit or addiction will usually just make the problem more intense.

Fabrice points out that people don’t need to be “taught” how to say “no” to some tempting thought. They just have to make a decision!

When David sits with Open Hands, Sara gets agitated and insists she really does want to defeat her procrastination. That’s the most common reaction to “Sitting with Open Hands.”

Then David asks if she’d like to try again. David verbalizes the first tempting thought again, and Sara immediately hits it out of the park in a convincing way.

David and Fabrice take turns as the “Devil,” verbalizing all Sara’s tempting thoughts. One by one, Sara destroys them. She leaves the session on a glow, quite excited about the new direction for her practice.

David and Fabrice emphasize that the Devil’s Advocate Technique is not a method you would just throw at someone with a habit or addiction. Instead, you would work with the person systematically, going through the T E A M model, one step at a time, just as you would with any patient. The Devil’s Advocate Technique is simply one of the M = Methods in TEAM. And it probably won’t be effective if you haven’t done skillful paradoxical agenda setting first, to find out if the patient really is motivated to give up his or her addiction.

Did it work? Was this little mini-session effective? That’s always the question, isn’t it?

Well, here’s the answer! Fabrice and I received this email from Sara this morning:

Hi Dr. Burns and Fabrice,

Thank you so much for the opportunity to volunteer last night for the podcast. What an awesome experience! I am so inspired and motivated that it was hard to stop creating my business postcard to email you that I had accomplished my mission!!!

This is really funny but truly AMAZING!!! I have done beyond what I agreed to do, and this just makes me feel so HAPPY!!!

THANK YOU, THANK YOU SO MUCH!!!

I’M LOVING THIS!

Sara Shane

Way to go Sara! Fabrice and I are so proud of you, and looking forward to the exciting expansion of your practice!

* Copyright © 2018 by David D. Burns, MD

Some Cool Upcoming Workshops

Coming in May!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

Coming in June! One of my best two day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

 

 

086: Role-Play Techniques (Part 4) — Feared Fantasy

086: Role-Play Techniques (Part 4) — Feared Fantasy

This is the fourth in a series of podcasts on several powerful role-playing techniques we use in TEAM-CBT. Today, we’re going to highlight the Feared Fantasy Technique.

Here, in a nutshell, is why I created this technique. In order to get over any form of anxiety, exposure is absolutely necessary. Exposure is not a complete treatment for anxiety, and is only one of 40 methods I use to treat anxiety, but it always MUST be included in the treatment package.

However, sometimes, people have fears that you cannot easily confront in reality. For example, you may have the hidden fear that others would judge you if they knew how insecure you felt inside, or if you failed at something, or if they were way more successful than you. You can’t just say to someone, “Do you think less of me because I’m actually quite insecure?” They’ll just deny it, and you’ll feel like a nut!

So I created the Feared Fantasy Technique. Essentially, you invite the patient to enter an Alice-in-Wonderland Nightmare World where their worst fear comes true, and where people not only think of you what you most dread, but they also mercilessly tell it to your face. This gives patients the chance to face the monster. In most, if not all cases, they suddenly discover, at the gut level, that the monster has no teeth.

Like the Externalization of Voices, this is a two-person technique, although I’ve sometimes done it with many people in groups. In this case, there can be numerous feared “monsters.”

In the two-person version, you and another person, who could be your therapist, go into the Alice and Wonderland Nightmare World and act out one of your worst fears, such as being rejected by an exceptionally hostile critic because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it because you discover that the monster has no teeth. Your worst fears don’t usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense. You use frequent role-reversals until the monster has been totally crushed.

I am joined in this podcast by our own beloved Dr. Fabrice Nye, and two members of my Tuesday training group at Stanford, Liz Richard, a Licensed Marriage and Family Therapist, and Dr. Rhonda Barovsky, a Forensic / Clinical Psychologist, along with Stephanie James, an LCSW psychotherapist and radio talk show host from Fort Collins, Colorado, who is visiting the group. Liz is a member of the “newbie” TEAM training group at Stanford and agreed to bring a list of her own negative thoughts that trigger her feelings of insecurity in the group. I am grateful to all of them for helping out with this podcast!

Sometimes, when I am helping a patient challenge a Negative Thought, like “I’m a bad mother” or “I’m a failure as a father,” or “my colleagues would look down on me if they knew how screwed up I actually am,” I start with a gentle technique like the Paradoxical Double Standard that we illustrated in the first podcast on role-playing techniques. It’s a gentle technique that would almost never threaten or upset a patient.

Once the patient has totally crushed the thought, I typically move up to the Externalization of Voices. This is a more challenging and powerful technique that provides a deeper level of recovery / enlightenment and allows me to model the differences between the Self-Defense Paradigm vs. the Acceptance Paradox.

Once the patient has knocked the ball out of the park with the Externalization of Voices, I often move up to the Feared Fantasy. This is the most extreme and powerful technique of all. And the moment the patient again defeats his or her most terrifying fear, the impact can be positive and extreme, and often ends in a kind of uncontrollable laughter The Buddhists call this “laughing enlightenment. It often happens the moment you suddenly realize that your worst fear was nothing more than a gigantic cosmic hoax!

You may want to read a brief description of how to use the Feared Fantasy Technique that I created several years ago for my training groups and workshops. At the end, you’ll find a comparison of the Externalization of Voices, Paradoxical Double Standard, and Feared Fantasy, along with a table contrasting the Self-Defense Paradigm with the Acceptance Paradox.

The example I am using in the write-up below is not the example in the podcast, but one I sometimes use in teaching. Often, participants are afraid to do role-playing in front of the group because of thoughts like these:

  1. I’ll probably look foolish and make a fool of myself.
  2. I’ll screw up and fail.
  3. People will judge me and think less of me.
  4. They’ll laugh at me and tell other people about what a loser I am!

It is difficult to confront these fears in reality since people generally don’t have these kinds of negative judgements toward colleagues in the group who are feeling insecure. In addition, if someone did have these kinds of thoughts they would deny having them. But in the Alice-in-Wonderland Nightmare World, people DO have these kinds of thoughts about you, and they DON’T deny them! So, it can be challenging at first to have to confront these kinds of mean-spirited perceptions, and incredibly freeing once you defeat them!

Feared Fantasy*

This is a form of Cognitive Exposure

  • Some fears are not easily confronted in reality

General instructions

Work in dyads. Decide who will play the role of therapist and who will play the role of patient

  • Use the workshop / seminar performance anxiety example

Therapist Instructions

  1. Explain that you’re going to enter an Alice-in-Wonderland Imaginary world where there are two strange rules:
  • If you think people are looking down on you, they really are.
  • Furthermore, they get right up in your face and verbalize all their negative thoughts about you. They aren’t at all nice. They try to humiliate.
  1. Ask the patient which role she or he wants to play first. Explain that you’ll do role-reversals, so the choice is not terribly important.

We’ll assume that you’ve chosen the performance anxiety example, and that you, the therapist, will start out in the role of a rejecting, judgmental audience member or friend. Your patient will play the role of himself or herself.

Now criticize your patient, saying the things that he or she would be afraid to hear, such as:

  • “Hey, I was in the audience when you did that role-play with Dr. Burns. You really looked foolish and I’ve been laughing at you ever since.”
  1. After your patient responds to each attack, ask who won the exchange. If the patient did not “win big,” do a role-reversal and see if you can come up with a more powerful response.

Tips on Defeating the Imaginary Critic

When you’re under attack, try to defeat the imaginary critic

  • You can use Self-Defense, the Acceptance Paradox, or a combination of the two

If the Self-Defense Paradigm was ineffective, try

  • The Acceptance Paradox
  • Or a combination of Acceptance and Self-Defense

If the Acceptance Paradox was ineffective, try

  • The Self-Defense Paradigm
  • Or a combination of Acceptance and Self-Defense

Comparing the Paradoxical Double Standard,
Externalization of Voices and Feared Fantasy*

Technique Patient’s Name Your Name Role-Reversals?
Paradoxical Double Standard His or her real name The name of an imaginary dear friend of the same gender as the patient. Preferably, it is not someone the patient actually knows. No
Externalization of Voices His or her real name Same name as the patient Yes
Feared Fantasy His or her real name You play the role of some judgmental or critical person the patient is afraid of. Yes

 

Comparing the Self-Defense Paradigm with the Acceptance Paradox*

Strategy

General Concept Negative Thought

Example of How to Defeat the NT

Self-Defense Paradigm You defeat the NT by arguing with it and insisting that it’s distorted and not true. A patient who suddenly relapses several weeks after recovery will often have this thought, “This shows that the therapy didn’t work and that I really am a hopeless case.” “That’s ridiculous. I had a fight with my wife last night, so it’s not surprising that I’d be feeling upset. The therapy was very effective, and this would be a good time to pull out the tools I learned and get to work.”
Acceptance
Paradox
You defeat the NT by buying into it and insisting that it is true, but you do this with a sense of humor or inner peace. During a moment of insecurity, a therapist may have the thought, “I’m not as good as I should be.” “As a matter of fact, I still have tons of flaws and a great deal to learn. Even when I’m 85 years old, there will still be tons of room for learning and improving, and that’s kind of exciting.”

The Self-Defense Paradigm is especially helpful for the types of NTs patients have during relapses, and it’s a good idea to prepare them to talk back to these thoughts when they first recover, and before they actually relapse, using the Externalization of Voices.

The Acceptance Paradox is especially helpful for the types of NTs that lead to feelings of worthless, inferiority, or a loss of self-esteem.

* Copyright © 2018 by David D. Burns, MD

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!

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Some Cool Upcoming Workshops

Coming in May!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

Coming in June! One of my best two day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

 

 

Antidepressant Discontinuation Syndrome

Antidepressant Discontinuation Syndrome

Hi all!

Check out this link  that indicates some sobering findings about the long-term effects of antidepressants and the difficulties many individuals are having when they try to get off of them.

As you know, I’ve never been opposed to psychiatric medications, which can sometimes be helpful, even life-saving, but I’m far more excited about the many new developments in psychotherapy for depression and all of the anxiety disorders. And I’m really glad that so many individuals struggling with depression can now be helped fairly quickly without medications.

Research studies indicate that up to 65% of individuals struggling with moderate to severe depression will improve substantially or recover completely within four weeks– without any other treatment–if they are simply given a copy of my first book, Feeling Good: The New Mood Therapy. It is not costly and there are no side effects, and no “discontinuation” effects, either!

Many therapists and general medical physicians throughout the world “prescribe” this book for individuals suffering from depression because it can accelerate recovery. Some experts have even suggested it should be considered as the first line of treatment for depression. I am hoping that my new book, Feeling Great, now in partial draft form, will be even more helpful, since I am including all the amazing new TEAM-CBT techniques that did not exist at the time I wrote Feeling Good.

If you know someone who’s struggling with depression and anxiety, Feeling Good might made a good gift for that person. And if you’re a therapist treating individuals who are depressed and anxious, “prescribing” Feeling Good for homework will boost your success!

Some Cool Upcoming Workshops

Coming on May 20th! Act fast if you want to join us! Partially sold out but a few slots are still available for online participants.

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live! Click here for registration information.

There are no spots left for the live workshop in Palo Alto, but we still have room for you to join us online. Mike Christensen and others will be available to help those who join online with the small group exercises in “virtual” rooms. In this workshop, you’ll have the chance to personal work, so you can boost your own feelings of confidence and self-esteem while at the same time learning tons of new tools that will greatly boost your clinical effectiveness!

Coming in June! One of my best two-day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada

Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well! And I’ll do a live demonstration at each location, to add some drama, illumination, and inspiration. Should be exciting! Hope you can join us!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

I think there are ways you can “share” these blogs, Feeling Good Podcasts, and Sunday FB Broadcasts with friends and colleagues. Please do that! This month, my Feeling Good Podcasts with beloved host, Dr. Fabrice Nye, will likely exceed 50,000 downloads for the first time. So you ARE helping! Thanks so much!

David