by Dr. Burns | Jan 3, 2018 | Ask Dr. David
Hi visitors and Feeling Good website members,
I got several questions from an individual that I answered in the comments section of the website, but then i thought I might edit it a little and elevate it to the status of a blog. So I apologize if you might have already read this, but if you haven’t you might find it interesting, especially if you like philosophy.
Here is the email I received from Zly:
Hi Dr. Burns,
I have bought several of your books: Feeling Good, Feeling Good Together, and When Panics Attacks. However, I am not very clear about some of your points, so I want to ask you some questions if you don’t mind:
- Does absolute truth exist?
- Is there a forth valid use of SHOULD STATEMENTS?
- Which laws should I obey? And why is the “legal should” valid?
Let me explain my questions. First, in Feeling Good Together, you said that protecting our TRUTH makes relationship worse. Are you saying that there is no absolute truth in the world?
Second, you have described three valid types of “should statements:” the “legal should,” the “moral should,” and the “laws of the universe should.” I am wondering if there might be a forth, undistorted SHOULD STATEMENT when you are making a choice. For example. recently, I have been bothered about making a choice between two job offers. I don’t know which offer is better, so I frequently ask myself: which job should I choose?
To explain my third question, I have read some books that seem to contradict each other, and I don’t know which book I should believe. For example, the multi-party-political system is legal in America but illegal in China. So, the sentence, “You should not support a multi-party-political system,” would be a valid “should” in China but not in America.
zly
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Hi Zly,
Thank you for the thoughtful questions. I edited your email to make it a bit clearer to my readers, and hope that is okay!
I will share my own take on these issues, realizing right away that some individuals may not agree with my ideas. As I came from a very religious upbringing, I am aware of the rigidity of some of those who have conservative religious orientations who believe with all their hearts that there is only one “right” way to think, feel, believe, and behave, and that they are in touch with “absolute truth.” But all too often, this way of thinking can become a justification for aggression toward those who think and believe differently. So I am not much of an advocate for absolute truth, and don’t really even know what that term means!
To my way of thinking, many of our beliefs and values are stipulations, or values that we assert, and not something that can be proven one way or the other. For example, you can choose to value all humans, or you can decide that certain humans are superior, or inferior, to others, based on skin color, race, age, intelligence, achievements, gender, or a myriad of other arbitrary criteria. You cannot prove that black people, or white people, or Jewish people, or Christian people, or immigrants from any country, are inherently superior or inferior. But many people do believe such ideas, because they were brought up to believe, think, or feel this way or some other way. To my way of thinking, many of these beliefs can do a great deal of damage, in terms of depression and anxiety on the one hand, or hatred and violent aggression on the other.
Generally, our laws and moral values are stipulations that we have, for the most part, agreed upon as humans, or as a particular group of humans. Many of our basic moral / religious beliefs can be found in the ten commandments, for example, as well as other basic religious writings. They cannot be proven one way or the other, they are simply rules we agree on.
Many religious or politically zealous people want to elevate their personal beliefs and values to the level of “absolute truth.” Sadly, this type of thinking sometimes leads to prejudice, violence and war, thinking one has the “truth.”
Also, in relationship conflicts, typically the two partners are saying, over and over again in a variety of ways, “I am right and you are wrong,” rather than trying to empathize and find the truth in what the other person is saying, thinking and feeling. As a result, the conflict typically escalates, and sometimes ends in violence. That’s what I mean when I say that “truth” is the cause of most of the suffering in the world today.
This type of absolutist thinking can be viewed, actually, as one of the ten cognitive distortions I first published in my book, Feeling Good. The distortion is called all-or-nothing thinking–that’s where you view and judge things, people, or ideas in absolute, black-or-white categories. This type of thinking can fuel feelings of superiority and hostility, when you think of yourself as being on the “all” side of the equation, as well as severe depression and even suicidal urges, when you think of yourself as being on the “nothing” side of the equation.
For example, when you are depressed, you may tell yourself, and believe with all your heart and mind, that you are “a failure” or “a loser” or “no good.” And when you are angry, you may tell yourself that someone else is “a loser” or “a jerk” or “no good.” Although all-or-nothing thinking is intensely distorted, it can be intensely addictive.
So that’s my take, or my rant, for better or worse, on “absolute truth!”
As far as your second question is concerned, you could just as easily say, “What job would be more desirable for me?” When you say, “What job SHOULD I select,” it sounds like a moral imperative to make the “correct” choice, when often there is no single correct choice. So, the “should” can trap you in a box, thinking that a “right” decision is overwhelmingly important when, it fact, there often is no inherently “correct” decision. All decisions can have unexpected positive and negative consequences, and happiness often has far more to do with how we cope with those consequences than in finding some imaginary “correct” decision.
So, in short, decisions about what job to pursue, or which college to attend, or who to marry, or where to live, are to my way of thinking, not usefully viewed as “shoulds.”
With regard to question three, different cultures sometimes have different values, and different rules which are stipulated and not proven. These are just the rules any society establishes for itself. A legal “should” is just a rule that a culture establishes. For example, when we say, “you should not drive 90 miles per hour on the highway,” we are simply saying that this speed is so dangerous that we have a rule against it, and you will get a ticket if you drive that fast. But it is not thought to be immoral to drive that fast–on a race track it is perfectly okay to drive as fast as you want, for example.
Some states in the United States may have maximum speed limits of 75 miles per hour. Others may have maximum speed limits of 65 miles per hour. It is not the case that one or the other speed limit is based on “absolute truth.” It’s just what the people in that state have agreed on.
Many people with a rigid, inflexible personality style want to insist that their rules, or stipulations, are somehow “absolute truth,” and this is one of the causes of war and hostility, often in the name of God or some higher principal. Rigid thinking is often seen with narcissistic individuals, but we also see rigid thinking in individuals struggling with depression and anxiety. But the rules we establish are just that—rules—and not manifestations of some invisible “absolute truth.”
Before the cause of epilepsy was known, some cultures viewed it as a good thing, and imagined that epileptic seizures were visitations from God, or manifestations of genius, and that those who suffered from seizures were special. Other cultures viewed seizures as visitations from evil spirits, or as defects in the afflicted individuals who were seen as inferior human beings. Later, when the cause of seizures was finally understood in terms of abnormal outbursts of electrical activity in the brain, we began to think about epilepsy as an “illness” instead of a sign of superiority or inferiority in the person with seizures.
Consider old age. In some cultures, elderly individuals are treated with great respect. In other cultures, the elderly are viewed in a negative manner, and old age is feared, while youth is idealized. These are just subjective decisions, not things that can be proven one way or the other. Young people, or old people, are not in any way “inherently” superior or inferior.
Of think about food preferences. I like blueberry pie, but I don’t like pumpkin pie. But it is not “true” that blueberry pie is inherently superior to pumpkin pie. It is simply a preference of mine, and not an expression of “absolute truth.”
It’s the same with racial, ethnic, and religious biases. Some people look down on blacks, Asians, Jews, the Irish, Mexicans, Christians, Muslims, gays, and on and on endlessly. Often these groups are targeted for hatred and mistreatment by rigid individuals who tell themselves and others that they represent “absolute truth.” But you cannot “prove” that any of these groups are, in fact, inherently inferior or superior. It is simply an arbitrary decision to hate. And the bias is often fueled by addictive feelings of moral superiority.
Science works the same way, partly through stipulation and partly through experimentation and testing. You always have to start with a stipulation that cannot be proven as right or wrong. Once you have done this, you can do experimentation based on research. For example, we can decide as a culture that pneumonia is an “illness,” a bad thing, so to speak. Once we have agreed on that, which is simply a stipulation, then we can do scientific work, searching for the causes and cures for pneumonia. That’s where empirical testing becomes vitally important, because you CAN prove that many theories are false, and that many treatments are not effective, whereas other theories and treatments prove more useful.
I don’t really spend any time at all searching for “absolute truth.” As the Buddha so often said, only specific and real problems can be solved. Problems that don’t exist don’t require solutions. All real problems exist at specific times and locations on the surface of the earth. When people come to me for help, or for treatment, we pinpoint specific problems in their lives, and then we solve those problems using a wide variety of strategies and techniques. The recovery is usually pretty exhilarating, but never involves looking for or finding any kind of “absolute truth.”
“Absolute truth,” like the “self,” does not exist. These are simply nonsensical concepts that we use to create misery for ourselves or others.
My take on it, only! Let me know if my rambling makes sense, or if you are still in the trance or enchantment of searching for “absolute truth.”
David
My live FB broadcasts have been moved to 3 PM Pacific (California) Time every Sunday afternoon. I hope you can join us! The show is for therapists and the general public alike. If you cannot join us live, you can download the shows and listen any time that’s convenient for you!
Feel free to submit questions you’d like me to cover in these shows. Your questions drive the discussion each Sunday afternoon!
David
How to Find My FB Broadcasts
Click on my Facebook tab on https://feelinggood.com/ if you’d like to watch me each week on my Live Facebook broadcast each Sunday afternoon around 3 p.m. PST. Make sure to “like” my Public Facebook page: https://www.facebook.com/DavidBurnsMD/ so you can watch it on my page or yours.
Join me as I answer mental health questions from viewers — therapists and non-therapists alike — from all over the world. Type your question in the Facebook feed and I’ll do my best to answer it.
If you miss the broadcast you can watch the saved videos on my Facebook page! Also, viewers can watch these Live Facebook broadcasts as well as other interesting TEAM-CBT videos on the Feeling Good Institute’s YouTube channel!
The David and Fabrice Feeling Good Podcasts
Fabrice and I hope you also enjoy our Feeling Good Podcasts, and also hope you can leave some positive comments for us and some five star ratings if you like what we’re doing! We are already enjoying 25,000 downloads per month from listeners like you. Thank you so much for your support of our podcasts!
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.
by Dr. Burns | Oct 25, 2017 | Ask Dr. David
Hungry to Learn More?
Hi Dr. Burns,
I am a 66 year old grad student at XYZ University and am an intern at a mental health clinic. I am excited about learning T.E.A.M. Where do you recommend beginning? Should I start with the “And It’s All Your Fault” webcast?
Thank you for what you are doing.
R
Dear R,
Thank you for your note, and way to go on your training! Very cool! (I have disguised your name and University to protect your identity, but probably not needed.) I hope to see you at one of the upcoming workshops!
Here are some suggestions for learning more about TEAM. You can
David
“And It’s All Your Fault!” Transforming Troubled Relationships Into Loving Ones
October 30 – 31, 2017–Raleigh, NC: Double Tree Raleigh Brownstone-University
November 1 – 2, 2017–Atlanta, GA: Atlanta Marriott Century Center
November 3 – 4, 2017–Denver, CO: Double Tree by Hilton Denver-Westminster
For more information, click here, or contact IAHB, phone: 800-258-8411
The Raleigh workshop on Oct 30 – 31 INCLUDES A LIVE WEBCAST– Click here for more information
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
Thanks! David
by Dr. Burns | Oct 23, 2017 | Ask Dr. David
Some Great Facebook Live Follow-Up
Hi feelinggood.com visitors,
After yesterday’s live Q and A on Facebook, I received an interesting email from one of the participants whom I’ll simply refer to as JD. We kind of ramble and babble, but I enjoyed our exchanges, and you might enjoy the dialogue as well! During the FB live broadcast, I described the three “deaths” of the ego that are necessary for the patient and for the therapist as well. JD apparently resonated with that discussion, and added some of his own beautifully thoughtful comments!
Enjoy, and feel free to add your own thoughts if you are interested!
As an aside, the next live FB Q and A will be at 2:30 PM, Sunday afternoon, on November 5th. There will be no live broadcast this Sunday, October 29th, because I’m flying to the east coast for three relationship workshops in Raleigh, Atlanta, and Denver.
Hello, Dr. Burns,
Thank you so much for responding to my question about Buddhism’s similarities to C.B.T. on your Facebook live video session yesterday (Sunday, October 22nd).
Your anecdote about “bullshitting about Buddhism” was hilarious and entertaining. I also enjoyed the opportunity to meet Miss Misty (David’s new cat). I’ve been a big fan of black cats all of my life, and always seem to attract them. Catching you and Misty today during your live broadcast was a happy synchronicity that made my Sunday and stoked my desire to go back to school and become a therapist.
One of the other commenters, who posted after I did, said that your live feed was for therapists, not patients. I missed the beginning of your talk and consequently missed any opening words or disclaimers to that effect which you might have laid out. I apologize if I was trespassing on your broadcast, but I was so happy to see you reading my thanks, and I want to repeat my thanks to you and reiterate what I said in my first comment, that I credit you with saving my life.
David’s comment: My podcasts, blogs, and broadcasts are for therapists as well as the general public. To me, there is only the thinnest of lines between “therapist” and “patient,” as we all tend to hurt in the same ways! So all are more than welcome to join!
I’m currently rebuilding my life after a four-year gay relationship characterized by verbal abuse. The insanity of the relationship led us to seek therapy, and while my partner never followed through with attending therapy, he did speak to a therapist who recommended your Feeling Good series of books, and that’s how we happened upon your work.
That was about a year ago. About four months ago, I left the relationship, as my partner seemed to be stepping up his irrational attacks proportionally to my starting to feel better. I’d done everything possible to accept responsibility for my own actions and to follow the wisdom contained in Feeling Good Together, but there came a point when it became clear my partner was not doing his share of accepting responsibility for himself–for example, finding a therapist for himself.
My summer since exiting the relationship has been pretty difficult, as I’ve mourned the loss of my former life and love while seeking refuge in the home of my parents, which opens up another whole can of worms. As I felt myself slipping into depression about a month ago, I picked up your Feeling Good Handbook and rediscovered the Acceptance Paradox. Upon reading about it one Saturday, in the throes of my depression, I instantly began to experience relief, to my wonderment.
David’s comment: Break up of loving relationships is almost always pretty painful. I’m sad you’re having to go through that. But yes, the Acceptance Paradox is totally mind-blowing, and I’m so glad that you “got it.”
That same night I accompanied my parents to a concert by the local philharmonic, held at the William Saroyan Theater in the downtown district of our city. As we were leaving, I happened to look up at the wall of the theater and see a quote by the eponymous author emblazoned there: ““The greatest happiness you can have is knowing that you do not necessarily require happiness.” This seemed like a resounding affirmation of the Acceptance Paradox, and upon reading it, my mood elevated even more!
In the past few weeks I’ve begun to adopt a Buddhist practice, meditating weekly with a local sangha. This past week I learned about the Dhammapada, an ancient Pali text whose 26 chapters contain what’s purported to be the sayings of the Buddha in verse form. It begins with this:
“All that we are is the result of what we have thought: it is founded on our thoughts, it is made up of our thoughts. If a man speaks or acts with an evil thought, pain follows him, as the wheel follows the foot of the ox that draws the carriage.”
From there, the C.B.T. parallels just keep on coming. What struck me in relation to my present situation was this third and fourth verses:
“Those who entertain such thoughts as ‘He abused me, he beat me, he conquered me, he robbed me’ will not still their hatred”
And its paired verse is
“Those who do not entertain such thoughts as ‘He abused me, he beat me, he conquered me, he robbed me, will still their hatred.”
Before you think this is a Buddhist lesson and stop reading, I’ll leave off quoting this text, but I am curious about what you meant by saying you were “anti-Buddhist.” Do you think that cultivating a Buddhist practice is a waste of time and that the mind is better trained through C.B.T. principles? Or was that a bit of hyperbole?
David comment: You are right, when I say I am “anti-Buddhist” it is just hyperbole, trying to send a message, I guess, that being a joiner and follower is perhaps not the path I personally prefer. Certainly, the Buddha was not a “Buddhist” either, so I think I am in pretty good company!
I also wonder if you have any advice for me. I’m 45 years old. After earning a Bachelor’s degree in Modern Literature from the University of California at XYZ 23 years ago, I left academia in search of “real-world” experience and continued my education in the proverbial School of Hard Knocks (at its campuses in S.F., NYC, and L.A.).
Now, having returned to the place where I began, I am filled with the desire to help improve life in the Central Valley, in particular for other marginalized people (I feel as though I had to leave my home town in order to become who I was meant to be) as well as for LGBT+ folks everywhere.
In my desperate search for help over the last few years, I found very few books aimed at LGBT people. This is a pity, as the gay community that I delved into these past 20 years is shockingly unwell.
It’s as if wellness is not a concept, especially in the gay male community. An almost nihilistic hedonism seems to be the norm, and self-destructive behaviors are celebrated, propagated, and inculcated with alarming uniformity. Do you have any thoughts in relation to this observation? And would you agree that there’s a need for specialized outreach to this community?
I realize you might not have time to respond, so I won’t be offended if you don’t. Thank you so much for being there. If you’ve read this all the way through, I apologize if I’ve bored you or overshared. You’re a real hero to me, and I really wish I could be your student and go on hikes with you all. 🙂
With much gratitude and all my wishes for your happiness and health,
JD
Doctor David‘s Response
Hi JD,
Thank you for the excellent email! I’d love to publish it, with your permission.
I liked your quoting from the Buddhist teachings, and it does sound a lot like cognitive therapy. We actually worked on anger thoughts on yesterday’s Sunday hike, using some of the new Paradoxical Agenda Setting techniques, which seemed to help a great deal. We also used the Acceptance Paradox which proved really helpful, too.
I am a strong gay supporter, in part because my father, a Lutheran minister, was anti-gay, and I felt that was unfair and a form of hatred, and clearly not an expression of religion, love or spirituality! I have many fine young therapists in my training groups who are gay, and they are doing some great outreach work, which I applaud and support.
I feel that gays and LGBT folks suffer very unfairly by so much hatred in our society, and in our so-called “modern” civilization throughout the world. The human race has a nasty dark side, and perhaps the prognosis for our long-term survival is not that good.
My wife and I do not regret so much that the human race may drive itself to extinction via nuclear war, global warming, or whatever, but we do regret that we will take so many innocent and vulnerable animal species along with us.
We also feel disgusted by those who hide their hostility and cruel behavior behind religious concepts, claiming they are doing this or that atrocity in the name of God, or some prophet, or some “higher” principal. To me, this absurd denial of their dark motives and aggression is almost more hateful than their cruelty to those they judge as inferior, defective, bad, or whatever.
I’ve also embedded some comments in your thoughtful and excellent email above!
David
JD’s Response
Hello David,
Thank you for your response. I am delighted to hear back from you, and I’m so happy you liked my email. Please feel free to publish it on your blog. Using my initials would be fine.
I’m grateful for the clarification of your “anti-Buddhist” statement. I’m not much of a joiner either, having grown up Catholic and endured 13 years of Catholic schooling before rebelling dramatically from it for the next few decades. I am still vehemently opposed to the Catholic Church, and my parents’ adherence to the church is one of the big sticking points in my current experiment in co-existing with them after 25 years away.
In Buddhism, I’ve found a helpful tool for calming and stilling my mind and accepting things as they are, as well as keeping a grateful focus on the present moment. I appreciate that, in contrast to Catholicism, Buddhism rejects hocus pocus, esoteric dogma, and the cruel rejection of others. It’s rooted in the real world and advocates a training of the mind as a means of alleviating suffering.
I believe you to be what’s known as a bodhisattva, if you don’t mind me saying so, a true adult who’s transcended the ego and lives in mindfulness of the world’s suffering, doing his best to free others from the cycle of their karma.
Ultimately, I agree with you and your wife that the real tragedy in our human condition is our devastation of the other species with whom we share the earth. I feel terribly for the innocent victims of our greed and heedless behavior. Becoming a vegan last year has connected me to purpose in a very fulfilling way, and since making that transition I’ve felt my capacity for empathy expand.
Thank you for your encouragement of gay therapists and their important outreach. Allies such as yourself are essential to the community’s feeling better, learning to overcome decades of social stigmatizing, and developing the skills to love and care for its own.
Please stay well and keep up the profoundly beautiful and helpful work.
With gratitude and deep respect,
JD
Doctor David’s Final Response
Hi JD,
Oh, thanks, thanks, thanks! We seem to be on the same wavelength!
David
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
Thanks! David
by Dr. Burns | Oct 16, 2017 | Ask Dr. David
Hi Web Visitors and friends,
I got a really interesting email from a psychologist I’m calling “JP,” an old friend who treats veterans struggling with PTSD. He had some deeply-appreciated praise for the Feeling Good Podcasts and raised some challenging questions about TEAM as well as the treatment of veterans struggling with trauma who may be motivated to maintain their symptoms, in some cases, due to disability payments. You might enjoy our exchange!
David
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Hi David,
I have listened to 52 Feeling Good podcasts. They’re excellent! Both enjoyable and informative. This is the best podcasts series I have ever heard as far as content that I can put to use as a psychologist. I look forward to listening to them and find them encouraging.
The only downside is that I wish there were more of them. I learn something every time I listen. For example, your talk about the negative impact of unrealistic positive thoughts helped me reframe some of my experiences when I tried to do much more than I could do well (which has had a negative impact on my career). I understand this now and it is helping me take more care regarding what I take on now. Keep up the good work!
I hope to come to the intensive in Canada in July!
If you have time, it would be great if you could respond to the questions below. These questions relate to my concerns regarding using the TEAM model with veterans. Please keep in mind the US VA health care system provides more psychotherapy than any other organization in the world.
In an effort to better serve our veterans by promoting evidence based treatments, the VA has already trained hundreds of clinicians in PE and Cognitive Processing Therapy and continues to provide this type of training on an ongoing basis to hundreds more staff and students as they enter the VA system.
In some ways, VA clinicians could be the perfect TEAM model providers because there seem to be an endless number of veterans seeking treatment for PTSD, depression and anxiety. As a result, there are no financial incentives to keep patients in treatment. If the VA were to promote the TEAM model the way it has promoted PE, then tens of thousands of lives would be affected across the country.
Questions:
- Most of the patients you described were highly educated and intellectual. Would these methods work as well on individuals with a high school or less education who have often made their living through manual labor?
- Have there been any published studies using the TEAM model?
- Are there any studies underway?
- How often do you have follow-up testing? TEAM seems to be having a clear impact within these long sessions. How much evidence do you have that these changes last six months or longer?
- As we have discussed, the VA both treats PTSD and provides disability payments based on the degree to which a veteran’s ability to work is impaired by his/her military service so there is a disincentive for reporting improvement. How would you address this issue?
Thanks!
JP
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For clarification on my response below:
TEAM is an acronym that stands for T = Testing, E = Empathy, A = Agenda Setting, and M = Methods.
CBT stands for Cognitive Behavioral Therapy.
Dear JP,
Thank you for your wonderful email and excellent questions! I look forward to seeing you at next summer’s intensive. It’s been a while since we have connected! So great to hear from you. There will also be a good intensive in San Francisco in the summer. That one also has evening sessions featuring live work and more practice for participants.
I’ll take a crack at your questions:
- The TEAM-CBT methods can work with high functioning individuals, but it is a bit more challenging and takes quite a bit of skill and training on the part of the therapist. Working with lower functioning individuals who have few resources is actually easier, in my experience, and can be extremely rewarding. This is perhaps not the way most mental health professionals think about it!
The best experience I’ve had along these lines was the group CBT program I developed for my hospital when I was still living in Philadelphia. Ours was an inner-city hospital in a gang warfare area, and we treated everyone in groups.
We simplified the cognitive therapy, since many of our patients could not read or write. Most of our patients had severe psychiatric symptoms with limited resources, and some were homeless.
The outcomes were tremendous, and the program was cost-effective as well, since we recruited the group leaders from the community. They worked under supervision of a psychologist.
The patients seemed extremely grateful for the programs we developed, and they were challenging, due to their severity, but actually easy to work with. I wrote the book, “Ten Days to Self-Esteem” as the manual for the patients, and we gave every patient a copy at intake to the program. It is written at about the fifth-grade level, with just a few paragraphs in each chapter, along with the exercises we did in each group. Each chapter was the focus of one of the groups in our ten day program. I also wrote a manual for the group leaders called Ten Days to Self-Esteem: The Leader’s Manual. Both books are available on Amazon, though the leader’s manual is now just an eBook.
For an example of how we simplified the treatment, we called the first cognitive distortion on my distortion list “black or white thinking” instead of “all-or-nothing thinking” to make it easier to grasp. We illustrated the distortions on posters, and each distortion was represented with an icon to make it easy to comprehend. We used a checkerboard for all-or-nothing thinking, for example, and a magnifying glass for Magnification and Minimization.
I was also very careful to use simple language when running groups, and I avoided any kind of psychological jargon or big words. But other than that, everything applied to this population, just like any other group of individuals struggling with severe depression, anxiety disorders, relationship conflicts, and habits and addictions
2. You asked about research, which is so important. I presented an informal study of TEAM in a keynote address at one of the Brief Therapy Conferences in Anaheim a few years ago, sponsored by the Milton Erickson Foundation in Phoenix. The study involved something like 450 therapy sessions conducted by four therapists at the Feeling Good Institute in Mt. View, California. The goal was to calculate the average rate of anxiety and depression symptom reduction per hour of therapy, which was about 25% to 30% per hour. I was able to make these calculations because in TEAM, we measure symptoms at the start and end of every therapy session, without exception.
I call this measure the “Recovery Coefficient,” and I believe it is a really accurate measure of therapist effectiveness, perhaps the first ever developed.
This rate of change was vastly faster than what is reported in controlled outcome studies using CBT or other forms of treatment, including medications. However, I do two-hour sessions, and typically see a complete or near-complete elimination of symptoms in that period of time. However, was not one of the therapists in that study.
An outcome study is about to begin at the FGI.
You can also read more about the research that triggered my evolution from CBT to TEAM-CBT, including the clinical experience that led to the new developments, at this link:
https://www.psychotherapynetworker.org/blog/details/1160/when-helping-doesnt-help
If you need the references to my published research studies, let me know. I developed TEAM-CBT based on process research on how psychotherapy actually works.
It is my belief that the controlled outcome studies have yielded very little useful information, and that the breakthroughs in understanding and in clinical treatment will result from process studies that document procedures and processes that are actually effective with patients.
TEAM-CBT evolved from this research on how psychotherapy works, and my findings, as well as my clinical experiences, pointed to the massive importance of motivation and resistance. TEAM includes many powerful resistance-busting techniques that I have developed in recent years at my weekly psychotherapy development and training group at Stanford.
However, it is not easy to learn how to do TEAM-CBT, due to therapist narcissism and codependency, as well as the fact that therapists have to unlearn much of what they have been taught. In my experience, some therapists are strongly biased and not terribly open to learning that their empathy skills and technical skills are not nearly as effective as they thought! In addition, I believe that some therapists are looking for easy formulas, as opposed to the really hard work of learning world-class therapy skills.
I apologize for my somewhat cynical attitude! And I would have to say that some therapists, like yourself, are absolutely delightful to teach and quick and hungry to learn new and more effective approaches.
3. See #2.
4. Please see my podcasts and blogs on Relapse Prevention Training, including this one: https://feelinggood.com/2017/07/31/048-relapse-prevention-training/
In my clinical practice, I have had about 35,000 to 40,000 therapy sessions, and have always done careful Relapse Prevention Training (RPT) prior to discharge. RPT takes about 30 minutes, and is incredibly important, because all human beings will “relapse” from time to time.
I encouraged all my patients to return anytime they relapsed and needed a tune-up. I can count on two hands the number who have returned for a tune-up, and that was usually just one or two sessions and then they were on their way again.
However, my clinical experiences are clearly not the same as controlled outcome studies, so we need to be cautious until that research can be done. However, short-term and long-term studies of the effects of simply reading my book, Feeling Good, with no other treatment, are outstanding, and comparable to or better than the effects of individual psychotherapy or treatment with antidepressant medications.
I do recall a study by Anne Simons PhD showing that the faster patients recover, and the more complete their recovery, the better the long-term prognosis. This is consistent with common sense. If patients come to you for treatment, and quickly and completely recover, they are getting the message that their depression and anxiety are very treatable, and that they are not hopeless.
In addition, it is crucial that they know that they will have relapses from time to time, and that the methods they learned in therapy that worked for them will likely always work for them. So they must be willing to pick up the tools and use them again when they fall back into a black hole of depression and self-doubt.
5. You and I have discussed this thorny issue of treating veterans receiving disability years ago, and I will repeat the solution I proposed at that time. You might consider giving veterans an option to select between two treatments:
- Treatment as Usual, which could include medications and a weekly chat about their symptoms, but no homework, no demands, no anxiety providing interventions, and so forth. This treatment would not threaten their disability.
- Rapid Recovery, which requires consistent homework between sessions, consistent attendance, and so forth. This treatment might threaten their disability, since the focus will be on recovery.
Then you could find out what group each veteran selected, and this might give you crucial information about motivation / resistance. At any point, too, veterans could change groups.
This approach might allow you to focus your creative efforts and energy on the patients who select the training in which they are accountable. I find that disability money can be a challenging obstacle to effective treatment. If a patient is involved in a lawsuit, hoping to get a settlement due to psychiatric symptoms, you will run into the same problem.
People are easily corrupted by money. In addition, I believe it is an ethics violation to treat individuals and to certify them for disability at the same time. This is a classic dual-role ethics conflict. If the veterans know that your therapy notes and records will be used in the evaluation of their disability, you will have the same problem. To my way of thinking, this is a therapy “non-starter” of the highest magnitude.
Good to hear from you, JP, and hope to see you before long!
David D. Burns, M.D.
Dear Web visitors,
I would like to invite you to some exciting events coming up in the near future. My relationship workshops will take place in three east coast cities at the end of October, and the first will be live-streamed, so you can “attend” from anywhere in the world. Here’s a new development: When you register, if you use the code Burns50, you will receive a $50 discount. Not a bad deal! Here are the details:
“And It’s All Your Fault!” Transforming Troubled Relationships Into Loving Ones
October 30 – 31, 2017–Raleigh, NC: Double Tree Raleigh Brownstone-University
November 1 – 2, 2017–Atlanta, GA: Atlanta Marriott Century Center
November 3 – 4, 2017–Denver, CO: Double Tree by Hilton Denver-Westminster
For more information, click here, or contact IAHB, phone: 800-258-8411
The Raleigh workshop on Oct 30 – 31 INCLUDES A LIVE WEBCAST–
Click here for more information
In addition, my Feeling Good talk will be sponsored by Stanford and is free to Stanford-affiliated health professionals. Three is a $40 fee for the general public. I’ll be discussing CBT as well as the developments led to the birth of TEAM-CBT, with a dramatic video clip of a patient having a full-blown panic attack. You will see the actual moment of her recovery during the session!
I will also present some inspiring vignettes illustrating patient’s recoveries from severe depression and hopelessness. I’m honored to have this opportunity to present at Stanford! Here are the details.
Feeling Good
Friday, October 27, 2017, 8 to 10 AM
Stanford University Li Ka Shen Center, Room 130
For health professionals as well as the general public
Sponsored by the Stanford Health Promotion Network, this presentation by David D. Burns, M.D., will focus on fast, effective, drug-free treatments for depression and anxiety disorders. This event is free for Stanford-affiliated individuals and $40 for others who wish to attend. Click here for registration and more information
I sincerely hope you can join me for one of these exciting events!
All the best,
David
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
Thanks! David
by Dr. Burns | Jul 7, 2017 | Ask Dr. David
Hi David.
My name is Hassan and I have been suffering from depression and anxiety for the last 32 years.
I am glad that after listening your podcasts and reading some of your other written materials, I have finally managed to reduced my mental suffering considerably. I am a math teacher and recently earned a degree in psychology, just to understand the causes of my mental disorders.
Could you kindly guide me on how I can take part in your workshops and other training sessions? I want to improve my learning in order to cure my psychological issues and help others in my country tackle anxiety and depression.
Hassan
Hi Hassan.
Thank you for your email. I feel sad you’ve been feeling depressed for so long, but I’m impressed by your hard work, and I’m sure it will pay off for you!
Here are several things might help, if you’d like to learn more about the new techniques I’ve been developing:
- Attend any of my workshops, if you can. They are listed on the workshop tab on my website, feelinggood.com. The two upcoming 4-day intensives later this month (Banff, Canada and San Francisco) should be extremely helpful and fun. In the fall, I will also be offering two-day workshops on the high-speed treatment of individuals who have experienced trauma, with additional workshops on other topics in 2018.
- You might benefit from my eBook, Tools, Not Schools, of Therapy. Order forms are on my website. This is a step by step guide in how to do TEAM-CBT. It is intended for therapists.
- You could join one of the weekly online training groups, and you can find information about them on my website as well. These would be ideal for you, because you can join in from anywhere in the world, and the teachers are outstanding! There are small numbers of individuals in each group, so you get lots of individual attention and chances to actually practice the new TEAM-CBT techniques.
- You can visit www.feelinggoodinstitute.com. They have a variety of online training groups, plus a TEAM-CBT certification program.
- You can read any of my books for the general public. They seem to be helpful to therapists as well as individuals who are looking for help with depression, anxiety, or relationship problems. All should be available from Amazon.com and other online book sellers. Here are some of the titles:
- Feeling Good: The New Mood Therapy
- Feeling Good Together
- The Feeling Good Handbook
- Ten Days to Self-Esteem
- When Panic Attacks
- Intimate Connections
- If you are ever in the San Francisco area on vacation, you would be welcome to visit one of my free of charge Tuesday evening training groups at the Stanford Medical School. You would be welcome on one of the Sunday morning hikes as well. I know it is a long way from your home, but we actually had a visitor (a neurologist) from China recently! She also came to a summer intensive, and then married one of our Tuesday group members, and now lives with him here in California!
Good luck, Hassan, and thank you so much for your kind email. Fabrice and I appreciate hearing from folks who have been listening to our Feeling Good Podcasts!
David
My two four-day intensives for mental health professionals this summer are filling up fast, but there are still a few slots available in both. One is in Banff, Canada and Burlingame, California. These are always the most effective and rewarding training conferences of the year. Here are the details:
Cognitive Behavioral Therapy: A Four-Day Intensive Training
- July 17 – 20, Banff, Canada
- For more information, click here
- Phone: 604.924.0296 Toll-free: 1.800.456.5424
High Speed, Drug Free Treatment of Depression and Anxiety Disorders
- A Four-Day TEAM-CBT Advanced Intensive
- July 31 – August 3, Burlingame, California
- For more information, click here
- phone: 800-258-8411
If interested, move quickly. The dates are fast approaching and they often sell out, since attendance is strictly limited at both events. I hope you can join us, and look forward to getting to know you if you attend!
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
Thanks! David
by Dr. Burns | May 29, 2017 | Ask Dr. David
Or is the answer, “none of the above”?
Hi Dr. Burns,
In your When Panic Attacks book you are saying that anxiety is mostly the problem of kind and nice people (or extremely kind and nice). So my question is what happened to the kind people in the last century?
We know anxiety disorders increased by that time, right? So is it the technology and increasing social withdrawal, is it increasing struggle for jobs, is it the decreasing quality of our diets (less vitamins, hormones and minerals).
Thanks for your kind answer.
Kerem
Thanks, Kerem,
You always ask cool questions. How about “none of the above” for an answer. There are really two related questions: 1. Do we have any valid information that rates of depression or anxiety are changing? 2. Do we have any valid information about environmental or biological factors that might account these changes?
With regard to the first question, I do not know of any valid historical information on changes in the rate of depression or anxiety in the past 50 or 100 years or more. To study rates of change, you first have to have valid measurement devices. My own depression and anxiety inventories are brief and reasonably good, with reliability coefficients (accuracy) around 95%. But they were only developed recently. The Beck Depression Inventory was the first depression test, and it was published in 1964, I believe. It’s reliability coefficient is lower, around 80% or less, but it was important historically because it showed that mysterious concepts like anxiety or depression can, in fact, be measured with reasonably high precision.
So before we get too fancy about interpreting changes in rates of various emotional problems, such as anxiety, we first need to get the evidence that the rates are, in fact, changing! But I’ve never seen any evidence, and in fact, this would be impossible without the administration of accurate anxiety tests to large populations repeatedly over time. I am not aware of any studies of that type. And my hunch is that depression and anxiety have been human afflictions for a long time, and were probably just as common hundreds, thousands, or even tens of thousands of years ago.
With regard to the second question, you wondered whether anxiety results from changes in technology, unemployment, or by the quality of the food we eat. The causes of all psychiatric disorders are still pretty much unknown. I am not aware of any valid or convincing evidence linking anxiety to technology, employment, diet, hormones or minerals. However, this doesn’t stop people from assuming these factors are real and valid. I think the only thing we can say for sure is that all, or nearly all, current or historical theories about the psychological and biological causes of emotional distress can be shown to be false.
Probably the most we can say right now is that genetic factors are likely to be very important, along with environmental factors as well. But that’s not saying much!
I guess for many people, a wrong theory is better than none at all. or they assume that because something appeals to them, or seems to made sense, it must be true. Sometimes people believe what they want to believe, without much concern for critical, skeptical thinking, valid research, or truth. Before scientists discovered the causes of disorders like polio or epilepsy, there were dozens of false claims about the causes of these afflictions, and many quack treatments as well.
My focus is not so much on the causes of things, but simply on the development of high-speed techniques to help people recover, without waiting for the causes of depression and anxiety to be discovered! We can now measure changes in depression and anxiety across single therapy sessions, and this is historically really important, in my opinion, and represents a major treatment breakthrough. I love psychotherapy, and it never ceases to blow my mind when I see someone suddenly recover from years or even decades of suffering, right before my eyes during a therapy session!
The photo I sent with this blog if from a recent Sunday hike. On the Sunday hike this week, I worked with a young and extraordinarily dedicated and skillful physician who’d been experiencing intense depression, guilt, and inadequacy. He treats many patients with fatal and horrific illnesses that yet have no cure, and has been telling himself that he isn’t really helping his patients.
At the start of the hike, he looked like he was carrying the weight of the world on his shoulders, and he described individuals and families he’d gotten very attached to, and then had to tell the son or father that they had just a few years to live due to some horrible disease for which there is no cure or treatment.
i worked with him, using TEAM-CBT, and toward the end the hike, his symptoms had vanished, and he was flooded with feelings of joy and relief. That’s what I like to see, and what warms my heart and motivates me. It is, for me, the greatest experience of all, to help someone escape from the suffering of anxiety, depression, and self-doubt. if people are interested, contact me and I can ask his permission to describe what was so helpful for him.
So that’s my focus–I am trying to bring about a revolution in treatment. And I’m trying to learn how to get the word out, as best I can, through my blogs and podcasts and books.
I’m sure my answer might not be very satisfying to you, Kerem, but I deeply appreciate your questions and the dialogue, so keep your questions and comments coming! And keep in mind that I am only expressing my own opinions, and that lots of others–many very intelligent experts, in fact–will strongly disagree with lots of my thinking!
David
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
Thanks! David
