Happy Holidays to everyone! Today’s podcast is nestled between Hanukkah (on the 22nd) and Christmas eve (on the 24th.) We send our warmest greetings to all of our listeners of all religious faiths.
Today, Rhonda, Dave and David discuss three questions you have submitted:
Does emotional trauma cause brain damage?
Do you have to have a good cry when something traumatic happens?
Why does avoidance make anxiety worse?
1. Is it true that emotional trauma affects the brain?
Hi again Dr Burns,
I love the 5 secrets, and have had great success in my new job by implementing them! I keep listening to all the 5 secrets podcasts over and over to keep it fresh for me and really loved the podcast on advanced techniques.
My question today is about how trauma affects the brain. ‘Trauma’ is the new buzz word in education, and psychologists are creating presentations geared for teachers and other school professionals that claim the “trauma-affected brain” is altered and cannot learn as easily. They allege imaging technology can prove this.
Do you know if PTSD/trauma actually impacts a person’s ability to learn? I thought that it was the negative thoughts that interfere with attitudes toward learning, not an actual brain impairment.
Another term that is used frequently is “intergenerational trauma”, meaning if my parent experienced trauma, it could be passed down to me and therefore impact my ability to cope with life stressors. Any thoughts? Any credible research you are aware of?
In the Ask David, could you also include your opinion on how Adverse Childhood Experiences impact people’s mental health and ability to cope? There are a range of experiences cited in studies from moving around a lot in childhood to witnessing a murder to molestation. After listening to your podcast episode 147 (Garry with PTSD) I was satisfied with the effectiveness of TEAM to treat trauma rapidly. But then I remembered a documentary I had seen about ‘feral children’ who were extremely neglected as children, and I wondered if there are some cases where the psychology or potential of a person is forever impacted by an adverse childhood experience. Your take?
All the best,
Jackie
Educational Consultant
Mountaintop School Division
Answer
David finds these buzzwords and buzz-theories somewhat misleading, and sometimes even pseudo-scientific. He has treated large numbers of patients struggling with the effects of severe trauma, and has found that trauma patients are usually the easiest to treat and the quickest to learn. David like to focus on rapid healing, using TEAM-CBT, rather than sending people the message that they are impaired, damaged or defective because of some emotionally traumatic experience.
In fact, nearly all humans have experienced quite a lot of traumatic events, which can range from mild to extreme. And lots of us have some degree of brain damage. My brain (David Burns) was squashed at birth, for example, and there are certain cognitive functions that I’m not very good at. For example, for some reason, I can’t often find something that’s right in front of me, and I have lots of trouble remembering names and faces.
I just try to accept my many shortcoming and work around them. The problem is rarely our flaws or imperfections, but rather the distorted negative messages we give ourselves; messages that generate anxiety, fear, inadequacy, shame, and so forth.
Of course, animals and humans with traumatic experiences at a young age, or any age, may struggle with fear and may seem, as you say, “feral.” My wife and I (David) have adopted many feral cats, and have found that consistent warmth and love can lead to dramatic changes and the development of trust. We all have a history, and every person’s story and suffering deserve respect and profound compassion.
2. What’s displacement? Is it true that you have to have a good cry when something traumatic happens?
Hi there again,
I’ve been practicing TEAM-CBT for a year while at the same time studying Dr. Gordon Neufeld’s theories on the need for “tears of futility” for true healing (including adaptation, maturation and development of resilience). He states that if we only work on the cognitive level, we risk to just displace the symptoms in our clients and they would miss out on maturation and adaptation. I’m wondering if you have ever seen a displacement of the symptom in treating your patients with TEAM-CBT?
In most live sessions I’ve seen with you you seem to have this gift / skill to make it safe for the client to let the tears flow and that this often seem to be the moment when a breakthrough is about to happen. So I wonder if you think the client needs to shed tears or at least feel the feelings of futility or “true sadness” before we should move forward to methods (in addition to getting perfect empathy scores)? And what role you think tears play in the healing process?
Would love to hear your thoughts on this! (See my last e-mail if you want more details to why I’m asking.)
Thanks,
Warmly, Malena
Answer
I am really pleased to see that you, Malena, are a certified TEAM-CBT therapist in Sweden! I always love to hear from a fellow Swede!
You are right, Malena, that emotion is very important in therapy, since it shows that the patient trusts the therapist and is willing to be vulnerable. This is a critical part of the E = Empathy in TEAM-CBT. Therapy without emotion, without tears, may be overly technical, dry and almost “empty.”
In addition, some patients do intellectualize as a way of avoiding emotions. I call this fear of negative emotions “Emotophobia.” I try to confront patients who do this in a gentle way. I might say, “Gee, Jim, I just asked you how you were feeling, and I notice that you didn’t really answer my question. Did you notice this as well?”
This technique is called Changing the Focus, and it has to be done in a kindly, non-threatening way. We discussed it on a recent podcast that was one of our most popular.
I’ve seen a patient recently who had incredible problems sharing his own feelings in interactions with his wife, and equally intense problems acknowledging her feelings. If a patient is determined to overcome this fear of his or her feelings, using the Five Secrets of Effective Communication, tremendous progress can be made, but the patient’s resistance has to be dealt with first.
Early in my career, I was aware of the idea that if you don’t cry when a traumatic event, like the loss of a loved one happens, that you are setting yourself up for emotional difficulties, so I often pushed my patients to cry. And occasionally this was very helpful.
But in general, I have not found it necessary to think that every patient has to cry, and it is definitely not true that crying during sessions is a panacea. During my residency training, I had many patients who cried constantly during therapy sessions without any improvement at all. They just kept crying and crying every session! You could even argue that this makes patients worse, because you continually activate and strengthen the same negative circuits in your brain.
When I learned cognitive therapy, I had many tools to help patients change their lives, and that’s when I became to see far more improvement and recovery. The tears were helpful, but rarely or never curative.
If you are getting perfect empathy scores from your patients on the scales on the Evaluation of Therapy Session, Malena, you are doing great! Way to go!
David (a fellow Swede)
3. Why does avoidance make anxiety worse?
Hi Dr. Burns,
I love your show and work so much. I can’t wait to buy “Feeling Great.”
There’s a question I’ve had for about three years that I’ve badly wanted to get my head wrapped around. It’s in regard to something I’ve heard you say on a Feeling Good Podcast: “Most experts in exposure therapy or behavior therapy say that attempts to control your symptoms (of anxiety) is the cause of all anxiety.” I have heard others say that too/
Why is this?
I understand if you push-through an anxiety you can learn whether it’s warranted or not.
But how is trying to avoid an anxiety actually the cause of all anxiety?
I want to be able to understand it for when I feel myself trying to move away from social anxiety I can understand at a moment’s notice why doing so actually is the cause of all my anxiety. To be able to skewer the rationalizations in my mind of why I shouldn’t push-through.
Thank you David.
Best Regards,
Mark
Answer
Rhonda, David and Dave discuss why avoidance makes anxiety worse, and why exposure often leads to improvement or even complete recovery. David describes the incredible resurgence of his own fear of heights when he took his children on a camping adventure in Havasupai Canyon in Arizona one spring when he and his wife were living in Philadelphia, and he avoided climbing down a cliff he had climbed down many times when he was younger.
Anxiety is not caused by the thing you fear, but by your distorted thoughts and fantasies. When you pull back instead of confronting the monster, you do not get the chance to discover that the monster has no teeth, so your negative thoughts and fantasies can quickly spiral out of control.
We will see you again next week for our final podcast of 2019. Thanks for so many wonderful questions, and for your support during the past year. We have had more than 1.5 million downloads, thanks to you! We look forward to serving you again in 2020!
If you like the podcasts, please tell your family, friends, and neighbors. You are our marketing team! And if you are a mental health professional, you might be interested in my February workshop on therapeutic resistance with Dr. Jill Levitt. It’s going to be a good one, and you can find the details below.
Rhonda, David, and Dave
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
Coming up in 2020
High Speed Methods to Reduce Resistance and Boost Motivation
This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.
Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts
TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?
As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?
Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
Today, Rhonda rejoins us as host after a three week hiatus! My neighbor, Dave Fribush, joins us as well, as we answer two thought-provoking questions!
Is it possible to treat “burnout?”
Can negative feelings can make physical pain worse?
1. Does “burnout” exist? How do you treat it?
Comment: Hi!
I have been listening to your podcast for a while now and it has helped, and has encouraged me and made me feel less alone. Thank for your work and sharing your podcast with us!
My situation now is very much defined by my burnout syndrome (a medical diagnosis in Sweden, not sure about the US) and/or depression. From what I’ve learnt there is no evidence of CBT as a treatment for burnout – really nothing other than adaptations at your workplace. What triggered me to ”hit the wall” was studying too hard and not giving my body and mind time to recover.
Do you have any thoughts on burnout and effective treatment of it? I feel I have made huge progress in the underlying reasons to my burnout like perfectionism, performance-based self-esteem, figuring out how I want my life to be, who I am etc (although the last one is a big one!). All this with the help of CBT and other sorts of therapy. What remains is mental fatigue, on and off anxiety, not being able to focus and hardly any mental or emotional resilience.
Through healthcare, you are basically treated for depression, the treatment being anti-depressants. I’ve been on sick leave full time for over four years now, am in my late twenties and am constantly frustrated, sad and feeling stuck. I want to get going towards this life I now know that I want but I don’t seem to get any better. I eat and sleep well and exercise. I realize this could be a complete medical question but nobody REALLY seems to know anything about burnout. A long question but hey ho 🙂 Would be grateful for any thoughts you might have, thanks again!
Sincerely,
Elisabeth
Hi Elisabeth,
I’m sorry to hear that you’ve been struggling for some time, but I’m glad you’ve been making progress, and I’m so glad you wrote to me.
To my way of thinking, there is really no such “thing” as burnout. Depression, anxiety, anger, and other negative feelings do exist. Burnout is just a vague buzzword for feeling upset when something upsetting has happened.
When I was in clinical practice, I saw as many as 17 depressed and anxious patients in one day, and as the day went on, I just got higher and higher and more energetic. That’s because I loved what I was doing and felt I had something to offer, a lot, actually. I only got “burned out,” or unhappy, if I felt I had said something that hurt someone’s feelings, or if I had not done a good job for someone. Then I got really upset, but it was my thoughts, and not what I was doing, that caused my feelings. That, of course, is the cognitive model.
I found it helpful to zero in on one moment when I was feeling depressed, anxious, or “burned out,” and to do a Daily Mood Log focusing on that moment. I’ll attach one to this email in case you are interested. I’ve also included a completed one so you can see how it works. This is not a similar case, just something I grabbed by way of illustration.
Thanks,
David (a fellow Swede)
On the show, I describe one of the most stressful experiences of my career, when I appeared on a Philadelphia TV show with Maury Povich, and a patient of mine threatened to commit suicide. Fortunately, the story had a surprise ending that was very positive.
So my message is one of hope. The idea is to focus on some specific thing you are upset about, as opposed to getting overly focused on a concept like “burnout.”
I think we all feel pretty exhausted at times, and if you’ve been studying or working too hard, it definitely makes sense to take a break to take care of yourself. When I transferred from my residency training program at Highland Hospital in Oakland, California, to the residency program at the University of Pennsylvania, in Philadelphia, one of my supervisors gave me this advice–he told me to make sure I set aside at least one half a day a week to stare at walls.
What he meant was that I was working intensely, 24/7, during the first two years of my residency, and he wanted to make sure I gave myself a break to rest from time to time. So every Sunday afternoon I just watched football games on TV, often with a cat on my lap. This was refreshing and helpful, and my supervisor’s advice helped me avoid feeling guilty for not working 24/7!
2. More on physical pain. Is it really true that negative feelings can make physical pain worse?
We recently did a podcast with Dr. David Hanscom, a back surgeon who emphasized non-surgical treatments for back pain that can be surprisingly helpful. In that podcast, I described my research indicating that 50% of the pain we experience can the result of negative feelings, such as depression, anxiety, and anger. And if you can reduce or eliminate those negative feelings, your physical pain will often diminish substantially, and may even disappear entirely.
I first discovered this amazing phenomenon when I had a dramatic and traumatic personal experience as a medical student. One night I was drinking beer at a bar in Palo Alto, and hurt a commotion, and turned to look. A fight had broken out, and although I was not involved in the fight, I saw a beer mug flying in slow motion toward my face. It hit my jaw, and glass exploded everywhere, and blood came gushing out of my mouth. I realized that my jaw was broken, and my front teeth were loose as well, so I ran outside to my old VW Beetle and drove at high speed to the emergency room of the Stanford Hospital. I ran inside and announced that I was a medical student and my jaw was broken.
They put me on a gurney, and ordered an x-ray. I was in intense pain, and I was scared and angry, and still intoxicated, and probably wasn’t the most cooperative patient.
Eventually, a plastic surgeon was consulted and he talked to me after reviewing the X-ray. He explained that I had a broken jaw, and that he was going to hospital me and do surgery in the morning. He said my jaw would be wired shut for six weeks.
I asked if I was going to lose my front teeth that were loose. He said he didn’t think so, but that I would have a dental consult to check things out after they removed the wires on my jaw in six weeks. Then he said that he knew I was in severe pain, and that he’d ordered pain shots for me during the night. He said he wanted me to be comfortable, and explained that he wanted me to request a pain shot any time I was in pain during the night. Then he put his hand on my shoulder and said, “This is very routine, and you’re going to be fine.”
At that very moment, my pain instantly went from severe to zero, and I did not need a single pain shot all night long.
Dave Fribush emphasizes that while the surgeon’s warmth and compassion were helpful, the thing that made my pain suddenly disappear was the sudden disappearance of my negative feelings–intense anxiety about losing my teeth, as well as anger at feeling that I was being neglected. And the very moment my negative feelings changed, my anger disappeared as well.
My later research confirmed that negative emotions can, in fact, magnify the experience of physical pain, and that, on average, 50% of the pain we experience results from our negative emotions. This finding should provide hope for individuals struggling with physical pain, especially since this is a drug-free treatment not involving opiates.
if you want to reduce your negative feelings, one approach would be to read one of my books, like Feeling Good or When Panic Attacks.
They are, of course, not guaranteed to cure you, but research confirms that many people who read them do develop a more positive outlook on life and experience significant reductions in depression and anxiety. And the can be obtain inexpensively at Amazon or other book sellers.
Next week, David, Rhonda and Dave will discuss three more questions you have submitted:
Does emotional trauma cause brain damage?
Do you have to have a good cry when something traumatic happens?
Why does avoidance make anxiety worse?
David & Rhonda
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
Coming up in 2020
High Speed Methods to Reduce Resistance and Boost Motivation
This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.
Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts
TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?
As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?
Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
This is a republishing of yesterday’s podcast. For some reason, it did not go out to my website followers.
Today, Rhonda could not join us due to the religious holidays, so we have recorded several podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, a friend and colleague from New York.
Dave, Michael and I answer two thought-provoking questions!
1. Working with Abused Women
Hi David (and Rhonda!),
I want to start out by stating how much I love your podcast. It has helped me understand myself, and, in turn, has made me a much more effective counselor.
I’m a drug and alcohol counselor, working here in Los Angeles. I work primarily with women from 18 – 25 years old who have aged out of the foster care system. They are an endearing group of women, as I know you are aware (I’ve heard you speak of working with this population), and they just want to feel loved and worthy. However, their deep-seated beliefs of being unworthy of good things happening in their lives prevents them from attaining their goals of getting jobs, getting their children back, and gaining housing.
These deep-seated beliefs are based on mistreatment by their families of origin, and their subsequent experiences in the social services system. Most were sexually abused or physically abused as children, taken out of their homes, then bounced around from one Foster Care family to the next.
Despite my best efforts, the majority of these women go back out to the streets just shy of completing our 6- to 12-month treatment program. Once on the streets they return to drug dealing, prostitution, and crime. After which, if they are lucky, they get picked up and incarcerated. Many die on the streets of drug overdoses or murder.
I’m using all of the tools I can to help them change their core beliefs, but it is challenging to say the least!
My question to you is—is there a book coming out which goes into depth about T.E.A.M. therapy? I need to become the most effective counselor I can in order to help these women recover and lead normal lives.
Thank you so much for your help! Keep up the good work. You are definitely saving lives!!
Pennie
Hi Pennie,
Thank you so much for your question. I did work with this population at the Presbyterian / University of Pennsylvania Hospital in Philadelphia, and found the patients to be incredibly rewarding and hungry for help, love, and connection, as you have said. I’m sure it is heart-breaking for you to see so many fall short, continue to struggle, and even die on the streets.
I found this population to be particularly easy and rewarding to work with because they seemed so grateful to be getting any kind of help at all. Many of our patients were homeless, and about a quarter of them could not read or write. We gave them more than eight hours of cognitive group therapy every day in a residential treatment setting, so they got 40 to 50 hours of therapy per week. The program was very inexpensive to run, and was more or less free to the participants, paid for by some type of medical assistance insurance, as well as by our hospital. Most patients showed dramatic changes within three or four days. The average length of stay was something like a week or ten days or so.
In today’s podcast, I describe a patient in one of our groups, a woman who was severely depressed. She thought of herself as “weak” and “a bad mother.” She recovered from her depression in just 20 minutes or so when I used a TEAM-CBT method called “The Paradoxical Double Standard Technique.
My book, Ten Days to Self-Esteem, is the program we used at my hospital in Philadelphia when working with this population. It is a simplified version of CBT, and it is a ten-step program that can be administered individually or in groups (which I prefer.) It is written using simple words for individuals with little education.
We gave a copy to every patient entering our program, and found that really boosted our outcomes. The hospital purchased them in quantities of 50 or more, and got the wholesale price, which made the books cheaper than having to copy the materials for the patients.
There’s also a companion Ten Days to Self-Esteem, The Leader’s Manual, that you can get as an eBook. It shows the group leaders how to set the groups up and what to do at each of the ten group sessions.
There are many additional resources for you, if you’d like to learn more about CBT, as well as TEAM-CBT. First, my new book, Feeling Great, is now at the publisher, PESI, and should be coming out in 2020. I’ll update you as more details become available. But yes, it does have all the new TEAM-CBT stuff in it. It is intended for therapists as well as the general public, and features lots of written exercises while you read, so you can really master the many new methods and concepts.
My psychotherapy eBook, Tools, Not Schools, of Therapy, is for therapists, and we use it in all of our TEAM-CBT training programs. It is an interactive book that shows you how to do TEAM-CBT in a step-by-step way. this book also features many challenging interactive written exercises to complete as you read.
You might enjoy some of my in person workshops, as well as the many weekly online TEAM-CBT training programs at the Feeling Good Institute. My one day workshops with Dr. Jill Levitt are really well received, and you can join online from anywhere in the world. My yearly intensives in the US and Canada are usually pretty awesome as well.
I hope this information is helpful, and Iwish you the very best in the important and compassionate work you are doing with this incredibly deserving group of women who are suffering so greatly!
2. Why don’t you advocate “Wellness” or “Holistic” Approaches?
A therapist named Georgina recently emailed me and was pretty excited about her clinical work which was dedicated to “Wellness” and to “Holistic” treatment methods. I mentioned in an email that I am “intensely anti-wellness and anti-holistic.”
She sounded a bit shocked and added: “I’m one of those clinicians who provide consults to other clinicians on Pilates and yoga in integrative psychiatry.”
Hi Georgina,
Thanks for your thoughtful emails! I know my statement was “politically incorrect” in an era that emphasizes lots of non-specific treatment methods like meditation, healthy dieting, daily exercise, yoga, and so forth.
The quick answer to your question, which you can also hear in the podcast on “fractal psychotherapy,” (https://feelinggood.com/2019/03/04/130-whats-fractal-psychotherapy/) is that I focus narrowly on one specific moment when the patient was upset, and if it is an individual mood problem, like depression or anxiety, I ask the patient to record his or her negative thoughts and feelings at that specific moment on the Daily Mood Log. This activates just a few brain networks, out of the billions or trillions of networks in the brain, and we selectively modify those networks using techniques specifically chosen for this individual patient. There are no no-specific interventions.
The goal is rapid complete recovery followed by highly specific Relapse Prevention Training, so the patient will know exactly what to do the next time s/he falls into the black hole of depression, hopelessness, and despair. Essentially, I give the patient a little ladder that she or he can use the next time the Negative Thoughts return.
No one can feel happy all the time, but nearly all people can learn to limit those bumps in the road that we all encounter from time to time.
It sounds like the work you do for patients with Parkinson’s Disease is terrific, and desperately needed. My father in law died of Parkinson’s Disease several years ago, and we saw and experienced personally what a devastating and tragic disease it is.
Although I do not include any ”wellness” or “holistic” tools or concepts in my treatment plans, I have nothing against aerobic exercise, yoga (my daughter totally loves it!), meditation (my host, Rhonda, is a strong advocate), or a healthy diet, or anything else someone may find fun, exciting or helpful. It’s just that I’m trained in, and have developed, highly specific, super-fast acting treatments.
I believe that “non-specific techniques” have only a placebo effect on mood, although the placebo effect itself can be quite strong and potentially very helpful. In addition, I believe that non-specific techniques can ONLY change mood if you change the way you think.
So, if you jog, or eat a healthy diet, or meditate daily, and tell yourself, “Wow, I’m really living a healthy life,” you will feel good if you believe this thought. The jogging or food you eat will not, itself, cure your depression, or panic attacks, or fix your broken marriage, or help you recover from OCD, or PTSD, and so forth.
These conditions ARE highly treatable, however, using specific, fast-acting techniques that are individualized to you. We call this treatment TEAM-CBT. Again, I’m sure that many people will HATE what I just said, but I guess we will need some pretty refined research—research that’s never been done—to find out! The research that’s out there definitely cannot answer this question.
All I offer is a quick cure for specific problems. I’m not offering “everything” to “everybody.” I am aware, too, that my answer may be cheered by some and may be angrily booed by others. I like to speak from the heart, and from my experience, but I’m often wrong, and sometimes way off the mark, so no problem if you disagree or think I’m nuts!
You might also find our first and second podcasts on Mindfulness Meditation to be useful or interesting.
David
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
Coming up in 2020
High Speed Methods to Reduce Resistance and Boost Motivation
This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.
Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts
TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?
As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?
Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
David and Rhonda goofed! We posted the wrong audio for today’s wonderful podcast on social anxiety and vulnerability featuring Michael Simpson. Rhonda has just returned from a month of teaching in India, and can hopefully get the error corrected soon so you can hear the proper audio.
David
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
Coming up in 2020
High Speed Methods to Reduce Resistance and Boost Motivation
This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.
Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts
TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?
As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?
Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
Incredible training. The best workshop I have ever attended. David is a compassionate, extremely knowledgeable teacher and psychiatrist. I guarantee you will not be disappointed! Marilyn Coffy, PhD
The following are unsolicited anonymous comments from participants on the workshop evaluation forms–
The live demonstration in the evening was freaking incredible!!!
The live demonstration was dynamite! . . . It was beautiful!!
The entire process was fantastic!
I liked all of it! I appreciated Dr. Burns willingness to be vulnerable with his own flaws and fears.
Today’s podcast features Michael Simpson, a friend and colleague of Dr Burns, who describes his personal battle with social anxiety. Dave Fribush will again be our host, since Rhonda is celebrating the important religious holiday of Yom Kippur with her family.
Michael first became acquainted with David when he read David’s book, When Panic Attacks, which he says was SO GOOD! But when he went to David’s website, www.feelinggood.com, he was shocked to see so much terrific free content for people, but the website was not well-presented. In fact, it was pretty sucky!
So, Michael sent David a brief video, pointing out all the problems, and offered to redo the website in exchange for some help with his social anxiety—and the relationship took off from there!
Michael describes his own experiences with social anxiety, which amounts to slight to moderate nervousness, tension and dis-ease during interactions with people. There is no apparent pattern to his triggers: he can become anxious (or not) around friends, strangers, men, women he is attracted to, and women he is not attracted to. He experiences the anxiety physically: butterflies in his stomach, tension around his face and a general tightness in his body. He is usually unaware of his negative thoughts, which involve fears of looking weak, being judged by others because of his anxiety, and being unable to connect with others while he is feeling anxious. He usually tries to hide all of these fears.
In addition, his social anxiety does not appear to inhibit him — he is a tall, handsome, articulate man, and when he confides his social anxiety to others, they are usually extremely surprised that someone who outwardly appears so confident could possibly be struggling with social anxiety.
Michael describes one of his first “homework assignments” from Dr. Burns, who suggested that instead of hiding his anxiety, he should approach attractive women he encounters on the street and simply tell them that sometimes he becomes anxious when speaking to attractive women. The purpose of the exercise was to confront his fear (Exposure) and do a real-world experiment to find out if his fears of being judged are realistic.
Opening up about his anxiety was very challenging for Michael, to say the least, given that he had spent most of his life trying to hide it. He describes walking around Times Square in New York City, procrastinating, and trying to muster up the courage to follow through on his assignment.
So, he finally approached a woman from Brazil whom he found exceptionally attractive. He kind of had to chase after her to stop her to tell her. We can call her Adrianna. Adrianna did not judge or reject Michael, and the two of them seemed hit it off tremendously. And they talked and hung out together every day.
Michael described their relationship as one of the deepest and most fulfilling relationships he’d ever experienced. He was amazed by Adrianna’s warmth, compassion, and openness, and appreciated the respect and love she conveyed to everyone she met. Michael also describes visiting her and spending a week together in Brazil after she returned home.
One of the take-home messages for Michael was that vulnerability, rather than trying to be cool, or trying to impress people that you have it all together, is the real key to intimacy and joy in our relationships with others.
Dave Fribush and David Burns feel very indebted to Michael for his awesome work on today’s podcast. Michael hopes his experiences will be helpful to any of you who have also struggled at times with social anxiety.
My new website makeover will probably be launched by the time you read this, so let us know what you think! It’s will be at the same address: www.feelinggood.com.
If you are struggling with social anxiety, you might also enjoy my book, Intimate Connections. It’s now a bit dated, but the ideas can still be tremendously helpful. Here’s an unsolicited endorsement I recently received from a young professional woman:
“I’d like to share a story about a book I started reading on my trip to Asheville this past weekend. On the plane, both tears and uncontrollable laughter simultaneously streamed from my face while reading the Intimate Connections book. No more peanut butter and jelly sandwiches telling myself what a loser I am!” ZR
David
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
Coming up in 2020
High Speed Methods to Reduce Resistance and Boost Motivation
This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.
Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts
TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?
As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?
Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
Happy Thanksgiving if you live in the United States! This is my favorite holiday, because it means just hanging out with the people you love, eating some wonderful food together, and doing simple things like a family hike, without the commercialism and “push” of some of the other holidays. I wish the very best to you and yours, too!
Today, Rhonda could not join us due to Yom Kippur, the highest Jewish holy day. So we will record three podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, who flew out from New York to attend my Empathy workshop two days ago. He will also join the Tuesday group at Stanford tonight. Michael is doing a massive upgrade / fast lift of my website, www.feelinggood.com, which will likely be published by the time you read this. Let us know what you think about the new “look.”
Dave Fribush, Michael and I answer many thought-provoking questions submitted by listeners like you!
1. How can I overcome my fear of blushing?
Hi David,
Hopefully this reaches you well. I am dealing with Erythrophobia (the fear of blushing) and have been having issues with going out with friends, being in public, in work meetings, etc. The weird part is that I don’t even get red, but the visualization in my head is so vivid sometimes (Kool-Aid man) that I believe it.
Sometimes, if I think about it long enough (like an internal panic attack for 20+min), I get kind of red. . . . Currently, I am trying to just break this habit and I have been reading your book When Panic Attacks and it has been pretty good at helping me.
I have been facing my fears and going out into public and hanging out with friends; I’m kind of anxious on the inside of getting red all of sudden, which puts me on edge. I look in the mirror and see that I am not red, but it’s been hard to train my brain to believe it. I started reading your book five days ago and it has helped a lot already. Since then, I have been able to accept
I don’t mind being occasionally red or nervous and I’m fairly confident, but I struggle to accept the idea of being perpetually red? Part of me wants to accept the idea that “Eff-it! If I’m red, I’m red! That’s who I am,” but another part of me knows that it’s not true; occasionally I might blush but it’s not the norm.
Please let me know if you have any advice. I think this might be a great podcast topic because I know a lot of people with Rosacea deal with anxiety and I’m sure that would help a lot of others.
I cannot do therapy through this medium, so this is just general teaching, but exposure / self-disclosure in one method you could use. You could tell 5 to 10 strangers every day something like this:
“Could I speak to you for a moment? I’ve had the fear of blushing almost all of my life, and I’ve been hiding it from everybody out of shame. But today, I’ve decided to stop hiding and being ashamed, so I’ve decided to tell people, and that’s why I’m telling you.”
Actually, blushing is NEVER a problem. The only problem is the shame. Without the shame, the blushing, like shyness, can be an asset, making you more human and more appealing.
Also, on my Sunday hike yesterday, we were joined by a young Stanford dermatologist who showed us some photos and videos of a new laser treatment for rosacea, which is similar to blushing. Apparently, the treatment is quite effective.
Thanks, David
2. How can you get over a broken heart?
Hi David,
First of all, I would like to thank you from my bottom of my heart for the wonderful jobs you are doing. I have a question regarding aftermath of divorce and searched feelinggood.com for any post but I couldn’t find any. My best friend is going through divorce process and he cannot forget the good memories he had with this wife. He still loves her so much and would like to continue their relationship but she’s not interested in that. They have been separated for 4 years and he tried his best to bring her back.
How can I help him move forward? Those good memories are haunting him?
Thanks,
Didi
Hi Didi,
Thanks for your terrific question, as most of us were rejected by someone we loved at some point in our lives.
You’re in luck! We just recorded a podcast on how to help a friend or loved one who’s hurting, and by the time you read this, it will have been published. It’s Podcast #164 on “How to HELP, and how NOT to Help!” It was published on October 28, 2019. You can find the link on the list of all of the published podcasts on my website. I would definitely listen before trying to “help” your friend!
Resources for your friend might include the book I wrote on this topic, which is called Intimate Connections. One of the themes is that rejection could never upset a human being—only distorted thoughts about being rejected. This book can be helpful to the many people who have been divorced, or who have broken up with someone they loved, and are having trouble getting back into the dating game effectively, as well as the many people who are having trouble getting into the dating game for the first time.
Another great resource for him would be the chapter on the Love Addiction in Feeling Good: The New Mood Therapy. It describes a woman who had just been rejected by her husband, who was having an affair with his secretary, and she was telling herself that she couldn’t be happy without his love. The story had an amazing outcome, and might be very helpful for your friend.
Of course, motivation is incredibly important. Your friend might not want to be “cured,” so to speak, since his depression and thoughts about his Ex keep the relationship alive in his mind, and also give him an excuse to avoid dating and developing new relationships, which can be anxiety-provoking and effortful for just about anybody!
David
3. How would you treat someone with anorexia nervosa?
This question was submitted by our friend, Professor Mark Noble, on behalf of one of his colleagues at the University of Rochester.
I, David, explain what anorexia is, and describe my experience with an anorexia patient I treated in Philadelphia when she was discharged from the inpatient unit. I emphasize the need for the TEAM-CBT technique called the Gentle Ultimatum, since the patient didn’t want o maintain her weight at a safe level, and just wanted to talk talk talk during sessions without doing any psychotherapy homework.
I also describe the “Coercive Therapy” also called Family Therapy for anorexia, developed at the Maudsley in London, and we talk about how the same principle—getting the parents to work together on the same team, with firmness, intense mutual support, and compassionate insistence—works for almost any problem children are having.
However, this requires the parents to support one another, and work together as a strong and loving team, and many parents who are in conflict will find it difficult to do this, since the urge to argue and fight can be so powerful. Then the parents sacrifice the well-being and happiness of their children in the name of ongoing war (blame, fighting, sticking up for “truth,” and so forth).
Dave F. and Michael Simpson ask why this approach of getting parents to work together, can be so incredibly powerful and helpful to children.
David
You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!
If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
Coming up in 2020
High Speed Methods to Reduce Resistance and Boost Motivation
This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.
Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts
TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?
As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?
Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.
This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.
3. The Annual South San Francisco Intensive
August 10 – 13, 2020
Small Group Practice with Personal Feedback and Mentoring, and Chances for Personal Work and Healing
