028: Scared Stiff — The Motivational Model (Part 6)

028: Scared Stiff — The Motivational Model (Part 6)

In this Podcast, David and Fabrice discuss the fourth powerful model in the treatment of anxiety—the Motivational Model. The key here is bringing the patient’s subconscious resistance to conscious awareness, and melting it away with paradoxical techniques. This is absolutely critical if you are hoping to see a complete elimination of symptoms in any type of anxiety.

You may recall that the Outcome Resistance for anxiety disorders usually results Magical Thinking—the anxious patient may be suffering intensely and asking for help, but secretly believes that something terrible will happen if the treatment is successful and the anxiety disappears. In other words, most anxious individuals are convinced that the anxiety is protecting him or her from some catastrophic event.

David brings this concept to life with a dramatic description of his treatment of a young man named Sam who’d been struggling with intense PTSD—Post-Traumatic Stress Disorder— for six months following a traumatic interaction with two sadistic gunmen.

David and Fabrice also discuss metaphors for understanding how healing actually occurs. Most therapists think of depression and anxiety as mountains that have evolved slowly, over years or decades. They sometimes also believe that treatment and recovery will also requires years and years of treatment, with very slow progress. Of course, if the therapist and patient believe this it will function as a self-fulfilling prophecy.

In sharp contrast, David describes a new way to think about recovery, as something extremely rapid, a personal transformation that happens suddenly, within a very brief time period within a therapy session. But this remarkable phenomenon is only possible when the patient’s resistance to change has been skillfully and compassionately addressed by the therapist. At that point, the patient and therapist are on the same TEAM, working together collaboratively. Then, amazing changes can often unfold quickly.

Plans for future Feeling Good Podcasts will include a series of fascinating podcasts that will feature an actual live therapy session, with David and his colleague, Dr. Jill Levitt, acting as co-therapists, including commentaries on how each step of T.E.A.M. is being implemented. This will give you the unique opportunity to look behind closed doors so you can observe actual healing taking place.

In addition, a future “Ask David” podcast is planned, as well as a podcast on “The Truth about Benzodiazepines,” plus podcasts featuring more treatment methods for anxiety such as Interpersonal Exposure Techniques and Cognitive Flooding. Dr. Burns also promises a fascinating Feeling Good Podcast on the use of the Five Secrets of Effective Communication with violent individuals who are threatening, hostile, and dangerous.

027: Scared Stiff — The Hidden Emotion Model (Part 5)

027: Scared Stiff — The Hidden Emotion Model (Part 5)

Fabrice launches this Podcast by asking David to remind us about the differences between healthy fear and unhealthy, neurotic anxiety, or an anxiety “disorder” like a phobia, or OCD, and so forth. David explains that negative thoughts, and not events, trigger all our emotions, healthy or unhealthy. However, healthy fear results from negative thoughts that are valid and undistorted, and does not need treatment. For example, if you are walking around Chicago in an area dominated by gangs, you may have the thought, “I could get shot. I better be careful because it’s dangerous here!” Your fear is healthy and can keep you vigilant and alive in a genuinely dangerous situation.

In contrast, neurotic, unhealthy anxiety results from thoughts that contain the same ten cognitive distortions that cause depression, such as All-or-Nothing Thinking, Jumping to Conclusions (e.g. Mind-Reading and Fortune-Telling), Emotional Reasoning, Magnification, Should Statements, and more.

David explains that the Hidden Emotion Model is radically different from CBT, exposure therapy, and most other current treatments for anxiety. The theory behind Hidden Emotion Technique is that “niceness” is the cause of (almost) all anxiety in the United States at this time. In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed to want.

David brings this powerful treatment technique to life with a vignette involving Terry, the woman with ten years of terrifying panic attacks described in previous podcast. When David asked about her very first panic attack, ten years earlier some amazing and illuminating information emerged.

David gives tips on how therapists can use the Hidden Emotion Model,

  1. The hidden emotion or conflict is buried in the present, and not in the past.
  2. It is something very ordinary, such as not liking your job, or your major in college, or a conflict with a friend, family member or colleague.
  3. The anxiety is nearly always a symbolic expression of the feeling or problem the patient is not bringing to conscious awareness. David gives listeners an exercise to see if they can pinpoint the symbolic meaning of Terry’s panic attacks.

Fabrice asks the important question—what do you do when the anxious patient insists that there aren’t any hidden feelings? David explains that most anxious individuals will say that, and describes how to bring the hidden feeling or problem to conscious awareness.

He emphasizes the three things he really likes about the Hidden Emotion Model:

  1. It explains the timing of anxiety attacks, so it has tremendous explanatory power. Freud said that anxiety is the mysterious emotion, that comes out of the blue, and strikes like lightning, without rhyme or reason. David disagrees, and emphasizes that anxiety rarely or never comes from out of the blue.
  2. The Hidden Emotion Model can have powerful and rapid healing effects for patients with every type of anxiety, as well as individuals struggling with hypochondriasis and those who go to medical doctors with complaints of pain, fatigue, or dizziness that does not appear to have a valid medical cause.
  3. The Hidden Emotion Model teaches us that the ultimate cause of most anxiety is the fear of the self, of our emotions and how we genuinely feel as human beings.
  4. The Hidden Emotion Model teaches us that recovery from anxiety does not involve recovery from some “defect” or “mental disorder,” but rather the discovery of what it is like to be human being, with all of our feelings, and that it is okay to have an express those feelings.

Finally, David explains that while this technique traces to the teachings of Freud, Freud might turn over in his grave and find it superficial or silly, since David simply tells anxious patients that they are suppressing or repressing something that’s bothering them, and insists they bring it to conscious awareness right away. David accepts this criticism, but also adds that the Hidden Emotion Technique works and frequently triggers complete recovery with patients who are only partially helped by the skillful use of cognitive techniques and exposure techniques.

However, the “niceness” phenomenon only seems to affect about 75% of anxious patients; sometimes, a phobia is just a phobia, with no hidden feeling or conflict. Those individuals will not be helped by this technique. Fortunately, we have dozens of other powerful techniques that will be curative!

026: Scared Stiff — The Exposure Model (Part 4)

026: Scared Stiff — The Exposure Model (Part 4)

In this Podcast, David and Fabrice discuss the Exposure Model for treating anxiety. They begin by briefly describing the three different deaths of the ego that are required for recovery from depression, anxiety, or a relationship conflict, respectively. For depression recovery often results from the “Great Death,” A Buddhist concept that involves the discovery that there is no such thing as a “self” that could be worthless, or inferior, or judged by another person. David and Fabrice only touch on this theme and promise an entire future podcast on this fascinating and helpful spiritual notion that can lead to recovery from depression.

For anxiety, the death of the ego is quite different, and involves surrendering to the monster the patient has always feared and avoided using a wide variety of exposure techniques. David traces the origin of Exposure Therapy to teachings in the Buddhist hold scriptures, the Tibetan Book of the Dead, more than 2,000 years ago. David describes the amazing and hilarious phenomenon of “laughing enlightenment,” which often happens when anxious individuals confront their fears.

David describes how he used Flooding, an extreme form of exposure, to get over his own blood phobia, which he’d had since childhood. His fear of blood caused him to drop out of medical school at Stanford for a year on two separate occasions. He finally decided to confront his fear by working for a month in the Emergency Room of Highland Hospital, a major trauma treatment center, in Oakland, California. David explains what happened when a totally bloody man on the verge of death was rushed into the ER after a bomb he was building in his basement blew up.

In the podcast David forgot to mention something fascinating about his experience at Highland. David had had a blood phobia since he was child, and blood phobia is thought to have genetic causes, and perhaps be inherited. And yet, David was totally cured in roughly 15 minutes without any medication at all. The important point is that even if things are biologically caused, they can often be treated with psychological techniques.

Most therapists hate the word, “cure.” David explains why he sometimes uses this term when treating anxious patients, and also explains the difference between a 100% cure and a 200% cure.

David emphasizes the importance of motivation and resistance in the treatment of anxiety, since few patients, if any, will want to use exposure techniques, because it is so terrifying. David and Fabrice will describe the Motivational Model in the next podcast.

David and Fabrice raise questions about the mechanism of recovery during exposure. Why does it work? Is it due to the change in thinking, or is there some other healing mechanism at work?

Fabrice asks about patients who resist exposure and protest that it won’t work. For example, a patient with the fear of heights might say, “Oh, exposure can’t possibly help, because every time I get in a situation where I’m exposed to heights, like when I’m in looking over a railing on the third floor of a building or hiking on a mountain trail, I get terrified. This has happened hundreds of times and it never helped!”

Finally, David describes a humorous but real example of his 8-minute treatment of a therapist with 20 years of failed therapy (several times a week of psychoanalysis) for her elevator phobia.

David and Fabrice end by talking about the enormous amount of information they have to share with listeners, including large numbers of creative exposure techniques that fall into three categories:

  1. Classical Exposure
  2. Cognitive Exposure
  3. Interpersonal Exposure

They promise future podcasts describing these fascinating techniques with more amazing vignettes based on patients Dr. Burns has treated, as well as his treatment of his own many fears and phobias!

 

025: Ask David — How do you handle a patient you don’t like (or who bores you)?

In this Podcast, David answers two intriguing questions posed by listeners, and one question posed by his host and colleague Dr. Fabrice Nye.

  1. How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide.
  2. How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely.
  3. How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.

024: Scared Stiff — The Cognitive Model (Part 3)

In this Podcast, David and Fabrice describe cognitive model of anxiety, which is based on three powerful ideas:

  1. Anxiety always results from negative thought (NTs) that involve the prediction of danger. For example, if you have public speaking anxiety, you are probably telling yourself something like this: “I just know I’m going to blow it. My voice will tremble. People will know I’m anxious. My mind will go blank. I’ll mumble and make a total fool of myself.” Or, if you struggle with panic attacks, you probably have thoughts like this: “I think I’m about to die. I can’t breathe properly. I’m about to pass out!” Or, “I’m about to lose control and go crazy.”
  2. The NTs that trigger anxiety are always distorted and illogical. In contrast, valid NTs cause healthy fear.
  3. When you put the lie to the distorted NTs, the anxiety will disappear. This can sometimes happen in an instant.

Dr. Burns describes his treatment of a woman named Terry who had suffered from ten years of incapacitating panic attacks and severe depression prior to contacting Dr. Burns. During each panic attack, Terry would experience tightness in her chest and tingling skin and tell herself she was about to pass out, suffocate, or die of a heart attack. Multiple emergency room visits, medical tests, and reassurances from doctors did not help. In addition, years of medication and psychotherapy were not at all helpful.

After trying a number of cognitive techniques that did not help, Dr. Burns persuaded her to let him induce an actual panic attack during an office visit so he could use the Experimental Technique, which is arguably the most powerful technique ever developed for the treatment of anxiety, and he televised the session. What happened next will blow your mind!

In the next podcast, Drs. Burns and Nye will describe the Exposure Model of treatment, and Dr. Burns will describe his personal struggles with his fear of blood during medical school.

 

→ Click here to download Terri’s Recovery Circle

023: Scared Stiff — What Causes Anxiety? What’s the Cure? (Part 2)

In this Podcast, David and Fabrice describe four powerful treatment models for anxiety, including

  • The Cognitive Model
  • The Exposure Model
  • The Motivational Model
  • The Hidden Emotion Model

Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger.  And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover.

Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.

Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever.

Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out!

In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.

022: Scared Stiff — What Is Anxiety? (Part 1)

In this Podcast, David and Fabrice answer these questions:

  • What is anxiety?
  • How does it differ from depression?
  • Do anxiety and depression always go hand in hand?
  • How does anxiety differ from healthy fear?
  • What are the most common forms of anxiety?
  • How common is anxiety?

Anxiety, like depression, has been called the world’s oldest con. That’s because you are always fooling yourself, and buying into negative thoughts that aren’t true, when you’re feeling anxious and insecure. Dr. Burns highlights the most common cognitive distortions that trigger anxiety, and discusses the powerful role of shame in anxiety.

In the next several podcasts, Dr. Burns will describe powerful, fast-acting, drug-free treatment methods that can help you defeat every type of anxiety, Including

  • Chronic worrying
  • Phobias
  • Social anxiety
  • Public speaking anxiety
  • Shyness
  • OCD (Obsessive-Compulsive Disorder)
  • PTSD (Post-Traumatic Stress Disorder)
  • Panic attacks
  • Agoraphobia
  • BDD (Body Dysmorphic Disorder)

So stay tuned!