156: Ask David: How can I cope with panic attacks and claustrophobia! What if the entire world thinks you’re not worthwhile?

156: Ask David: How can I cope with panic attacks and claustrophobia! What if the entire world thinks you’re not worthwhile?

Plus, Thomas Szaas, TV Shrinks, and more!

David and Rhonda are joined today by David’s neighbor, friend, and hiking buddy, Dave Fribush. We thank Dave for his support of our podcasts!

We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the “Tiger Monastery” in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery.

Here’s his email: 

Dear David,

Hope you are well. I am now on episode #104 of the podcast and your podcast and books have impacted my life in a big way. I wanted to share a picture with you that I have attached to this email. This picture was taken while trekking up to the “Tiger Monastery” in BHUTAN. It was nine hours of rigorous trekking while I thoroughly enjoyed listening to your podcasts all through the day.



Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us! 

Here are the questions for today’s program:

Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question – I have suffered from panic attacks for years – the past 2 years I’ve become agoraphobic and don’t want to be far away from my house. So, my phobia is now “having panic attacks.” Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying.

Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide.

Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a “study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis.”

I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student’s the results of your research.

Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this?

If a person is worthwhile but the world thinks they are not worthwhile, isn’t this almost as bad as not actually being worthwhile. Don’t we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think?

Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date!

I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours.

Robert also asks: My other question is an idea for future podcasts and it is…How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy.

Some of the Hollywood therapists people know best are:

  • Judd Hirsch as the shrink in Ordinary People
  • Lorraine Bracco as the shrink in The Sopranos
  • Peter Bogdanovich as the shrink’s shrink in The Sopranos
  • Billy Crystal as the shrink in Analyze This!
  • Robin Williams in Good Will Hunting
  • Kelsey Grammer in Frasier

I am sure there are many others. These are the ones who quickly came to mind

I just found an article about this that might help make the case that what the public sees on TV and in the movies is not really reflective of the therapeutic process or good therapy. Here’s the link:


Thanks for tuning in!

David and Rhonda

References for Nathan

Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012.

Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients’ and therapists’ shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 – 643.


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

* * *

You may have missed the Calgary and South San Francisco intensives, but there will be two more awesome workshops
for you this fall.

High-Speed Treatment of Depression
and Anxiety Disorders

A Four-Day TEAM-CBT Advanced Intensive

November 4 – 7, 2019
The Atlanta, Georgia Intensive

Sponsored by Praxis

* * *

I also have a tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with friends, colleagues, and loved ones.

Advanced Empathy Tools for Connecting
with Challenging Patients,
Colleagues, Friends, and Loved Ones

With Drs. David Burns and Jill Levitt

Oct 6, 2019 | 7 CE hours, $135

Do you have a patient, colleague, friend or loved one who:

  • Complains endlessly but doesn’t listen to any of your good advice?
  • Appears irate, but insists s/he isn’t upset?
  • Refuses to express his / her feelings?
  • Never listens?
  • Argues, and always has to be right?
  • Always has to be in control?
  • Is relentlessly critical?
  • “Yes-but’s” when you try to make a point?
  • Insists you don’t really care—or understand—when you think you do?

Then you’re going to LOVE this workshop with David and Jill. You’ll learn about–

  • The Powerful “Law of Opposites”
  • How to find out how your patients really feel about you–if you dare!
  • How to transform therapeutic failure into success
  • How to talk to people who refuse to talk to you

You’ll also learn–

  • Why your worst therapeutic failure is actually your greatest success in disguise
  • The fine points of the Five Secrets of Effective Communication
  • Three Advanced Empathy Techniques: Multiple Choice Empathy, Changing the Focus, and Positive Reframing
  • And more

There will be lots of small group practice with expert feedback and mentoring to help you refine your skills!

Attend in person or
from your home via Live Streaming

Sign up early because we always sell-out for the in-person seats. Of course, there will be lots of skilled trainers to help the online participants with the small group exercises, so you’ll have a great experience either way.

My one-day workshops with Dr. Levitt are usually pretty awesome! It is always an honor to teach with Jill!

Learn More & Register


* * *

Coming up in 2020

High Speed Methods to Reduce Resistance
and Boost Motivation

With Drs. David Burns and Jill Levitt

Feb 9. 2020 |  7 CE hours. $135

Learn More & Register

 The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register


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!