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083: Role-Play Techniques (Part 1) — Externalization of Voices / Acceptance Paradox

083: Role-Play Techniques (Part 1) — Externalization of Voices / Acceptance Paradox

This is the first several podcasts on the Role-Playing Techniques David has created. They include:

  • Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
  • Paradoxical Double Standard Technique
  • Feared Fantasy
  • Devil’s Advocate
  • Forced Empathy
  • Man from Mars
  • And more

David’s explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique–while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT.

Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and “Sarah,” one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.

Sarah has brought a partially complete Daily Mood Log to the session. The Upsetting Event was that Sarah has decided to move to Austin, Texas in two weeks. She has many moderately strong negative feelings about the move, including sadness (30), anxiety and nervousness (75), inadequacy (60), loneliness (75), self-consciousness, and discouragement (70). She also felt stuck and defeated (70). The numbers in parentheses indicate how strong each type of feeling was on a scale from 0 (not at all) to 100 (extremely.)

Her Negative Thoughts include:

  • “All of my friends are ahead of me in life (careers and relationships).”
  • “I should be further along in my career and I should be 100% certain this is the best career for me in the long term.
  • “For the most part, I haven’t helped most of my clients very much.”
  • “My anxiety over the past year indicates that I’m in the wrong profession.”
  • “I’ll never get back in the great shape, physically and emotionally, that I was in three years ago.”
  • “Moving to California set my life back by a year.”
  • “I won’t be able to make new friends in Austin.”
  • “I will be lonely and without friends.”
  • “I won’t be able to cope with stress.”
  • “My therapy skills aren’t good enough,”

and more.  Her belief in many of her Negative thoughts is quite high, in the range of 70% to 100%. However, her belief in one of them, “Moving to California set my life back by a year,” was only 20%.

Although David did not intend this to be a live therapy session, but rather a practice session to demonstrate how the Externalization of Voices works, David does some brief paradoxical Agenda Setting first, since Sarah’s example is real, and not made up. David uses several techniques to melt away Sarah’s Outcome Resistance, including:

  • The Invitation
  • The Miracle Cure Question
  • The Magic Button
  • Positive Reframing

During the Positive Reframing, David asks Sarah two things about her negative thoughts and feelings:

  1. What does each negative thought or feeling reveal about you and your core values that is positive and awesome?
  2. What are some advantages, or benefits, of each negative thought or feeling?

They come up with a list of ten positives, including these: “My negative thoughts and feelings show that

  1. I’m realistic and honest.
  2. I’m thoughtful.
  3. I’m committed to self-care, since I want to have good mental and physical health.
  4. I’m motivated to grow and improve my therapy skills.
  5. I have compassion for my clients and want to give them the best care that I can.
  6. I’m honest about my shortcomings.
  7. I’m humble.
  8. I have high standards.
  9. I want to connect with others.
  10. I’m committed to my career.

They conclude the Paradoxical Agenda Setting with the Magic Dial. Sarah decides to lower her negative feelings f to much lower levels, in the range of 5% to 15%.

Then, David asks Sarah which Negative Thought she wants to work on first. She chose the thought about never being able to get back into top physical and mental shape again. They identify the many cognitive distortions in the thought, such as All-or-Nothing Thinking, Overgeneralization, Mental Filter, Discounting the Positive, Fortune-Telling, Magnification and Minimization, Emotional Reasoning, Should Statements, and self-Blame.

Then David explains how the Externalization of Voices works, and they launch into the technique. David starts out as the “Negative Sarah,” and attacks her with the Negative Thought she wanted to attack first, using the second-person, “You.” Sarah responds in the role of the “Positive Sarah,” using the first-person, “I.”

Sarah fairly quickly knocks the ball out of the park, and easily crushes the Negative Thought David has attacked her with. Then David attacks Sarah with the rest of her Negative Thoughts, one at a time, doing occasional role-reversals to illustrate different ways to attack the thought. They continue doing role-reversals until Sarah described her victory over each Negative Thought as “huge.”

This only takes a few minutes. Then Sarah re-rates her negative feelings on the Daily Mood Log, and nearly all have been reduced to zero. David cross-examines Sarah to find out if this amazingly rapid and dramatic change was real, or if she was just being “nice” to try to produce a good role-play for David!

Fabrice raps up the podcast with his (as usual) great interview with David and Sarah, bringing out many of the teaching points during the session. He emphasizes that you can actually use many of David’s 50 Methods when doing Externalization of Voices, and points out the power of “Let’s Be Specific” that David demonstrated during the role-playing.

Next week: The Paradoxical Double Standard Technique!

Coming Soon! Advanced, High-Speed TEAM-CBT for the Treatment of Depression and Anxiety 

We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.

  • 6 CE Credits
  • The cost is $135
  • You can join in person or online from wherever you live!

You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!

In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!

You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.

Jill and I hope you can join us!

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

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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.

 

 

082: Neil Sattin Interview — Change your Thoughts, Change Your Life!

082: Neil Sattin Interview — Change your Thoughts, Change Your Life!

In this podcast, David and Fabrice feature David’s recent interview on the topic of “Change your Thoughts, Change Your Life!” The interview was first published on Neil Sattin’s highly regarded Relationship Alive Podcast. Although some of the material may be familiar, there’s much that’s new, and you will enjoy the chemistry between Neil and David as they discuss each of the ten cognitive distortions and raise many challenging questions, such as:

  • Is it really true that only our thoughts–and NOT external events–can change the way we feel?
  • If someone has the belief, “I’m unlovable,” isn’t that type of thought immutable? How could you possibly change or modify a thought that may be rooted in traumatic experiences and so deeply embedded in a patient’s psyche?
  • Should we try to change other people’s cognitive distortions, or just our own?
  • How can we challenge each of the ten cognitive distortions?

And much more!

David’s first interview with Neil received more than 25,000 downloads in the first month, and this riveting interview promises to be every bit as popular. If you want to download a transcript of this exciting interview, you can do so at www.neilsattin.com/feelinggood2.

Coming Soon!

Next week we will begin an exciting series on the powerful role-playing techniques in TEAM-CBT, including

  1. Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
  2. Paradoxical Double Standard Technique
  3. Devil’s Advocate
  4. Forced Empathy
  5. Man from Mars
  6. And more

These episode will feature students and teachers in David’s Tuesday training group at Stanford, so you will get a taste of what an actual Tuesday group is like and see, first hand, how these methods work. They are unique to TEAM-CBT, and most have been created by Dr. Burns. We will also devote one episode to live Shame-Attacking Exercises, featuring the master of Shame Attacking, Dr. Joseph Towery, and we will all be out on the street doing Shame Attacking ourselves.

These episodes will be designed for therapists as well as your patients, and of course also for the general public.

Also Coming Soon!

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

You will LOVE this workshop because you will learn and practice techniques you can use in your clinical practice, but you will also have the chance to do your own personal work! And you will also have the unique opportunity to experience the tag-team teaching of David and Jill working together!

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

Subscribe

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

 

 

080: Ask David: Where Do Negative Thoughts Come From?

080: Ask David: Where Do Negative Thoughts Come From?

“I’m a loser. . . I’m a failure. . . Where do my negative thoughts come from? “

In this podcast, David and Fabrice answer several fascinating questions submitted by listeners:

  1. Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
  2. Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
  3. Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?

Two Cool Upcoming Workshops for you!

March 22 and 23, 2018 Rapid Recovery from Trauma, (David D. Burns, MD) J&K Seminars, Lancaster, Pa 15 CE credits, includes live evening demonstration on the evening of day 1.
You can join in person or online from wherever you live! 

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

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

Subscribe

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

 

 

079: What’s the Secret of a “Meaningful” Life? Live Therapy with Daisy

079: What’s the Secret of a “Meaningful” Life? Live Therapy with Daisy

“I’m a failure. . . I’m not good enough. . . My life will be empty and meaningless without . . . “

Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering.

Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems.

At the time, I did not know who Daisy was, and was not aware that she was living in this area. Now, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.

The focus of the session was a problem that many young couples face–infertility. In spite of heroic, costly, and exhausting efforts to conceive using IVF (in vitro fertilization), Daisy and Zane have still not been blessed with a pregnancy. And Daisy is finding herself between a cognitive rock and a hard place. She is suffering, on the one hand, from intense feelings of failure, shame, and inadequacy because she has not yet become pregnant. But at the same time, she has mixed feelings about having children, and feels that if she can find happiness with children, she will be ostracized by society and seen as some kind of oddball.

Daisy’s scores on the Brief Mood Survey, which she completed just before the session began, indicated mild to moderate depression, severe anxiety, mild anger, and a profound loss of pleasure and satisfaction in her life–indicating an almost complete absence of any strongly positive feelings.

Daisy brought a partially complete Daily Mood Log to the session. The upsetting event she recorded at the top was “four years of infertility; three years of failed treatment. Daisy mentioned that a fifth upcoming trial with IVF was planned in a couple weeks, and that she was feeling intense anxiety. The negative feelings she circled on the Daily Mood Log, plus her intensity estimates, included:

  1. sad, blue, depressed, down, unhappy: 90%
  2. anxious, worried: 100%
  3. ashamed: 70%
  4. inferior, worthless, defective, incompetent: 100%
  5. lonely, alone: 70%
  6. hopeless, discouraged, pessimistic, despairing: 100%
  7. thwarted, defeated: 90%

As you can see, all of these feelings intense. These feelings did not result from the real problem, the infertility, but rather from Daisy’s Negative Thoughts about the problem, including:

  1. My life will be empty and meaningless without children. 90%
  2. People with children live happier and more fulfilling lives. 100%
  3. I am defective and inferior to people who can have children. 70%
  4. I’m missing out on the most important part of life. 100%
  5. If this treatment doesn’t work, my life will be a failure. 80%
  6. I should have done more in my career, given that I don’t have kids. 100%
  7. Without children, there isn’t much to look forward to. 100%
  8. It’s unfair that this treatment doesn’t work for us. 70%
  9. I’m a disappointment to my family. 80%
  10. If I don’t want kids, that means there is something wrong with me. 100

As you listen to the session unfolding, Dr. Burns reviews the T = Testing, followed by E = Empathy. Dr. Burns uses the Five Secrets of Effective Communication to acknowledge Daisy’s tremendous pain, without trying to save, help, or rescue her. Then he uses several Paradoxical Agenda Setting techniques to melt away any potential resistance to change, including the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. She decides she wants to dial down her negative emotions to much lower levels, without necessarily making all of them disappear completely. Then Daisy and David complete the “% Goal” column on the Daily Mood Log, indicating the ideal level for each type of feeling that she hopes to achieve by the end of the session.

  1. sad, blue, depressed, down, unhappy: 90% / 30%
  2. anxious, worried: 100% / 30%
  3. ashamed: 70% / 10%
  4. inferior, worthless, defective, incompetent: 100% / 5%
  5. lonely, alone: 70% / 20%
  6. hopeless, discouraged, pessimistic, despairing: 100% / 40%
  7. thwarted, defeated: 90% / 40%

As you can see, she wanted to reduce some of her feelings dramatically, such as shame, inferiority, and loneliness, and wanted to reduce other feelings moderately, including depression, anxiety, hopelessness, and feeling defeated.

At this point David and Daisy used the Downward Arrow Technique to pinpoint the underlying beliefs that were triggering this problem, starting with a new Negative Thought that popped into Daisy’s mind:

  • If the IVF doesn’t work, we won’t have kids, we won’t have kids coming home for holidays and milestones–it will just be the two of us.
  • Then our lives will be lacking connection.
  • Then our lives won’t be meaningful.
  • Then there would be no purpose in life.

As you can see, these chain of negative thoughts reveals at least two Self-Defeating Beliefs:

  1. A woman must have children to have a purposeful, meaningful, rewarding life.
  2. You must have a meaningful, purposeful life to feel happy and fulfilled.

Then David and Daisy use a variety of M = Methods to help Daisy challenge her negative thoughts, as well as these underlying beliefs, starting with the first negative thought, “My life will be empty and meaningless without children.” The Methods included Identify the Distortions, Examine the Evidence, the Paradoxical Double Standard Technique, the Externalization of Voices with role-reversals, and the Acceptance Paradox as well as the Self-Defense Paradigm.

Fabrice noticed that at one point David switched from the Paradoxical Double Standard to the Acceptance Paradox, and then went back to the Paradoxical Double Standard before switching to the Externalization of Voices for a second chem. David explains his strategy.

At the end of the session, which lasted less than two hours, Daisy was dramatically improved. If you review her completed Daily Mood Log here, you will see that she achieved or exceeded all of her emotion-reduction goals for the session. In addition, her end-of-session scores on the Brief Mood Survey indicated dramatic reductions in depression, anxiety and anger, an a huge boost in Positive Feelings. On the Evaluation of Therapy session, she gave David perfect scores on the Empathy and Helpfulness scales, and indicated what she liked least and most about the session.

What she liked the least: “It took me a while to reveal my ambivalence about having kids.”

Actually, David overlooked this as well until half way through the session, and this did make for a kind of turning point in the session. Things seem to get more immediate and real at that point.

What she liked the best: “I feel completely different–more hopeful, less anxious, and less despairing.”

Fabrice and I are deeply grateful to Daisy and Zane for allowing us to share their story with you. Although the facts of your life are likely to be very different, you may also sometimes feel down or inadequate because you, too, have not measured up to some “requirement” based on messages from society. And perhaps Daisy’s experience can inspire you to break out of your own inner prison as well, believing that you, too, are perhaps inferior, or “not good enough,” because of this or that flaw!

Daisy Follow-Up

The next day, I received this email from Daisy:

Hi David,

I was planning to send you a thank you email, and you beat me to it. Thank you so much for taking the time to work with me on what has been an excruciating situation for years. Both Zane and I are extremely grateful for all the opportunities we have to spend time with you and learn from you. I actually thought it was amazing how quickly you were able to zero in on my ambivalence towards having children as well as the anger I have towards my mom and her expectations. It’s really hard for me to acknowledge either of those things, even to myself, and I thought it was so brilliant how you were able to pull those out so quickly.

There were so many “aha” moments for me last night but a couple really stand out. One was about self-compassion being the most important part of life. The other was about how it makes no sense to judge ourselves as “defective” in a global way. Those insights really hit me at a gut level last night. I’m sure I’ll be drifting out of enlightenment soon and am very grateful for your very generous offer to give me a tune-up, especially as we go through all these treatments again!

I will work on my Daily Mood Log and send it to you later this evening.

Also, many thanks to Fabrice for his insights and for making the recording possible!

Best,

Daisy

Zane Follow-Up

I also received this wonderful email from Zane:

Hi David,

I also wanted to thank you for having us on the show. I really enjoyed hearing your views about what a “meaningful” life means (or doesn’t mean). It was my “aha” moment. I’ve often seen that way of thinking as a slippery slope, but only had a vague sense as to why. Hearing you describe it as a trap really made a lot of sense. Daisy and I were talking it over this morning and the thought occurred to me that meaning could often be defined as having enjoyment or interest (in one’s life or work). Therefore, looking to the world, a relationship, an experience, or a job, or [fill-in the blank] is a hidden should statement (e.g. “My life should be meaningful, and if it’s not, it’s not very good.”). Having this thought or belief kind of takes responsibility to make life fun and interesting off of oneself, and places it on external circumstances or others. Am I understanding this concept correctly?

I’m also grateful for the books and DVD you hooked me up with. And extra-large thanks to Fabrice the “Fab Man” for being the man behind the magic in orchestrating these podcasts!

Zane

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

Subscribe

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

 

 

033: Live Session (Mark) — Methods Phase (Part 5)

033: Live Session (Mark) — Methods Phase (Part 5)

Part 5—M = Methods

 

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Podcast 33: Live Therapy Session with Mark: “I’ve been a failure.”

M = Methods, part 1

So far, the therapy with Mark had focused on

T = Testing: David and Jill review Mark’s feelings at the start of the session

E = Empathy: David and Jill listen and provide empathy as Mark describes his feelings of shame and discouragement because of his failure to develop a loving relationship with his oldest son.

A = (Paradoxical) Agenda Setting: David and Jill find out what, if anything, Mark hopes to get out of this session, which appears to be complete relief from his negative thoughts and feelings. Then the bring his subconscious resistance to change to conscious awareness, and melt it away using the Magic Dial, Positive Reframing, the Acid Test, and the Magic Dial.

In this session, David and Jill began using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%.

Do you know what the necessary and sufficient conditions are for feeling emotionally upset? The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought. And if you review his Daily Mood Log from the last session, you’ll see that Mark does have a high degree of belief in all his negative thoughts. When you’re feeling depressed, anxious, inadequate, or hopeless, I suspect that your mind is also flooded with negative thoughts that seem entirely true to you.

Do you know the necessary and sufficient conditions for emotional change?

The necessary condition is that you can challenge the negative thought with a positive thought that is 100% true. Rationalizations and half-truths will never help anyone, at least not in my experience. But having a valid positive thought is not sufficient for emotional change. For example, Mark could tell himself that he’s a very high powered physician in a world-famous medical center, and that thought would be 100% true. But that thought won’t help Mark because he’ll still believe there’s something defective in his brain that prevents him from having a loving relationship with his son.

The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic.

But how can we challenge Mark’s belief in the NT. Remember, he is incredibly intelligent, and he’s been hooked on this NT for decades. So we can’t just tell him to cheer up, or encourage him to think more positively, or reassure him that his brain is A-Okay. Not only will those simplistic approaches fail, they would likely annoy him because they sound patronizing and might convey the message that’s he’s an idiot for believing something so ridiculous.

Instead, as a TEAM-CBT therapist, I think of 15, 20 or even more powerful and innovative techniques that I can use to gently guide the patient to his or her own discovery that the negative thought is simply not true. That’s what we do during the M = Methods portion of a TEAM-CBT session.

You will listen as David and Jill generate Next, Jill and David generate a Recovery Circle, selecting 16 techniques they could use to help Mark challenge the Negative Thought in the middle of the Recovery Circle. To see the Recovery Circle, CLICK HERE. David and Fabrice discuss the rationale for the Recovery Circle–you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy.

One of the first methods we use is so basic that it is programmed right into the Recovery Circle, and it’s called Identify the Distortions. Fairly early in today’s recording, Jill and David will ask Mark to identify the distortions in his Negative Thought (NT), “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” At that point, Fabrice will ask you to pause the recording and see how many distortions you can identify in the thought. You can write them down on a piece of paper, or simply print the linked PDF and identify them with check marks on the list of 10 cognitive distortions from my book, Feeling Good: The New Mood Therapy. CLICK HERE FOR TEN COGNITIVE DISTORTIONS

After Mark identifies the distortions in his Negative Thought, Jill and David encourage him to challenge it, using a variety of techniques on the Recovery Circle, starting with the Paradoxical Double Standard Technique. This is a gentle technique that is often effective for people who are compassionate. Because this technique seems to be helping,  they ask Mark to record his positive thought in the Daily Mood Log, and to indicate how strongly he believes it. Then you will see that Mark’s belief in the Negative Thought is reduced to zero if you CLICK HERE.

In the next podcast, David and Jill will continue with the Methods portion of the session using additional techniques on the Recovery Circle. This will be a unique opportunity to hear many of these techniques in real time with a real person, as opposed to simply reading about them in a book. So–stay tuned to our Feeling Good Podcasts–and thank you so much for your enthusiastic support!

David, Jill, Mark and Fabrice