FEELING GOOD
Posts About Exposure

Feeling Good

Blog
163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more

163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more

Can you treat anxiety without meds?

How do you interpret dreams?

Are negative thoughts cyclical?

How can I get over anxiety when selling?

How does exposure work?

Will you teach on the East Coast again?

Hi! We’ve had tons of great questions from listeners like you. Here’s the first:

Question #1. TREATING ANXIETY WITHOUT MEDICATIONS

Hi Dr. Burns,

I would love to talk to you!!!

I have been going to a wonderful counselor for several years, and he is the one who recommended your book. My question is how can you overcome anxiety without taking medicine?

I have been on a very low dose medicine for years and would love to discontinue but when I try the anxiety seems to come back.

Thank you.

Lisa

Hi Lisa,

Thank you for your email! This is one of my favorite topics, since I’ve personally had at least 17 different anxiety disorders that I’ve had to overcome. That’s why I love treating anxiety. Whatever you’ve had, I can say, “I’ve had that too, and I know how it sucks! And I can put you on the road to recovery, too!”

Did you read When Panic Attacks, or one of the earlier books? The written exercises would be the way to go, I think.

You will find more than 40 methods in that book. Write back if you have questions after reading it. Focus on one specific moment when you are anxious, and do a Daily Mood Log, as illustrated in Chapter 3.

You can also listen to the free Feeling Good Podcasts on anxiety. Go to my website, FeelingGood.com, and click on the Podcast tab. There, you’ll find a list of all the podcasts, with links. In the right hand panel of every page, you’ll find the search function. You can type in “anxiety,” or “social anxiety,” and so forth, and all the relevant podcasts and blogs will pop right up. You can also sign up in that same right-hand panel of every page so you’ll receive all the new podcasts, along with the show notes.

In addition, withdrawal effects are pretty much inevitable when going off of benzodiazepines, if that is the type of medication you are taking. These are the drugs most often prescribed for anxiety, like Valium, Librium, Ativan, Xanax, and so forth. Typically, the withdrawal, which typically involves insomnia and increased anxiety, take several weeks to wear off.

Your medical doctor can guide you in this. I cannot advise you about medications in this forum, so make sure you check with your doctor!

David

Question #2. How can you interpret dreams?

Hello, Dr. Burns.

I am terrified that this may be the most boring question you have ever received, but, I’ll press on none the less.

I often experience very vivid dreams after listening to your podcasts. In fact, I recently dozed off after listening to one of your podcasts on procrastination (#75) and forgot to turn off my phone. In my dream I was in my childhood house and could hear you talking away in some far corner of the house and I was really getting quite annoyed and angry.

I really wanted to find you to tell you to shut up, but I couldn’t get the words out.

When I awoke, podcast #77 was playing, which seems to explain some of my unconscious hostility. I struggle with most of my relationships and don’t really want to deal with all the hard work I have to do to improve them.

So, there you have it!

Thanks for listening to me and all your Herculean efforts on behalf of all those in the struggle to grow.

Mike

Hi Mike,

I explain how dreams function, and give an example with my dream that I had a broken jaw!

Question #3. Are Negative Thoughts cyclical?

David, I have a question about our strong attraction or inclination to negative thoughts.

Are our psychological processes cyclical? People seem to recycle the same negative thoughts for years. Even if we produce a strong alternative thought or reattribution it may not be a default choice the next time. How can we make the alternative/ positive thoughts a conscious choice?

Thanks,

Rajesh

Hi Rajesh:

Negative Thoughts are not cyclical for the most part, but are an inherent part of our human nature. The podcast on fractal psychotherapy might be useful, since the same Negative Thoughts will tend to come back over and over throughout your life. And once you have learned how to combat those thoughts, you can use the same techniques to smash the thoughts whenever they pop back into your mind.

The written exercises I describe in my books, like the Daily Mood Log, are extremely helpful, even mandatory, in building new brain networks and strengthening them through repeated practice.

Bipolar manic-depressive illness is a little different, and it can be quick cyclical. (David will briefly explain this.)

Thanks Rajesh for yet another great question!

david

Question #4. I’m in sales. How do I combat my Negative Thoughts about each person I approach?

Hi David,

I have been struggling with anxiety for the last 18 months and recently faced up to the fact I have also been suffering from depression. And then I discovered your podcasts.

I have been spending a lot of time on the episodes I believe I can benefit from the most. I have found your solutions to be the most beneficial I have come across. Thank you for sharing your ideas and techniques with all of us!

A couple of questions—How would you advise constructing a work day to reduce anxiety? I work in sales and feel anxious before every phone call or visit I encounter, and the anxiety can be for reasons that seem to be related solely to each sales encounter on individual basis! And my anxiety will grow as the day goes on.

My second point would be, would there be a benefit in monitoring positive thoughts and feelings throughout the day, like happiness and hopefulness, rather than negative feelings?

Hi Rudi,

I’ve done a lot of sales work, including door-to-door sales when I was young. When I was 8 years old, I sold show tickets door to door. When I was a teenager, I sold Fiesta Chips, Cosmo’s Cock Roach Power, tick powder for dogs, and For Econoline Vans door to door in Phoenix. So, I feel a soft spot in my heart for everyone involved in sales! In fact, I’m still involved in sales! But these days I’m selling happiness, self-esteem, and intimacy.

I think it could be useful to do a written Daily Mood Log on the anxiety you feel before one of your calls. I think you will find there are certain themes that are common to each call, such as fears of rejection, disapproval, or failure. Once you’ve dealt with these fears successfully, I think they will help in all of your sales encounters. If you send me a partially filled out Daily Mood Log, perhaps Rhonda and I could provide more specific tips on how to crush your Negative Thoughts. If you listen to Rhonda’s work on performance anxiety, you may find it extremely helpful.

In addition, the Five Secrets of Effective Communication are the keys to successful sales. I used to think that you had to sell yourself, or your product, which is rarely true. I learned that the key is to form a warm relationship with your customers. David will explain what he learned from his mother, who sold women’s clothing part-time at a department store in Phoenix.

Thanks, Rudi, I hope to hear more.

Question #4. Why and how does exposure for anxiety work?

Hi Dr. Burns,

I am a big fan and believe that you are the greatest living psychologist of our time. I have seen you in person and hear your recent PESI presentation (link).

Quick question, when exposure is used to get rid of anxiety, what do you think is the mechanism in the brain? It works paradoxically, instead of strengthening a neuro-network it extinguishes it. Any ideas how.

Thanks for your time, and again I have learned so much from you in my over 30-year career, thank you for that also.

Sincerely, Dr. Mark

Hi Dr. Mark,

With your permission, will include this on an upcoming Ask David on my Feeling Good Podcast, but I think you discover a couple things during exposure:

  1. When you stop running away and confront the monster, you discover that the monster has no teeth, so you go into enlightenment. This is the basis of Buddhism and the teachings in the Tibetan book of the dead.
  2. During exposure, you also discover that after a while the anxiety just kind of wears out, dwindles, and disappears. The brain simply cannot continue creating anxiety for prolonged periods of time, especially when you are doing everything you can to make it as intense as possible.
  3. You discover that you can, in fact, endure the anxiety and survive, and that you do not have to “escape” from the feeling of anxiety via avoidance.

One other thing that is important is that I treat anxiety with four models, not one: 1. The Motivational Model; 2. The Hidden Emotion model; 3. The Exposure Model; and 4. The Cognitive Model. All play vitally important and unique roles in the treatment of anxiety. Exposure alone is NOT a treatment for anxiety, just one tool among many that can be helpful, and often incredibly helpful, as you’ll see in the upcoming podcast on the treatment of Sara, a woman struggling with severe OCD for more than 20 years.

Great question! Hope to catch you in one of my upcoming in-person / online workshops!

Thanks, David

Mark’s reply and a brief final question

Hi Dr. Burns,

Yes, of course you have my permission to use my question! Also, I do understand your impressive approach to treatment (not just exposure), and again it is genius. I also love that you see the connection between Buddhism and cognitive restructuring, where as Dr. Beck only went as far back as Socrates and the Greek Stoic philosophers. I don’t know if you ever read the Dhammapada (best translation I found is Eknath Easwaran) as it clearly states that our life is shaped by our mind, and that our feelings follow our thoughts just like a cart follows the ox that pulls it.

Thanks again! Will you be coming to the East coast again soon?

Hi again, Mark,

Yes, I’ll be coming to Atlanta for a four-day intensive in November! Check my workshop tab at www.feelinggood.com for more information. (https://feelinggood.com/workshops/)

david

David D. Burns, M.D. / Rhonda Barovsky, Psy.D.

Subscribe

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. Today’s featured photo is courtesy of Nancy Mueller–www.nancymuellerphotography.com.

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 one more awesome intensive 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 two tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, next year–

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!

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

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.

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register

058: Ask David — Third-Wave Therapies & Exposure for OCD

058: Ask David — Third-Wave Therapies & Exposure for OCD

 

Podcast 58, Ask David

David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn. Marilyn experienced a severe depression relapse eight weeks after her initial session with Matt and David, because of a painful metastasis to her rib cage which frightened and demoralized her. She graciously agreed to come in for a tune-up with David and Matt which will be published as a special podcast within the next week or so. You will not want to miss this session!

David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT. David stresses the difference between specific and non-specific therapeutic techniques. He also discusses the distressing but exciting fact that few or no therapies have proven to be much more effective than placebos in the treatment of depression, and why this is the case.

Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby. David concedes that if he’d thought of using Cognitive Flooding initially, it likely would have been effective. He also argues that Exposure and Response Prevention are not treatments for OCD, or for any anxiety disorder, but are simply tools one can use in treatment. David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. These models are discussed in detail on previous podcasts.

David and Fabrice appreciate your questions, and also encourage you to leave podcasts reviews on iTunes if you like what they are doing, since your reviews will help to popularize the Feeling Good Podcasts!

 

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

Subscribe

042: Shame-Attacking Exercises

042: Shame-Attacking Exercises

Picture 9Making a Fool of Yourself — On Purpose!

In this podcast, David and Fabrice discuss a mind-blowing technique developed by the late Dr. Albert Ellis to help individuals struggling with shyness. It’s called Shame-Attacking Exercises. Essentially, you do something bizarre in public to overcome your fear of making a fool of yourself; and you will probably discover that the world doesn’t come to end. When used skillfully, this method can be incredibly liberating.

However, there are several ethical considerations. First, before therapists can ask their patients to do Shame Attacking Exercises, therapists have to do Shame-Attacking Exercises themselves! David explains his first, terrifying Shame-Attacking Exercise in a Chinese restaurant in New York after giving a talk at a workshop sponsored by Dr. Ellis.

In addition, therapists have to be careful in the way they use Shame Attacking Exercises, and who they use them with. You have to have an excellent therapeutic alliance with your patient, and the patient has to trust you. In addition, the exercises have to be in an appropriate location—for example, it would be disrespectful to do them in a hospital. And you have to be careful that the Shame Attacking Exercises is not aggressive or frightening to other people.

He also describes how Shame-Attacking Exercises helped a man and a woman he treated who were both afraid to flirt with people they were attracted to, and in both cases, he had to push fairly hard since the patients put up stiff resistance to the idea.

TEAM-CBT includes many powerful techniques, and while they have the potential to bring about rapid and often fantastic change, they also have the potential to hurt if not used skillfully and appropriately. Any listeners who are interested in using these techniques should first consult with a mental health professional to make sure the techniques are appropriate and likely to be helpful to you.

All that being said, you will (we hope) LOVE this podcast!

In upcoming podcasts, David and Fabrice will address questions on OCD (Obsessive-Compulsive Disorder) submitted by several listeners. Is OCD an organic illness? Are drugs necessary in the treatment? What’s the prognosis? David will describe powerful, drug-free treatment methods based on the four models he uses to treat all anxiety disorders: the Motivational, Cognitive, Exposure, and Hidden Emotion Models.

Subscribe

An Anxiety Question and a Blessing from Turkey for “David Uncle!”

An Anxiety Question and a Blessing from Turkey for “David Uncle!”

Hi Dr. Burns,

whenpanicattacks-sm  Thank you for your life-saving books and blogs. They really help. I have given your book, When Panic Attacks, to others. It is so good! What I admire the most is your empathy and your desire to seek the truth.

I have a simple request. Can you clarify the use of cognitive flooding and thought-disputing? I find these two methods to be quite useful but confusing at times. For example, it doesn’t seem logical to flood my mind with panic thoughts and then turn around and dispute them. Perhaps morning flooding and evening disputing?

I don’t know that a general answer is possible but any thoughts you have are sincerely appreciated. I understand you do not give personal advice and that if you do answer, it will be for the help of many others who follow your blogs and appreciate your insights.

Bill

Hi Bill, Thanks for your kind comments and question. I am embarrassed that I can’t give you a good clear answer. But I’ll try to babble briefly. Remember that there are four treatment models for anxiety, and I use all four with every anxious patient I treat.

  • The Motivational Model—where you bring the anxious patient’s Outcome and Process Resistance to conscious awareness and melt them away.
  • The Cognitive Model—where you challenge the distorted negative thoughts that trigger the anxiety, using a wide variety of techniques such as Identify the Distortions, Externalization of Voices, the Experimental Technique, and so forth. You call this “thought disputing,” but there are more than 50 ways of disputing and crushing negative thoughts.
  • The Hidden Emotion Model—often the overly “nice” anxious individual is sweeping some feeling, conflict, or problem under the rug and not dealing with it. When the patient brings the problem to conscious awareness and deals with it, the anxiety often disappears completely.
  • The Exposure Model—where you flood yourself with anxiety by facing your fears. If you stick with it, in most case the anxiety will diminish over time and then disappear. You call this “cognitive flooding,” although that’s just one of many exposure techniques.

I describe these four models and methods in my recent series of Feeling Good Podcasts on the treatment of anxiety (Podcasts 22 to 28). You might enjoy listening to them, and can link to the first one if you CLICK HERE. All four treatment methods are helpful, but they work in different ways. You never know which method or methods will be the most helpful to any individual.

But I have to confess I don’t “schedule” them as you have suggested. However, that’s not a bad idea! In my experience, depressed and anxious individuals who work with these techniques, and actually try them, including the written exercises, as opposed to just reading about them, nearly always have the best outcomes. So stick with it!

And of course, if you need help or guidance, it never hurts to check with a mental health professional. However, I would personally tend to avoid a psychiatrist as my first choice, as you are likely to get drugs, drugs, drugs. Although I am a psychiatrist, and have prescribed medications on occasion, I find that most depressed and anxious individuals can now be treated quickly and effectively without medications. In addition, research studies indicate that many people recover from depression anxiety on their own after reading one of my books, but if you need a little guidance from an expert, there’s no shame in that at all! Sometimes, we all need a little help from our friends!

Sincerely,

David

 

Hi Dear David Burns,

feelinggood  Firstly, I want to say thanks a lot for you book, “Feeling Good: the New Mood Therapy”! This book has changed my life! Now I love life and enjoy everything in life.

My story started after reading your book second time! Thanks very much! God bless you David uncle!

Sedef (from Turkey)

Hi Sedef,

Thank you so much for your kind and incredible comments, and for your blessing! I am thrilled that you are now loving life and enjoying life! That is like a miracle and the greatest gift a human being can receive.

It is many years since I wrote Feeling Good as a young man, editing it while we were on summer vacation in California, at Lake Tahoe. You might not have even been alive at that time! It seems like a miracle that my words have now touched you, so many miles away. God bless you, too, Sedef!

All the best,

David Uncle

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!