Thanks, Shaun! And good luck with whatever career path you pursue!
The externalization of voices using the acceptance paradox and self-defense paradigm podcast was mind blowing! It shows the irrationality of the patients distortions out load, making them seem even more silly.
I’m a big fan of yours. I read Feeling Good, and the Feeling Good Handbook back in high school when I had some anxiety; which was cured then. Now I’m 33 and a cardiac sonographer, but strongly considering, because of you and TEAM-CBT, going back to school to be a clinical psychologist. I stumbled upon your podcasts and failfully been listening since podcast 3. Each one gets better and better. It gets me super excited and eagerly looking foward to one day, doing TEAM Therapy.
I 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 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 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!
You will also leave this workshop with renewed confidence as well as specific, powerful tools that you can use right away to improve your clinical outcomes!
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. Online slots are also limited.
Jill and I hope you can join us!
COMING IN JUNE! One of my best two day workshops ever!
“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates June 4 -5, 2018 Calgary, Canada June 6 – 7, 2018 Winnipeg, Canada Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!
I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!
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
Man from Mars
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 Miracle Cure Question
The Magic Button
During the Positive Reframing, David asks Sarah two things about her negative thoughts and feelings:
What does each negative thought or feeling reveal about you and your core values that is positive and awesome?
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
I’m realistic and honest.
I’m committed to self-care, since I want to have good mental and physical health.
I’m motivated to grow and improve my therapy skills.
I have compassion for my clients and want to give them the best care that I can.
I’m honest about my shortcomings.
I have high standards.
I want to connect with others.
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!
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!
Crushing Negative Thoughts / Resurrection / Relapse Prevention Training
In this third and final podcast featuring live therapy with Marilyn, David and Matt move on to the M = Methods phase of the session along, and encourage Marilyn to challenge the Negative Thoughts on her Daily Mood Log. The use Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and Acceptance Paradox. Marilyn emerges as a powerful partner and begins to crush the negative thoughts that had seemed so real, devastating and overwhelming at the start of the session.
David emphasizes that the perceptions of therapists can often be way off base, so even though Marilyn appeared to change—fairly dramatically—during the session, David, Fabrice, and Matt will not know for sure until they review Marilyn’s end of session mood ratings on the Daily Mood Log as well as the Brief Mood Survey, and Evaluation of Therapy Session.
David defines a relapse as one minute or more of feeling lousy. Given this definition, all human beings will “relapse” frequently, including Marilyn. Relapses nearly always feel demoralizing and painful, but do not have to be devastating, or even long-lived, if the patient is prepared for them. No one is entitled to feel happy all the time, but it is entirely possible to keep our inevitable and occasional trips to the gates of hell rather brief. You will hear David and Matt doing Relapse Prevention Training with Marilyn using a number of techniques, including the Externalization of Voices.
Fabrice, Marilyn, Matt and David discuss the session, and what it meant to Marilyn from a personal and spiritual perspective. You can view this session as a powerful psychological experience—Marilyn described it as a “mind-blowing” experience. You can also see it as a profoundly spiritual experience: the emergence, resurrection, or rebirth from the “Dark Night of the Soul.” And you can ask yourself—did a genuine miracle happen here today?
Matt, Fabrice, and I are deeply indebted to Marilyn for making this phenomenal and intensely personal experience available to all of us. Thank you, Marilyn. We love you!
I want to thank my co-host, Fabrice, for making these podcasts happen! What a joy it is to work with you every week, Fabrice!
I also want to thank you, Matt, for support and friendship over these many years! Matt, as you know, I often sing your praises in my workshops around the country, telling people how amazing you are. Now they will see what I mean first-hand!
I hope that through these three podcasts, Marilyn has touched you and many people. If you were helped by these recordings, please let your friends and colleagues know, so that they might have the chance to “tune in” as well.
In the show notes for the first session with Marilyn, I mentioned the highly controversial theory that our pain usually results from our thoughts, and not from the circumstances of our lives, and put a link to a survey on the home page to see what you thought.
What do you think now? If you are interested, take thirty seconds to indicate your thinking on the survey below. Then we can look at the results of our informal experiment, and see if your thinking has changed.
Note: We’ll publish the raw, uncut version of the complete session separately (iTunes does not seem to distinguish it from the regular podcast episode).
The next three podcasts feature a therapy session with Marilyn, a woman recently diagnosed with Stage 4 (terminal) non-smoker’s lung cancer. We are enormously grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will inspire you, and give you courage in facing losses, traumas and problems in your own life.
At the beginning of the therapy, Marilyn is in shock, experiencing, quite understandably, extreme levels of depression, anxiety, shame, loneliness, hopelessness, and anger. What’s the cause of her negative feelings?
According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel.
When you’re upset, you’ve probably noticed that your mind will usually be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings.
In addition, you may not be aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In fact, in my first book, Feeling Good, I listed the cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events, can be enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel.
But is this notion really true? Can’t traumatic events upset us? And can we really change the way we think and feel when the circumstances of our lives are genuinely awful? Or is this just a lot of pop psychology?
A lot of people don’t buy into the notion only your thoughts can upset you. It just seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers the negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real.
Would you agree? I know that’s what I used to think! If you’re interested, and you have not yet listened to the first Marilyn podcast, you can take the brief poll on the home page and let us know what you think!
The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating. At the end of the third podcast, you’ll have the chance to take the poll again.
In this podcast, Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session. If you’d like, you can review the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative feelings are all severe, and that her negative thoughts focus on several themes, including
Her fears of cancer, pain, and death.
Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, and feeling that she’s perhaps been duped by religions.
Her feelings of incompleteness at never having had a truly loving life partner.
Her intense self-criticisms, beating up on herself for excessive drinking during her life.
The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, where David and Matt will attempt to reduce Marilyn’s resistance and enhance her motivation using the Miracle Cure Question, the Magic Button, the Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, where David and Matt will encourage Marilyn to challenge her negative thoughts using Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and the Acceptance Paradox, followed by Relapse Prevention Training, the end of session testing, and wrap-up.
Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a spiritual person who suddenly finds herself without hope or faith, and totally lost, we have called part one, The Dark Night of the Soul, a concept from William Johnston’s classic book on religious mysticism entitled, The Inner Eye of Love.
We are hopeful these broadcasts will stimulate comments and discussions on the philosophical and spiritual messages embedded in the Marilyn session from you and our other listeners. Is it true that only our thoughts can upset us? And is the total loss of faith a necessary step on the path to enlightenment?
Live Session (Marilyn) — The Dark Night of the Soul (Part 1)
Fabrice reads a question submitted by a reader on how to handle relapses following recovery from depression. David emphasizes the importance of this question, since there is a 100% probably that every patient will relapse following recovery. And if the patient has not been properly prepared, the relapses can be disastrous. But on the other hand, if the patient has been prepared, the relapses do not have to be problematic.
What is a relapse? David defines a relapse as one minute or more of feeling crappy. Given that definition, we all relapse pretty much every day. However, some people can pop out of a bad mood really quickly, while others can get stuck in these “relapses” for weeks, months, or even years.
David describes the Relapse Prevention Training (RPT) techniques he has developed, but cautions that RPT does not make sense until the patient has experienced a complete elimination of symptoms. If the patient is being treated for depression, that means that the score the depression test has fallen all the way to zero (no symptoms whatsoever) and that the patients feel joy and self-esteem.
There are four keys to David’s RPT, including:
The patient must be informed that relapse is an absolute certainty. The question is not “will this patient relapse” but rather, “when will this patient relapse?”
Patients have to know that the therapy technique that worked for them the first time they recovered will always work for them. It might be the Cost-Benefit analysis, Pleasure-Predicting Sheet, Acceptance Paradox, Double Standard Technique, Five Secrets of Effective Communication, Hidden Emotion Technique, or Experimental Technique, or simply recording their negative thoughts on the Daily Mood Log and identifying the distortions in them.
Patients need to identify and modify the Self-Defeating Beliefs (SDBs) that triggered their depression and anxiety in the first place, such as Perfectionism, Perceived Perfectionism, or the Achievement, Love or Approval Addictions. In several previous podcasts, David and Fabrice have described the Uncovering Techniques that can be used to quickly pinpoint any patient’s SDBs.
Patients need to write down and challenge the Negative Thoughts that will inevitably emerge at the time they relapse, such as “This relapse proves I’m hopeless after all,” or “This relapse proves the therapy didn’t work,” etc.
David and Fabrice illustrate step #4 using a powerful technique called Externalization of Voices. David has patients record this role play procedure on a cell phone or other recording device so they can play it and listen if needed during an actual relapse.
David explains that he used this approach with every patient he discharged, and encouraged them all to come back anytime they had a relapse that they couldn’t handle. In spite of having more than 35,000 therapy sessions with individuals with severe depression and anxiety, David says that he can count on two hands the number who every returned for “tune-ups” following termination of therapy, and in most of those cases, the patients were able to recover once again in just or two sessions.
In the next Feeling Good Podcast, David and his highly esteemed colleague, Dr. Matthew May, will begin their live work with Marilyn, a severely depressed colleague who is facing “The Dark Night of the Soul.” Fabrice, as usual, will narrate and elicit enlightening commentaries on the therapeutic strategies that David and Matt are using as the session with Marilyn unfolds.
Podcast 34: Live Therapy Session with Mark: “I’ve been a failure.”
M = Methods (cont’d)
In the last podcast, David and Jill helped Mark challenge one of his negative thoughts, “There must be a defect in my brain that prevents me from developing a loving relationship with my son,” using Identify the distortions and the Paradoxical Double Standard Technique. In this podcast, they continue encouraging mark to challenge his negative thoughts using additional techniques, including the Externalization of Voices, which is arguably the most powerful Cognitive Therapy technique ever created. The goal of the Externalization of Voices is to create genuine and lasting change at the gut level.
Although it is one of the first cognitive Therapy techniques Dr. Burns created, it is rarely used by cognitive therapists in the United States, perhaps because it is so edgy, or perhaps because it is sophisticated and requires a high degree of therapist skill. The Externalization of Voices is often paired with another technique Dr. Burns created called the Acceptance Paradox. The goal of the Acceptance Paradox is a profound and lasting change in the patient’s core beliefs and values, and it sometimes triggers spiritual enlightenment, although it is an entirely secular method.
Jill and David also use the Semantic Method and Re-attribution in this segment, and end with a brief illustration of how Mark might interact differently with his son using the Five Secrets of Effective Communication. David and Jill emphasize that this is the “External Solution,” and that up to this point in the session they’ve been working on the “Internal Solution.”
In the next podcast, Jill and David will return to T = Testing to find out how Mark feels at the end of the session, and how he rates Jill and David for Empathy, Helpfulness, and other measures of the therapeutic relationship. At the end of the session, Dr. Burns asks Mark if the change was real, or simply something fake for the purpose of the podcast. At that point, something stunning happens, which turned out to be the highlight of the entire session. So stay tuned!
And thank you, so much, for your ongoing support of our efforts! We all greatly appreciate your many kind and encouraging comments and emails on our podcasts. That motivates us to work really hard (and joyously) to bring more of this kind of teaching to you!
One quick note. I do not answer messages from Facebook, as I am getting far more than I could ever attend to. Which is great, but sad for me since I don’t want people to feel ignored. The best way to contact me is to make comments at the end end of my blogs, as I often respond to those, or simply to contact me through my website, feelinggood.com.