109: David’s Top 10 List!

109: David’s Top 10 List!

A fan named Tanuj asked:

“I’ve heard Dr. Burns mention that he is most proud of a few of the techniques he’s developed, and he mentioned that the Disarming Technique would be near the top of the list. I believe he said there were three or five of them. I was wondering what the others were. Does he have a top 5?”

Thank you, Tanuj. I got to thinking and actually came up with 10. Fabrice and I will briefly discuss each one on today’s podcast. So here they are!

  1. The list of Ten Cognitive Distortions that I created for my first book, Feeling Good: The New Mood Therapy. This list has been reproduced enormous numbers of times in the media and has been translated into more than 30 languages.
  2. The Disarming Technique and Law of Opposites. This means that you can nearly always put the lie to a criticism by finding the truth in it. However, this can be difficult because it requires the death of the ego, or self, the so-called “Great Death” that the Buddhists have emphasized as a key to enlightenment. This method has transformed my clinical practice and personal life and has been very helpful to many of my patients as well. However, it is not easy to learn, in part because it does involve the death of the “self.”
  3. The Externalization of Voices plus Acceptance Paradox. This was one of the first cognitive therapy techniques I developed, and I have used it more than any other technique during my career. It’s totally mind-blowing.
  4. The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow. You can use these techniques to quickly pinpoint the Self-Defeating Beliefs that trigger painful mood swings, such as Perfectionism, Perceived Perfectionism, the Love Addiction, and Brushfire Fallacy, and more.
  5. The Feared Fantasy and Acceptance Paradox. This is a powerful and innovative exposure technique that can help people overcome the fear of being judged or rejected. It can also help people modify Self-Defeating Beliefs like Perfectionism and the Achievement Addiction, and the Approval Addiction.
  6. The Experimental Technique for extremely rapid treatment of patients with Panic Attacks. With this technique, you can sometimes—often—cure Panic Disorder in a single session. But this requires great courage on the part of the therapist and patient, and a great therapeutic alliance with lots of trust.
  7. My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain. In other words, we found that depression probably does NOT result from a deficient of the neurotransmitter, serotonin. Although we published this research in the top psychiatric journal, it was largely ignored for 25 years because people were so hooked on the “chemical imbalance” theory of depression. Now the study has been quoted frequently, and most neuro-scientists no longer give that theory a great deal of credibility.
  8. Brief Mood Survey. I believe I was the first, or one of the first, therapists in the world to require testing of every patient at every treatment session. I started with the Beck Depression Inventory, but have since developed briefer and more accurate scales that patients can complete in the waiting room before and after every sessions. These scales indicate the severity of symptoms such as depression, anxiety, anger, suicidal urges, positive feelings, and relationship satisfaction or conflict. Patients also rate therapist empathy and helpfulness after each session. This simple procedure has revolutionized treatment, because therapists can now see, for the first time, how effective, or ineffective, they are in every single therapy session. The testing has also made data-driven, science-based psychotherapy possible. However, it requires courage on the part of the therapist because the information will often be surprising to the therapist, and disturbing!
  9. Positive Reframing, and all of the new, paradoxical Agenda Setting techniques have made super-high-speed TEAM-CBT treatment methods possible. I now see recovery at speeds I would have thought impossible 20 years ago.
  1. The use of extended, two-hour therapy sessions rather than weekly 50-minute sessions has also been huge. That’s because I often see a complete elimination of symptoms of depression and anxiety in a single extended session of TEAM-CBT, as opposed to months or even years of conventional treatment. Many of my students are reporting similar results. This,  I think, is truly revolutionary!

Well, that’s it. That’s what I’m the most proud of! I suppose I could also include my first book, Feeling Good: The New Mood Therapy, which has sold more than 5 million copies worldwide, and has helped many people recover, as well as the development of TEAM-CBT.
Thank you again for your question, and please accept my apology if I am bragging too much, which can be really offensive. However, my mother once said, “If you don’t toot your own horn, no one else is going to toot it for you,” so hopefully the podcast and write-up will be okay.

David

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Coming Soon!
October / November / December 2018–
Cool Workshops for You!

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Sunday October 28th, 2018 (9 am-4 pm PST)

Live in Palo Alto plus online streaming

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.

Learn from David and Jill–a dynamic teaching duo!

6 CE*s. $135

To register, go to the Feeling Good Institute

or call  650-353-6544

* * *

Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Pasadena, CA

and

November 1-2, 2018–Woodland Hills, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

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TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI

To register, or for more information, call: 800-844-8260

088: Role-Play Techniques —Feared Fantasy Revisited

088: Role-Play Techniques —Feared Fantasy Revisited

088: Feared Fantasy, Part 2, and the Anti-Brushfire Technique*

Hi everybody!

Fabrice and I are thrilled to share this podcast with you, which I think you will really enjoy! We decided to include a second podcast on the Feared Fantasy Technique since it is so dynamic and powerful. We will also demonstrate the “Anti-Brushfire Technique,” which is another useful role-playing technique for individuals who fear disapproval.

We are joined tonight by two members of my weekly Stanford training group for Bay Area mental health professionals, Alisha Beal and Werner Spitzbaden. Both have brought along lists of some of their negative thoughts, which are based on real concerns.

Alisha has just completed our 12-week introductory “newbies” training group in TEAM-CBT. That group will merge with our “advanced” group next week, and she is feeling anxious and insecure for two reasons:

  1. She is concerned that people in the advanced group will think she’s not up to speed, and she’s worried that she will make a fool or herself when she has to practice techniques and get feedback from her colleague or answers questions in the class.
  2. Alisha blushes easily and is concerned that people will think she isn’t very bright and doesn’t know any anything when they see her blushing.

These concerns feel very real, and trigger fairly strong feelings of anxiety! Her negative thoughts included these:

  1. I’ll mess up.
  2. They’ll think I didn’t learn anything.
  3. I’ll blush and they’ll know I don’t know what I’m doing.
  4. I’ll make a fool of myself.
  5. David will realize that he wasted time and people when he created the introductory training group.

Werner’s concerns are similar. He has been in the advanced group for many months and has been doing a tremendous job of learning TEAM-CBT. However, he hasn’t work as a therapist for several years, but has been doing administrative work for a prominent California health delivery system. Werner is excited about the new TEAM-CBT skills he’s been developing, and wants to get back into clinical work. He has just accepted a part time position at the Feeling Good Institute in Mt. View, California.

This is great, but Werner is worried that his therapy skills won’t be good enough, and he’s afraid that the other staff members may judge him. He’s telling himself:

  1. I won’t succeed.
  2. I should know so much more than I do!
  3. I won’t do a good job!!
  4. I’ll develop a bad reputation, and no one will want to work with me.
  5. They’ll judge me and think that I’m not competent.

As you can see, although the details of his situation are quite different from Alisha’s, the underlying fears are similar.

And perhaps you’ve had similar fears and insecurities at times as well! Have you? I know that I’ve often felt that way! And that’s one of the reasons I find the techniques in this podcast so incredibly helpful and fascinating!

As you listen to the podcast, you will see what happens when Alicia and Werner both enter into an Alice and Wonderland Nightmare World where they will confront the monster they fear the most. I think you will find the results interesting, powerful, and entertaining, as they both suddenly achieve what the Buddhists have called “laughing enlightenment” for 2500 years!

* Copyright © 2018 by David D. Burns, MD

 

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.

Some Cool Upcoming Workshops

 

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!

David

 

 

086: Role-Play Techniques (Part 4) — Feared Fantasy

086: Role-Play Techniques (Part 4) — Feared Fantasy

This is the fourth in a series of podcasts on several powerful role-playing techniques we use in TEAM-CBT. Today, we’re going to highlight the Feared Fantasy Technique.

Here, in a nutshell, is why I created this technique. In order to get over any form of anxiety, exposure is absolutely necessary. Exposure is not a complete treatment for anxiety, and is only one of 40 methods I use to treat anxiety, but it always MUST be included in the treatment package.

However, sometimes, people have fears that you cannot easily confront in reality. For example, you may have the hidden fear that others would judge you if they knew how insecure you felt inside, or if you failed at something, or if they were way more successful than you. You can’t just say to someone, “Do you think less of me because I’m actually quite insecure?” They’ll just deny it, and you’ll feel like a nut!

So I created the Feared Fantasy Technique. Essentially, you invite the patient to enter an Alice-in-Wonderland Nightmare World where their worst fear comes true, and where people not only think of you what you most dread, but they also mercilessly tell it to your face. This gives patients the chance to face the monster. In most, if not all cases, they suddenly discover, at the gut level, that the monster has no teeth.

Like the Externalization of Voices, this is a two-person technique, although I’ve sometimes done it with many people in groups. In this case, there can be numerous feared “monsters.”

In the two-person version, you and another person, who could be your therapist, go into the Alice and Wonderland Nightmare World and act out one of your worst fears, such as being rejected by an exceptionally hostile critic because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it because you discover that the monster has no teeth. Your worst fears don’t usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense. You use frequent role-reversals until the monster has been totally crushed.

I am joined in this podcast by our own beloved Dr. Fabrice Nye, and two members of my Tuesday training group at Stanford, Liz Richard, a Licensed Marriage and Family Therapist, and Dr. Rhonda Barovsky, a Forensic / Clinical Psychologist, along with Stephanie James, an LCSW psychotherapist and radio talk show host from Fort Collins, Colorado, who is visiting the group. Liz is a member of the “newbie” TEAM training group at Stanford and agreed to bring a list of her own negative thoughts that trigger her feelings of insecurity in the group. I am grateful to all of them for helping out with this podcast!

Sometimes, when I am helping a patient challenge a Negative Thought, like “I’m a bad mother” or “I’m a failure as a father,” or “my colleagues would look down on me if they knew how screwed up I actually am,” I start with a gentle technique like the Paradoxical Double Standard that we illustrated in the first podcast on role-playing techniques. It’s a gentle technique that would almost never threaten or upset a patient.

Once the patient has totally crushed the thought, I typically move up to the Externalization of Voices. This is a more challenging and powerful technique that provides a deeper level of recovery / enlightenment and allows me to model the differences between the Self-Defense Paradigm vs. the Acceptance Paradox.

Once the patient has knocked the ball out of the park with the Externalization of Voices, I often move up to the Feared Fantasy. This is the most extreme and powerful technique of all. And the moment the patient again defeats his or her most terrifying fear, the impact can be positive and extreme, and often ends in a kind of uncontrollable laughter The Buddhists call this “laughing enlightenment. It often happens the moment you suddenly realize that your worst fear was nothing more than a gigantic cosmic hoax!

You may want to read a brief description of how to use the Feared Fantasy Technique that I created several years ago for my training groups and workshops. At the end, you’ll find a comparison of the Externalization of Voices, Paradoxical Double Standard, and Feared Fantasy, along with a table contrasting the Self-Defense Paradigm with the Acceptance Paradox.

The example I am using in the write-up below is not the example in the podcast, but one I sometimes use in teaching. Often, participants are afraid to do role-playing in front of the group because of thoughts like these:

  1. I’ll probably look foolish and make a fool of myself.
  2. I’ll screw up and fail.
  3. People will judge me and think less of me.
  4. They’ll laugh at me and tell other people about what a loser I am!

It is difficult to confront these fears in reality since people generally don’t have these kinds of negative judgements toward colleagues in the group who are feeling insecure. In addition, if someone did have these kinds of thoughts they would deny having them. But in the Alice-in-Wonderland Nightmare World, people DO have these kinds of thoughts about you, and they DON’T deny them! So, it can be challenging at first to have to confront these kinds of mean-spirited perceptions, and incredibly freeing once you defeat them!

Feared Fantasy*

This is a form of Cognitive Exposure

  • Some fears are not easily confronted in reality

General instructions

Work in dyads. Decide who will play the role of therapist and who will play the role of patient

  • Use the workshop / seminar performance anxiety example

Therapist Instructions

  1. Explain that you’re going to enter an Alice-in-Wonderland Imaginary world where there are two strange rules:
  • If you think people are looking down on you, they really are.
  • Furthermore, they get right up in your face and verbalize all their negative thoughts about you. They aren’t at all nice. They try to humiliate.
  1. Ask the patient which role she or he wants to play first. Explain that you’ll do role-reversals, so the choice is not terribly important.

We’ll assume that you’ve chosen the performance anxiety example, and that you, the therapist, will start out in the role of a rejecting, judgmental audience member or friend. Your patient will play the role of himself or herself.

Now criticize your patient, saying the things that he or she would be afraid to hear, such as:

  • “Hey, I was in the audience when you did that role-play with Dr. Burns. You really looked foolish and I’ve been laughing at you ever since.”
  1. After your patient responds to each attack, ask who won the exchange. If the patient did not “win big,” do a role-reversal and see if you can come up with a more powerful response.

Tips on Defeating the Imaginary Critic

When you’re under attack, try to defeat the imaginary critic

  • You can use Self-Defense, the Acceptance Paradox, or a combination of the two

If the Self-Defense Paradigm was ineffective, try

  • The Acceptance Paradox
  • Or a combination of Acceptance and Self-Defense

If the Acceptance Paradox was ineffective, try

  • The Self-Defense Paradigm
  • Or a combination of Acceptance and Self-Defense

Comparing the Paradoxical Double Standard,
Externalization of Voices and Feared Fantasy*

Technique Patient’s Name Your Name Role-Reversals?
Paradoxical Double Standard His or her real name The name of an imaginary dear friend of the same gender as the patient. Preferably, it is not someone the patient actually knows. No
Externalization of Voices His or her real name Same name as the patient Yes
Feared Fantasy His or her real name You play the role of some judgmental or critical person the patient is afraid of. Yes

 

Comparing the Self-Defense Paradigm with the Acceptance Paradox*

Strategy

General Concept Negative Thought

Example of How to Defeat the NT

Self-Defense Paradigm You defeat the NT by arguing with it and insisting that it’s distorted and not true. A patient who suddenly relapses several weeks after recovery will often have this thought, “This shows that the therapy didn’t work and that I really am a hopeless case.” “That’s ridiculous. I had a fight with my wife last night, so it’s not surprising that I’d be feeling upset. The therapy was very effective, and this would be a good time to pull out the tools I learned and get to work.”
Acceptance
Paradox
You defeat the NT by buying into it and insisting that it is true, but you do this with a sense of humor or inner peace. During a moment of insecurity, a therapist may have the thought, “I’m not as good as I should be.” “As a matter of fact, I still have tons of flaws and a great deal to learn. Even when I’m 85 years old, there will still be tons of room for learning and improving, and that’s kind of exciting.”

The Self-Defense Paradigm is especially helpful for the types of NTs patients have during relapses, and it’s a good idea to prepare them to talk back to these thoughts when they first recover, and before they actually relapse, using the Externalization of Voices.

The Acceptance Paradox is especially helpful for the types of NTs that lead to feelings of worthless, inferiority, or a loss of self-esteem.

* Copyright © 2018 by David D. Burns, MD

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.

Some Cool Upcoming Workshops

Coming in May!

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!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

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!

David