064: Ask David — Quick Cure for Excessive Worrying?

064: Ask David — Quick Cure for Excessive Worrying?

How would you treat excessive worrying?

In today’s podcast, David and Fabrice address a question submitted by a listener from South Africa named Kevin. He asks how David would treat excessive worrying.

David describes a new patient who had struggled with 53 years of failed therapy for excessive, relentless worrying, and describes how she was “totally and irreversibly cured” in just two therapy sessions, which was the “good news.” The Hidden Emotion Technique was the key to her remarkably rapid recovery. David explains that the “even better news” was that her relentless worrying would come back over and over in the future, and that this was actually a really good thing!

Do you know why? Listen to this podcast you’ll find out!

David also emphasizes the importance of using all the four models, along with a Daily Mood Log, when treating any form of anxiety: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. To learn more about how these four powerful treatment models work, you can listen to Podcasts 022 through #028. Their titles are listed here, or you can link to #022, the first anxiety broadcast, by clicking here.

The DSM5 is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is used to assign diagnoses to patients. David critiques the DSM5  diagnostic criteria for “Generalized Anxiety Disorder” (GAD) and emphasizes that while worrying exists, and can easily be treated in most cases, the “mental disorder” called Generalized Anxiety Disorder does not exist, and is simply a fantasy made up by the psychiatrists who have created the DSM.

Soon, David and Fabrice will launch a series of five podcasts on the Five Secrets of Effective Communication, focusing on one technique each week. Say tuned, because these podcasts could change your life and show you the road to more loving and satisfying relationships with friends, patients, colleagues, and family members–and “enemies” as well!

David and Fabrice love your questions so keep them coming!

Fabrice and I hope you enjoy our Podcasts, and also hope you can leave some positive comments for us and some 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.

 

Priceless and Beyond Valuable

Priceless and Beyond Valuable

Hi, Dr. Burns.

This is Mona, I’m writing to you the second time.

Not sure if you can remember my case with hypochondriasis. I was reading the What-If Technique in your book, When Panic Attacks, and did the exercise, starting with my Negative Thought, “I think I have Hepatitis C or HIV.” As you suggested, I asked myself, “If that were true, what’s the worst that could happen? What am I the most afraid of?” You said you could ask this question over and over, and it was a good way to get at the deepest core fears that fuel our anxiety.

It worked really well, and the end result was, “I’m gonna end up being alone and lonely,” which send tears streaming down my face. As a result, I had a conversation about my fear of rejection with my husband sitting next to me that made me feel very relieved.

Now the second very emotional moment came when I was listening to your podcast describing the case of Ralph which was EXACTLY identical to my case. I couldn’t hold back my tears listening to his struggle and couldn’t stop laughing with my tears coming down when you said the good news is that you’re going to experience the same whenever you have a Hidden Emotion.

I just wanted to let you know that these podcasts are all very constructive and I’d recommend them to anyone who is reading either Feeling Good: The New Mood Therapy, or When Panic Attacks. The podcasts really showcase each technique and make the points made in the books crystal clear.

Dr. Burns, I don’t know how to thank you for all these insights and I would like you to know that your contributions are priceless and beyond valuable.

I don’t really believe in God but if you do, God bless you!

Mona

Thank you, Mona! Your email means a great deal to Fabrice and me. We are so happy that people like the Feeling Good Podcasts and find them beneficial! They are fun to do because I really enjoy working with Fabrice, but I hear from many therapists and non-therapists alike who say they really help, and that is what we hoped might happen.

On one of the Sunday hikes, a young therapist who works with children and teenagers told me that he listed to one Podcast per day for 30 days, and this really boosted his understanding of TEAM-CBT. I could see that this was absolutely true, because he has only recently joined my free weekly training group at Stanford, but his psychotherapy skills are simply zooming forward.

Mona, all the very best to you!

David

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

 

044: Can OCD Be Cured?

Can OCD Be Cured? — More Examples of the Hidden Emotion Technique

In this podcast, David describes his treatment of a physician with OCD who was tortured by the fear that he would impulsively throw his newborn baby over the railing of his second-floor apartment. He also describes a psychologist with OCD who washed her hands more than 50 times a day for fear of contamination. In addition, she spent hours every day making sure that nothing in her house was arranged in groups of three—including furniture, table settings, decorative objects, magazines on tables, and so forth. Arrangements in groups of 2 were okay, as were groups of 4, 5 or more objects. Why was she so obsessed?

What were the hidden emotions that fueled these obsessions and compulsions? David and Fabrice will give you the chance to pause the recording on three occasions to jot down your hypotheses before they give you the answers. It won’t be important to get it “right,” but it is highly desirable to take a stab at it.

This podcast will be of interest to you if you or a loved one is struggling with OCD, or any form of anxiety, including phobias, panic attacks, chronic worrying, and so forth. That’s because the hidden emotion phenomenon, or excessive “niceness,” may be a the root of your fears as well. Bringing those feelings to conscious awareness will often lead to sudden relief, or even a complete elimination of your symptoms.

In the next Feeling Good Podcast, David and Fabrice will describe dramatic examples of exposure and response prevention in the treatment of OCD, including a woman who was tortured by the fear that she’d received the wrong baby at the hospital after her first child was born. What causes these bizarre symptoms, and what’s the most effective treatment? Stayed tuned and you’ll find out!

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043: OCD — The Hidden Emotion Technique

Using the Hidden Emotion Technique With Obsessive-Compulsive Disorder

In this podcast, David and Fabrice answer questions on OCD (Obsessive-Compulsive Disorder) submitted by three listeners. Is it an organic illness? Are drugs necessary in the treatment? What’s the best book to read if you want to heal yourself? What’s the prognosis?

Drs. Nye and Burns begin by explaining OCD and answering the questions. David emphasizes the importance of using four treatment models when working with OCD—the cognitive model, the motivational model, the exposure model, and the hidden emotion model if you are hoping for a rapid and complete elimination of symptoms. Treatment that focus on only one treatment method, such as exposure and response prevention, may have only limited success.

He describes his treatment of a medical student named Ralph with classic OCD. Ralph was frequently plagued by the fear he was dying of AIDS; then he’d get so anxious that he’d go to the emergency room and insist on having a blood test for HIV. These always came out negative, and this brought temporary relief, but within a few days Ralph would be worrying about AIDS again and feeling the overwhelming compulsion to get yet another blood test.

The case was especially curious because Ralph was engaged and faithful to his fiancé, so there was no rational reason for him to think he had become infected with the HIV virus. However, he’d tell himself, “Maybe I drew blood on a patient with AIDS and then pricked myself with the needle, and then forgot. And how can I know that this didn’t happen?” This are extremely typical of the kind of obsessions that plague OCD patients. Ralph would torture himself with these thoughts until he succumbed to the urge to get another blood test for AIDS.

Although years of conventional psychotherapy had failed this patient, the Hidden Emotion Technique led to an incredible recovery in just a few minutes during a therapy session. You will find this true story inspiring and amazing! And David provides an even more amazing 40-year follow up report!

In the next Feeling Good Podcast, David and Fabrice will describe more examples of patients with severe OCD who experienced dramatic relief because of David’s Hidden Emotion Technique. This technique can be helpful for all anxiety disorders, and not just OCD. However, David emphasizes that this is just one of many techniques he uses in the treatment of anxious patients. He cautions therapists against thinking three is just ONE best technique for any anxiety disorder, including OCD.

See link to podcast #027: Scared Stiff — The Hidden Emotion Model.

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027: Scared Stiff — The Hidden Emotion Model (Part 5)

027: Scared Stiff — The Hidden Emotion Model (Part 5)

Fabrice launches this Podcast by asking David to remind us about the differences between healthy fear and unhealthy, neurotic anxiety, or an anxiety “disorder” like a phobia, or OCD, and so forth. David explains that negative thoughts, and not events, trigger all our emotions, healthy or unhealthy. However, healthy fear results from negative thoughts that are valid and undistorted, and does not need treatment. For example, if you are walking around Chicago in an area dominated by gangs, you may have the thought, “I could get shot. I better be careful because it’s dangerous here!” Your fear is healthy and can keep you vigilant and alive in a genuinely dangerous situation.

In contrast, neurotic, unhealthy anxiety results from thoughts that contain the same ten cognitive distortions that cause depression, such as All-or-Nothing Thinking, Jumping to Conclusions (e.g. Mind-Reading and Fortune-Telling), Emotional Reasoning, Magnification, Should Statements, and more.

David explains that the Hidden Emotion Model is radically different from CBT, exposure therapy, and most other current treatments for anxiety. The theory behind Hidden Emotion Technique is that “niceness” is the cause of (almost) all anxiety in the United States at this time. In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed to want.

David brings this powerful treatment technique to life with a vignette involving Terry, the woman with ten years of terrifying panic attacks described in previous podcast. When David asked about her very first panic attack, ten years earlier some amazing and illuminating information emerged.

David gives tips on how therapists can use the Hidden Emotion Model,

  1. The hidden emotion or conflict is buried in the present, and not in the past.
  2. It is something very ordinary, such as not liking your job, or your major in college, or a conflict with a friend, family member or colleague.
  3. The anxiety is nearly always a symbolic expression of the feeling or problem the patient is not bringing to conscious awareness. David gives listeners an exercise to see if they can pinpoint the symbolic meaning of Terry’s panic attacks.

Fabrice asks the important question—what do you do when the anxious patient insists that there aren’t any hidden feelings? David explains that most anxious individuals will say that, and describes how to bring the hidden feeling or problem to conscious awareness.

He emphasizes the three things he really likes about the Hidden Emotion Model:

  1. It explains the timing of anxiety attacks, so it has tremendous explanatory power. Freud said that anxiety is the mysterious emotion, that comes out of the blue, and strikes like lightning, without rhyme or reason. David disagrees, and emphasizes that anxiety rarely or never comes from out of the blue.
  2. The Hidden Emotion Model can have powerful and rapid healing effects for patients with every type of anxiety, as well as individuals struggling with hypochondriasis and those who go to medical doctors with complaints of pain, fatigue, or dizziness that does not appear to have a valid medical cause.
  3. The Hidden Emotion Model teaches us that the ultimate cause of most anxiety is the fear of the self, of our emotions and how we genuinely feel as human beings.
  4. The Hidden Emotion Model teaches us that recovery from anxiety does not involve recovery from some “defect” or “mental disorder,” but rather the discovery of what it is like to be human being, with all of our feelings, and that it is okay to have an express those feelings.

Finally, David explains that while this technique traces to the teachings of Freud, Freud might turn over in his grave and find it superficial or silly, since David simply tells anxious patients that they are suppressing or repressing something that’s bothering them, and insists they bring it to conscious awareness right away. David accepts this criticism, but also adds that the Hidden Emotion Technique works and frequently triggers complete recovery with patients who are only partially helped by the skillful use of cognitive techniques and exposure techniques.

However, the “niceness” phenomenon only seems to affect about 75% of anxious patients; sometimes, a phobia is just a phobia, with no hidden feeling or conflict. Those individuals will not be helped by this technique. Fortunately, we have dozens of other powerful techniques that will be curative!

What if the People Around Me are Not Real?

What if the People Around Me are Not Real?

Hi Dr. Burns,

I have read your book, Feeling Good, and now I’m reading your more recent book, When Panic Attacks. I done a Cost-Benefit analysis for one of my negative thoughts and that helped me greatly. I also found some cognitive distortions in my negative thoughts as well.

I have a question. Sometimes I think that the people around me might not be real or are all doing stuff just to keep me happy, almost as if my life is a some kind of a simulation. Iif you watched the movie, ‘Truman Show,’ you will know what I mean!

I especially feel this way when some coincidence in my daily life occurs, like running into a friend who I hadn’t seen for a long time, at some random place, or when I learn that someone else had thoughts that were similar to my thoughts at the same time.

If you have some tips or could share some of your experiences with patients who had similar problems, I would appreciate it!

Sal

Hi Sal,

Thanks for your question! I enjoy answering questions, and hopefully others will be interested as well. However, I cannot safely or ethically give medical advice or treatment in this medium, so my comments will be quite general, and might not apply to you. Remember to consult with a licensed mental health professional or physician in person for any questions concerning your health.

Now that my disclaimer is out of the way, I will try to answer your excellent question. During my psychiatric residency, I learned about two of the more unusual symptoms of anxiety called depersonalization and derealization. Depersonalization is when you get the feeling that you are unreal, and derealization is when you get the feeling that the world is unreal. So it sounds like the feelings you described could just be symptoms of anxiety. And if so, you’re on the right track reading my book, When Panic Attacks, which, as you know, is all about anxiety.

Sometimes anxiety results from the hidden emotion phenomenon I talk about in the book. I don’t know if you’ve read that section yet. That’s when you’re upset about something or someone in your life, but you’re not aware of this due to excessive “niceness,” so you sweep your feelings under the rug, so to speak, and you kind of “forget” about the problem that’s bugging you. Then the feelings come out indirectly, as anxiety. Then you use all your energy ruminating about the anxiety, and don’t take the time to figure out what’s really bothering you.

So I always include the Hidden Emotion Technique in my arsenal when treating someone with anxiety, because it can sometimes be tremendously helpful to pinpoint what the problem is, and then do something about it. Essentially, you think about your life, and the people you know, and the things you’re doing, and ask yourself questions like this:

  • Is there something bothering me that I pushing out of my mind?
  • Am I mad at someone?
  • Do I have some feelings or emotions that I feel like I’m not “supposed” to have?
  • Do I feel tense or uncomfortable about something, or someone, in my life?

Any questions along these lines can help. Usually, the hidden problem or feeling is something recent, not something buried in the past. I have no idea if this is the cause of your symptoms, but it is often a useful tool in understanding and treating anxiety.

I’ve had a Feeling Good Podcast on the Hidden Emotion topic, and you can probably find it easily if you review the podcasts on my website. I’ve got them all organized together there now. I think it was an Ask David podcast on how to deal with an “identity crisis.” In fact, I found it for you, so CLICK HERE if interested.

To listen to a podcast gives an overview of the four models I use in treating anxiety, CLICK HERE.

Also, the most recent Feeling Good Podcasts cover the topic of anxiety, and there is an entire podcast devoted to the Hidden Emotion Technique as well. It is scheduled for Monday, March 13, 2017. I think all the podcasts on the treatment of anxiety might be of interest to you.

Thanks again!

David

Treatment of Hypochondriasis / Health Anxiety

Treatment of Hypochondriasis / Health Anxiety

Hi Dr. Burns,

I have read feeling good and listened to all your podcasts as of today. I have a history of hypochondria and depression and your book helped me tremendously in overcoming my anxiety. I am beyond happy that I can finally have control over my emotions.

I used to go to psychotherapy sessions with multiple different psychotherapists and more often than not the solutions they offered were along the line of “keep as busy as possible not to give in to the thoughts” or “imagine the obsessive thoughts as a spoiled brat that you should not give into” which all failed dramatically. And believe me when I say they even made it worse than before!

Recently I was listening to some your anxiety podcasts in which you introduced the exposure technique. You described how it worked in the case of Pedro, the young man with OCD who was having intrusive thoughts of Jesus having sex with Mary in all the positions of the Kama Sutra. And the harder he tried to control these forbidden thoughts, the more intense they became!

You also described the Experimental Technique you used in your panic attack patients. I was wondering if these techniques can be helpful in the case of patients dealing with health anxiety.

I read a research paper of a psychiatrist treating her hypochondriac patients with exposure techniques. For example, in my case, if I’m always scared of contracting HIV, I might volunteer to work with HIV positive patients so I could confront my fear. I was wondering if that could help with the urge to get tested very often and if there are any other techniques you specifically find useful in this case.

I used the exposure technique successfully to eliminate my frightening thoughts of slitting my wrists or throat with a razor. These thoughts used to give me a tremendous amount of anxiety and I would always try to eliminate them from my mind as soon as they appeared, almost automatically thinking that’s the way to protect myself. That didn’t work! But now they are completely gone as I spent a full half-day just repeating those images in my mind, over and over again. I tried to imagine all the graphic details until I was completely bored with them! I would like to thank you for reaching out and sharing your knowledge and expertise with people despite the fact that you don’t practice anymore.

And by the way that jumping jacks story with your patient who thought she was about to die during a panic attack has become an inside joke between me and my husband!

Sincerely,

Mona

Hi Mona,

Thank you for your kind comments about the Feeling Good podcasts! I know that my host, Fabrice, will be thrilled to hear that you like them and find them helpful!

There are so many things I appreciate about your wonderful email that I’m not sure where to begin. I do want to emphasize that I cannot treat anyone or give medical advice in this medium, so my answer, as always, will consist of general teaching.

First, I resonated when you described previous therapists who gave you advice, thinking that would help. To my way of thinking, an awful lot of “psychotherapy” consists of schmoozing behind closed doors with the occasional piece of advice thrown in, and in most cases, that just doesn’t get the job done. In fact it can make people feel worse, because it is often sounds patronizing.

Second, I have a current series of several Feeling Good podcast on the treatment of anxiety using four models that are all described in my book, When Panic Attacks. They are the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. All four models have tremendous healing power, and I integrate all four into my treatment of each individual with anxiety, because you never know which one, or which combination, will give you the “ah-ha” moment when the anxiety suddenly disappears completely. You can listen to those podcasts right now if you like, either on iTunes or right here on my website, feelinggood.com.

In the treatment of OCD, the Exposure Model usually has two components: Exposure and Response Prevention. So if a person has an irrational fear of HIV, as you described in your email, they could use Cognitive Exposure or Classical Exposure. Cognitive Exposure might involve fantasizing dying of HIV until the fantasy becomes totally boring. Classical Exposure might involve volunteer work with HIV patients, as you mentioned.

In therapy, I work with the patient to figure out what type of Exposure will be the most effective. The Exposure has to be anxiety-provoking, or it won’t be helpful. And, as you say, the goal of exposure is not to control the anxiety—which makes it worse—but simply to flood yourself with the anxiety until it finally loses its power over you.

Response Prevention would mean, in this case, refusing to give in to the urge to get repeated blood tests, if that’s what you are doing to deal with your fear of HIV. But the Response Prevention has to be tailored to your compulsion. Let’s assume that you had OCD with a handwashing compulsion, so you are washing your hands repeatedly all day long to get rid of the imagined “contamination.” Response Prevention would mean refusing to give in to the urge to wash your hands repeatedly. The anxiety will increase for several days, but if you refuse to give in, the compulsion will generally diminish and disappear. This is a bit like drug withdrawal, actually.

But Exposure is just one of four effective treatment models. I treated a medical student with severe OCD who also had the fear of HIV, and Exposure and Response Prevention were only somewhat helpful, and definitely not curative. In his case, the Hidden Emotion Technique ruled the day. If you are interested, you can read about that fantastic technique in my book, When Panic Attacks, and of course, one of the Feeling Good podcasts on anxiety will focus on this technique.

I have treated many patients with health anxiety / hypochondriasis and the Hidden Emotion Technique almost always contributed greatly to their (frequently rapid and complete) recovery. But in therapy, I use more than 75 techniques to help folks—it just isn’t the case that you can have one “formula” that works for everyone, since we are all individuals and our negative thoughts and feelings will be unique—so that requires an individualized approach to treatment, namely TEAM-CBT. (That’s my commercial message!)

All the best,

David

023: Scared Stiff — What Causes Anxiety? What’s the Cure? (Part 2)

In this Podcast, David and Fabrice describe four powerful treatment models for anxiety, including

  • The Cognitive Model
  • The Exposure Model
  • The Motivational Model
  • The Hidden Emotion Model

Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger.  And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover.

Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.

Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever.

Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out!

In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.

021: Ask David — Shameful Sexual Fantasies

In this podcast, David and Fabrice discuss a question posed by a listener with Obsessive-Compulsive Disorder who is plagued with intrusive and shameful sexual fantasies. David discusses his treatment strategies for a young man from Argentina who was struggling with forbidden fantasies of Jesus having sex with the Virgin Mary in all positions of the Kama Sutra, but the harder he tried to control them, the more intense and tantalizing they became. Being a good Catholic lad, he was terrified and tearful he would burn in hell if he didn’t overcome this problem.

If you’ve ever struggled with shameful sexual fantasies, you might be intrigued by this fascinating discussion of Cognitive Flooding, therapeutic resistance, and the Hidden Emotion Technique!