100: The New Micro-Neurosurgery–A Remarkable Interview with Dr. Mark Noble!

100: The New Micro-Neurosurgery–A Remarkable Interview with Dr. Mark Noble!

How Does TEAM-CBT Affect the Brain?

The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest!

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Mark and David at the Cupertino Plaza for a sumptuous dim sum feast at the Joy Luck Palace following a Sunday hike.

Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the “inner universe” Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time.

The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon.

Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective.

Dr. Noble also discusses David’s “fractal” theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the “homeostasis” of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse.

This is because neurons that “fire together wire together.” In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together.

Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well.

Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right.

Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!

You might be interested in some of the comments from individuals who attended the Stanford seminar and heard Dr. Noble’s talk:

  • Mark’s work was wonderful in helping me understand the map of TEAM onto the brain. We’re all micro-neurosurgeons!! Everyone has honorary MDs!
  • Loved the presentation!
  • Mark’s presentation was fascinating! I got really excited about all of the interesting research that could come out of it.
  • I absolutely appreciated Mark’s presentation on his research and how made the connections with TEAM. This was truly very interesting and helpful, and made me realize how fortunate I am to belong to this Tuesday group!
  • Interesting new perspectives brought in by our guest speaker
  • I highly enjoyed Mark’s visit and was captivated by the information! Thank you!
  • Loved learning how frames and filters interact to build experience.
  • AWESOME PRESENTATION! It was wonderful to hear Mark’s presentation. He did an outstanding job and I was extremely fascinated with the information he presented to us. He did a fantastic job in describing brain functioning in relation to TEAM CBT. Loved every minute of it!
  • I loved the concept of fractals in creating the concentrated surge of change into the next “valley” rang true.
  • I resonated with the importance of “storytelling” and the value of a client being heard and respected when the therapist uses the Five Secrets of Effective Communication, and how this induces a sense of the client being equal, and how that can quiet the agitated brain!

David

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Attend my 2018 Summer Intensive in San Francisco!

This year, I am again offering my annual SF summer intensive in August at the South San Francisco Conference Center. This four-day intensive is almost always my most exciting and rewarding workshop of the year.

Here are the details:

David’s TEAM-CBT Summer Intensive

August 6 – 9, 2018, South San Francisco Conference Center, California

For more information, click here, or call IAHB.org at 800-258-8411

Here are just a few of the really cool things about this intensive:

  • You will have the chance to practice techniques in small groups after I demonstrate each technique with a live demonstration in the front of the room.
  • You will get immediate feedback and personal grooming from me and from many of my colleagues from my weekly TEAM-CBT training group at Stanford. They’ll be there to help you, and I’ll be there to help you, too!
  • There will be a live demonstration on the evening of day 1. The amazing Dr. Jill Levitt will be my co-therapist. Last year’s live demonstration, and in fact all of them in recent years, have been jaw-dropping and incredibly inspirational!
  • You’ll get a chance to practice TEAM-CBT in real time the evening of day 3. This will be an incredibly challenging but rewarding “solo flight.”
  • You will be able to do your own personal work on the last day of the workshop using the Externalization of Voices and Acceptance Paradox. In previous workshops, at least 60% of the participants indicated they experienced jubilant enlightenment during this exercise. Their fears and insecurities suddenly vanished!
  • You’ll learn how to do Relapse Prevention Training (RPT).
  • You’ll learn how to improve your empathy skills.
  • You’ll learn tons of powerful cognitive, behavioral, and motivational treatment techniques for depression and all of the anxiety disorders.
  • You will have the abundant opportunities to schmooze with colleagues, network, and have fun.
  • You will have two fabulous free luncheon banquets featuring talks by Sunny Choi, LCSW, who is using TEAM-CBT successfully with an underserved population in primary care with limited resources and language skills (“I must apologize for my success.”), and the wonderful Vandana Aspen, PhD, who will speak on “New Treatment Strategies for Eating Disorders.”)
  • And much more.

If you can only attend one of my workshops this year, the South San Francisco August intensive is the one to attend!

 

078: Five Simple Ways to Boost Your Happiness–#5: You Can CHANGE the Way You FEEL!

Building Self-Esteem and Overcoming Toxic Shame–as well as feelings of depression, anxiety, inferiority, hopelessness, and anger!

Let’s face it–nearly all of us fall into the black hole of depression, anxiety, shame, and self-doubt at times. Then it’s time to ask yourself what you’re telling yourself, write down your negative thoughts, identify the distortions in them, and substitute thoughts that are more positive and realistic. Sound too easy? The results can be mind-blowing!

David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT.

David hopes to make the actual video of this dramatic therapy session available soon right here at www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.)

While listening, you can download pdfs about each of seven steps to help you break out of bad moods and boost your self-esteem:

Step 1. Identify the Upsetting Event

If you click on Melanie’s Daily Mood Log you will see that the Upsetting Event was something seemingly innocuous.

Step 2. Rate Your Negative Feelings

If you click on Melanie’s Daily Mood Log again, you will see how she circled her feelings and rate each type of a feeling on a scale from 0% to 100%. You will see that her negative feelings were actually incredibly intense.

Daily Mood Log with feelings circled and rated

Step 3. Record Your Negative Thoughts

Cognitive therapists, going all the way back to the Greek Stoic philosopher, Epictetus nearly 2,000 years ago, say that we are upset, not by things, or events, but by our thoughts about them. If you click on Melanie’s Daily Mood Log with Negative Thoughts yet again, you will see what she was telling herself about the phone call from the member of her church.

Step 4. Positive Reframing

This is one of the many powerful new features of TEAM-CBT. Before trying to change the way you think and feel, focus on your negative thoughts and feelings one at a time and ask yourself two questions:

  1. What are some benefits, or advantages, of this negative thought or feelings?
  2. What does this negative thought or feeling show about me and my core values that’s positive and awesome?

Briefly stop the recording and review Melanie’s Daily Mood Log. Then see how many positives you can list. For example, what does Melanie’s shame show about her that is awesome and positive? And what are some really beautiful things about her sadness and depression? What are some potential benefits of her anxiety?

Step 5. Identify the Distortions

After the Paradoxical Agenda Setting (in this case, Positive Reframing), I asked Melanie what Negative Thought she wanted to work on first. She selected the second negative thought, “She’ll tell other people who will judge me.” See how many distortions you can find in this thought, using the list of ten distortions on her Daily Mood Log.

When you’re done, you can see how Melanie identified the distortions in this thought, using abbreviations, in the Distortion column of her Daily Mood Log. However, on the podcast, David identified one additional distortion he had overlooked during the live session with Melanie. Can you figure out which one it is?

Step 6. Challenge the Negative Thought

There are more 50 techniques that you can use to challenge a Negative Thought. After listing roughly 17 promising methods during the session, Melanie decided that she wanted to start out with a gentle method called the Paradoxical Double Standard Technique. If you click on Melanie’s Daily Mood Log  again, you can see the Positive Thoughts Melanie came up with to challenge the Negative Thought, “She’ll tell other people who will judge me.” You will also see how strongly she believed them. Remember that the Necessary Condition for Emotional Change is that the Positive Thoughts all have to be 100% true. Rationalizations and half-truths will rarely, if ever, give anyone genuine relief or mood elevation.

Now the question is this: Did the Positive Thoughts reduce Melanie’s belief in the Negative Thought? Remember the Sufficient Condition for emotional change: the Positive Thoughts must drastically reduce the belief in the Negative Thoughts. That’s the whole goal, in fact, of cognitive therapy. Remember, when you change the way you THINK you can change the way you FEEL!

If you click on Melanie’s Daily Mood Log again, you’ll see that her belief in the Negative Thought was, in fact reduced. Sometimes, you will want to reduce your belief in a Negative Thought all the way to zero. But in this case, 35% was sufficient, since some people may, in fact, judge Melanie, although most people probably will not.

Step 7. Outcome: Re-rate Your Negative Feelings

Once you’ve clobbered one negative thoughts, it’s generally much easier to knock the rest of your Negative Thoughts out of the park. This was the case with Melanie. If you review her final Daily Mood Log, you can see how she challenged the rest of her Negative Thoughts and the incredible impact this had on her feelings.

Coming Soon!

Next week we will have something very special and very precious for you–

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

This will be a dramatic and inspiring podcast that Fabrice and I feel very grateful to be able to share with you. The podcast will be based on an actual therapy session with a young woman who is struggling with depression, anxiety, and self-doubt because of fertility issues, due to strong. societal messages that women should have children and should want children. This will be a unique opportunity to go behind closed doors to see TEAM-CBT live and real with someone like yourself who is struggling with intense negative thoughts and feelings.

The live therapy sessions we have published previously–with Mark, who felt like a failure as a father, and with Marilyn, who was confronted by a sudden and totally unexpected horrific diagnosis of Stage 4 lung cancer–received tremendously positive feedback from all of you. Now we are proud to present yet another live therapy session next week! So mark your calendars!

Two Cool Upcoming Workshops for you!

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!

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

Additional Resources for the General Public (all available at Amazon.com, as well as other booksellers)

  • Feeling Good: The New Mood Therapy
  • The Feeling Good Handbook
  • Feeling Good Together
  • When Panic Attacks

General public and mental health professionals might enjoy the recent article about David in Stanford Magazine authored by Robert Strauss entitled “Mind Over Misery.”

Additional Resources for Mental Health Professionals

David’s TEAM-CBT Psychotherapy ebook: Tools, Not Schools, of Therapy

David’s Tuesday evening TEAM-CBT meets at the Behavioral Sciences Building, 401 Quarry Road, Room 2209 from 5:00 to 7:30 PM, and is free. It is open to all SF Bay Area mental health professionals as well as graduate students in any mental health field, including but not limited to Stanford graduate students. There are teachers include:

  • David Burns, MD
  • Helen Yeni-Komshian, MD
  • Jill Levitt, PhD
  • Daniele Levy, PhD

For information, requirements, and consent form, contact our Greeter, Sara Swedorski, saraswedorski@gmail.com.

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

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

 

 

Moved to Tears by Mark’s Live Therapy Podcast / How do You Treat Habits and Addictions?

Moved to Tears by Mark’s Live Therapy Podcast / How do You Treat Habits and Addictions?

Dear David,

I wanted to contact you to tell you how tremendously informative, interesting, moving and inspiring I find your work and your podcasts.

I have listened to all the podcasts—many twice. I find that on the 2nd listening, I pick more up. I get out on my bike and the miles just fly by as I listen to these!

One day my wife returned just as your wonderful episodes with Mark were concluding. As she walked in, I was weeping tears of relief as I also understood (at the same time as Mark did) that my depression and anxiety said something beautiful and awesome about me, rather than only indicating something broken and weak.

I struggled (through the tears) to tell her that these were tears of joy and relief, and not sadness.

Also, I found your book Feeling Good and the Feeling Good Handbook most helpful for my own depression and anxiety. Your wisdom about Action leading to Motivation is something I use every day personally and professionally.

I would be extremely grateful if you could help me with something that has been bothering me professionally for years. I work at the Scottish Government as a personal trainer specializing in eating for weight loss. I have used your own and other CBT based books to help people with stick to weight loss eating plans with some success. But I really get the sense that your TEAM methods might “turbo-charge” the CBT methods.

Can you detail how the paradoxical agenda setting / outcome and process resistance stage might work in eating for weight loss scenarios to help people get (and stay) motivated to stop overeating (even if it’s not a huge overconsumption, just enough to keep them overweight). How can the TEAM approach help them stick to a sensible weight loss plan?

With 35 million people (in the UK alone) in these overweight/obese categories and no signs of a slowdown, I really feel that a large-scale adoption of a “turbo-charged” approach to motivation may help turn this around.

Your very gratefully,

Greg

P.S. I look forward to watching your next live interview on Sunday which I missed this week.

Hi Greg,

Thank you for your thoughtful email and kind comments about the Feeling Good Podcasts, which I will pass along to our “patient,” Mark, and Dr. Jill Levitt, my co-therapist, and my host, Dr. Fabrice Nye. I was inspired and touched by the tears you experienced while listening to the podcast, and I’m so glad you enjoyed the live therapy with Mark!

You asked some questions about the treatment of habits and addictions, such as overeating. The Outcome Resistance issue for habits and addictions is having to give up your greatest, or only, source of pleasure and reward. The Process Resistance issue involves discipline and deprivation. That’s not a very appealing deal, because you have to give up intense and frequent instant gratification in exchange for discipline and deprivation, and this explains why treatment programs are so ineffective.

Incidentally, most treatment programs focus on trying to “help,” as opposed to focusing on why the patient really does not want to give up the habit or addiction. Without a really strong focus on motivation and resistance, nearly all treatment programs will be doomed to failure, or mediocre results at best.

And that’s what you see if you examine the controlled outcome studies that have been published. I am not aware of any really effective treatment program for any habit or addiction. Of course, every approach has advocates, and every approach works for some folks—but I’m talking about controlled outcome studies with an experimental group and a control group, in terms of short-term and long-term results. Most treatments barely outperform placebo treatment, at best.

Of course, the advocates of these approaches do not like to admit this, because they have a heavy intellectual, emotional, or financial commitment to their approach, which might be AA for alcohol misuse, or this or that commercial weight loss program that’s advertised heavily on television. Once your income, ego, or name gets invested in a particular approach, it can be very difficult, or nearly impossible, to let go and look at things objectively and admit that your favorite approach really doesn’t have much merit! Sadly, the needs of market and the needs of science often clash, and in our field, marketing usually wins.

So what do we do in TEAM-CBT? I can only give you some hints about it here, but I’ll take a stab at it and hope for the best.

Recently, several people I’ve hiked with have asked for help with their overeating. One fairly easy approach to learn is called the “Double Paradox,” and I touched on it briefly in last Sunday’s live Q and A on Facebook. You can do it on paper most effectively. First, I ask the person to list all the advantages of eating as much as you like of whatever you like whenever you like.

There are tons of advantages, including:

  • That Cinnabon (or whatever food you love) will taste SO GOOD!
  • I’m entitled to a little treat after a hard and frustrating day at work.
  • That treat will make me feel so good.
  • Eating will help me cope with negative feelings of depression loneliness, frustration, anxiety, boredom, and disappointment.
  • Eating good food is a deeply meaningful social activity with friends and family, and shows my love for others.
  • Good food tastes SO GOOD, and that’s my favorite kind of mint chocolate (or whatever.)
  • Eating is easy and rewarding.
  • Being overweight gives me an excuse to avoid dating and risking rejection.
  • Cooking and preparing wonderful food for my family is a source of great source of pleasure.
  • I’m too old to have to worry about being thin.
  • Why should I have to follow the rules of society? I have the right to be any way I want to be.
  • etc. etc.

Most individuals who are overweight should be able to come up with at least a dozen overwhelming benefits and advantages of overeating.

If the patient cannot or will not do this, then you might as well give up, because you’re already defeated by his or her denial. The fact is, overeating REALLY IS one of the great pleasures in life. You can prime the pump a little by suggesting one or two benefits of overeating, but the patient should do most of the work on this.

Then I ask the patient to list the many disadvantages of diet and exercise. For example:

  • It’s hard to diet.
  • I’ll have to struggle with cravings and temptations.
  • It’s unfair because life is already hard.
  • It’s no fun to go out and jog when it’s cold and rainy.
  • I never get a runner’s high anyway.
  • I hate exercising and I love eating!
  • It’s way more rewarding to watch TV and eat Doritos.
  • Even if I lose weight, I’ll just gain it all back later on anyway.
  • Losing weight is hopeless, so I might as well give up.
  • Other people can eat whatever they want and still be thin. Why should I have to suffer?
  • Etc etc etc.

Most individuals who are overweight should be able to come up with at least a dozen or more overwhelming disadvantages of diet and exercise.

Once we have these lists, I use another technique I’ve created called the Acid Test, which involves saying something like this:

“Gee, Jim (or Mary), given all those tremendous advantages or overeating, and the many powerful and real disadvantages of diet and exercise, it’s not at all clear to me why you’d want to change.”

Now it’s up to the patient to decide that he or she actually does not want to diet and exercise, or that he or she does want to. In most cases, your work will be done. If the patient decides he or she does not want to change, you can just “Sit with Open Hands” and ask if there’s anything he or she does want help with. This requires a therapeutic attitude of “non-attachment,” which is challenging for co-dependent therapists who are addicted to “helping.”

If the patient can convince you that he or she does want to change, in most cases he or she will run with the ball and not require any further help from you. There are tons of ways to diet, and tons of ways to exercise, and it does not make much difference what approach the patient takes if he or she is motivated. In my experience, most will know what approach they want to pursue.

Notice that this approach requires the therapist to become the voice of the patient’s conscious or subconscious resistance, and give up the role of “helper.” Some therapists can learn how to do this; most cannot, due to their own compulsive addiction to throwing “help” at patients.

I do have many more techniques, but this is getting long so let it be an introduction of sorts. Let me know if you liked this blog, and if you want more techniques to combat habits and addictions.

In addition, if you like or decide to use some of these techniques, such as the Double Paradox, the Acid Test, Sitting with Open Hands, and other approaches I have described in my podcasts, blogs, workshops, and books. I always appreciate some acknowledgement that I created them. I say this because sometimes people have taken my ideas and techniques, given them a slightly different name, and claimed them for their own. Quite a few have even started their own schools of therapy, based on one of the techniques I’ve created, without giving me any credit. I find this annoying!

I’m not criticizing you, just blowing off some steam! One of the reasons I always admired Dr. Albert Ellis is that he never did that. He always gave credit where credit was due, and had tremendous integrity. He was, arguably, a bit eccentric, but totally honest!

Thanks again, Greg!

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

Was It Real? Or a Hoax?

Was It Real? Or a Hoax?

At most of my workshops, I do a live demonstration with a volunteer from the audience who has been struggling with feelings of depression, anxiety, or just simply being “not good enough.” That includes nearly all of us, including mental health professionals! I know I’ve felt like that on many occasions.

I’m a firm believer that when you do your own personal work, and heal yourself, you have vastly more to offer your patients. You are no longer just a technician but a healer, and you say this to your patients: “I know how you feel, because I’ve been there myself. And I can show you the way out of the woods, as well!”

That’s why I always include personal work in the training I offer in TEAM-CBT, both at Stanford, and at my workshops around the US and Canada, and on the Sunday hikes as well. Live demonstrations have proven to be one of the most effective and inspiring teaching methods–but they aren’t entirely without controversy.

The main problem is that when I do live demonstrations, I often see  a dramatic reduction in symptoms, or even a complete elimination of symptoms, in a single therapy session lasting approximately two hours. And sometimes, the results are so dramatic that some people in the audience insist that it could not be real.

That’s what happened at my summer intensive in Burlingame, California, this year. A wonderful young woman who we can call “Holly” volunteered for the live demonstration. Although she’d been struggling with intense feelings of anxiety and low self-esteem throughout her entire life, she responded so dramatically that a few people in the audience thought it was a hoax, and that she was a paid actress. I know this because I received some angry comments on the written feedback form that participants filled out at the end of the demonstration. Most people were thrilled and inspired by what they saw, fortunately, but some were clearly not convinced.

Well, now you can judge for yourself. Our “Holly” kindly volunteered to do a brief video describing her experiences at the workshop, and how she’s been feeling ever since. I think you’ll enjoy it, and find her comments to be mesmerizing. The video was shot, unknown to me, by a colleague, Lisa Kelley, who happened to run into Holly a week or two after the workshop.

You can watch the video here. Then afterwards, you can read more below and I’ll show you exactly what happened, step by step, when Jill and I were working with Holly.

 

Some mental health professional are understandably very skeptical about such extremely rapid recovery because most of us have been trained to believe that recovery from depression is an inherently slow process that unfolds only after many years of treatment, or may even require more than a decade of treatment. So when they see an extremely rapid elimination of symptoms, they simply cannot accept it, and feel the need to explain it away. There was a time when I felt this way, too!

In addition, when I was growing up in Phoenix, faith healers often came to town, or appeared on television, doing miraculous healing in front of huge audiences of true believers. But most people realized that these charismatic faith healers in white suites with Bibles in hand were, for the most part, frauds.

My co-therapist for the session at the workshop was Dr. Jill Levitt, who teaches with me at the Tuesday group at Stanford. Jill is a phenomenally skillful and compassionate clinical psychologist, and I always treasure the opportunity to work with her. When we work together, magic seems to happen. I feel very fortunate to teach with Jill and to have her as a colleague. We will be presenting two workshops together this fall at the ABCT conference in San Diego. Here’s the link if you want to check it out!

The before session testing indicated that our “patient,” Holly, was struggling with very significant depression and anxiety, and she said she’d struggled with these painful feelings unsuccessfully for many years. You can see Holly’s scores on the Brief Mood Survey that she completed just before the session began if you click here.

Although her depression score is only moderate, you can see that her feelings of worthlessness and low self-esteem were extreme, and that her feelings of anxiety were quite also intense. In addition, her score on the Positive Feelings test was very low, indicating very few positive feelings about herself and her life.

Jill and I started the TEAM-CBT session with T = Testing. If you click here, you can see the Daily Mood Log that Holly filled out just before the session started. As you can see, Holly was struggling with a myriad of negative feelings and intensely negative thoughts. Holly told us that she’d really always felt like that and had never really felt happy or good about herself, although she usually kept her negative thoughts and feelings hidden. This was especially sad.

At the start of the session, Jill and I empathized (E = Empathy), and we seemed to develop excellent rapport with Holly very quickly. After only about 20 minutes or so, she gave us an “A” on empathy, and said she felt understood and accepted.

Then we went on to A = (Paradoxical) Agenda Setting. The goal is to find out what, if anything, the patient wants help with during the session, and then to melt away his or her resistance to change. Holly said that she wanted to feel better about her life, if possible, so Jill and I used the Magic Button. Essentially, we asked Holly to imagine there was a Magic Button, and if she pressed it, all of her negative thoughts and feelings would instantly disappear, with no effort, and she’d be flooded with feelings of joy.

Would she press it?

Like almost every person I’ve worked with, she said she’d press it immediately!

Then Jill and I said that while we had some fabulous tools to help her, we weren’t convinced it would be such a good idea to press that Magic Button, because we might lose something very valuable at the same time.

Then we introduced a tool that proved exceptionally helpful called Positive Reframing. We asked Holly to list, with our help, two things about each of her negative thoughts and feelings:

  1. What does this negative thought or feeling show about me and my personal values that’s beautiful and positive, or even awesome?
  2. What are some advantages, or benefits, of this negative thought or feeling?

If you like, you can take a look at Holly’s Daily Mood Log and see what you can come up with! Make your own list before you continue reading.

This exercise may be really hard for you at first, because this is not the way we usually think about psychiatric “symptoms!” We don’t usually ask ourselves what’s really GREAT about feelings worthless, or hopeless, or ashamed or enraged. And we don’t usually ask ourselves what’s really wonderful about our own self-critical thoughts, such as “I’m an idiot” or “I’m fat and ugly.”

It was also hard for Holly, but she got into the swing of things pretty quickly, and together, we came up with a pretty impressive Positive Reframing List that you can review by clicking here after you’ve completed your own list.

The idea is that since your negative thoughts and feelings are beneficial, and reflect your core values, it might not be such a good idea to press the Magic Button and make them disappear entirely. To resolve this dilemma, we introduced the idea of the Magic Dial. We explained that since Holly’s negative thoughts and feelings revealed so many awesome things about her, and had helped her tremendously during her life, may she might instead prefer to dial her negative feelings down to some lower level, rather than getting rid of them entirely.

Holly listed her ideal levels for each negative feeling in the “% Goal” column of her Daily Mood Log, as you can see if you click here. Her ideal levels for each feeling were much lower, in the range of 10% to 30% for each feeling.

Essentially, Jill and I have made a “deal” with Holly’s subconscious mind. We’ve said, “We’ll lower them only to these levels.” This also puts Holly in charge of the session, so that we’re not pushing or selling anything, and so that we’re following her agenda. This is one of the most important parts of TEAM-CBT.

The “% Goal” column on the Daily Mood Log is not written in stone, and is actually a kind of illusion. That’s because Holly’s goals for each negative feeling might change once she begins to crush her negative thoughts.

We then went on to the M = Methods phase of the TEAM-CBT session, and helped Holly challenge each of her Negative Thoughts using several powerful techniques, including:

  1. Identify the Distortions
  2. Externalization of Voices
  3. Acceptance Paradox
  4. Self-Defense Paradigm

As it turned out, these techniques were incredibly effective, and her recovery was rapid and, I think it is fair to say, fantastic, and almost immediate. This is why some in the audience found it so hard to accept or believe. What happened, really, was like a miracle.

You can see Holly’s end of session scores on the Brief Mood Survey if you click here. In addition, all of her negative feelings on the Daily Mood Log fell all the way to zero. Holly was more than simply “improved” by the end of the session. I think it is fair to say that she was (and still is) jubilant.

And she now has so much more to bring to her own patients, the troubled teenagers she treats. And that’s why I’m a firm believer that doing your own personal work is vitally important to therapists. Because then, like Holly, you can tell your own patients, “I know what you feel like, because I’ve been there myself, and know what that pain is like. And I can show you the path out of the woods, and what a joy that will be!”

Fortunately, by the end of the four day program, most of the participants had changed their thinking and realized that the live demonstration had been absolutely real. I hope you feel the same way! I was humbled and thrilled to receive a standing ovation, something that only occasionally happens, and something that means a lot to me.

Holly graciously gave me permission to post the video here for you. I hope you have enjoy it!

I am very indebted to Holly for her courageous and deeply meaningful contribution to the workshop, and now you will have a chance to share the joy that she is feeling!

All the best,

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

052: Your Responses to the Live Work with Marilyn — Are People Honest in Their Ratings, and Do the Improvements Stick?

052: Your Responses to the Live Work with Marilyn — Are People Honest in Their Ratings, and Do the Improvements Stick?

The responses to the Marilyn session were extremely positive. At the start of the podcast, Fabrice reads a response from a listener who was moved and inspired by the work Marilyn did.

David and Fabrice discuss two questions commonly raised by people who have seen David’s live demonstrations with individuals experiencing severe depression and anxiety. Since the change in Marilyn’s scores were so fantastic, some skeptical listeners have asked, “Was this real, or was it staged?” Others have asked if patients are simply giving favorable answers on the Brief Mood Survey and Evaluation of Therapy Session forms as a way of being “nice” to the therapist.

David points out that the opposite is true. If patients are in treatment voluntarily, without some kind of hidden agenda such as applying for disability, they tend to be exceptionally honest in the way they fill out the forms. In fact, most therapists find that they get failing grades from nearly every patient on every scale at every session at first. This can be very upsetting, especially to therapists who are narcissistic and defensive about criticism. But if the therapist is humble and open to the feedback, the patient’s feedback on the Brief Mood Survey as well as the Evaluation of Therapy Session forms can provide a fabulous opportunity for growth and learning.

So in short, it is not true that patients fill out the forms just to be “nice” and to please the therapists. The scores are brutally real! If you are a therapist and a doubters, you can give the assessment instruments a try, and I think you’ll be surprised, and perhaps even shocked when you review the data!

Still, David acknowledges that the rapid and phenomenal changes he now sees most of the time when using TEAM-CBT are hard to believe, especially when you’ve been trained to think that recovery is a long, slow process. David discusses a model of brain function proposed by a molecular biologist / geneticist, Dr. Mark Noble, that allows for extremely rapid change.

David and Fabrice also address the question—can these kinds of miraculous results last, or are they only a flash in the pan? David emphasizes the importance of ongoing practice whenever the negative thoughts return. The “one and done” philosophy is not realistic. Part of being human is getting upset during moments of vulnerability, and that’s when you have to pick up the tools and use them again!

David describes experiencing three hours of panic just a few days ago, and Fabrice asks what techniques he used to deal with his own negative feelings, including Identify the Distortions, Examine the Evidence, Reattribution, and the Acceptance Paradox.

David agrees with the Dalai Lama that happiness is one of the goals of life, but emphasizes that it is not realistic to think one can be happy all the time. Fortunately, you can be happy most of the time–but you have to be willing to pick up the tools and use them from time to time when you fall into a black hole!

David and Fabrice

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 Podcast 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

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049: Live Therapy with Marilyn, Part 1, The Dark Night of the Soul

049: Live Therapy with Marilyn, Part 1, The Dark Night of the Soul

You FEEL the Way You THINK! . . . Or Do You?

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)

 

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048: Relapse Prevention Training

Relapse Prevention Training

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:

  1. 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?”
  2. 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.
  3. 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.
  4. 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.

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Learning TEAM-CBT Requires Hard Work — But the Results Can Be Amazing!

Learning TEAM-CBT Requires Hard Work — But the Results Can Be Amazing!

This is a terrific email I received this morning.

Hi Dr. Burns,

I first attended your 2-hour workshop at the Evolution of Psychotherapy Conference in Anaheim in 2013. That got me started!

Then I took your 2-day training on High Speed Trauma Treatment in Pasadena 2015. That got me hooked!

Since January 2017, I’ve listened to your podcasts, each about 4 or 5 times.

I’ve read your Feeling Good Handbook – did all the exercises.

I’ve read your Feeling Good Together – did all the exercises – and my wife is practicing these.

Working through your book, When Panic Attacks, now.

Changed my life! My marriage went from pretty good to perfect! I mean perfect! All the complaints I had about my wife disappeared. She didn’t change anything!!!

What changed?

In my marriage I realized I was creating the problem I was fighting against. Yes, that’s the truth. The Five Secrets showed me my mistakes: 1. Defensiveness 2. Truth 3. Solving the Problem, and others. As a result of the Five Secrets my wife has now become my best friend. I use the Five Secrets at work too and have never felt more confident and relaxed.

My therapy practice continues to change dramatically. Finally, I’ve begun to use the Paradoxical Agenda Setting effectively. This was tough for me to learn. After a few failures, and soul searching, I’m beginning now to truly see and feel the strength and beauty of my clients’ resistance. The energy of our alliance is amazing, and you’re right, when you have that power, it’s a short jump to the elimination of symptoms.

One quick example: An African American woman in 40s had suffered from feelings of inadequacy 100% of the time since she was little. After listing the beauty of her inadequacy, she decided that she was ready to get rid of it. Why? She said it was “a thorn in my flesh.” We used the list of Cognitive Distortions, with positive thought replacement, and the Acceptance Paradox to defeat her feeling of inadequacy.

She realized that she had a choice: Live with trying NOT to be inadequate (“a thorn in my flesh”) or accept feeling inadequate in some things. Upon realizing this, she laughed and said, “I’m not feeling inadequate anymore. Feeling inadequate is normal.” She couldn’t believe it. Her scores on the depression and anxiety tests went to 0, and she left session elated. I also received perfect empathy scores. All of this transformation happened in one (2 hour) session.

I already have 4 or 5 other examples recently.

I am just so grateful to you. You’ve been generous in correspondences as well. You are truly a treasure.

All the best,

Mike

(Case study disguised to protect identity.)

Michael Mikulski, LMFT
Director of MFT Training, Pacific Clinics
Pasadena, CA 91107
mmikulski@pacificclinics.org

Thanks, Mike! You’ve “got it,” so to speak, thanks to your hard work and commitment. That’s what it takes to learn TEAM-CBT! Keep up the fantastic work you are doing! I am so glad that at least some therapists are learning these new methods and bring rapid relief to so many people who are suffering!

Your fantastic email also illustrates the importance of Healing Yourself. If we, the presumed experts, can use our techniques to bring more joy and intimacy into our own lives, then we have credibility, and our status changes from technician to healer. That is one reason why I emphasize the importance of doing personal work in my Tuesday psychotherapy training seminar at Stanford, on my Sunday hikes, and at my workshops. It is, to my way of thinking, an essential ingredient of psychotherapy training.

I also want to thank my esteem podcast host, Dr. Fabrice Nye, for making the Feeling Good Podcasts a reality! We just finished another recording session at noon today and really enjoy bring this information to all of you!

All the best,

David

 

035: Live Session (Mark) — Final Testing, Wrap Up (Part 7)

035: Live Session (Mark) — Final Testing, Wrap Up (Part 7)

Part 7: T = Testing Revisited, Conclusion of the Live Therapy Session with Mark

This is the last live therapy podcast with Mark, the physician who was convinced he was a failure as a father because of his difficulties forming a close, loving relationship with his oldest son. Although the session appeared to go well, we can’t be sure until we see Mark’s end of session mood ratings on the Daily Mood Log and on the Brief Mood Survey and and Evaluation of Therapy Session. David emphasizes that therapists’ perceptions of patients are notoriously inaccurate, but most therapists are unaware of this because they don’t use the rigorous testing procedures at the start and end of sessions.

To review Mark’s partially completed Daily Mood Log, CLICK HERE. Jill and David will ask him to complete the additional negative thoughts on his own after the session.

To review mark’s end of session Brief Mood Survey and Evaluation of Therapy Session, CLICK HERE.

After David review’s the phenomenal changes Mark reported from the start to the end of the session, David asks if the ratings were genuine, or, as some listeners might suspect, faked in order to try to please the therapists. Mark bursts into tears and says, in a choked voice, that it was a life-changing experience.

After the end of the session, David and Fabrice discuss a number of highlights from the work with Mark:

  • The testing indicated a complete or near-complete elimination of symptoms. In 2 ½ hours, Jill and David have essentially completed an entire course of psychotherapy. Although there may still be some work to be done with Mark, the hard part has already been completed.
  • David emphasizes that he now views psychotherapy as a procedure to be done at one sitting, much like surgery, with brief follow-up visits, rather than a long, drawn out procedure meeting once pre week for months or even many years. And although a single 2 or 2 1/2 hour session may be more costly than a traditional 50-minute hour, it can be vastly more cost-effective Than dozens of sessions with little or no progress. In addition, it is vastly better for the patient who walks out feeling good today, rather than having to endure weeks, months, or even many years of traditional talk therapy or antidepressant drug therapy.
  • David and Fabrice talk about the fact that no one is permitted to feel happy all the time, and that Mark’s negative thoughts and feelings WILL return, David defines a “relapse” as one minute or more of feeling lousy. Given that definition, we will ALL relapse forever! But it doesn’t have to be a problem for Mark if he is prepared for this, and knows how to pop out of the relapses quickly, rather than getting stuck in them. This is where Relapse Prevention Training (RPT) becomes so important following the initial dramatic recovery. RPT only takes about 30 minutes and is easy to learn, and will perhaps be the topic for a future Feeling Good Podcast if our listeners express an interest in it.
  • David discusses the difference between an Internal Solution and an External Solution. In this session, David and Jill have guided Mark in the Internal Solution—this means crushing the negative thoughts that triggered Mark’s feelings of unhappiness, anxiety, shame, failure, and anger for years, if not decades. Now that he is feeling so much better about himself, he may want some help with the External Solution. This will involve learning how to develop a more loving relationship with his son using tools like the Relationship Journal and the Five Secrets of Effective Communication. This will be far easier now that Mark is no longer using up all his energy beating up on himself and feeling depressed and inadequate.
  • David wraps up by talking about the true wealth we have as therapists. Although we won’t develop the riches of a Bill Gates doing psychotherapy, we do have the fabulous and precious opportunity to see people as they really are inside, and to witness miracles like the one we saw in the session with Mark.
  • David expresses the hope that listeners have benefitted by listening. Although we are all different, most of us have had the painful experience, like Mark, of believing we were somehow failures, or inferior, or defective, or simply not good enough. We are deeply indebted to Mark’ courage and generosity in giving us the opportunity to see the solution to this ancient and almost universal human problem!

There are many resources for listeners who want to learn more about TEAM-CBT, including:

  • David’s exciting two-day and four-day training workshops, listed on his website, feelinggood.com.
  • Tons of free resources for patients and therapists at feelinggood.com. Please sign up using the widget in the upper right hand corner of any page on his website and you will receive email notifications and links to every post.
  • David’s psychotherapy eBook entitled Tools, Not Schools of Therapy.
  • David’s Tuesday psychotherapy training groups at Stanford, which are co-led Jill Levitt, PhD and Helen Yeni-Komshian, MD. The training is free of charge to Bay Area and northern California therapists. You will have the chance to do free personal work, too!
  • David’s famous Sunday hikes, also free to members of the training groups.
  • Paid online and in-person weekly TEAM-CBT training groups, plus intensive TEAM-CBT treatment programs, at the Feeling Good Institute in Mt. View California.
  • In addition, many TEAM-CBT training and treatment programs are now offered in many cities throughout the US and Canada. For more information, visit feelinggood.com or www.feelinggoodinstitute.com.