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188: How to Crush Negative Thoughts: The Cognitive Distortion Starter Kit!

188: How to Crush Negative Thoughts: The Cognitive Distortion Starter Kit!

This is the first in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions in David’s book, Feeling Good: The New Mood Therapy.

David and Rhonda discuss the amazing positive feedback that Rhonda received following her two recent podcasts doing live personal work. David emphasizes that being open and genuine about your own flaws and insecurities can often lead to far more meaningful relationships with others. This is a paradox, since we often hide our shortcomings, fearing others will judge and reject us if they see how we really feel, and how flawed we are.

David and Rhonda begin the discussion of the Cognitive Distortion Starter Kit with a review the three principles of cognitive therapy:

  1. Our positive and negative feelings do NOT result from what happens in our lives, but rather from our thoughts about what’s happening or what happened.
  2. Depression and anxiety result from distorted, illogical, misleading thoughts. What you’re telling yourself is simply not true. Depression and anxiety are the world’s oldest cons.
  3. When you change the way you THINK, you can change the way you FEEL. This can usually happen rapidly and without drugs.

The first idea goes back at least 2,000 years to the teachings of the Greek Stoic philosophers. Although the idea that our thoughts create all of our feelings is very basic, and enlightening, many people still don’t get it! This even includes lots of therapists who wrongly believe that our feelings result from what’s happening to us!

David describes an innovative “Pepper Shaker” game devised by George Collette, one of his colleagues in Philadelphia to make the hospitalized psychiatric patients aware, through personal experience, that their feelings really do result from their thoughts. The game can be done in a group setting, and is entertaining. Rhonda suggested that the therapists who attend David’s Tuesday training group at Stanford might enjoy this game as well!

There are key differences between healthy and unhealthy negative emotions. Healthy negative feelings, like sadness, remorse, or fear, also result from our thoughts, and not from what is happening to us. However, the negative thoughts that trigger healthy feelings are valid and don’t need to be treated or changed. In contrast, unhealthy negative feelings, like depression, neurotic guilt, or anxiety, always result from distorted negative thoughts.

David and Rhonda briefly describe each of the ten cognitive distortions, with examples. They warn listeners that the goal of these podcasts will be to learn how to change your own distorted thoughts, and not someone else’s. Pointing out the distortions in someone else’s thoughts or statements is obnoxious and will nearly always lead to conflict. David and Rhonda do a humorous role-play to illustrate just how incredibly annoying it is when you try to correct someone else’s distortions, or when someone tries to correct your own distorted thoughts!

David and Rhonda remind listeners to focus on one negative thought from a Daily Mood Log, like “I’m defective” or “my case is hopeless,” and to remember that the thought will typically contain many distortions, and possibly all ten. This means that there will be lots of techniques—often 20 or more—to help you crush the thought.

They also discuss the new idea that you can do Positive Reframing with cognitive distortions as well as negative thoughts and feelings.

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the first distortion, All-or-Nothing Thinking.

David D. Burns, MD / Rhonda Barovsky, PsyD

 

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You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and specializes in TEAM-CBT for depression, anxiety, and relationship problems. She can be reached at rbarovsky@aol.com.

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

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

* * *

This is the cover of my new book, Feeling Great. It will be released in September of 2020, but you will soon be able to pre-order it on Amazon, possibly by the time you read this! 
CoverFeelingGreat1

Need Training or CE Credits?

Check Out these Awesome Upcoming Workshops!

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

Corona Cast 4: I Might Lose My Husband!

Corona Cast 4: I Might Lose My Husband!

David and Rhonda are joined in today’s podcast by Dr. Taylor Chesney, a former student of David’s who is now the head of the Feeling Good Institute of New York City. She is a prominent TEAM-CBT therapist and trainer, and specializes in the treatment of children and teenagers.

Taylor kindly agreed to do some live work today on her panic and despair because of the impact of the pandemic on her family. Her situation is especially challenging and poignant because her husband, Gregg, is a highly esteemed Emergency Room / Intensive Care physician in New York, and he is constantly working to save the lives of Covid-19 victims. Ten days ago he moved to a separate apartment several blocks away so he will not put his wife and children in harm’s way in case he contracts the Covid-19 virus.

But will he, himself, be struck down by this vicious virus? He told Taylor that he recently had to intubate several of his colleagues, which is horrifying. Taylor fears that  she may lose her beloved husband, and that her three children may have to grow up without a father. She also feels overwhelmed because she’s supporting many people now.

David begins with a brief overview of the cognitive model, including several key points:

  1. All negative feelings result from thoughts, and not from what’s actually happening. So even in a crisis that is as real and devastating as the Covid-19 pandemic, all of our emotions will still result from the way we think about it. Remember the teachings of Epictetus 2,000 years ago, when he wrote: “People are disturbed, not by things, but by the views we take of them.”

This is potentially empowering, because we usually cannot change the fact—the pandemic is real and we are powerless to make it disappear—but we may be able to change our perceptions (eg thoughts, or “cognitions”) about what’s happening.

There’s a healthy and an unhealthy version of every kind of negative feeling. For example, healthy fear is not the same as unhealthy anxiety; healthy sadness and grief are not the same as clinical depression; healthy remorse is not the same as neurotic guilt. And so forth. Our goal is not teaching you how to be happy all the time no matter what—that would be absurd—but simply to reduce or eliminate unhealthy negative feelings.

  1. Healthy negative feelings result from valid negative thoughts, and do not have to be “treated.” Unhealthy negative feelings, in contrast, result from negative thoughts that are distorted and illogical. David reminds us that even in a crisis, depression and anxiety are still the world’s oldest cons, and that you CAN change the way you feel.

But is this possible? It just doesn’t sound right! Can Taylor really change the way she thinks and feels when the crisis is so overwhelming and so real? And can you?

As the session unfolds, Taylor tearfully describes her intense fears for her husband, who she loves so greatly, as well as their three young children. She says that 75% of the time, she’s “okay,” when she’s awake and involved with caring for her kids, but 25% of the time—especially late at night when she’s alone with the kids—things get pretty desperate, and sobs for 30 minutes or more while experiencing “sheer terror.”

What’s making the situation more painful is that Gregg is temporarily living six blocks away in order to protect his family in the event he does contract the potentially deadly virus. Taylor says that “it feels like we’re kicking him out. He’s at war. He’s fighting, struggling, suffering.” She says he’s passionate about his work, but she wishes he’d quit!

Take a look at Taylor’s  Daily Mood Log at the start of the session. As you can see, she is focusing on how she is feeling every night before going to sleep. She circled seven different categories of negative feelings, and all are intense, including the depression, anxiety and frustration clusters (all are 100%), the lonely and hopeless categories (both 90%), as well as feeling “bad” (50%.)

You can also see the negative thoughts she recorded. She is telling herself that:

Negative Thoughts % Now
1.      I shouldn’t have to do this alone. 90
2.      I can’t handle parenting alone. 70
3.      I shouldn’t burden Gregg with my feelings. 70
4.      I shouldn’t share my feelings. 50
5.      I should be strong and tough. 80
6.      I’ll let my patients down if I don’t have enough time for them. 50
7.      I’ll lose Gregg. 50 – 100
8.      I shouldn’t have to do this. 100
9.      I should be able to work and support my family while Gregg stays at home safely. 50

You can also see that her belief in these thoughts varied from 50% to 100%.

After empathizing for 30 minutes, Rhonda and David asked about her goals for the session, which would be to turn down the intensity of her negative feelings. Together, Rhonda, Taylor and David do Positive Reframing, asking two questions about each negative thought and feeling:

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

Together, they generate an impressive list of Positives. Then Taylor decides she can use the Magic Dial and reduce her negative feelings, while not eliminating them completely, as you can see at this link.

Then they use a variety of techniques to challenge each negative thought, staring with #4, “I shouldn’t share my feelings.” Taylor identifies many distortions in this thought, including Should Statement, Emotional Reasoning, Mind-Reading, Self-Blame, and Mental Filter.

Taylor decides to think about it like this instead:

“It’s okay to share my feelings. It could bring us closer together. It’s human to be struggling, given the circumstances. My feelings matter to Gregg.”

She believes this Positive Thought 100%, and her belief in the Negative Thought fell to 5%, which was enough, since there was a little truth in the thought. You might have to be thoughtful about the timing of self-disclosure.

Rhonda and David continue to challenge the rest of Taylor’s Negative Thoughts, using a variety of techniques such as the Externalization of Voices, Acceptance Paradox, Paradoxical Double Standard Technique, and more. The most challenging Negative Thought was #7—her fear that Gregg might die.

At the end of the session Taylor recorded a substantial reduction in her negative feelings.

Thanks for tuning in, and please let us know what you thought about today’s program!

Rhonda, Taylor, and David

Taylor Chesney, PsyD is Director of Treatment and Training,  Feeling Good Institute-NYC,

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

* * *

IMPORTANT ANNOUNCEMENT

FREE TEAM THERAPY FOR HEALTHCARE WORKERS

Health care workers face incredibly challenging times, having to fight a potentially fatal epidemic without adequate supplies or protection. The TEAM therapy community is now offering free TEAM-CBT treatment for 100 health care workers in Bay Area, California counties. For more information, please go to the website:  Feelinggood.foundation.

* * *

This is the cover of my new book, Feeling Great. It will be released in September of 2020, but you will soon be able to pre-order it on Amazon, possibly by the time you read this! 
CoverFeelingGreat1

Need Training or CE Credits?

Check Out these Awesome Upcoming Workshops!

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

Corona Cast 3: Quieting Conflict / Boosting Love

Corona Cast 3: Quieting Conflict / Boosting Love

My mother won’t follow my advice!

David and Rhonda are joined in today’s podcast by Alex Clarke, MD, a former student of David’s who is practicing TEAM therapy at the Feeling Good Institute in Mountain View, California, and by Zeina Halim, a TEAM therapist and student in David’s Tuesday Stanford psychotherapy training group.

In our last two podcasts (Corona Cast 1 and 2) (links) we focused on the impact of the corona crisis on internal feelings like depression, anxiety, panic, hopelessness, and so forth. In this week’s Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example. Zeina was concerned that her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother might get the virus and die.

However, Zeina’s mother is very self-reliant and independent, and didn’t take kindly to Zeina’s frequent reminders to do this or do that so as to be safe. They ended up arguing and feeling frustrated with each other.

Perhaps you’ve also run into problems with friends and loved ones because of the corona crisis. When people get confined into close quarters, under conditions of intense stress and uncertainty, clashes are almost inevitable.

When you’re angry with someone , you’ll nearly always be viewing the other person in a distorted way. For example, you may be telling yourself that s/he “should” not think, feel or behave the way he or she is thinking, feeling, or behaving. Of course, this is a classic other-directed “should statement.”

Or you may be telling yourself that the other person is being “stubborn” or “unreasonable” (Labeling; Mind-Reading). Or you may tell yourself that you’re right and the other person is wrong (All-or-Nothing Thinking; Blame). And in most cases, you’ll be telling yourself that the conflict is the other person’s fault and that you’re the innocent victim of his or her bad behavior (Blame.)

These are just a few of the cognitive distortions (link) that fuel conflict. But it’s these distorted thoughts, and NOT what the other person is thinking, feeling, or saying, that actually causes your negative feelings. You are making yourself angry–the other person is NOT causing your anger or frustration! You are creating these feelings. And the thoughts that trigger these feeling are wrong thoughts.

This can be a VERY hard pill to swallow. You, and not the person you’re mad at, are triggering your feelings of frustration and anger. In addition, the thoughts that upset you are not valid. They’re distorted, and just plain WRONG.

If you don’t like this message, you might want to stop reading! I get it! It is SO MUCH more rewarding to blame the other person!

In today’s podcast, we discuss and illustrate a sophisticated TEAM-CBT technique called “Forced Empathy” (link). Forced Empathy forces you see things from the perspective of someone you’re at odds with. It will ONLY be effective if you want a closer relationship with the person you’re at odds with. If you want to remain in battle–as most people do–then you’re welcome to do that. Go for it.

If, in contrast, you do want to feel closer and more loving, Forced Empathy can lead to a helpful shift in how you think about the person you’re angry with. When you suddenly see things through the eyes of the person you’re angry with, you may suddenly discover that your thoughts about the other person’s motives were not correct.

Alex and David describe how the technique works in a step-by-step way, and then illustrate it with a role-play between Zeina and her mother. This is a recreation of the technique they used live in the Stanford Tuesday group a couple weeks before the recording.

Forced Empathy proved to be extraordinarily helpful to Zeina, and brought tears to her eyes. Once she saw things from her mother’s perspective, the tone of their interactions suddenly softened, and the tension was replaced by feelings of love and acceptance.

Zeina was surprised to discover that, among other things, her mother, while not wanting to die, had no fear of death, but didn’t appreciate being constantly told what to do, or what not to do, and that she loved and admired Zeina tremendously.

Zeina also discovered that in the highly unlikely event that her mother did die, she would want to spend her last days or weeks with her Zeina, feeling close, and loving one another, instead of arguing.

Is this relevant to you and your friends and loved ones? In today’s podcast, we talk about how you can improve your relationships with friends and loved ones during these challenging times using the Five Secrets of Effective Communication.

We emphasized one of the important take home messages in podcast 164 on “How to Help, and How NOT to Help.” Sometimes, people just want someone to care about them and listen, without having someone trying to help them or give them advice. Learning to do this can be incredibly freeing, but it’s not easy, because so many of us are addicted to “helping.”

If you want some additional help, check out David’s book, Feeling Good Together which you can purchase inexpensively on amazon.

Thanks for tuning in, and let us know what you thought about today’s program!

Until next time,

Rhonda, Alex, Zeina, and David

Dr. Alex Clarke specializes in TEAM-CBT, and can be reached at alex@clarkemd.com.  Zeina Halim, MA, AMFT specializes in the treatment of TEAM-CBT executives wanting to boost performance, as well as anyone aged 16 or older struggling with depression or anxiety. She can be reached at zeinahalimtherapy@gmail.com. She is supervised and employed by Matthew May, MD.

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and specializes in TEAM-CBT for depression, anxiety, and relationship problems. She can be reached at rbarovsky@aol.com.

Today’s featured photo of Zeina is courtesy of Nancy Mueller photograpy in Los Altos California.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

* * *

IMPORTANT ANNOUNCEMENT

FREE TEAM THERAPY FOR HEALTHCARE WORKERS

Health care workers face incredibly challenging times, having to fight a potentially fatal epidemic without adequate supplies or protection. The TEAM therapy community is now offering free TEAM-CBT treatment for 100 health care workers in San Mateo and Santa Clara counties. For more information, please contact the Feeling Good Foundation.

* * *

This is the cover of my new book, Feeling Great. It will be released in September of 2020, but you will soon be able to pre-order it on Amazon, possibly by the time you read this! 
CoverFeelingGreat1

Need Training or CE Credits?

Check Out these Awesome Upcoming Workshops!

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

184: Ask David: What Comes First? Negative Thoughts or Feelings? Solving the Chicken vs. the Egg Problem, and More!

184: Ask David: What Comes First? Negative Thoughts or Feelings? Solving the Chicken vs. the Egg Problem, and More!

Today, Rhonda and David answer several challenging questions submitted by listeners like you.

  1. What schools of therapy are embedded in TEAM?
  2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?
  3. “Can TEAM-CBT help bipolar patients during the depressed phase?”
  4. How do you make Externalization of Voices work? I get stuck! For example, my patient said, “It’s unfair that I cannot get a job!”
  5. Is there a cure for OCD?

1. What schools of therapy are embedded in TEAM?

Dear Dr. Burns,

I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy “integrates features and techniques from more than a dozen schools of therapy.” I’m aware of many of the CBT techniques you use, but I don’t think I’ve read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques?

Madelen

Hi Madelen,

This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy.

Here are some of the schools of therapy that I draw upon TEAM-CBT.

      1. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic)
      2. Flooding / Experimental technique: behavior therapy (exposure)
      3. Externalization of Voices: Gestalt / Psychodrama / Buddhism
      4. Acceptance Paradox: Buddhism
      5. Self-Defense Paradigm: REBT
      6. CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques
      7. Identify the distortions / examine the evidence: cognitive therapy
      8. Empathy: Rogerian (humanistic) therapy
      9. Five Secrets / Forced Empathy: Interpersonal therapy
      10. Shame-Attacking Exercises: Humor-based therapy / Buddhism
      11. Be Specific / Let’s Define Terms: Semantic
      12. Feared Fantasy: Role-Playing / Psychodrama / Exposure
      13. One-Minute Drill / Relationship Probe: Couple’s Therapy
      14. Time Projection / Memory Rescripting: Hypnotherapy
      15. Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy)
      16. Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy
      17. Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior
      18. Storytelling: indirect hypnosis.
      19. Positive Reframing: Paradoxical psychotherapy.
      20. Hidden emotion technique: psychoanalytic / psychodynamic
  1. Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David

2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?

Hello Dr Burns,

I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist.

I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example?

Thank you very much!

Audrey

Hi Audrey,

Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like “I’m a loser” or “my case is hopeless.” My research, which I’ll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey.

david 

3. “Can TEAM-CBT help bipolar patients during the depressed phase?”

Name: Sarah

Comment: Hi, Dr. Burns.

I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts.

I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before.

My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes.

For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness.

In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease?

In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do?

I would love to hear your take on it. Thank you so much for your endless work helping people to feel good!

Sarah

David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment.

4. Externalization of Voices: How do you make it work? I get stuck! “It’s unfair that I cannot get a job!”

Dear Dr Burns and Rhonda,

I’ve just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes.

I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can’t find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts.

I have a question about Externalization of Voices. In all of the examples you’ve shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to “win huge”. I’m less experienced and find I’m not batting 1000. What do you do when neither you nor the patient have been able to win huge?

Many thanks again for all you do,

Calvin

PS The episode on How to Help and How Not to Help was one of the best yet!

Hi Calvin,

Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with?

All the best,

David D. Burns, M.D.

Hi David,

There have been a couple of examples where we could only get a small win.

With the first patient, the thought he was tackling was: “It’s not fair that I’ve worked so hard in life, but I can’t get a job.”

I tried modelling self-defense, along the lines of “I’ve accomplished a lot given how many challenges I’ve faced.” I also tried suggesting the Acceptance Paradox with something like: “It’s true that life’s not fair. Who said it should be fair?” This was only a ‘small win.’ I felt stuck.

Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was “I’m going to be chronically tired and no longer able to enjoy life the way I used to.” We tried: “Sure, I may be more tired than I used to be, but I’ll still be able to enjoy life to some extent.” Again, this was a small win, not enough to crush it.

Thanks again for your willingness to help!

Calvin

David’s response

Hi Calvin,

All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.”

Let’s focus on the first thought, “It’s not fair that I’ve worked so hard in life, but I can’t get a job.”

This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts.

When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well.

The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth.

This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.)

You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job.

If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy.

Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques.

When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome?

For example,

      1. My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense.
      2. The sadness shows my passion for life, for work, and for being productive.
      3. My anger shows that I have a moral compass and value fairness.
      4. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve.
      5. My anxiety, in other words, is a form of self-love.
      6. My anger shows self-respect, since I have a lot to offer and contribute.
      7. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed.

This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up.

Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear.

Then you resolve the patient’s dilemma with the Magic Dial.

All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices.

If you do this skillfully, the Ext of Voices will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too!

If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all!

Not sure how much training you’ve had in TEAM. Rhonda and I can discuss these two examples when she returns from India in a month or so, but there are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance.

There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy.

Thanks!

David

5. Is there a cure for OCD?

Hi Dr. Burns,

I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counselling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too.

I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives?

Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy.

I know you do not reply to personal messages but would really be grateful if you could reply to this mail

Looking forward to hearing from you

Regards

“Betsy”

In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story plus lots of additional great resources on OCD, including podcasts 43 – 45 (this page provides links to all the podcasts), and more.

Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety.

Thanks for listening today, and thanks for all the kind comments and totally awesome questions!

David and Rhonda

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You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Level 4 Certified TEAM-CBT Therapist and Trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems.

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

 

Coming up in 2020

I will present two workshops at the upcoming

Psychotherapy Networker Conference!

Saturday, March 21, 2020
Feeling Great—A New, High-Speed
Treatment for Depression

Sunday, March 22, 2020
Overcoming Magical Thinking with the Anxious Client—
A Paradoxical Approach

Plus, my new book, Feeling Great,
will be officially announced with banners and such!

CoverFeelingGreat1

* * *

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

Move rapidly if you want to come. We are already SOLD OUT in person, but there are still slots available online.

There will be many helpers from the Feeling Good Institute to assist and guide you in the small group exercises in person and online as well.  Our last workshop on resistance in February was our most highly rated ever! We hope to make this a terrific and fun learning experience for you, too!

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135 (online only)

Learn More & Register

* * *

2-Day Clinical Master Class

Rapid Recovery from Anxiety Disorders–
GAD, Phobias, Panic Attacks, Social Anxiety,
OCD, PTSD and Health Anxiety

by David D. Burns, MD

June 4 – 5, 2020, Seattle, Washington

* * *

The All-New Annual South San Francisco Intensive!

Enhanced Empathy Training

August 10 – 13, 2020

It’s Going to Be Awesome!

Videos, Live Demonstrations

Small Group Practice with

Personal Feedback and Mentoring,

and Chances for Personal Work and Healing

During this four-day intensive workshop you will learn:

  • How to develop deeper and more meaningful relationships with challenging, difficult clients.
  • How to deal skillfully with people who refuse to open up and talk to you; won’t listen; are relentlessly critical, narcissistic or controlling; always have to be right; use, abuse, or exploit you; complain endlessly; are hostile, threatening or violent; as well as clients who are overwhelmed, hopeless and suicidal.
  • How to develop more loving relationships with the people you care about—as well as the ones you don’t.
  • Powerful new techniques to help clients who are struggling with conflicts with loved ones, friends, or colleagues.
  • How to deal with the inner chatter and powerful feelings that make it so difficult to deal with conflict when you feel angry or hurt.
  • How to identify and modify the self-defeating beliefs that make us vulnerable to conflicts with others.
  • How to identify and melt away the intense outcome and process resistance that make the treatment of relationship problems so challenging.

Learn More and Register

* * *

Watch for the Awesome

December Evolution of Psychotherapy Conference

Anaheim, December 9 – 13, 2020

Sponsored by the Erikson Institute

It is always spectacular and I’ll be presenting, too!

Details TBA

180: Feeling Great: The Book and the App!

180: Feeling Great: The Book and the App!

Rhonda and David are joined today by Jeremy Karmel, who is working with David on a new Feeling Great app.

Rhonda begins by reading several amazing emails from fans whose lives have been changed by the podcasts as well as David’s books, including Jessica, Tim, and Mike. Thank you, everyone, for such kind and thoughtful comments!

NMP-8052

This great photo of Rhonda is courtesy of Nancy Mueller, a local photographer who kindly took some pics at my home in Los Altos, California.

David describes his upcoming book, Feeling Great, which will be released in September of 2020. It will move well beyond his first book, Feeling Good: The New Mood Therapy, all will incorporate all of the latest hi-speed treatment techniques in TEAM-CBT (aka “Feeling Great Therapy.”) David describes his excitement about the team he is working with to publish his latest book, including Linda Jackson at PESI (the publishing company), and Jenessa Jackson, his editor.

Jeremy describes why he approached David to develop a Feeling Great app. As a Stanford student, he was depressed and had to drop out of school for semester. Antidepressants and talk therapy had done nothing for him, so he was feeling hopeless.

Then Jeremy discovered one of Dr. Burns’ students, Dr. Matthew May, and recovered in just two weeks, which was mind-blowing. Matt was one of the first practitioners in the world to use the new TEAM-CBT, Jeremy felt a tremendous drive to make these powerful new techniques available to people around the world.

Picture1

Jeremy Karmel

David and Rhonda, of course, share this goal! In fact, Rhonda has recently gone to Mexico City as well as India to support the sudden and strong emergence of TEAM-CBT in those countries.

Rhonda asks Jeremy many questions about the amazing recovery he experienced in his work with Dr. May, and how he’s been doing since. Then Rhonda, Jeremy, and David address a number of intriguing questions about the new app. For example, there is tremendous evidence from research that David’s first book, Feeling Good, has significant antidepressant effects. In fact, many published studies have confirmed that more than 50% of depressed individuals will recover or improve dramatically within four weeks if you just give them a copy of the book.

Is it possible that an app that incorporates all the great methods in Feeling Good, plus all the new techniques in TEAM-CBT, could be even more effective? And if so, would this mean that an electronic app could even outperform human therapists as well as antidepressant medications?

David says that this has been his dream for more than 40 years, and he thinks this is a definite possibility. Jeremy agrees, since the app, now in creation, has the potential to be far more powerful and systematic than reading a book or even going to a therapist.

Rhonda asks: “Are you trying to put human therapists out of business?”

David believes that there will always be a place for human therapists, since the person to person support and connection is invaluable and desperately needed.

However, the Feeling Great app can actually be a friend of human therapists, just as his book, Feeling Good, has been, working hand in hand with therapists helping to accelerate the recovery of their patients.

In addition, the app can bring rapid help and relief to millions of people worldwide who cannot afford therapy, and those who simply cannot find effective therapy. David emphasizes the goal of having an entirely free version of the app for people without resources.

Rhonda asks: “Will you be doing research as well as self-help “treatment” with the new app?”

The answer to that is absolutely, yes, and the implications for incredible research into the causes and treatments for depression, anxiety and relationship problems are immense, especially if thousands or even tens of thousands of individuals use the Feeling Great app.

For example, David has developed many psychological assessment instruments to help therapists and patients alike, but the costs and time required to develop and validate even a single short test can be substantial. In contrast, one might get more than enough data to evaluate a new instrument in just one day, which is mind-boggling.

In addition, every time someone uses the app, we will learn more and more about what works, and what does not. This type of analysis is vitally important, but practically impossible, or at the very least arduous and confusing, when working with human therapists, due to the complexity of what’s happening, and the intense bias of therapists and researchers alike. The computer, by way of contrast, does not mind being wrong and moving in different and more promising directions!

Rhonda, Jeremy and David will let all of you know when a beta version of the new app, is available, and hopes that many of you will try it out and let us know what you think! David will also let you know when pre-ordering for his new book, Feeling Great will be available as well!

David and Rhonda

References on Homework Compliance and Motivation

Burns, D. D., Shaw, B. F., & Crocker, W. (1987). Thinking styles and coping strategies of depressed women: An empirical investigation. Behavior Research and Therapy, 25(3): 223 – 225.

Burns, D. D., & Nolen-Hoeksema, S. (1991). Coping styles, homework compliance and the effectiveness of cognitive – behavioral therapy. Journal of Consulting and Clinical Psychology, 59(2): 305 – 311.

Burns, D. D., & Nolen-Hoeksema, S. (1992). Therapeutic empathy and recovery from depression in cognitive – behavioral therapy: a structural equation model. Journal of Consulting and Clinical Psychology, 60(3): 441 – 449.

Burns, D. D., & Spangler, D. (2000). Does psychotherapy homework lead to changes in depression in cognitive behavioral therapy? Or does clinical improvement lead to homework compliance? Journal of Consulting and Clinical Psychology, 68(1): 46 – 59.

Burns, D. D., & Spangler, D. (2001). Can We Confirm Our Theories? Can We Measure Causal Effects? A Reply to Kazantzis et al. (2001). Journal of Consulting and Clinical Psychology, 69(6), 1084-1086.

Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012.

Subscribe

You can reach Dr. Burns at david@feelinggood.com. Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at rbarovsky@aol.com. She is a Certified TEAM-CBT therapist and specializes in the treatment of trauma, anxiety, depression, and relationship problems. She also does forensic work in family court, but finds TEAM-CBT to be way more rewarding!

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

 

Coming up in 2020

The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

TEAM-CBT includes more than 100 powerful techniques to change the distorted thoughts that trigger negative emotions. But what techniques should I select for my patient who feels depressed, anxious, or angry?

As you know, in my book, Feeling Good, I listed the ten most common cognitive distortions, like All-or-Nothing Thinking, Should Statements, Emotional Reasoning, and more, and you probably use that list all the time in your clinical work. But do you know which techniques work the best for each distortion?

Come to this workshop and find out! You’ll learn with tons of cool techniques you can use every day to boost your clinical effectiveness.

This workshop will be live-streamed (and in person in Palo Alto, CA) so you can join from anywhere in the world! There will be many expert online helpers to assist you with the small-group exercises.

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register