165: Ask David: Why do shrinks kill themselves? How to find out if your loved one is suicidal.

165: Ask David: Why do shrinks kill themselves? How to find out if your loved one is suicidal.

In today’s podcast, David and Rhonda answer two questions about suicide submitted by podcast fans.

Question 1. Why do shrinks kill themselves?

Dear Dr Burns,

Before I get to my question (which I hope you will consider addressing in your ‘Ask David’ segment of the podcast), I would like to extend my gratitude to you. Your book, Feeling Good, came to me at a time when I was struggling to make sense of my depression and anxiety, and it has been a vital part of my recovery journey. The exercises and the podcast have been such lifelines, and I am grateful to you for the incredible and life-changing work that you do.

I know you have addressed the topic of suicide in a previous episode, but I recently was struck by a piece of news from my alma mater, the University of Pennsylvania, where a senior member of the college’s counselling services (CAPS) died by suicide. Here was someone who had spent his life’s work on promoting suicide prevention, and had a great deal of knowledge on resilience. How can we process/understand the decisions that someone like this might make to take his life. How can I arrive at the understanding that his decision doesn’t necessarily spell doom for the rest of us? What TEAM-CBT exercises can we do to make sense of the world when it might not make much sense at first glance, during situations like these?

Thank you very, very much,

Sindhu

Dr. David’s Answer

Thanks, Sindhu, this is a really great question.

I’ll put this in the Ask David folder. Should I use your name?

Here’s the short answer. It’s a lot like saying that an infectious disease expert shouldn’t get pneumonia, or that an orthopedic surgeon shouldn’t have back pain, or a broken leg. I know of at least three mental health professionals who have committed suicide, but my knowledge based is tiny. I’m sure there are thousands of mental health professionals who have committed suicide.

People can commit suicide for many reasons, and I can only mention a few here, as my knowledge, like yours, is limited.

  1. Hopelessness is one of the most common causes of suicide in depressed individuals. Hopelessness always results from cognitive distortions, and never from a valid appraisal of one’s circumstances. Depressed people often turn to suicide, thinking (wrongly) that it is the only escape from their suffering.
  2. You may have done something that you are profoundly ashamed of, and fear it is about to be made public. Like the fellow in New York arrested for child abuse who hung himself just a few weeks ago.
  3. I am convinced that sometimes people commit suicide to get back at someone they are angry with, someone perhaps who rejected them.
  4. Physician-assisted suicide. I believe that physician assisted suicide is absolutely indicated and compassionate if someone is in excruciating pain from an irreversible terminal illness.
  5. The Achievement Addiction. Feelings of failure and worthlessness. In our culture, we sometimes (wrongly) base our feelings of self-esteem on our success in life, our income, or our achievements. And so, if your achievements are only “ordinary,” you may feel worthless, like “a failure,” and kill yourself.
  6. The Love Addiction: Many people (wrongly) tell themselves they must be loved to feel happy and worthwhile, and then kill themselves when they are rejected by someone they thought they loved and “needed.”
  7. Drug and alcohol abuse: These habit, when severe, can greatly disrupt a person’s life. They can also make someone more impulsive, and more likely to jump or pull the trigger when intoxicated.

There are likely way more causes than just these common ones. For example, a psychotic process like schizophrenia might sometimes play a role as well.

I suspect you may have a hidden “Should Statement,” telling yourself that a mental health professional “should not” get depressed or have the urge to commit suicide. But to me, that would be a nonsensical claim, and it isn’t even clear to me why you might think that way. In fact, most people are drawn to this profession because of their own unresolved suffering. There is, I suspect, MORE depression and anxiety in mental health professionals, but I have not seen data, so I’m not certain of this. But I’ve trained tens of thousands of mental health professionals, and pretty much ALL of the ones I’ve known personally have struggled at times, and sometimes intensely.

People also ask, “Why did so and so commit suicide? S/he was so famous and loved and wealthy!” Well, famous and loved and wealthy people often suffer and commit suicide, too.

Finally, I would say that suicide is both tragic and devastating—for the patient for sure, for the family and friends who typically suffer for years, and for the therapist as well. Fortunately, the family and friends can be helped, if they ask, but it is too late for the person who was depressed. And the tragedy is needless in most cases, since the patient’s intense negative feelings can be treated effectively in nearly all cases.

David

Question 2. How can you find out if a friend or loved one is suicidal?

Many people are afraid to ask a depressed friend or family member if they are feeling suicidal, fearing this will create conflict or may even cause the person to become suicidal. For the most part, these fears are unfounded, and the biggest mistake could be avoiding the topic.

Most people who are feeling suicidal are willing to discuss their feelings fairly openly. Several types of questions can be useful.

Suicidal thoughts or fantasies. Most people with depression due have suicidal thoughts or fantasies from time to time, and these are not necessarily dangerous.

First, you can ask, “do you sometimes feel hopeless, or have thoughts of death, or wishing you were dead?” If s/he says yes, you can ask him / her to tell you about these thoughts and feelings. You can also ask if s/he thinks of suicide as the only way out of his / her suffering.

Second, you can ask if s/he simply has passive suicidal thoughts, like “Sometimes I feel like I’d be better off if I were dead,” or active suicidal thoughts, like, “Sometimes I have fantasies of killing myself.”

Suicidal urges. You can ask if s/he sometimes has urges to kill himself / herself. Suicidal thoughts or fantasies without suicidal urges are usually not especially dangerous.

Suicidal plans. You can ask if s/he has made any plans to actually commit suicide. If so, what method would s/he use? Jumping? Shooting? Hanging? Cutting?

You can also ask if s/he has been acting on these plans. For example, if shooting is the choice, you can ask if s/he has access to a gun and bullets. If jumping is the choice, you can ask where s/he plans to jump from.

Deterrents. When evaluating suicide, you can also ask if there are any strong deterrents, such as religious beliefs, impact on family and friends, and so forth. If there are no strong deterrents, the situation is more dangerous.

Desire to live, desire to die. You can also ask the person how strong their desire to live is, and how strong is their desire to die?

Past suicide attempts. If the person has made suicide attempts in the past, the risk of a future suicide attempt is greater.

Drugs and alcohol. You can ask if the person drinks or uses drugs, and has ever has a stronger urge to commit suicide when intoxicated. This is a danger sign.

Impulsiveness. Some people make suicide attempts when they’re feeling impulsive, kind of on the spur of the moment. You can ask if they every have these kids of sudden impulses.

Willingness to reach out. You can ask if they’d be willing to reach out and ask for help if they ever have a suicidal urge.

Honesty. You can ask if they were felt reasonably open and honest in asking your questions, or if it was difficult to answer some of the questions.

Once you have explored these types of questions, you can decide whether action is necessary. If the person seems in danger of making a suicide attempt, you can bring him / her to an emergency room for an evaluation.

If s/he refuses, you can dial 911 and ask for help. Generally, the police will come immediately and do a safety check, and bring the person to an emergency room involuntarily if necessary. You can also call his or her therapist and alert that person to the situation.

This may all sound grim and very unpleasant, but these kinds of conversations can sometimes be lifesaving, and can protect you from much greater pain later on.

In a future podcast, we will focus on this question: How do you treat someone who is suicidal using TEAM-CBT?

David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

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. 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.

* * *

I have two tremendous one-day workshop scheduled with my esteemed colleague, Dr. Jill Levitt, next year–

Workshops in 2020

High Speed Methods to Reduce Resistance
and Boost Motivation

This is the most important, and least understood, topic in psychotherapy. Nearly all therapeutic failure results from the failure to address resistance effectively. Therapists do not understand what causes resistance or how treat resistant and oppositional patients who “yes-but” you or fail to follow through on homework assignments.

Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!

You can join this workshop in person or online (live streaming) from anywhere in the world!

With Drs. David Burns and Jill Levitt

Feb 9. 2020 |  7 CE hours. $135

Learn More & Register

 

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.

You can join this workshop in person or online (live streaming) from anywhere in the world!

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register

Coming this summer!

The Annual South San Francisco Intensive!

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

Ultra-Rapid TEAM-CBT for Depression and Anxiety Disorders

Learn More and Register

“What should I do if I hate my therapist?” A Fascinating Interview with Dr. Jill Levitt!

“What should I do if I hate my therapist?” A Fascinating Interview with Dr. Jill Levitt!

Dear colleague,

You might enjoy this link to a dynamic interview with my esteemed colleague, Dr. Jill Levitt, published a few days ago in the San Francisco magazine, BobCut. Jill is the Director of Clinical Training at the Feeling Good Institute in Mt. View, California, and teaches with me at Stanford. The article should be of interest to therapists and patients alike.

Jill answers these question. and more:

  • How do I know if I need to go to therapy?
  • How does someone deal with burnout if they don’t have the means to quit their job and don’t think they have time for therapy?
  • How can you say “No” and set boundaries at work?
  • Won’t people be disappointed in you if you say no?
  • What should I do if I hate my therapist?
  • What qualities should people look for in a therapist?
  • If someone is struggling with anxiety, they don’t want to just go to any therapist, they want to find someone who can really help them. How can find a therapist who has the specific skills that will help you? 
  • If you disclose a problem such as substance abuse, is my therapist required to report it?
  • Why do I only get angry/upset with my inner circle including my family and partner?
  • I feel so insecure, small and insignificant in the real world. How can I help this feeling of overwhelming fear and anxiety?
  • Can you describe how you’ve seen the evolution of your patients change over the past few years? Because mental health is a bigger topic in the media, more people are talking about it, and more people are open to seeking help. It’s slowly becoming less stigmatized. So have you seen the attitudes of your patients change? And have you seen the levels of resistance that they come in with change over the past few years?
  • What makes TEAM-CBT different from other forms of therapy practices?
  • And more!

I hope you enjoy Jill’s interview!

David

* * *

You may have missed the Calgary and South San Francisco intensives, but there will be one more awesome intensive this fall, and it’s right around the corner!

High-Speed Treatment of Depression
and Anxiety Disorders

A Four-Day TEAM-CBT Advanced Intensive

November 4 – 7, 2019
The Atlanta, Georgia Intensive

Information and Registration

* * *

I also have two tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, next year–

Coming up in 2020

High Speed Methods to Reduce Resistance
and Boost Motivation

This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.

Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!

With Drs. David Burns and Jill Levitt

Feb 9. 2020 |  7 CE hours. $135

Learn More & Register

 

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.

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register

 

Coming this summer!

The Annual South San Francisco Intensive!

July 6 – 9, 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

Ultra-Rapid TEAM-CBT for Depression and Anxiety Disorders

Learn More and Register

A Podcast Fan Comments on “How to HELP, and how NOT to Help!”

A Podcast Fan Comments on “How to HELP, and how NOT to Help!”

Hi David and Rhonda,

I just wanted to tell you I LOVED the latest podcast on when not to help. I know you mentioned you’ve covered many of these ideas before, but this podcast really helped it all sink in for me, especially as a non-therapist. Also, I can’t seem to find Dave’s email, but I wanted to say I thought he added some especially valuable perspectives as a non-therapist.

Rhonda, I absolutely loved the story you shared about your son. And I’m so grateful for the therapist that allowed her 5 secrets response to be played. Listening to that was incredibly eye-opening – I’ve made the same mistake countless times but didn’t really get it until now.

Thank you both for all your amazing work on these podcasts!

best,

Daisy

David’s Reply

Thanks Daisy for your kind and thoughtful comment! I’m so glad this message is “getting through” at last! Some ideas are so hard to convey, because they seem to go against our natural human impulses, like the urge to jump in and “help” or “rescue” a friend or loved one who is in distress.

David

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.

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

* * *

You may have missed the Calgary and South San Francisco intensives, but there will be one more awesome intensive this fall.

High-Speed Treatment of Depression
and Anxiety Disorders

A Four-Day TEAM-CBT Advanced Intensive

November 4 – 7, 2019
The Atlanta, Georgia Intensive

Sponsored by Praxis

* * *

I also have two tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, next year–

Coming up in 2020

High Speed Methods to Reduce Resistance
and Boost Motivation

This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.

Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!

With Drs. David Burns and Jill Levitt

Feb 9. 2020 |  7 CE hours. $135

Learn More & Register

 

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.

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register

 

Coming this summer!

The Annual South San Francisco Intensive!

July 6 – 9, 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

Ultra-Rapid TEAM-CBT for Depression and Anxiety Disorders

Learn More and Register

164: How to HELP, and how NOT to Help!

164: How to HELP, and how NOT to Help!

Lately, I’ve received numerous emails asking, in essence, “how can I help my loved one who has this or that problem?” I would say that I get several emails like that every week.

For example, here’s one from a man we’ll call “Karl.”

Love you podcasts. Listen as often as I can. keep reading your books.

Our son is in an unhappy marriage. Last night we talked and he mentioned that there is no love in their marriage. Just coldness. The children “feel” the chasm. There is a lack of trust in the home.

Our son feels he did not protect the children in defense of their mom, even though he disagreed with her. Now the children feel their father does not have their best interests. Our daughter-in-law feels that everything is fine. She uses the passive-aggressive “silent treatment” to punish others.

Our son says she is controlling and manipulative, and that the children have become that way also. There’s no truth in the home. Years ago, she wanted them to go to counseling, but our son refused; now the tables are turned.

Sad. We want to help but don’t know how to approach it.

What podcasts would be helpful to us? And to our son and daughter-in-law? We visit our grandchildren often, sometimes one-on-one. Communications are open with them and with our son.

Daughter-in-law feels, and tells others, we are conspiring against her

Karl

Thank you Karl, for that moving email. It can be really sad and frustrating to see a couple in conflict who are at odds with each, especially when your son and grandchildren are involved. And I can imagine you might also be feeling anxious and a bit helpless, and deeply concerned!

When I wrote Feeling Good forty years ago, I tried to make it clear that the cognitive therapy tools I described in that book are for people to use to help themselves. It is okay to correct your own distorted negative thoughts in order to break out of a bad mood. But it is generally NOT a good idea to try to correct someone else’s distorted thoughts, because they’ll just get ticked off at you!

This is a very understandable error, because you may get really excited by the things I’m teaching, and how helpful they can be when you’re feeling depressed, anxious, or insecure. So it just makes sense that you would want to share these tools with others.

But those are generally NOT the tools to use when you’re talking to your son, daughter, spouse, or friend who’s feeling down in the dumps. There is a way to help someone you love who’s hurting—but you’ll have to use an entirely different set of tools and skills—the Five Secrets of Effective Communication—WITHOUT trying to “help.”

So, the short answer to your question is—skillful listening is all that’s called for. Anything more runs the risk of getting you into trouble. But this may require a radical change in the way you communicate, as well as your personal philosophy.

Let’s talk about what TO do, and what NOT to do when patients, friends or people you care about express angst, or seem troubled, or describe problems in their lives, and they seem to be hurting a lot.

DO NOT

  1. Give advice
  2. Try to help
  3. Try to cheer the person up
  4. Try to solve the problem s/he is struggling with
  5. Try to get the other person to think or act more positively
  6. Try to minimize the problem by saying it’s not that bad, or things will get better.
  7. Point out ways the other person may be thinking or acting in a self-defeating manner.

Before we tell you what does work, let me focus on just one of these errors, to bring it to life for you. Recently, Rhonda and I recorded a live therapy session with a man named who was upset because his mother had lost the use of her legs to due a rare neurological disorder, and needed much greater care in an assisted living facility. This required selling the house his mother was living so they could afford the assisted living facility, and it was a great loss for everyone, since Kevin was raised in that house, and his parents and grandparents had lived there, too.

After Rhonda and I empathized with him for about thirty minutes, we asked the other therapists to offer empathy as well, as part of their practice and training that evening. We stressed the importance of simply summarizing what Kevin had told us (Thought Empathy) and how he was feeling (Feeling Empathy), without trying to “help.” One of the therapists, who was new to the group, kind of missed the mark, She did what we call “cheerleading,” telling Kevin what a wonderful and heroic person he was without acknowledging what he’d be saying and how painful it was for him.

You’ll hear this brief excerpt from the session in the podcast. When we asked Kevin how he felt about her comment, he had to tell her that he was embarrassed, and not helped, by what she’d said.

Here’s why. When you don’t acknowledge someone’s profound negative feelings of loss, anxiety, sadness, anger, and more, you might unintentionally convey the message that you don’t want to hear about how they really feel inside. And when you cheerlead, it also conveys the message that the person is not very intelligent, and simply has to be cheered up, and then everything will be okay!

We cannot be too hard on this therapist, because her efforts came from the heart, and I’m sure she felt sad for this man. And most of us have made the same mistake at times, or even often. I frequently hear parents trying to cheer their children up, or trying to tell their children what to do, or how to change, without really listening.

But, most of the time, it just doesn’t work like that!

Now that you know what NOT to do, what can you do that WILL help?

DO

Use the Five Secrets of Effective Communication, with an emphasis on the listening skills. One of the most important skills is called Feeling Empathy—simply acknowledging how the other person is feeling, and asking them to tell you more, and if you got it right.

For example, let’s say a friend or family member is procrastinating on something important, like a research report or college application, and is feeling pretty upset and self-critical. You could say something like this: “It sounds like you’re beating up on yourself for procrastinating, I’m wondering if you’re feeling

  1. down, sad or depressed?
  2. anxious, worried, pressured, or nervous?
  3. guilty or ashamed?
  4. inadequate, worthless, defective, or inferior?
  5. alone or lonely?
  6. humiliated or self-conscious?
  7. discouraged or hopeless?
  8. stuck or defeated?
  9. angry, annoyed, hurt, or upset?”

I find that people really like it when I ask these questions, and I let them answer each one. Then I ask them about their negative thoughts. What are they telling themselves? What are the upsetting messages?

When you use this approach, you are literally doing nothing to “help” the other person, but if you listen skillfully, she or he will probably really appreciate your listening, and you may end up feeling really close. In fact, I (David), had this exact experience just a couple days ago with a student who was struggling and feeling down.

Often, the person who’s depressed will be someone you love, like a family member, so your concerns for him or her, and your desire to “help,” are an expression of your love. But listening skillfully will likely be a whole lot more effective. And you can express your own feelings, too, with “I Feel” Statements, like “I feel sad to hear how down you’ve been feeling, because I love you a lot.”

Example

A woman named Clarissa was concerned because her son, Billy, who is in his early 20s, had been severely depressed for several years, and had not responded to treatment with antidepressants and even lithium. Clarissa had read my book, Feeling Good, and listened to almost all of the Feeling Good Podcasts. She described herself as a true “TEAM-CBT convert because she’d worked with a therapist trained in TEAM-CBT and no longer suffered from the depression and anxiety she’d struggled with most of her adult life. She agreed with a lot of what I’d said on the podcasts about the chemical imbalance theory (there’s no convincing evidence for it) and antidepressants (recent research suggests they do not outperform placebos to a clinically significant degree).

But Billy was saying things like this:

“Mom, I KNOW I have a chemical imbalance because this cloud will suddenly come over me, and I feel TERRIBLE. It’s not about negative thoughts—I don’t have any negative thoughts. My depression is clearly the result of a chemical imbalance, and I feel doomed by my genes.”

Then Clarissa would try to cheer him up, which always failed, or would try to convince him that it’s not about a chemical imbalance and that if he really tried TEAM-CBT, he could overcome his depression, just as she had done. These are such common errors!

How could Clarissa respond more effectively? If she focuses on good listening skills, instead of trying to win an argument, she might say something like this:

“Billy, I really love you, and feel so sad to hear about your depression. You’re absolutely right, too. Sometimes a bad mood seems to come from out of the blue, with no rhyme or reason. And genes can be important. I’ve struggled with depression in the past, and maybe you’ve inherited some of my genes. Tell me more about how you’ve been feeling. Have you been feeling down, anxious, ashamed, hopeless, or angry? What you’re saying is so important, and I really want to her what’s it’s been like for you.”

Can you see that Billy would be more likely to open up and might even share some things that he’s been hiding, out of a sense of frustration, anger, or shame? And can you also see that providing some love and support—pure listening, with compassion—might be a lot more helpful than getting into an argument about the causes of depression? He might open up about all sorts of things that have been eating away at him—problems with girls, sex, sports, or his studies, or concerns about his looks, or even feelings of shame about his depression.

The next question is—when DO you help someone? And HOW do you help them.

The approach I use as a therapist might be the same approach you’d want to use. At the beginning of every therapy session, I empathize without trying to help, exactly as I’ve been teaching you in this podcast, and in this document, and I give the other person some time—typically about 30 minutes or so—just to vent while I use the Five Secrets of Effective Communication—listening skillfully—without trying to “help.”

Then I ask the patient to grade me on empathy. I say, “How am I doing so far in terms of understanding how you’re thinking and feeling? Would you give me an A, a B, a C, or perhaps even a D?”

Most of the time, the other person WILL give you a grade. If they give you an A, you’re in good shape. But if they give you an A-, or a B+, or worse, ask them to explain the part you’re missing, or not getting right.

When they tell you, you can use the Five Secrets again, summarizing the part you missed, and then ask what your grade is, to see if you’ve improved. Usually, your grade will improve a lot.

Do NOT try to “help” until you received an A!

So, let’s assume you’ve gotten an A. What then?

Then I do what’s called the Invitation Step in TEAM therapy—I ask if the other person wants help with any of the problems s/he has been discussing. You can ask the same question.

If the other person does NOT want help, but just wanted to talk and get support, your job is done. You can also ask if they want to talk some more. Most of the time, all people want is a little listening and support, and they’re not looking for help or advice.

But if the other person DOES want help, you can ask what kind of help they’re looking for. Then you can decide if you’re in a position to provide that type of help. Sometimes, the help they’re looking for might not be something you can provide. For example, they may be angry at someone they’re not getting along with, and may want you to tell the other person to change. I explain that this is not something I would know how to do, but I could possibly help them change the way they interact with that person.

This may sound really simple, but it takes a lot of practice and determination! It can be a lot harder than it looks.

Many people will NOT want to go down this road, and will insist on jumping in to help or cheerlead. You can do that if you want, but in my experience, pushing help on people who are hurting is rarely helpful. The “need” to help or rescue can result from your love and compassion, but it can also result from narcissism, codependency, or the desire to control or dominate another person. I see it as a kind of an addiction, too.

If you want to learn more about this, here are some things you can do:

  • You can read my book, Feeling Good Together, and do the written exercises while reading, so you can master the Five Secrets of Effective Communication. This is a BIG assignment, but the reward, in terms of more loving and satisfying relationships with the people you love, will be equally great.
  • You can try using “I Feel” Statements and Feeling Empathy with at least one person every day this week.

Feeling Good Together

David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

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. 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.

* * *

You may have missed the Calgary and South San Francisco intensives, but there will be one more awesome intensive this fall.

High-Speed Treatment of Depression
and Anxiety Disorders

A Four-Day TEAM-CBT Advanced Intensive

November 4 – 7, 2019
The Atlanta, Georgia Intensive

Sponsored by Praxis

* * *

I also have two tremendous one-day workshop scheduled with my colleague, Dr. Jill Levitt, next year–

Coming up in 2020

High Speed Methods to Reduce Resistance
and Boost Motivation

This is the most important, and least understood, topic in the behavioral sciences. Nearly all therapeutic failure results from the failure to address resistance. Therapists do not understand what causes resistance or how treat it effectively.

Come to this workshop and learn how to melt away resistance for incredibly high-speed recovery!

With Drs. David Burns and Jill Levitt

Feb 9. 2020 |  7 CE hours. $135

Learn More & Register

 

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.

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register

 

Coming this summer!

The Annual South San Francisco Intensive!

July 6 – 9, 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

Ultra-Rapid TEAM-CBT for Depression and Anxiety Disorders

Learn More and Register

Habits and Addictions Workshop was a Huge Success!

Habits and Addictions Workshop was a Huge Success!

The Awesome Anxiety Workshop is Coming in May!

I want to thank so many of you who attended the workshop on Unwanted Habits and Addictions by Drs. David Burns and Jill Levitt which was streamed live on Sunday, February 10, 2019. It was our biggest workshop turnout by far, and it was pretty amazing.  Half way down you will find some information about our upcoming anxiety workshop in May. We have a large registration already, so move fast if you want to be included. Also, the two summer intensives will be here before you know it!

The following is a kind report on the workshop last Sunday that I received from one of our beloved online participants.

Dear Drs. Burns and Levitt,

This was my second online workshop with Drs. Burns and Levitt, and I must say that I was extremely satisfied with both of these fantastic training programs. The workshop this last Sunday was brilliantly conducted, and the learning experience was just amazing.

Even now as I am reflecting on it, I realize that I learned a tremendous amount in just one day. I especially appreciated the balance of didactic learning and experiential exercises. They incorporated three individual group practice sessions with a personal leader to make sure that each and every participant had the chance to participate and receive individual feedback and mentoring. Then, over and above this, we also had two great demos.

It was amazing and awesome how they managed to include so much in just seven hours! But it didn’t even feel too heavy.

I also liked how Dr. Angela Krumm kept navigating the questions of the online participants, like myself, so we also felt included. I enjoyed it thoroughly, even though I had to attend it from 9.30 PM to 6.00 AM due to my time zone (India). It was extremely worth it.

I strongly recommend these workshops to every therapist all over the world! I do not want to miss a single one of these.

I sincerely appreciate and thank Dr Burns, Dr Jill Levitt and to Dr. Maor Katz and the entire TEAM of FGI for bringing it to us, and for making this amazing learning experience accessible to people far and wide.

Thank you very much!

Dipti Joshi

* * *

Coming in May!

TEAM-CBT Methods for Anxiety Disorders–

Step-by-Step Training for Therapists

by David D. Burns, MD and Jill Levitt, PhD

WHEN: Sunday May 19th, 2019, 8:30 am – 4:30 pm PST
(11:30 am-7:30 pm EST)

WHERE: Join us live online or in person
at the Creekside Inn, Palo Alto, CA

HOW MUCH DOES IT COST? $135,

WILL I GET CE CREDITS? YES!
7 CE hours available

WILL I GET CREDIT IN THE TEAM-CBT CERTIFICATION PROGRAM? YES!

This workshop counts towards Levels 1, 2 or 3 TEAM-CBT Certification.

WHO CAN ATTEND? Therapists of all levels are welcome

CAN I REGISTER IF I’M NOT A THERAPIST? Sadly, this workshop is geared for therapists. I teach in a very clear and basic way that anyone can benefit from. If you are super-determined to attend a workshop, try one of my two summer intensives, also listed below. They are also for therapists, but anyone can benefit from them.

CAN I WORK ON MY OWN FEELINGS OF ANXIETY AND INSECURITY?
Absolutely! Heal yourself, heal your clients!

WILL I HAVE FUN? Yes!

WILL I HAVE SOME GREAT FREE BREAKFAST AND LUNCH? Yes!

WILL I HANG OUT WITH SOME COOL PEOPLE? Yes!

You will also:

  • Learn new skills to reduce resistance and boost the motivation to change. This is THE key to the treatment.
  • Learn how to treat all of the anxiety disorders quickly.
  • See actual live videos of the Six-Minute Cure for Severe and Incapacitating Panic Disorder and the Fifteen-Minute Cure for Severe OCD.
  • Practice and master the Externalization of Voices and Acceptance Paradox to overcome your own feelings of inadequacy and self-doubt.
  • Master Relapse Prevention Training for lasting results.

You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, videos, and breakout group practice to enhance skill-building.

This wonderful workshop will stream live and is easily accessible from anywhere in the world on any device with WiFi. To join, just click on the link provided before the workshop.

More than twelve expert trainers will be available to assist
the online participants in the small group exercises!

You can attend in person or from home via Live Streaming

Act fast if you want to attend!

Don’t miss out learning from David Burns, MD,
one of the pioneers of Cognitive Therapy,

and Jill Levitt, PhD, Director of Training
at the Feeling Good Institute in Mt. View, CA!

* * *
Coming this Summer

There will be two awesome summer intensives for you this year!

July 15 – 18, 2019
Calgary four-day intensive
Sponsored by Jack Hirose & Assoc.

July 29 – August 1, 2019
South San Francisco four-day intensive
Sponsored by Praxis

THE INTENSIVES ARE THE BEST WORKSHOPS OF THE YEAR!

If you can join us, they will be even better!

Three Cool Workshops for You!

Three Cool Workshops for You!

(Please note time correction on workshop #1: now 8:30 to 4:30, and 7 rather than 6 CE credit hours for you. More good stuff for the same price!)

Coming Soon!

Learn State of the Art Treatment for

Relationship Conflicts / Trauma / Anxiety Disorders

Live Streaming at all 3 workshops—join from anywhere in the world!

* * *

1. TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Sunday October 28th, 2018 (8:30 am-4:30 pm PST)

Live in Palo Alto plus online streaming

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

Join us for a day of fun and inspiring learning on site in Palo Alto OR online from anywhere in the world. Learn from David and Jill–a dynamic duo!

7 CE*s. $135

To register, go to the Feeling Good Institute or call  650-353-6544

* * *

2. Rapid Recovery from Trauma–
New, High-Speed Treatment Techniques

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Pasadena, CA

and

November 1-2, 2018–Woodland Hills, CA

(The Woodland Hills workshop includes Live Streaming
if you cannot attend in person.)

The symptoms of trauma can be devastating. Dr. Burns will describe TEAM-CBT, a new approach that offers rapid and lasting change. Dr. Burns will do a live therapy demonstration the evening of day 1 with a volunteer from the workshop. This promises to be illuminating and inspiring.

To register, go to www.IAHB.org or call 1-800-258-8411

Register Now!

* * *

3. TREAT ANXIETY FAST–

Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

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

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

and

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

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

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

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

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

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

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers! This workshop will feature a dramatic, live therapy demonstration with an audience volunteer the evening of day 1.

Sponsored by PESI

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

I hope to see you at one of these workshops. Make sure you say hello!

David Burns, MD

094: 50 Methods in 50 Minutes! (Part 2)

094: 50 Methods in 50 Minutes! (Part 2)

Hi Everybody!

In today’s episode, David and Fabrice describe and discuss the remaining 26 techniques on David’s list of “Fifty Ways to Untwist Your Thinking.” They fall into the following categories:

  1. Uncovering Techniques
  2. Motivational Techniques
  3. Classical Exposure Techniques
  4. Cognitive Exposure Techniques
  5. Interpersonal Exposure Techniques
  6. Interpersonal Techniques

Hope you enjoy today’s podcast! We’ve got lots of good stuff coming up soon, including:

Do you have a “self?” Can your “self” be judged?

Why do people resist using the Five Secrets of Effective Communication? (a very exciting topic!)

Live therapy: David and Jill treat someone with a relationship problem.

So stay tuned! And please spread the word among your friends and colleagues if you like our show. We are trying hard to expand our audience. We are now seeing more than 50,000 downloads of our Feeling Good Podcasts every month, but would love to grow even larger. Feel free to share them with your friends.

In our next Feeling Good Podcast, we will show you how to use the Recovery Circle to select the most helpful techniques to challenge your own negative thoughts so that you’ll be Feeling Good!

Thanks so much!

David

* Copyright © 2018 by David D. Burns, MD

 

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

Subscribe

Attend a Summer Intensive!

This year, I am offering a July summer intensive in Whistler, Canada, and one in August at the South San Francisco Conference center. The intensives are almost always my most exciting and fun workshops of the year. Hope you can join us at one of these locations.

Here are some details:

Advanced Cognitive Behavioral Therapy: 

A Four-Day Intensive Training in TEAM-CBT

July 3 – 6, 2018 Whistler, BC, Canada

For more information, contact Jack Hirose & Associates Inc.
Phone: 604.924.0296, Toll-free: 1.800.456.5424

* * *

High Speed, Drug Free Treatment of Depression and Anxiety Disorders–

A Four-Day

Advanced TEAM-CBT Intensive

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

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

If you can only attend one of my workshops, consider attending one of these intensives!

 

 

 

Treatment of Hypochondriasis / Health Anxiety

Treatment of Hypochondriasis / Health Anxiety

Hi Dr. Burns,

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

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

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

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

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

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

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

Sincerely,

Mona

Hi Mona,

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

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

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

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

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

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

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

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

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

All the best,

David