Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

The Mindfulness Mystery Tour! And Two Mind-Boggling Discoveries about Meditation! Featuring Jason Meno

Today, Jason Meno, our beloved AI guy on the Feeling Great App team, shares some incredible and innovative research he recently did on the effect of meditation on how we think and feel. As you know, basic research is a high priority of our app team, and our major focus is to make basic discoveries in how people change, and especially on what triggers rapid and dramatic change. We use that information to develop and refine the app on an ongoing basis, and also to contribute to basic science.

Jason recently created a "New Cool Tools Club" which has 160 members who Jason can notify whenever he has a cool new app tool that he wants to test. If you are interested in joining, you can find his contact information at the end of the show notes. There is no charge if you'd like to join this group!

Jason had a strong background in Buddhism and has been working with our company for several years, focusing in the last year on the AI chat bot portion of the Feeling Great App. He has meditated for many years, and uses TEAM-CBT as well to deal with his personal moments of stress and unhappiness, something that most if not all of us experience at times!

Introduction

Jason was interested in evaluating the short-term impact of meditating, and did a literature review but found that most or all of the published studies had a focus on the effects of daily meditation over longer periods of time, like two months for example.

He was also interested in how long and how often people should meditate, and what types of meditations, if any, were the most effective.

So, he decided to test a one-hour meditation experience consisting of five ten-minute recorded meditations, including

1. A body scan meditation, systematically relaxing various parts of your body, beginning with your feet and toes.
2. A breathing and counting meditation, where you focus on your breathing and count the breaths going in and out.
3. A loving kindness meditation, starting with sending feelings of love, happiness, and health first to someone you love, then to yourself, then to someone you aren't especially close to, or don't particularly like, and on and on until you are projecting love and kindness to the entire universe.
4. A mindfulness exercise where you notice if you are thinking, hearing, watching, remembering, and so forth as various thoughts pass through your mind.
5. A "Do Nothing" meditation where you are instructed to simply "do nothing" for ten minutes.

Because previous research on meditation did not use scales that assessed specific kinds of negative feelings in the here-and-now, he decided to use the highly accurate 7-item negative feelings sliders as well as the 7-item positive feelings sliders prior to the start of the medicine, after each meditation, and at the end of the app.

He also asked many questions about motivation and expectations prior to the start of the meditation experiences, all answered from 0 (not at all) to 100 (completely), including

1. How familiar are you with David's work?
2. How familiar are you with meditation?
3. How strongly do you believe that meditation will make you feel better?
4. How strongly do you believe that meditation will be rewarding?
5. How strongly do you believe that meditation will only have a small effect?
6. How strongly do you believe that meditation will be a waste of time?
7. How strongly do you believe that meditation will make you feel worse?
8. How strongly do you believe that it will be painful or difficult?

You can find these data at this link.

He also asked every participant to generate an upsetting negative thought, like "I'm a loser," and use 0 to 1000 sliders to indicate how strongly they believed that thought, and how upsetting it was.

60 individuals started the experiment, and 35 completed it, with 25 dropping out prematurely before they completed some of the meditations.

He presented the data as a two-group analysis, those who completed and those who failed to complete the hour of meditation. Here, are just a few of the preliminary findings, and more refined analyses are planned so we can look at causal effects.

1. Both groups were moderately to very familiar with David's work and with meditation.
2. The completers had higher scores on the questions about positive expectations than the dropouts, although the differences were not great.
3. The dropouts had substantially higher scores on four questions about negative expectations for the experience, like "it will be a waste of time" or "it will be painful or difficult."
4. The initial scores on the belief in the negative thought were similar in the two groups (76% and 74%, respectively), but the Upsettingness of the thought was a bit higher in the completers (83% and 79%.
5. The mean of the initial scores on the 7 negative feelings sliders was significantly higher in the dropouts (37% and 46%, respectively), while the initial scores on the 7 positive feelings sliders was somewhat lower in the dropouts (49% and 45%, respectively).
6. Both groups expected a modest reduction in negative feelings and a modest boost in positive feelings during the hour of meditation.

Results on the 35 completers

1. After the first ten-minute meditation, there were significant reductions in the negative feeling sliders (from 37% before to 25% after) and increases in the positive feeling sliders (from 45% before to 55% after).
2. There did not appear to be any additional improvements in negative or positive feelings in the subsequent four meditations.
3. There was a significant reduction in the belief in the negative thought after the first meditation, and the reduction continued throughout the next four meditations. (76% to 54%), for a reduction of 29%.
4. There was a significant reduction in the upsetness caused by the negative thought after the first meditation, and the reduction continued throughout the next four meditations (79% to 47%) for a reduction of 40.5%.

You can find the remarkable results if you click here!

There are many fascinating results, but one of the most amazing--which we've replicated almost exactly in independent beta tests--is the remarkable similarity between the changes in negative and positive feelings the participants predicted, and the actual results. They are so close it looks like somebody faked the data, but that's not the case at all.

We will have to do more analyses to figure out what this means, but in simple terms, this seems to be iron clad proof that our expectations of the mood changing results of any intervention can be tremendously powerful. In fact, you could argue--and it would need further statistical analyses to test--that the causal impact of the expectations eclipsed the causal impact of the actual intervention, which in this case was meditation.

One of the cool things about quantitative research is that it nearly always shoots down our favorite hypotheses, and also gives us new and totally unexpected gifts to stimulate our thinking! In this instance, there were at least two mind-boggling and toally unexpected results:

1. When people mediate, the improvement in negative feelings is accompanied by parallel reductions in participants belief in their negative thoughts.
2. Participants predictions of the changes in seven negative and seven positive feelings by the end of the hour of meditation were spot on, and seemed almost impossibly accurate!

Discussion

The findings are exciting and specific, and suggest that the reduction in negative feelings during meditation may be, and is, mediated by the reduction in the users' belief in their negative thoughts. We will attempt to look into this more deeply using non-recursive analytic methods with SEM (structural equation modeling).

All samples are biased, and it can sometimes be extremely helpful to understand the bias in your sample when interpreting the results. The sample in this case included users favorably disposed to meditation, and responding to an email inviting them to participate in a meditation experiment. Only those who persisted the full hour were analyzed in the final outcome data, which could be another source of bias in the data. How much improvement would we have documented if we were analyzing completers (45) AND dropouts (35)?

Actually, this type of analysis is possible using Direct FIML (Full-Information Maximum Likelihood) with SEM techniques. I will, in fact, do these analyses as soon as I get the data set from Jason. This will allow me to estimate the scores at the end for all participants, including those who dropped out. It seems mathematically impossible, but it actually can be done.

If those who dropped out are systematically different from those who continued, it will "know" and correct for this. For example, if those who dropped out were, on average, doing more poorly, then the estimates based on those who persisted will be biased, and the degree of bias could potentially be infinite. The SEM analyses will also tell us if there are no significant differences in those who persisted and those who dropped out.

Finally, the data LOOKS like the meditation "caused" some fairly significant improvements, although the results were in some ways puzzling. Using SEM, I should be able to determine whether, and to what degree, the improvement was simply a "placebo" effect resulting from the participants expectations of improvement, as opposed to an actual result of the meditation.

So, stay tuned for updates on this amazing and deeply appreciated research initiative by our beloved Jason Meno!

Thanks for listening today.

Rhonda, Jason, and David

Ask David How Can I Change an SDB (Self-Defeating Belief)? How Can I Cope with Intense Public Speaking Anxiety? Featuring Rhonda Barovsky, Psy.D., Matthew May, MD, Jason Meno and David Burns, MD (Jason is an AI Scientist on our Feeling Great App Team)

1. Anonymous asks: How can I change an SDB (Self-Defeating Belief)?
2. Hiranmay asks: How can I deal with my intense anxiety before public speaking.

Answers to Your Questions

Note: These answers below were written BEFORE the podcast, and the live discussion always adds new and different angles.

Today, Jason Meno, our beloved AI guy on our app team, also chimes in on the many super questions submitted by Andrew (#3 - #10.)

1. Anonymous asks: How can I change an SDB?

Dear Dr. Burns,

I'm an avid listener of the Feeling Good podcast and for the past few weeks, an avid user of the Feeling Great app. Thank you for your incredible work and dedication to making people everywhere feel better about themselves.

I have a question about self-defeating beliefs that I'm hoping you can address, either on the show or on your website. You have mentioned on several occasions that SDBs are the root cause of negative thoughts and consequently of negative feelings.

Yet, to me it doesn't feel like SDBs are really addressed enough on the podcast. There seem to only be a handful of episodes covering the topic. It also seems there is a very limited toolbox of methods to use on SDBs, almost like dealing with them is considered an afterthought. If SDBs really are the cause of it all, shouldn't the primary focus be on defeating them first and only then, on defeating negative thoughts?

I'm just a little bit lost when it comes to defeating SDBs, which seem to be way harder to deal with than negative thoughts. Any insights or thoughts on the subject will be greatly appreciated.

Sincerely,

Anonymous

David's reply

Dear Anonymous,

Will start a new Ask David with your excellent question. Thanks,

david

First, you can look up Self-Defeating Beliefs in the search function on my website, and you'll find many great examples. Here's what I got just from "Self-Defeating Belief." You could also search for a specific type, like Perfectionism, Perceived Perfectionism, Achievement Addiction, Love Addiction, Approval Addiction, Submissiveness, etc.

In general, there are two approaches to any SDB. Four approaches can be used in this order:

1. 1. Do a Cost-Benefit Analysis of the SDB.
   2. If Disadvantages outweigh Advantages, use Semantic Technique to modify the SDB.
   3. Do an experiment to see if the SDB is actually valid.
   4. Use the Feared Fantasy Technique to put the lie to the SDB at the gut level.

Here's our latest thinking, which is a step beyond the four steps above. Do a Daily Mood Log on one specific moment when you were struggling with your SDB. We will discuss these ideas in greater depth on the show, of course!

You can also find a great deal on SDBs in my books, like Feeling Good, the Feeling Good Handbook, and more. But right now, I don't even know what SDB you might want help with / more information about.

Also, in the Feeling Great App, there's a terrific class called "Your PhD in Shoulds." It includes a lesson on perfectionism.

2. Hiranmay asks: How can I deal with my intense anxiety before public speaking without working on the negative thoughts I have afterwards, like

• "I am going to mess this up"
• "People are going to notice something obviously wrong in my presentation that I missed, and I will look like a fool."
• "This talk is important, it must go well!

Here's his email:

Dear Dr. Burns,

I love your books and the feeling good podcast. They have made such a huge difference in my life (in a good way of course).

I have an "ask David" question on acute anxiety:

If I have to play a badminton match or give a presentation, I usually get some or a lot of anxiety the day before the big event as well as the morning of. I then use all the methods you have taught, and the anxiety reduces. However, it usually comes back with a bang just before I give the talk or play a match. Cognitive techniques are not very helpful to me 30 minutes or 5 minutes before the presentation or match. I don't have the time to sit down and write my thoughts or cannot focus at all on my thoughts. Are there any strategies to reduce this form of acute "relapse" or nerves.

Here are some more details:

Event: 30 minutes before my presentation. I just entered the seminar room, and the first speaker is about to start their talk. I am next. I can feel my heart starting to pound and I am getting the familiar sense of anxiety and nerves.

Thoughts: "I am going to mess this up". "People are going to notice something obviously wrong in my presentation that I missed, and I will look like a fool". "This talk is important, it must go well".

Although to be honest, this is my analysis of what my thoughts were after the fact. 5-15 minutes before the presentation, I usually just notice my thoughts racing.

To reiterate: I am not looking for help with working on these thoughts after the presentation. Any strategies to acutely deal with anxiety or rather relapse of anxiety when I don't have time to use all the wonderful TEAM tools would be very helpful.

Thanks so much.

Best,

Hiranmay (pronounced he-run-may) living in Basel, Switzerland.

David's Reply

Sure, as a starting point I'd like to see your work with these thoughts on a Daily Mood Log. Do you have one that you could send me, with the percents filled in, etc.

That will allow me to see what your strategies are on challenging these thoughts, and whether you can knock them out of the park, or only challenge them "somewhat."

Best, david

You can see Hiranmay's excellent DML if you check here.

David Continues

Hi Hiranmay,

It sounds like are not interested in help with the thoughts you recorded in your email below, since this, by definition, is "after the presentation." If you like, you could perhaps "make up" some thoughts you might be having BEFORE you start to speak.

As someone who has had, and recovered from crippling public speaking anxiety, I have tons of powerful techniques, but would need some help from you so I'll have something to go on.

By the way, I absolutely DO NOT BELIEVE you when you say those are not the thoughts you are having in the minutes before you begin to speak! So, your requirement that we are not allowed to work on them is a bit of a hindrance.

As an aside, I will include this in an Ask David podcast, if that is okay!

Sincerely, david

I asked H to send me a copy of his Daily Mood Log, which was really well done, and responded with a few suggestions.

Then I sent this note:

David's Subsequent Response

One thing I noticed on your Daily Mood Log is your fear of making a mistake, or having a critical question from someone in the group, or not being able to impress your audience sufficiently. These fears are common in public speaking anxiety. We've all struggled with them at one time or another, I think!

I have changed my focus from needing to impress the audience with myself or my talk, and instead I try to remember to try to impress them with themselves, and how awesome they are.

Here's an example. I once gave a presentation on the serotonin theory of depression for about 1,000 psychiatrists at a prominent medical school in Texas. It was going well and suddenly a man at the rear stood up and started shouting something like this:

"I'm so sick of all you establishment researchers thinking you know so much and ignoring my work. I have discovered the cause and cure for depression in my laboratory. (He claimed it was some kind of vitamin deficiency.) But everyone is ignoring my work (and more ranting and raving.)

There was a chilled silence in the room. Here's how I responded:

"I appreciate was you're saying, and I agree. I think our current focus on deficiencies in brain serotonin is extremely misguided, and predict, as you say, that research will show that the chemical imbalance theory of depression is not valid. And often, the most important breakthroughs come from laboratories like yours, where someone who is unknown discovers the actual cause of an illness after being ignored for years and years. I'd be honored if you'd approach me at the end of my talk so I can learn more about your pioneering research!"

Notice I did not defend myself, but tried to make HIM feel good.

At the end of my talk, about 20 or more people came crowding up to the podium with questions and such. I saw him at the back of the group, pushing his way to the front. I braced for another attack. He said,

"Dr. Burns, that was the best presentation I've ever heard by far on the serotonin theory of depression. If you would give me permission, I would love to show your slides to my students and colleagues!"

I have very little fear of being attacked by people in the audience, and I now speak all the time in front of groups. I used to have paralyzing public speaking anxiety. But the monsters I feared were all in my brain!

Warmly, david

Andrew asks 8 cool questions! (#3 - #10) which are listed below, along with my answers. Jason Meno also sent some awesome answers, which you'll find below as well, right after my answers to the 8 questions.

418 The Fear of Driving Featuring Werner Spitzfaden, LCSW and Rhonda Barovsky, PsyD

Today, we feature Werner Spitzfaden, LCSW, a Level 3 certified TEAM-CBT therapist who recently treated Rhonda, who's driving phobia returned during the pandemic because she did very little driving at that time. After you overcome any fear or phobia, it has a way of returning if you don't continue confronting your fear. Werner describes his skillful and compassionate work with Rhonda!

Werner is a dear colleague and friend with over 35 plus years of clinical experience treating phobias, such as the fear of flying, claustrophobia (the fear of being trapped in small places), and driving (especially over bridges and overpasses). He also treats depression, panic and other forms of anxiety, and works in corporate environments to improve communication and teamwork.

Let's dive right in, Please take a look at Rhonda's completed Daily Mood Log,

As you can see, the upsetting event was thinking about driving over an overpass, and she rated her initial anxiety cluster at 100%, indicating extreme anxiety. She was also 90% ashamed, and 80% Inferior, worthless, inadequate, defective, and incompetent. She was also feeling 99% embarrassed, foolish, humiliated, and self-conscious, and 85% hopeless, despairing, frustrated, stuck, angry, annoyed, irritated, upset, and devastated. Her sadness was only modestly elevated at 25%.

There are several teaching points. First, most of Rhonda's negative feelings were severely to extremely elevated. Second, although she is asking for help with a phobia, anxiety often goes hand-in-hand with a wide variety of negative feelings, including shame and inadequacy. This is because anxious individuals often feel like there's something terribly and shamefully wrong with them.

Rhonda's feelings of shame are not unusual. Shame is a central feature of anxiety, whereas a loss of self-esteem is a central feature of depression. Werner added that the fear of driving often goes along with the fear of heights as well as claustrophobia.

Rhonda admitted to engaging in many "safety behaviors" which typically make anxiety temporarily better but worse in the long run. Rhonda's "safety behaviors" included going out of her way when driving to avoid scary overpasses as well as asking her husband to drive her many place. As you can see, these totally understandable "safety behaviors" relieve your anxiety in the here-and-now because they are forms of avoidance, but that's why they makes anxiety worse in the long run. The urge to avoid of the thing(s) you fear is universal among individuals struggling with all forms of anxiety.

Werner emphasized the importance of empathy in the initial phase of treatment, and throughout the treatment, since trust and the courage to face your fears is so central in the treatment of all forms of anxiety and, of course, depression as well.

Rhonda invited Werner and another TEAM-CBT colleague, Lee Flowers, to stay with her in Berkeley during the recent TEAM intensive that David and Jill Levitt directed at the South SF Conference Center near the airport. She drove the group to and from the workshop to face her fears and get some motivation and support at the same time.

You can see many of her negative thoughts about driving on Rhonda's completed Daily Mood Log, including these:

1. The bridge will collapse. 95%
2. Other cars will make the bridge unstable. 100%
3. I'll have a heart attack. 95%
4. I'm so dumb for not driving on this overpass. 1005
5. I'm an ass. 100%
6. I can't do this. 100%
7. I'll die. 100%
8. Lee and Werner will see me at my worst. 100%
9. I need to study the exact route before I start. 100%
10. I'll get into an accident. 100%

As you can see, the list includes a mixture of fear-inducing thoughts as well as self-critical thoughts and shame-inducing thoughts, like "Lee and Werner will see me at my worst."

Whenever you are working with anyone with anxiety, you have to emphasize first, to create trust, warmth, and understanding. This won't cure anyone of anything, but will give your patients the courage to face their fears when you get to the M - Methods portion of your TEAM session.

After you get your A in empathy, you can move on to A = Paradoxical Agenda Setting. That where you bring Outcome and Process Resistance to conscious awareness. Then you melt them away using a variety of TEAM-CBT techniques. Outcome Resistance means that Rhonda may have mixed feelings about a "cure" for her driving phobia. In other words, although she WANTS to get rid of this fear, she may subconsciously NOT want to get rid of it.

Can you think of why? Take a moment to think about it, and make a guess. You'll find the answer at the end of the show notes.

Process Resistance means she may WANT a cure for her driving phobia, but may not be willing to do what it takes to defeat this fear.

What will she have to do? Take a moment to think about it, and make a guess. You'll find the answer at the end of the show notes.

Werner and Rhonda described a number of TEAM-CBT M = Methods that they used to reduce Outcome Resistance, including

• The Miracle Cure Question
• The Magic Button
• Positive Reframing
• The Pivot Question
• The Magic Dial.

To put this phase in a nutshell, Werner highlighted how Rhonda's intensely negative feelings helped her and revealed many positive things about her core values as a therapist and human being. This is a shame-reducing technique and you can use the Magic Dial to ask your patient what they would like to dial each negative feeling down to, without reducing them all the way to zero. You can see Ronda's goals on Rhonda's completed Daily Mood Log in the Emotions Table

Next, Werner worked on Process Resistance, bringing the work on Paradoxical Agenda Setting to closure.

At the start of the M = Methods portion of their work, Rhonda identified the distortions in two of her thoughts ("I'm dumb," and "I can't do this."). See how many distortions you can find. Wrote them down on a piece of paper and when you're done you can see the answers at the end of the show notes.

Werner pointed out that Rhonda's anger, directed against herself, had become a springboard for agitation which intensified her anxiety.

Werner and Rhonda challenged some of her negative thoughts with Examine the Evidence, Externalization of Voices (illustrated live during the podcast),Double Standard Technique and the Paradoxical Double Standard Technique as well as a Fear Hierarchy, which you can see if you click here.

The also did Cognitive Flooding (also called Imaginal Exposure) three times, and by the third time Rhonda could only increase her negative feelings into the mild range, whereas they had started out in the extremely elevated range.

They also used breathing exercise plus getting into the here-and-now to calm herself while driving over overpasses.

All of this was background work for actually driving during the intensive, and the highlight was driving home in the dark on the third evening of the intensive. For Rhonda, this was the most fearful thing of all! She said at the start her anxiety was "greater than 100%," but she felt triumphant when she arrived home.

Werner gave her specific homework, like driving over a specific overpass four times, and also encouraged Michael, Rhonda's husband, not to give in to her requests to do the driving on a planned trip to visit friends in Sacramento.

I am deeply grateful to Rhonda for giving us such a raw and real glimpse into her courageous and victorious win over her intense driving phobia, and a big thanks also to Werner for being such a kind and powerful TEAM-CBT therapist, teacher!, and beloved friend!

Thanks for listening today,

Rhonda, Werner, and David

Solution to puzzles above

• Outcome Resistance: If she's "cured," she'll have to start driving much more, and that will include driving over overpasses and bridges. This concept will freak her out now, because she's still afraid something horrible might happen if she stops avoiding them.
• Process Resistance: To overcome her fears, she'll have to face them and experience some fairly intense fear along the way. Werner can support her, and drive with her, as he did, but she will still freak out at first when driving on overpasses and bridges.
• The distortions in those two negative thoughts included All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Mind-Reading, Magnification and Minimization, Emotional Reasoning, Hidden Shoulds, Labeling, and Self-Blame.

Podcast 417 Bullying Featuring Manuel Sierra, MD (pictured above)

Today, we welcome an old friend, Manuel Sierra, MD, who practices pediatric psychiatry in Idaho, and Dr. Matt May, a familiar and beloved colleague, to discuss bullying.

Below you'll find a great list of questions Dr. Matt May submitted just prior to today's podcast, along with some links you may wish to explore for more information. We addressed some of the questions, but certainly not all, during the podcast!

Manuel described bullying, and said the ¼ of children and adults have experienced bullying. The consequences can be severe, including suicidal urges or completed suicides, along with shame and a severe loss of self-esteem, and more. He pointed out that bullies are good at zeroing in on aspects of ourselves that we feel insecure about, including how we look, our ethnicity, our aptitudes, and more. He provided links to resources on bullying.

The bully picks on someone who is weak, so there is a power imbalance, and does the bullying to gain popularity and power, at the expense of the victim. David and Manuel emphasized that the bullying per se cannot cause the depression, shame, and so forth, but rather the victim must buy into the bully's mean-spirited statements, like "you're weak," or "you have an ugly zit on your nose," "your mother is a dirty whore," and more.

Then, the inner dialogue of the victim often goes like this:

1. I must be a terrible and horrible person to get bullied like this.
2. I'm worthless.
3. All the kids are looking down on me.
4. Everybody hates me!
5. Everyone is laughing at me.
6. I'm just a loser.

And that, of course, is the voice of the "inner bully" who does all the emotional damage. Manuel and David both emphasized that the goal of treatment is to help the victim see that the "badness" is not with them, but rather with the kid (or adult) who's doing the bullying.

Because the victims nearly always feel ashamed, they will often suffer in silence, keeping the bullying a secret. David described what he calls the "abuse contract" that many, and perhaps most, humans buy into when being hurt or exploited. It's really a contract between the abuser and the abused, and there are there parts to the agreement.

1. I get to hurt you for my own pleasure. This might include sexual, physical, financial, or psychological torture or abuse.
2. You, the victim are entirely to blame for this. You are the bad one. I am superior and totally innocent. You deserve what's happening to you.
3. We have to keep this a secret, even from ourselves. You cannot even hint that I am doing something wrong. If you try that, I will REALLY hurt you.

David emphasized that the tendency to "accept" this type of horrible contract is not limited to children, but includes adults as well.

He emphasized that sometimes the child who is being bullied will tell parents, who then tell the teacher or school officials, who will tell the bully to stop. This is rarely effective, and often makes the situation worse, since the bully tells the victim that they are a snitch and now they will REALLY get what they "deserve."

Matt described many types of bullying, including physical, psychological, and cyber bullying. Manuel described some of the signs to look for if you suspect a problem with your child, including:

1. Not wanting to go to school.
2. Saying things like "everyone thinks I'm terrible."
3. Changes in sleep, eating habits, and energy.
4. Somatic symptoms such as stomach aches and headaches.

Manuel emphasized that the goal is not to eliminate negative feelings entirely, but rather to reduce the time you spend feeling anxious, humiliated and upset after being bullied. He also emphasized that ongoing practice talking back to your own negative thoughts is an important key to change, in exactly the same way that athletes must commit to ongoing daily practice to boost their physical skills and stamina.

Manuel emphasized the importance of empathy and support, as well as asking victims if they'd want some help combatting their automatic negative thoughts and feelings. He shared that he endured considerable bullying as a kid, and was bullied because he was poor, of Mexican heritage, short, wearing glasses ("four eyes"), and young, and sometimes called "a fag" and other hurtful things.

He said that reattribution is one useful strategy, among many, for combatting automatic thoughts and negative feelings. Instead of automatically blaming yourself for the bullying, you can ask questions like this: "What is it in their life that makes them want to do things like this.?" And "They are trying to hurt and embarrass me. Why are they doing that."

The goal is to help the victim see that the "badness" and shame really reside within the bully, and not with them. The bully is trying to tear you down. Ask yourself why? The bully thinks that this is the best way for them to gain popularity, power, and importance.

Toward the end of the podcast, I, David, again emphasized that the Outer Bully can hurt us physically, by hitting for example, but only the Inner Bully can make us suffer emotionally. And if you've used the Externalization of Voices to crush the inner bully, and you no longer feel intimidated or ashamed when some tries to bully you, it becomes infinitely easier to respond effectively to the Outer Bully, using the Five Secrets, including Disarming and Stroking, as well as humor.

To demonstrate this, I invited the other guests to try to bully me as an old person (I'm about to turn 82), and urged them to say the cruelest things they could think of. This is called the Feared Fantasy Technique.

I was surprised and pleased at how incredibly easy it was to get "the edge on them. " I hope you enjoy that aspect of the podcast.

We will likely approach this topic again, with a focus on cyber bullying, and will restrict our focus to children and teens.

How to Help!

Matt once worked with a child who encountered their own 'inner bully' in the form of negative thoughts that would occur when they were unable to assemble LEGO's. The child could express certain thoughts, but was too young to write, so Matt wrote these down:

1. I'll never be able to do it
2. It's impossible
3. I'm not good at anything
4. There is something wrong with me

Matt asked the child if they would like to learn a trick for how to feel better and the child agreed.

Matt wrote down some new thoughts for the child to choose from to describe the situation that was upsetting to them.

Multiple Choice Positive Thoughts:

1. I really, really want to do this!
2. It's ok if I can't do it, yet
3. Some things take lots and lots of practice
4. I may be able to do it later
5. I can do lots of things really well already
6. I can probably get better with practice
7. People love me and like to help
8. Nobody's good at everything all the time
9. Everybody messes up sometimes
10. It might help to take a break
11. I can always choose to like myself

The child said they really liked #11 and felt better right away and during future 'relapses'!

Thanks,

Matt

Thanks for listening today. Below you'll find the email Matt sent prior to the show.

Manuel, Rhonda, Matt, and David

Matt wrote:

Just to stir up trouble and make you all sweat, I'm sending a few questions we might address:

1. What is bullying? How are we defining this term? Is it Liberal Propaganda? How dare I say that?
2. What's the difference between bullying and micro-aggressions / gaslighting? Am I crazy, if I think I'm being gaslighted?
3. If I avoid bullying, in-person, including physical, emotional and verbal abuse...am I safe, on the Internet, at least?
4. Is there such a thing as 'Safety'? Isn't that the thing we need, the most? Whose job is it, to make me feel safe? Why do some people think that safety doesn't exist?
5. What is the significance of bullying? Does it matter or have any tangible effects on individuals or society? Link: https://www.ncbi.nlm.nih.gov/books/NBK390414/

What are some common misconceptions when it comes to bullying? Here are some that Matt has seen on DML's:

1. It was all my fault / I deserved it / This happened because I am (insert label: bad/weak/defective, etc.)
2. Bullying is normal, nothing can be done about it. Everyone gets bullied. It builds character. I should just get over it.
3. I shouldn't *still* feel upset. That was a long time ago and I've done a lot of therapy.
4. I can't speak up or talk about it, it's just too disturbing and upsetting.
5. People would judge me and reject me, if they knew what happened to me
6. All conflict is dangerous and must be avoided, at all costs
7. I'm just a loser, a born victim, worthless in every way.
8. This will always happen to me and people who believe #2 are correct
9. I should be more accepting of bullies, they're people, too.
10. Bullies shouldn't be bullies and should be hunted to the ends of the earth, and destroyed.

What is the *cause* of bullying behaviors? Why would anyone choose to be cruel, manipulative and selfish?

1. What is the 'Dark Triad'?
2. Which feature of the 'Dark Triad' is most closely associated with bullying? Link: https://en.wikipedia.org/wiki/Bullying

What can be done about bullying?

1. How can TEAM therapy help someone who is being bullied?
2. Can TEAM therapy help a bully?
3. What can parents do, if their child is being bullied? Can TEAM help?
4. What can parents do, if their child is bullying? Can TEAM help?
5. What can society do?

Other Questions:

1. What is the "Internal Bully"?
2. How does the "Internal Bully" relate to depression?
3. What is the greatest predictor of bullying behavior and thinking?
4. Who's to blame, anyway, here?

Podcast 416 Ask David is it reckless to question the existence of the "soul?"' How can I make myself accountable? Do we have a "personality," or is that just another illusion? Do questions about the "self" and "free will" involve All-or-Nothing thinking?

The answers below were prepared prior to the podcast, and simply based on email exchanges. Be sure to listen to the live podcast discussion to get a variety of opinions and comments!

Questions for today's podcast.

#1: Weren't your comments on the self a bit reckless, given that the existence of / or belief in the "soul" is a prerequisite for most religions?

#2: How can I make myself accountable for doing the exercises in your books?

#3. Holy asks if the concept of having "a personality" is the same as the question of having "a self?"

#4. Could questions about the "self" and "free will" involve All-or-Nothing Thinking?

Question #1. (not question, just a comment worthy of a response)

Your comments on the "self" were shallow, mocking and restless.

The recent episode on 'Do I have a self?' (Episode 406) was very shallow and mocking of people who thought there was a soul/self. Given a soul is a prerequisite for most religions, dismissing it out of hand without meaningful discussion seems reckless.

David's response

Thanks, there's a lot of truth in your comment and we'll definitely include this on an upcoming Ask David!

To give a brief response prior to the show, I would say that I am not trying to defend or attack any religion, but don't want to give up my right to freedom of thought. I, David, am not saying that the "soul" does not exist, but what I am saying is hard to convey, and I probably won't be successful now, either.

But, when you talk about a "soul," I do not have any idea what you mean by that word, or what you are referring to, if anything. To me, words like "self" or "soul" are simply language that is "out of gear," as Wittgenstein might say. Meaning can only occur in a specific concept. It is not the case that there are "pure meanings" for abstract concepts. Thinking along those lines was the huge error that Plato and Aristotle made.

Now, let's say I go to YouTube and listen to some really kick-ass music that I totally love. I might say, "Wow, that guy (like James Brown, for example) really has soul!"

What I'm saying is that I tremendously admire and appreciate his talent, his energy, and so forth. I am not referring to something metaphysical.

My concern about your comment is that it sounds scolding, at least to my ear, like the "morality police," perhaps. Personally, I have seen a great deal of evil done in the name of this or that religion, and I have no doubt that you have, too!

Still, I am sure you have strong religious beliefs, which I respect, and apologize for having offended you. But I admit I am ambivalent, and partially happy that you are offended, and speaking out, because I believe that critical thinking is also tremendously precious, just as your religious beliefs are precious to you.

In a selfish way, I have to confess I am also happy for the criticism, because controversy stirs up interest, and I am trying to interest people in our podcasts, which are ultimately dedicated to healing and relief of suffering.

Still, I cannot deny the truth in your comment, that my "critical thinking" can be a disguise for a put down.

When I wrote Feeling Good, I was very aware already (in the 1970s) that the chemicals categorized as "antidepressants" had few or no clinically significant effects above and beyond their placebo effects, and subsequent research has validated this.

But I did not emphasize this in that book because I did not want to pull the rug out from anybody, and hurt anybody's feelings. After all, if you are getting a nice "placebo effect," that's a good thing, at lest to some extent.

Now, I'm older, so I'm more willing to speak my mind, and let the chips fall where they may.

And you have bravely spoken your mind, too. Kudos to you!

And that's the end of my prayer! Keep those good thoughts rolling along.

Amen

Best, david (PS I'm sure you'll get way better answers from the others on the podcast tomorrow!)

Question #2. How can I make myself accountable for doing the exercises in your books?

Good to have Fabrice back. Regarding your books I have a question. I have trouble holding myself accountable doing the exercises in the book. Do you have any advice on how to prioritize doing the homework and being disciplined with it? How did other depressed people get better using your books? I already filled out multiple notebooks but appear to be stuck. Any help appreciated!

David's Response

Thanks, we will address your question on a future Ask David podcast, if that's ok.

Question #3. Holy asks if the concept of having "a personality" is the same as the question of having "a self?"

@HolyLoveQuest • 1 day ago

Thank you for this video on this topic, it was very clear to me!

It's a shame that this chapter of your Feeling Great book was removed, because to me this philosophical point is one important tool (among the many techniques that you propose) to get read of negative thinking, and to heal.

What you said about the DSM is refreshing, and I agree with it. So, you said schizophrenia and bipolar1 are mental disorders, and you explained why, but what would be the third: psychopathy? It would be nice if you do another video where you dig on this. Your voice on it is really important. What the APA is doing is really concerning. Other psychiatrists disagree with this business of labelling people. And you're right, it's detrimental to human beings.

There is another psychological concept that you didn't talk about, but who looks similar to the "self", which is the "personality". What is your take on it, the same or different?

Lastly, now in the spiritual domain, is the notion of the soul the same for you than the "self"? Or, in your opinion, could it be a possibility of an essential part of us which links us all to the Spirit, to spirituality?

Looking forward to watching the other philosophical videos!

David's Response

Will include in next Ask David Podcast!

Question 4. Could questions about the "self" and "free will" involve All-or-Nothing Thinking?

Matt send me the following email he received and asked if we could include it in our next podcast, and my answer was "of course!"

Hi,

I'd like to tell you about my experience with my son. He is 14 years old and despite our honest attempts not to label, he has always been the problem child: selfish, disobedient etc.

Recently we started him on Prozac and the changes have been incredible. Things that have been way beyond his best times are now simple, like going to sleep on time or having a good time with his brother. Every night my wife and I tell each other about some new miracle.

So, I wonder what you can say about this from the lens of free will. An obvious conclusion would be that the choices he made until now were not "free" because his brain was not presenting him with the same set of choices that other kids experience. On the other hand, if he is acting better now, we could say that it is not his choice, just a pill making the decision for him. I feel like that would be insulting and degrading.

I wonder if a lot of resistance to therapy and especially pharmacotherapy is related to anxiety about the question: "If I can be changed by a pill, then who am I?"

I had another thought after listening to the episode on "self". The position that self doesn't exist seems extreme to me, maybe like "all or nothing thinking". Maybe we could answer that question with a "magic dial". How much do we agree that there are selves and free wills? I agree that there are problems associated with having a self and free will, but I think there are practical and theoretical reasons on the other side as well.

Maybe the golden path is in the middle?

David's Response:

Will include your excellent question in the next Ask David Podcast! I am so happy to hear the good news about your son!

At this point I will briefly say that concerns about "free will" might definitely include all-or-nothing thinking in the following sense. There is an awful lot of our thoughts, beliefs, feelings, behaviors, preferences, and so forth that is kind of hard-wired by evolution, genetics, and who knows what.

For example, I really love blueberry pie that way my mother made it, but I never cared for pumpkin pie. I cannot "will" myself to like pumpkin pie! So I don't have free will in that sense.

Similarly, I can't "will" myself to want to stop breathing permanently, or to stop feeling hungry when I haven't eaten, and I can't "will" myself to levitate when mediating or being able to high jump over something five feet high.

The list goes on and on. And even when I freely chose something, like what type of new shirt to purchase, I have no doubt by genes and innate preferences, and possibly my upbringing, will strongly influence my choices.

We all have biases, preferences, and desires that we do not choose, at least not consciously, Like sexual preferences, for example. We're kind of stuck with what we've got.

Now we can make free choices, of course, but we cannot be "totally free," because we exist and are human. A cat can't "not" get excited by a wiggly piece of string or a mouse that's running away.

But we CAN make conscious choices, obviously, just as I made the decision to print your excellent question and type out this brief response!

Warmly, david

Question #1: John asks: Can you do TEAM on your own?

Question #2: John asks: Can you provide more insights or instructions on how to do Positive Reframing on your own? It seems to be an incredibly important key to TEAM-CBT.

Question #3: Ann asks: What can I do when I blush and my face turns bright red?

Question #4: Dylan asks: Can you have a delayed reaction to the CBT exercises?

#415 September 23 Ask, New questions

Question #1: John asks: Can you do TEAM on your own?

Oh, one other point that occurred to me, the people doing personal work on your podcasts are generally TEAM CBT therapists or people familiar with the TEAM model. They are obviously very familiar with the steps and techniques in TEAM, and yet they seem to require the insight and guidance from yourself and Jill.

Why do you think that is if they are so well versed in TEAM already? Does that mean that a person from the general public doing their own work using your books without the guidance of a TEAM therapist is futile? Or would you always recommend someone using a therapist?

Kind Regards

John

David's response

Can we include it in another podcast? Would love to just read it and jam on it with R and M.

Warmly, david

Question #2: John asks: Can you provide more insights or instructions on how to do Positive Reframing on your own? It seems to be an incredibly important key to TEAM-CBT.

On Mon, Aug 5, 2024 at 9:24 PM John Macken [email protected]> wrote:

Hey there David and Rhonda,

I hope you're keeping well, this is John from Ireland, we had a previous correspondence on Should statements! David, thanks very much for asking for access to the beta app, I'm really enjoying the modules! I heard you say on one of your apps that you are planning some workshops in relation to the app, will they be available online do you think? Would love to tune in if possible!

I am always grateful for your inspiring work! I love your passion for the work that you and Rhonda do and that comes across from both of you during every podcast episode. Your FG community sounds amazing! Who knows, maybe one day I'll ditch the corporate career and join the cult!

I have another question on Positive Reframing! As someone who is still trying to find my own journey to enlightenment following many months of anxiety and depression, I feel I am falling at this positive reframing step. I still find I am bumping up against resistance and I feel that my positive values and benefits don't count. It's almost as if there is some kind of discounting the positive going on like my negative points vastly outweigh my positive points. It's like there is such a negative filter there is no space for recognizing positive qualities.

I was listening to the beginning of Episode 310 where a listener had an excellent contribution on Positive Reframing from your live work with Nasli. That got me thinking, would it be possible to hear more insights and detail on how to perform your own Positive Reframing work? Or do you have guidelines or a worksheet anywhere? It feels like the most powerful of all the steps!

Among the many incredible tools that have been created under TEAM it seems the Agenda setting piece is probably the most powerful and innovative. I have listened to many of your Live Sessions intently and it seems that your gift and that of Jill Levitt is in convincing the patient of the beauty of their depression and anxiety. It feels that they are almost recovered or very nearly once you go through that step.

On the face of it, it looks like what you're doing is very simple but there is a nuance and complexity to it that is incredible and without sounding too grandstanding or over dramatic this "gift" seems to be where the healing power lies. If you could bottle that gift you would change the world or be a billionaire or both! It is astounding to listen to. I would love to hear more about your insights into this area and how people can unlock this for themselves.

For example, I found podcast 387 on Acceptance and Daring to be average incredibly powerful and insightful and convincing and these are pieces I'm trying to implement in my life.

Love and admire your work and would love to make it over to one of your in person workshops someday when they are available to the general public,

Warm regards

John

David's response

We will address positive reframing on the show.

Question #3: Ann asks: What can I do when I blush and my face turns bright red?

Dr. Burns,

I hope you're both doing well. I wanted to share with you that you have changed my life dramatically. I have always thought that everyone else had a problem as far as attitudes and behaviors. But you have taught me through all three of your books and podcasts that my thoughts are why I've been so anxious and depressed.

I have been on medication since I was 20 years old. Now, I'm weaning off of my medication because of all of the work I've done with your book and a therapist trained in TEAM therapy. My relationship is much better with my husband and it was me that was pushing him away from me. Talk about enlightenment!?

I'm anxious about getting completely off of my clonazepam because it helps me "control" my face from turning red. My red face makes me so anxious and I start sweating profusely whenever I'm in a situation that's embarrassing. Thank God, my menopause has helped me with explaining why my face is so red. This has been going on since I can remember. I think I was 5 years old in school when it first happened. Most people stare at me because my face gets really red. I've repeatedly tried looking at people, while my face is turning red, to see if they are truly looking at me and sometimes they are and not. The redness lasts for around two minutes but if feels like hours. What can I do? I want to get off all of my meds but my psychiatrist says to do it slowly. I haven't listened to all of your podcasts but I don't think there's one out there regarding a 49 year old lady suffering from a red face. Maybe an ask David? I hope I've been specific enough for you. I cannot thank you enough for everything you do for people.

Thank you,

Ann Zernone

David's response

Yes, we actually had a podcast on this exact thing, and happy to add it to the next Ask David if you like. Best, david

88 Role Play Techniques: Feared Fantasy Revisited https://feelinggood.com/2018/05/14/088-role-play-techniques-feared-fantasy-revisited/

168 The Blushing Cure https://feelinggood.com/2019/11/25/168-ask-david-the-blushing-cure-how-to-heal-a-broken-heart-treating-anorexia-and-more/

Question #4: Dylan asks: Can you have a delayed reaction to the CBT exercises?

Hi David,

I'm a big fan of your work. Quick question: do you commonly come across people who do CBT exercises and they don't get their anxiety or depression levels reduced super low right after doing the exercises but a couple days later they experience the results?

Dylan Aames

Unfit Productions, LLC

President

@JohnnyPlissken-xs7hq • 12 hours ago

David replies

Will talks about having this same experience on the live show.

Feeling Down? Try the Feeling Great App for Free!

The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com!

Life Coaching: A New Dimension in Counseling

Today we discuss the recent upsurge in life coaching, and feature one of the leaders in this emerging field, Angela Poch, and one of her wonderful students, Lorna Bird.

Lorna Bird

Angela Poch (see featured photo) is a Registered Professional Counsellor (RPC) with the Canadian Professional Counselling Association, certified Master Life Coach, and TEAM-CBT Level 4 Advanced Therapist and Trainer. She has been teaching health and wellness for over 30 years and was Vice President of Education with the Adventist Association of Health & Wellness Coaching. She has written several articles and books on health and wellness including, "The Truth Will Set You Free." She has a YouTube channel (@talkingteamcbt) interviewing clinicians about their journeys with TEAM-CBT. She also has a channel on psychology and health (@bodymindhealth4u).

Lorna Bird holds a Diploma of Counseling from Australia and is a certified Life and Health Coach. She is also a Level 3 certified TEAM-CBT therapist https://www.yestohealth.com.au/

Angela and Lorna will give us the true scoop on coaching. To get started, what IS coaching, and how does it differ from psychotherapy?

I am aware that our podcast goes worldwide, so the answer may differ depending on the country or state where you live. According to AI,

"In California, the term "psychotherapist" is defined in the Civil Code to include a number of mental health professionals, including psychologists, psychiatrists, and clinical social workers. In general, anyone who provides psychotherapy or counseling in California, whether in person, by phone, or online, must be licensed.in California."

Coaching is quite different. Again, according to AI,

"In California, there are no specific state-mandated requirements for individuals to use the term "coach" or practice life coaching, meaning anyone can technically call themselves a coach without obtaining a specific license."

Angela Poch resides in Canada, and she has been a leading and beloved member of the TEAM-CBT community. She emphasized several differences between a "coach" and a licensed mental health professional:

Diagnosis: A coach does not diagnose clients into the familiar DSM categories of "mental disorders," such as "Major Depressive Illness," "Bipolar Disorder," "Schizophrenia," or any of the hundreds of "mental disorders" listed in the DSM. In the same vein, licensed mental health professionals will typically screen for suicidal thoughts and urges, and will treat suicidal individuals, but this is forbidden territory for coaches.

Purpose / aims of coaching: The purpose or aims of coaching do not, as a rule, involve delving into your past to search for the "cause(s)" of your problems, such as adverse childhood experiences or traumas. Instead, the focus of coaching is primarily on making changes in the here-and-now in how you think, feel, and relate to others. This might involve learning to challenge distorted negative thoughts so you will think and feel more positively about your life, as well as how to relate to others more skillfully. Coaching is goal-oriented and forward-moving rather than dwelling on the past. Of course, good counsellors and licensed mental health professionals may also provide tools to move forward as well, so there can be overlap.

Training / credentialing: Because coaching is so new, there are not yet any widely accepted standards or requirements for calling yourself a "coach." There is a varying degree of training to be "certified," which might just consist of watching a couple videos to 100's of hours of supervision with the ICF (International Coaching Federation), and everything in between.

Here's a generalized diagram Angela created to help with further clarification. NOTE: many TEAM-CBT therapists also are client/goal focused as well as and will often use coaching-style tools.

Angela described a 20-hour "Feeling Great Coach" certification program she has developed. Her program is based almost entirely on TEAM-CBT and includes a final exam you must pass to get certified.

She also offers a TEAM-CBT Masterclass & Mentoring Program for both coaches as well as therapists that includes live training twice a month, online practice groups, case consultation in small groups, one-on-one mentoring sessions, and personal work as well. She said this integrates seamlessly with FGI's Fast Track program, any of David's intensives, or the Tuesday group for those who want more individualized support and training.

Lorna enthusiastically described her experiences learning from many of Angela's training programs. I (David) have had the pleasure of knowing and working with Angela for many years now, starting with her attendance at a number of my intensives and two-day TEAM-CBT training programs in Canada. Lorna is really enjoying the Masterclass Mentoring Program and recommends you take Angela's free workshop called "Effective Compassion." You can check it out at

www.teamcbt.ca/effectivecompassion

How do I, David, feel about coaching? I am, for the most part, enthusiastic, but with a few reservations. I would have to confess that I spent 5 years in medical school, four more years in psychiatric residency, plus two years in post-doctoral research training at top institutions, but did not learn much at all, if anything, that has really helped me treat human beings who are hurting. Of course, I did learn how to prescribe drugs for those with severe difficulties, like Bipolar I Disorder, or Paranoid Schizophrenia, but that definitely did not require years and years of intensive medically oriented training.

All I ever really wanted to do was psychotherapy. In my last year or so of post-doctoral psychiatric training, I discovered cognitive therapy, although it was not a part of the required curriculum, and learned quite a lot that has been really helpful in working with patients.

But for the most part, all of the extensive medical training I received had very little, at best, to do with how I now work with patients, and an awful lot of what I do was things I had to figure out for myself. I do have great respect for psychology training (either clinical psychology or PsyD training), because of the emphasis on research and critical thinking, but I do think there is lots of room for new approaches such as coaching to emerge and evolve, and it seems to be the case that more people than ever are still struggling with depression, anxiety, addictions, rage, and more.

Like any field, I think coaching is vulnerable to misuse by narcissistic individuals who wish to deceive or exploit the general public, and individuals who are naïve or unaware of the background or training of their therapists are perhaps at great risk of abuse. But I would also say that this problem is in no way limited to coaching, since a great many licensed mental health professionals have been charged and convicted of all manner of unethical conduct and as well as malpractice over the years as well.

That's why I'm enthusiastic about responsible leaders who, like Angela Poch, are blazing new trails and setting the bar high for those who wish to enter the field of life coaching. I'm also delighted to see that for years now, the Feeling Good Institute (FGI, feelinggoodinsititute.com) has included coaches in their superb training programs as well, and many high profile individuals you may be familiar with, like our beloved Professor Mark Noble, have taken and benefit from TEAM-CBT certification via the FGI.

To learn more, contact Angela at [email protected] or visit https://angelapoch.com/ to learn about Angela's many training and treatment programs.

You can reach Lorna at:[email protected] or https://www.yestohealth.com.au/

And here is the contact information for TEAM-CBT Australia: https://www.teamcbtaustralia.com.au/

Ask David Disturbing Intrusive Thoughts-- where do they come from? Alone and Liking It--is that Okay? Help with those darned Shoulds, and more!

The following show notes were written before the show. The actual live discussions will vary somewhat from the answers you will find here, which simply included David's email exchanges with those who asked the questions. .

1. Rodolfo asks about disturbing and unwelcome intrusive thoughts.

1. Brittany asks if it's okay to enjoy / prefer being alone.

1. John, from Ireland, asks, "Help! I'm shoulding on myself again! What can I do? Please do another podcast on Should Statements."

1. Rodolfo asks about disturbing and unwelcome intrusive thoughts.

1. Rodolfo asks about ADHD & Intrusive Thoughts

Hello Dr. Burns, my name is Rudy. First and foremost, your writings and podcasts have been life changing for me. You're AMAZING!

I was recently diagnosed with ADHD and I started experiencing intrusive thoughts around November of last year. I thought I had OCD, but apparently intrusive thoughts are a common companion in ADHD. What would be the best course of action in defeating them? How would I apply TEAM to them?

David's Response

In all my books, like Feeling Great, I outline a step by step approach to writing down and challenging thoughts. You can also listen to the podcast on the four models for treating anxiety.

Can we use your great comment on a podcast, and add your question to our next Ask David podcast?

Can you send me an example of the types of intrusive thoughts you're having? Sometimes writing them down and challenging can be helpful, but need to see what we're talking about.

Best, david

Rodolfo responds

Thank you for the swift response! Ok, so writing down my intrusive thoughts, regardless of their nature, and challenging them. I don't, however, know which method/route to challenge them with. I have Feeling Great, so I will read through it again. I will also check out the podcasts.

My intrusive thoughts have been disgusting violent acts involving my wife and son. ***I HAVE NO INTENTIONS OR DESIRE TO COMMIT ANY OF THEM***. I've had images of my wife getting shot, not necessarily by me. Sometimes I'll see my arms give out and my son will fall. I've seen my wife sitting down, and she gets hit in the back of the head.

When they appear, I begin to freak out immensely because they are the complete opposite of who I am and what I want to do, which is protect them. I know I'm not doing something right when it comes to your methods because I still freak out.

David Responds

Thanks! Although disturbing, this is a very common and often easily treatable OCD type of problem. Best, david

Rodolfo responds

What a relief. I thought I was going insane here! I would be honored if you all covered it in a podcast. All I listen to in my car now is the Feeling Good podcast!

David Responds

Often, intrusive OCD thoughts reflect suppressed problems / feelings people have, especially when the person is exceptionally "nice," and used to sweeping feelings under the rug, so to speak. I cannot treat you in this medium, obviously, but I'm wondering if you have some negative feelings, like anger or frustration, toward your wife and child? When these are "squashed," they can come out indirectly, disguised as anxious thoughts and feelings. This is called the Hidden Emotion Technique, which you can look up using the search on my website, if curious, or read about it in my book, When Panic Attacks.

Best, david

2. Brittany asks if it's okay to enjoy / prefer being alone.

Hi Dr. Burns,

I was listening to your podcast on self-acceptance, and it was really interesting hearing the results. I like how you said that just because we accept something about ourselves doesn't mean we aren't still working on it. I think people confuse that a lot.

One thing I've accepted about myself is that I really do enjoy being alone. I think in the past I would try to find a buddy in uncomfortable situations like the first day of work or orientation or going to a baby shower alone etc. but now I find that I am most comfortable when I'm not included with everyone else. However, I think it can come across as off putting to some.

Sometimes I get the feeling they see me excluding myself as rejection to them. That's not my intention and nobody's ever actually said that but it's a thought that pops up.

Just wondered if you think this form of acceptance is good or bad? I mean it's been good for me. Just maybe it's bad for others?

-Brittany

David's response

This is a cool question and nice comment, too, about our podcast. Can we read this on a podcast and use it for an Ask David?

Personally, I am trying to say "no" more often when asked to do things with other people, and sometimes it's hard. But if I don't say no, I get way too much on my plate and can't keep up!

Warmly, david

Brittany's reply

That makes perfect sense to me. I've kind of taken the position where I don't really want to make more friends because I feel like I'm already falling short with spending enough time with my cats and everyone else. Let alone time for myself.

David's reply

Exactly! Our culture has this myth that's it's somehow impossible or immoral to enjoy just being with oneself!

David

3. John, from Ireland, asks, "Help! I'm shoulding on myself again! What can I do? Please do another podcast on Should Statements."

Hi David and Rhonda!

Love the podcast and the work you folks are doing! I listen to the podcasts regularly and you are both bringing such great benefits to the world!

I would love to hear another podcast on should statements. I've been going through a pretty bad and extended period of anxiety and depression in recent months and have been really trying to challenge my thoughts without much success. I'm addicted to shoulds unfortunately and beat up on myself relentlessly.

I've tried to do a cost benefit analysis and the motivation piece is a huge part of the benefits side that is keeping me stuck. I really want to give up my should statements, they are making my life a misery. But I'm finding I don't want to let go of the motivation piece.

I have given a sample below. I'd love to know if there were further steps/techniques I could use aside from the CBA to address the benefits and the perceived motivation piece so I can fully let go of the shoulds!

Thanks so much both, John from Ireland

Negative Thought: "I should have plans on a Saturday." 99% SHLD, ER, SB, MF, DP.

Benefits

1. Lets me know when I'm not performing to the standard I set for myself
2. Shows me my passion/goal in life for doing fun exciting things
3. Motivates me to move to make plans, scolds me until I do so.
4. Keeps me vigilant that I'm aware of my shortcomings
5. Reminds me of the value of being socially connected, meeting and having fun with friends.
6. It's easy, it's familiar, it's such a habit. (process resistance)

Costs

1. Emotional Cost. Beats me up relentlessly, makes me feel depressed, anxious and lowers my self-esteem.
2. Reinforces perfectionistic beliefs
3. Counterproductive in terms of motivation, makes me feel so low,
4. Huge interpersonal cost, feel isolated alone. Prevents intimate connections
5. Not able to be present or flow in a conversation, quality of conversation/connection drops
6. Self-fulfilling prophecy, if I'm telling myself that then I ignore other possibilities.

Benefits 40 / Costs 60

David's reply

Feeling Great is now available in the app store, and you can try it for free. It also has a class called "Your PhD in Shoulds."

I'll add your question to our next podcast list for an Ask David.

Since you've told me you can't yet get the app in Ireland, I'll send you the script of that lesson.

Thanks!

David

John continues the exchange

Hi David,

Thank you so much for taking the time to correspond today and thank you so much for all the work you're doing for free. The world would be a better place with more Rhonda's and Dr. Burns' in the world. One of the things that has brought me some peace in the last few weeks is going for a long walk in the evening after work listening to your podcasts!

I have attached a DML that I've been working on to give a bit more context. I made some inroads on that original should statement, however, as you can see from the DML more shoulds keep popping up. I have identified the Self Defeating Beliefs that resonate with me at the bottom of the document. I'm working hard to find healthy acceptance, I know this is key for me. I'm not entirely sure a lot of the time what exactly I should be accepting. That I'm a flawed person with many defects, just like everyone else maybe?

To give some further context and without overburdening you with too much detail:

• I feel my anxieties are one of the main parts of my problem and I would love to get over these. I feel defective that I'm not resilient enough for the challenges of life. I have fears mainly around people, fear of letting people down, fear of being judged or rejected and just feeling different to others I suppose.
• I've struggled with recurring anxiety and some depressive periods from when I was a young child (likely biological - my dad has the same issue). I have strong feelings of defectiveness and not being up to standard compared to my peers.
• I have a very busy corporate finance job where I've been working very long hours over an extended number of weeks and months. I don't' love my job, fell into it really. Could be a hidden emotion thing going on.
• I started working from home more and more in recent months as my workload increased and my anxiety and mood really started to dip as work took over my life. I started to get really burned out in April. A lot of why I enjoyed the job previously was having fun with my teammates but that has become impossible in recent times due to everyone's workload.
• I do CrossFit which is probably an extreme form of exercise and between that and work I fell into some kind of perfectionism where I couldn't really find joy out of anything, aiming for higher and higher achievements. This brought on tons of shoulds and all or nothing thinking and self-blame, I think.
• My dad, who had been doing well for a good few years fell into a deep depression and anxious state around April time too and has been in hospital for a number of weeks and our family is trying to support him through this. We're finding the standard of mental health care in Ireland really really poor unfortunately. I find his issues quite triggering for me a lot of the time and I'll believe I'm defective because he is defective and there is nothing I can do about it. Dad is entirely dependent on medication to get him out of his slump and has a bad case of do-nothingism. He is beating himself up relentlessly too and I gave him a copy of Feeling Good to read but he hasn't looked at it at all.
• I have just turned 40 and I'm still single, so I feel like I'm letting my family down for not being emotionally able for a relationship or kids or be a better brother/son. I know I'm probably being harsh here as they say the opposite, but I feel I could/should be doing more.

I have probably fired way too much detail at you, so I'll stop there!

Thanks so much again!

John

Listen to this podcast for the great discussions and commentary by Rhonda, Matt, and David

Feeling Down? Try the Feeling Great App for Free!

The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com!

What's a Give-Get Imbalance? What's the Best Treatment for Anxiety and Dysthymia? Can you do Externalization of Voices on Your Own?

The show notes for today's podcast were largely written prior to the show. Tune in to the podcast to hear the discussion of these questions by Rhonda, Matt, and David.

And keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks!

1. Suzanna asks: What's a "Give-Get" imbalance? And how can you get over it?
2. Martin asks: What's the best treatment for anxiety and dysthymia?
3. Eoghan (pronounced Owen) asks: Can you do Externalization of Voices on your own?

1. Suzanna asks: What's a "Give-Get" imbalance? And how can you get over it?

Description of Suzanna's problem.

Suzanna is a woman with a grown daughter with severe brain damage due to a severe brain infection (viral encephalitis) when she was an infant. Suzanna was constantly giving of herself and catering to her daughter. She explains that her daughter can be very demanding and throws tantrums to get her way, and kind of controls the entire home in this way.

She can only talk a little and has the vocabulary of about a two-and-a-half-year-old. She can mostly express the things she wants or doesn`t want on a very basic level. She mostly understands what I want from her, but mostly does not want to do what I ask her to do. She can be very stubborn. And I cannot reason with her because she has her own logic and, in her eyes, only her logic is valid. Maybe all a little bit like a two-and-a-half-year-old.

Suzanna struggles with negative feelings including guilt, anxiety and depression, because she is constantly giving, giving, giving and feeling exhausted and resentful. And she tells herself, "I should be a better mum." Can you spot any distortions in this thought?

Put your ideas in the text box, or jot them down on a piece of paper, and then I'll share my thinking with you!

What are the distortions in the thought, "I should be a better mum"?

There are many distortions in this thought, including All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Magnification and Minimization, Emotional Reasoning, Self-Directed Should Statements, and Self-Blame. There may be one or two more, too!

The first step in change nearly always includes dealing with motivation and resistance. Suzanna decided to do a Cost-Benefit Analysis, as you can see below, and a revision of her Self-Defeating Belief, as you can see below.

Another helpful step might include "No Practice," which simply means saying "no" so you don't constantly get trapped by "giving," as well as "giving in."

A third critically important strategy involves the mom and dad making the decision to work together as a loving team in the management of a troubled child, rather than fighting and arguing with each other, as we've discussed on previous podcasts. However, in many, or possibly most cases, the parents are not willing to do this. They are more concerned about being "right" and so they continue to do battle with each other, as well as the child who needs a more loving structure.

David

Cost-Benefit Analysis Self-Defeating Belief: I should be a better mum to my daughter

Advantages of this belief(How does believing this help me?)

Disadvantages of this belief(How does believing this hurt me?)

This thought motivates me to:

• Put myself out.
• Push myself to give what I have.
• Find ways to advance her development. Find ways to involve her in everyday life.
• Invest myself into her and her life as much as I can, physically, emotionally and time wise.
• Try to find ways that my daughter can have a fulfilling life.
• Try hard to connect to her, her pain, her needs, her sadness and her frustration.
• Try to make her life as easy as possible.
• Try my hardest to see her world through her eyes and gain deeper understanding of how she feels.
• Try to understand what is upsetting her when she throws a tantrum.
• Stay healthy and fit to have energy for her.
• Try to make her life rewarding and meaningful.
• Fulfill my duty as a mum to my daughter who needs my support.
• I can feel good about myself.
• I satisfy other people's expectations of me.
• Protects me from criticisms from my husband

• I am a prisoner to my daughter.
• No matter how hard I try I don`t seem to make a meaningful difference to her life and to her development.
• I am a "Siamese Twin" to her. I cannot move or do anything if she doesn`t want to.
• I reason with my emotions instead of thinking rational at times.
• I let my daughter get away with "murder".
• I find excuses for her behaviour.
• I find excuses for her why she cannot behave differently.
• I beat up on myself when I feel I failed her.
• I take all responsibilities away from My daughter and make them my own.
• I blame myself when I cannot motivate her to do something.
• I blame myself when she is bored and unhappy.
• I feel guilty doing my own things.
• I feel guilty when I do not involve her in my activities.
• I feel guilty when I expect her to do entertain herself for a while.
• I cannot live my own life.
• I cannot be myself at times.
• She rules my life, and she lives my life.
• I feel trapped and frustrated.
• I feel I need to constantly entertain her.
• I feel responsible for her happiness.
• I feel responsible when My daughter is sad and frustrated.
• I feel exhausted and overwhelmed at times.
• I feel unhappy and unfulfilled.

Advantages: 20 Disadvantages: 80

Semantic Method: Re write your personal value

I want to be a mum to My daughter and help her along and invest myself into her. But I also want to treat myself the way I treat her. She has a "right" to live a happy and fulfilling life, but so do I. Our needs and desires are equally important and deserve the same attention and care. I can only continue to look after My daughter well if I look after myself too and take myself and my needs and desires as seriously as I do hers. There needs to be a give-get balance so that both of us can be healthy and happy and stay healthy and happy. I want to help her to slowly take new steps into independence and support her lovingly along the way.

2. What's the best treatment for anxiety and dysthymia?

Hello Dr. Burns,

What method of treatment would you suggest for GAD and dysthymia? 3rd wave CBT, ACT? What is best based on science?

Can you recommend some books please?

thank you

Martin

David's Reply

My books are listed on my website, FeelingGood.com. They all describe my approach, which is a bit like CBT on steroids. But every patient is treated individually and uniquely, following a structured and systematic approach that facilitates rapid and dramatic change.

I don't recommend "methods of treatment" or "schools of therapy" based on so-called "diagnoses," but treat the individual with TEAM. Every session with every patient is an experiment, with precise measures at the start and end of every session.

The new Feeling Great App, now available, gets a mean of 50% or more reductions in seven negative feelings, such as depression, anxiety, and more, in 72 minutes of starting to use the bot. You can check it out for free! Anxiety and depression often co-exist, and the app targets both.

My book, When Panic Attacks, describes my approach to anxiety, based on four models of treatment: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. If you use the search function, you can find podcasts describing those models. Also, there's a free anxiety class on this website.

Thanks, Martín, for your excellent question!

Best, david

3. Can you do Externalization of Voices on your own?

Hi David,

Long time listener of your great podcast and huge fan of your book Feeling Great.

I've often heard you mention that "externalization of voices" is one of, if not the most powerful CBT techniques. I am just wondering if it is still almost as effective when done solo without a therapist i.e. the person takes on both the roles of positive and negative by recording themselves talking or similar?

Also, have you any data comparing the efficacy of TEAM CBT work carried out solo using Feeling Great/your podcast as a guide vs. TEAM CBT performed with a trained TEAM therapist?

I am very much looking forward to the Feeling Great app launch in the UK as hopefully that will be a much more effective way to do personal work without a therapist.

Many thanks,

Eoghan (pronounced Owen)

David's reply

Thank you, Eoghan! Appreciate your support and thoughtful question.

I don't have any data on the use of EOV on your own. One could use a recording device, like your cell phone, and record your negative thoughts in second person, "you," and try to defeat them when you play them back, one at a time.

But in my experience, people nearly always need an experienced role player to do role reversals to show them how to get to a "huge" win. People almost never get a huge win when doing it for the first time, because the therapist (in the role of positive self) can model unfamiliar strategies for the patient.

Generally, a hugely successful response involves a combination of self-defense, self-acceptance, and the CAT, or counter-attack technique. And sometimes other methods as well, like Be Specific, for example

Radical new learning is definitely the key to success with EOV.

Now, thanks to the app, everyone can practice, since we've trained our Obie Bot to role-play with users, do role reversals, give feedback, and so forth.

Great question that I will include in the next Ask David if that's okay!

We are also exploring the combination of the Feeling Great App plus a trained TEAM therapist from the Feeling Good Institute in Mountain View, California.

We are hoping that 1 + 1 may equal 3. Wouldn't that be awesome?

What I've found when doing research is that the results are virtually always wildly unexpected! Somethings come out great, and some things come out dismally. I always tell myself that "the Lord giveth, and the Lord taketh away!"

Seems to be the rule in research! Especially when you're wanting to be guided by the truth, and not so much by your hopes and expectations.

Best, David

Ask David: What's Self-Esteem? What's Self-Acceptance?

In today's podcast we address six common questions about self-esteem, including:

• What is Self-Esteem?
• How does it differ from self-confidence?
• How does it differ from self-acceptance?
• What's the difference between conditional and unconditional self-esteem?
• What's the best way to develop self-esteem?
• What do you mean when you say that once you develop unconditional self-esteem, you should get rid of it as fast as possible?

Please keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks!

Brandon Vance and Heather Clague begin today's show with a pitch for their upcoming Feeling Great App Group, an 8 week experience that will begin in September. If you use the Feeling Great App, or plan to get it, this group would be an inexpensive and incredible enhancement, so you can meet with like-minded people once a week to schmooze, practice the techniques in the app, and get your questions answered by compassionate and personable experts.

For more information go to www.FeelingGreatTherapyCenter.com/appgroup.

Feeling Great App Group Sept-Nov 2024

Led by Brandon Vance MD and Heather Clague MD, meets online for 80 minutes for 8 weeks, offered Mondays 4-5:20pm Pacific Time, September 23rd - November 11th. Cost is $12 per session ($96 total) plus the cost of the app ($99 per year after 7 day free trial). Sliding scale for both the group and the app are available. No one turned away for lack of funds.

Feeling Down? Try the Feeling Great App for Free!

It's now in the IOS and Android app stores, and you can check it out for free. It's works super fast. Let us know what you think! Thanks!

Rhonda, Matt, and David appreciate your support. Keep your questions and testimonials coming. They mean a lot to us!