Today, the Cognitive Distortion Starter Kit Continues with Should Statements Rhonda begins by reading a beautiful email from one of our listeners, and I give a brief shout out for my new book, Feeling Great, which can be pre-ordered on Amazon now (see below for the link). Thanks to your support, as of today (July 2) it is already the #1 best seller in the Amazon depression AND anxiety categories for impending new books! David and Rhonda briefly summarize the history of Should Statements, starting with the Buddha 2500 years ago, and culminating in the work of Karen Horney and Albert Ellis in the 20th century. They both emphasized that nearly all emotional suffering as well as relationship conflict results from “Shoulds.” David and Rhonda describe the four categories of Should Statements:  Shoulds directed against yourself cause depression, anxiety, guilt, and shame. and even lead to suicidal urges. Should directed against others cause anger, and can even lead to violence. Shoulds directed against the world cause frustration. Hidden Shoulds.  They also describe the three valid types of Should Statements:  Moral Shoulds Legal Shoulds Laws of the Universe Shoulds  David and Rhonda provide vignettes illustrating the tremendous emotional damage that can result from “Shoulds” and describe a number of strategies for combating them, including:  Positive Reframing the Semantic Technique Socratic Questioning the Acceptance Paradox  The final podcast in this series will focus on the two types of Blame:  Self-Blame, which nearly always marches hand-in-hand with Self-Directed Shoulds Other-Blame, which nearly always marches hand-in-hand with Other-Directed Shoulds  Rhonda and David

205: How to Crush Negative Thoughts: Should Statements

This podcast features David D. Burns MD, author of "Feeling Good, The New Mood Therapy," describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the general public alike!

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392 The Empty Nest Cure Featuring Jill Levitt, PhD   Plus BIG NEWS! The Magical Annual Intensive  Returns this Summer  at the South San Francisco Conference Center August 9 -13, 2024 You can Review the Exciting Details Below  Or click this link!   Today we are proud to feature our beloved Dr. Jill Levitt. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and co-leader of my Tuesday evening psychotherapy training group at Stanford. She is a dear friend, and one of the world’s top psychotherapists and psychotherapy teachers. Today, Jill joins us to discuss the so-called “Empty Nest” syndrome. According to Wikipedia, this is the “feeling of grief and loneliness parents may feel when their children move out of the family home, such as to live on their own or to pursue a higher education.“ Jill emailed Rhonda and me to explain why she thought a podcast on this topic might be of some value. She wrote, Recently, I was working with two different women around the same age who were having similar feelings of guilt and shame about the choices they made around parenting versus working. Jane is a 60 year old high level executive with two boys who was super successful and is now retired. She is telling herself, “  I did not do enough for my boys. I should have worked less. I should have spent more time with them. I was selfish, and worked because I enjoyed it. I should have done more for them. I’m a terrible mother.  Stephanie, in contrast, is a 60 year old stay-at-home mom of four adult kids, and now that her last kid has left for college, she is telling herself:  I should have had a career. I have done nothing with my life. I am a smart woman so I should have done more. I am inferior compared to other women who have contributed to society in some way.  Jane and Stephanie both struggled with feelings of guilt, shame, sadness and inferiority, and they were both telling themselves that they should have made different choices. I’m sure your life is very different from their lives, but you may have also looked in to the past and beaten up on yourself for what you should or shouldn’t have done. Or, you may be beating up on yourself right now with shoulds, telling yourself that you should be better, or smarter or more successful or popular than you are. In fact, according to the late Dr. Albert Ellis, these “Should Statements” are responsible for most of the suffering in the world, and there are several different types, including:  Self-Directed Shoulds, like “I shouldn’t be so klutzy and shy in social situations. These self-directed shoulds trigger feelings of depression, anxiety, inadequacy, inferiority, guilt, shame and loneliness, to name just a few. Other-Directed Shoulds, like “So and so shouldn’t be such a jerk!” Or, “You have no right to feel the way you do!” These other-directed shoulds trigger feelings of anger, blame, resentment, irritation, and rage, and can easily escalate into violence, and even war.  I’m sure you can see that both women were struggling with Self-Directed Shoulds. What can you do about these shoulds and the unhappiness they trigger? Jill explains how both women experienced rapid recovery when she used simple TEAM methods systematically, including empathy and Positive Reframing as well as other basic techniques like the Double Standard Technique and the Externalization of Voices, and more. I, David, then described a woman he treated who fell into a depression when her two daughters went off to college. And she was perplexed, because she’d always had a super loving relationship with them, just as she’d had with her own mother when she was growing up. When I explored this with her, a Hidden Emotion suddenly emerged, as you’ll hear on the podcast, and that also led to a complete recovery in just two sessions. Then Jill had a sudden “eureka” moment and realized that the Hidden emotion phenomenon was also central to the anxiety that one of her two patients was experiencing. One of the neat things I (David) really like about TEAM is that we don’t treat people with formulas for “disorders” or “syndromes.” These three woman all had the same “Empty Nest Syndrome,” but the causes and the cures for all of them were unique, as you’ll understand when you listen to this podcast. Our 400th podcast is coming up soon, and we want to thank all of you in advance for your support and encouragement over the past several years, which we all DEEPLY appreciate! We’ll be joined by a number of our podcast stars from the past 100 shows, as well as our beloved founder, Dr. Fabrice Nye! And we have one VERY special event coming up this summer that might interest you if you’re a shrink. I (David) have done very few workshops over the past five years because of the pandemic as well as the intensive demands of developing our Feeling Great App which will be available soon. The most fantastic work of the year was always the summer intensive at the South San Francisco Conference Center. Well, guess what! We’re bringing it back this year. The dates will be August DATES, and it will have the same magic it has always had, but with some cool innovations.  It will be Thursday to Sunday noon, 3 ½ days instead of four, but it will include two fantastic evening sessions, so you will get a MASSIVE amount of teaching. It will be sponsored by the Feeling Good Institute in Mountain View for the first time, Jill and I will teach together, just as we do in the Tuesday group. Of course, Rhonda will be hosting the event as well! There will be many expert helpers from the FGI to assist you in the small group exercises throughout, so you will LEARN from actual practice with immediate expert mentoring and feedback. There will be a live demonstration with an audience volunteer, as in earlier years, plus your chance to do live work in small groups on the evening of the third day. This is always the top rated event during the intensive. You can attend in person if you move fast (seating will be limited to around 100 or so) or online (for half price or so.) That will give people from around the world the chance to attend without the extra cost and time to come in person. The online people will have leaders guiding you in the same exercises we will do with the in-person group. You’ll get intensive TEAM training in the high-speed treatment of depression and anxiety, so you can really “get it” all at once and see how all the pieces of this amazing approach fit together. You’ll also have the chance to do your own personal work and healing, which is arguably the most important dimension of professional training. There’s a whole lot more but I’m running out of steam.   For more information, click this link! Here are the details: High-Speed CBT for Depression and Anxiety— An Intensive Workshop for Therapists with Dr. David Burns and Dr. Jill Levitt Join in person or online! Dates (3 ½ days) Thursday, August 8: 8:30am-8:30pm Friday August 9: 8:30am-4:30pm Saturday August 10: 8:30am-9:00pm Sunday, August 11 8:30am-12:00pm PT Location South San Francisco Conference Center (10 minutes from SF Airport) Cost In Person $895* Early Bird Price (only 100 seats) Online $495* Early Bird Price To receive the online price, you must enter the discount code: OnlineOnly when purchasing The $100 price increase for live and online starts on 6/3/24  Rhonda, Jill, and I hope to see you there! And thanks for listening today!

392: The Empty Nest Cure

Evolution of TEAM from CBT Porn Compulsive Liars Angry Patients Who Resist Where's the App? and More! Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers! Today's live discussion was especially fun and lively, so make sure you listen to the actual live podcast. Questions for this Ask David Podcast  Stan asks if any of my early methods have been abandoned by newer and more effective methods as CBT evolved into TEAM. Stan asks if mild porn is harmful or helpful. Rima ask how you can deal with compulsive liars. Pretika asks what to do with patients who angrily resist positive reframing. Anonymous asks several questions about the Feeling Great App.    1. Stan asks about new approaches in TEAM for habits and addictions, as well the evolution of TEAM, as compared with the much earlier classical CBT. 2. Stan also asks if mild porno is helpful or harmful. Hi David. I read in the eBook (I think it was) that you have radically changed your approach and have many new methods for Habits and Addictions. I actually have many of your books such as:  Feeling Good Feeling Good Handbook When Panic Attacks Intimate Connections Feeling Good together Feeling Great eBook  I wonder if you could please tell us in one of your Ask David podcasts which methods described in your earlier books you no longer recommend, because they have been superseded by more effective ones described in Feeling Great for example. I am sure there must be a lot of material that is still valid in those earlier books and which is not mentioned in Feeling Great. It would be great to know which ones you no longer recommend for the general public. I also want to ask you about Porn Addiction. Do you think occasional mild porn use is harmful or beneficial? I read in a BBC article that porn probably isn’t harmful for most men, and can even be positive for couples. For example, some couples start to engage in oral sex after seeing it on the internet. Porn seems a bit like alcohol, if you abuse it it will be bad for your health but if you don’t go for the strong stuff and don’t over use it, it could be OK. I think some people might misinterpret your references to porn addiction as being any kind and intensity of porn use.  Maybe these people feel anxious and shameful for using it as a result. I would welcome your clarification on this issue. Finally, even though I know you have heard it thousands, or hundreds of thousands of times, your work is having a really positive effect on my life. I am truly grateful for all that you do. Thank you, David. Warm regards Stan David’s Reply Hi Stan, I can turn this into a couple Ask David questions for the podcast if you like. There have been many upgrades of the therapy ideas and techniques over the years, as we develop greater understanding of how people change, and what works and what tends not to work. In addition, I would say that we develop new methods and ideas on a weekly basis. The TEAM models lends itself very nicely to evolution, perhaps one of the strong points. I can speak in more detail on the podcast, but here are two ideas. First, I have come to appreciate more and more that all change in emotions comes from a reduction in belief in the negative thoughts that trigger negative feelings with few, if any, exceptions. In addition, any reduction in belief in negative thoughts will case an immediate reduction in the negative feelings that thought causes. This insight angers many people who don’t really “get” it, so I don’t push it. I find that people sometimes do not take kindly to statements that challenge their sacred beliefs. A simple example would be jogging, or aerobic exercise. Some people believe on faith or personal experience that exercise has a mood elevating effect due to release of endogenous “endorphins” in the brain, and many even claim that exercise is the most effective antidepressant known. While some people do experience a mood lift after strenuous exercise, I believe this is due to the change in their thoughts, telling themselves and believing that this is going to be good for the health and outlook. So that thought can have potent effects on mood. I can describe some experiments on exercise and mood. Second, I have tilted much further in the direction of appreciating the existence and power of resistance in all emotional and behavioral problems, and the often magical power of the new resistance-melting techniques I’ve developed in opening the door to the possibility of rapid and dramatic change. I’m also very aware of the therapy wars, predicated on the belief that our group as THE answer and your group consists of fools! And typically, one or both of those who are arguing have never measured anything in their patients on a session by session basis to see if things are working or not. This is just the tip of the iceberg, however! You can find a free offer of two free chapters on Habits and Addictions on every page of my website in the right-hand panel. You will find a strong emphasis on powerful new techniques that focus on motivation, such as the Triple Paradox, the Decision-Making Tool, the Devil’s Advocate Technique, and more. Most of the techniques I developed in the early days of CBT still have a lot of power and I use almost all of them, sometimes with various modifications and upgrades. For example, I have added the CAT to the Acceptance Paradox and Self-Defense Paradigm in the Externalization of Voices (EOV), and now there are two versions of the CAT, one of them created just last week! On the porno question, I am not an expert in sociology research, so I don’t know, and I try to avoid giving expert answers on things I don’t have expertise in. My goal is not to proclaim what people should or shouldn’t do, but rather to help people who come to me asking for help. It is tempting to assume your own views are straight from God, but I find that my own narcissism just gets me into trouble most of the time! I do like your thinking, though, that much of the time there are no absolute answers, rather personal preferences, and the impact will often depend on how things are used. As you say, a glass of wine could add to your meal. A bottle of wine daily might get you into trouble with your health and habits! Warmly, david 3. Rima asks about compulsive liars How do you deal with people who are compulsive liars? I found that even when using the five secrets, they either get really angry and start on the offensive or completely deny no matter what you say. If you have a client or someone in your personal life that you have deal with that lies a lot even when faced with facts and proof, what is the best way to handle it? On another point, I know that we all tell lies to a certain extent but I’m wondering whether you can impart some wisdom on why some people are compulsive liars. David response: I have a policy of NEVER answering general questions. If you want help with a relationship problem, please fill out the first four steps of a Relationship Journal. That way, we can see what the other person said, and what you said next. Otherwise, you might frame it as wanting help figuring out how to “handle” this other person who is “to blame,” or behaving badly, and so forth, without pinpointing your own role in the problem, which is the whole key to interpersonal therapy. Then we will have some dynamite to play with, as opposed to bullshit which tends to be too gooey in my experience! Certainly, people who lie compulsively can be challenging and irritating for sure, but let’s take a look at the whole picture so we can also answer this question: Are you responding in a way that reduces the likelihood that they’ll be honest? I’d LOVE to answer this question again once you send an RJ partially filled out. Thanks!  4. Preetika Chandna asks about patients who angrily resist Positive Reframing My client was offended by the positive reframe questions (any benefits and values for anxiety). She was unable to 'see' any benefits to her anxiety despite 'priming the pump' and gathered evidence from friends to emphasize her point. She ultimately dropped out of therapy. I'm wondering if we can move forward without positive reframing and circle back later, or is an open hands with empathy the best option when a client refuses to reframe and is actually offended by the suggestion? David’s Take Sometimes you can do effective work without the A = Paradoxical Agenda Setting step in a highly motivated patient. However, I suspect a more fundamental problem is occurring here. Whenever you’re stuck with an angry patient, immediately go to E = Empathy, and don’t use any methods until you get an A, and have really re-established a warm, trusting relationship with the patient. I have emphasized the importance of using the BMS and EOTS with every patient at every session. Have you been doing this, and have you been getting a perfect score on the Empathy and Helpfulness Scales? This seems unlikely to me. Often anxious patients feel shame, especially if they have social anxiety, but this is also common with panic attacks and some other forms of anxiety. If she’s ashamed of her anxiety, it would make sense that he might get defensive when asked to positively reframe it. At this point, I can only speculate, since I don’t know the details of this case. Sometimes, it makes sense to pay a colleague for a couple consultation sessions to get “unstuck.” These are always extremely productive learning sessions. Positive Reframing, or Assessment of Resistance, is an art form, and sometimes you just can’t “see” the reasons for the resistance at first. You might recall, or want to listen to, our live session with Sunny, who developed a sudden relapse of intense anxiety when he decided to change his approach to work, or non-work. (see podcast # X). The traditional positive reframing was not effective, but then when we started on methods, I suddenly “saw” something none of us had seen before during the session. His “anxiety” was actually a sign that something wonderful was happening! You can always start with M = Methods, and then when you run into resistance, you can revisit resistance with a Paradoxical CBA, or Externalization of Resistance, or some other approach. But the crucial thing is to get on the same page, and stay on the same page, with your patient. David 5. From a therapist who wishes to be anonymous I have a question,  I think that habits and addiction (including the online additional chapters) are very important. I wonder if they will ever get their own book and app?  David’s take: Eventually we hope to include that dimension in our Feeling Great App.  The Feeling Great book is designed for self-help. I wonder if you have suggestions regarding using the different role-playing techniques (such as externalization of voices) for patients or individuals that works on their own?  David’s take: Yes, we use these role-playing techniques in the Feeling Great App.  When are we expecting the app?  David’s take: First quarter of 2024. Thank you ! Thanks for listening today!  

391: Ask David: Evolution of TEAM from CBT; Porn; Compulsive Liars; and More!

Self-Acceptance, People who Resist, Secrets of Dynamic Job Interviews, Five Secrets with your Boss, Do Cognitive Distortions Cause Transgenderism? Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers! Questions for the this Ask David Podcast  Rizwan suggests a new method for self-acceptance. Anonymous asks how to convince someone that depression is NOT due to a chemical imbalance in the brain. My father does not believe that you can change the way you FEEL by changing the way you THINK! Marc asks about tips for job interviews, as well as how to respond during periodic performance reviews at work. Brian asks if transgenderism could be the result of distorted thoughts.  1. Rizwan asks I have a question about the Acceptance Paradox that came to my mind during our Tuesday training group on 19 Dec, 23. As homework, will it be useful to ask clients to make a list of things which they have already accepted in life and made peace with? At the next stage, in the session, would it be useful if the therapist asks them, "why did you accept and make peace with those things? “Can you use the same criteria to accept other things in your lives which you are not accepting now?" Sincerely, Rizwan   David’s take Yes, you can certainly try that and let us know how it works out? I do lots of spontaneous and “new” things in almost every therapy session. Some things work out, and others do not. That way, I learn from my clinical work. One thing to be aware of is that your proposed approach might overlap with “helping,” when a paradoxical approach might have more “punch” / impact, After all, the Acceptance Paradox is arguably more of a decision, than a skill. But try, even with yourself if you like, and let us know what you discover. TEAM constantly evolves, and you can be an important part of that process! Best, david 2. Anonymous asks how to convince someone that depression is not due to a chemical imbalance in the brain and that you can change the way you FEEL by changing the way you THINK? Hi David I love listening to your podcasts. And now I am seeing differences in my life but not my father who has been depressed for around 40 years. He is on medicines and has an extreme belief that it's on the basis of chemical imbalance. He is a pharmacist by profession, and loves to learn about how chemical changes mood swings. I am not able to convince him to read your books. He just take sleeping pills every single and sleeps all day. He is learning something about neuroplasticity which is actually the case that happens in cbt. But he think it's some kind of thought changing therapy which cannot change the chemical in our brain. Please help David. I would love you to answer this. Regards, Anonymous David’s Response Hi, I once gave the keynote address at a research conference at the Harvard Medical School. When the department chairman introduced me, he something like, “Dr. David Burns is going to show us how you can change brain chemistry with CBT, and without drugs!” It was pretty cool! That’s one dimension. And we could add more evidence and research findings to support our side of the argument. But on another level, we see the underlying issue of trying to convince someone who is taking an adversarial position and content with their own thinking and beliefs, and determined to argue no matter what evidence you present. In my experience, spending time trying to convince them is almost always a losing cause. All you do is engage in a frustrating philosophical debate, at least that’s my thinking! The podcasts on the theme of “How to Help and How NOT to Help” might be useful, in case you are looking for help with your relationship with your father. Your love and concern for him is huge and very touching! Okay to use in an Ask David? I will not use your first name! Best, david 3. Marc asks for tips on job interviewing. Hi David, I hope you are keeping well. I am wondering if you have any tips / strategies/resources that you recommend for an upcoming job interview? Also, you once told a story of someone who worked in the tech industry that you counselled, and you recommended some questions for him to ask in periodic performance reviews. Does this ring a bell at all? I've had trouble remembering/locating this Podcast. Stay well, Marc David replies Hi Marc, Yes, we can discuss the secrets of successful job interview  on a podcast. I have LOTS of tips, actually, and we can perhaps do a podcast on this. We could also focus on how to respond to your supervisor during performance reviews, and I DO have an amazing story about that as well; it was the fellow who had been fired six times in two years. Thanks for reminding me. I might have given him the name of Rameesh, but not sure! Best, David  4. Brian asks: Could transgenderism result from distorted thoughts? Hi David, Happy New Year, and thank you for your amazing Monday podcasts. I just started listening to yours today about transgenderism. Could transgenderism be the result of distorted thoughts? I know it's a very sensitive subject like anti-depressants. Thanks, Brian David’s Reply Hi Brian, Thanks for the question. Copying Robin, as she’s the expert. But to my way of thinking, the answer is no. I believe, though I’m no expert, that gender identity as well as sexual preferences are primarily biological in origin, although there are obviously strong cultural influences and biases. For example, ice cream preferences are kind of inherent to people, and mysterious, and cannot be changed by changing our thinking! I love blueberry pie, and many others don’t care for it. Just a preference! Saying that gender results from distorted thoughts might also be hurtful, as if our identities might be somehow “wrong” or “defective.” Might use as an Ask David question if you and Robin have no objection. Best, david Thanks for listening today!

390: Ask David: Self-Acceptance, People who Resist, Transgenderism, Job Interviews, and more

Featured Photo is Dr. Amy Huberman The Amy Story, Part 2: The Joys of Doing the Laundry!  Amy and her exuberant son, Sasha, and wife, Alena Last week you heard Part 1 of the Amy session, which included T = Testing, E = Empathy, and A = Assessment of Resistance. Today, you will hear Part 2 of Amy's exciting journey from perfectionism to JOY. M = Methods We used a variety of Methods to help Amy challenge her negative thoughts, starting with the first, “I’m failing my patients.” We started with Identify and Explain the Distortions, then went to the Double Standard Technique, and ended up with the Externalization of Voices. As a reminder, you can see Amy's  Daily Mood Log at the start of her session here.. As an exercise, see how many distortions, or thinking errors, you can find in her first Negative Thought, “I’m failing my patients,“ using the list of cognitive distortions on the bottom of her Daily Mood Log. You’ll find the list of the ten cognitive distortions if you click here.  After you’ve identified each distortion, see if you can explain two things about it:  Why is this distortion in Amy’s thought unrealistic and misleading? Why might it be incredibly unfair and hurtful?  You’ll find my list of the distortions in this thought at the end of the show notes. But don’t look until you’ve made your list! These techniques we used were effective , as you’ll hear on the podcast, especially the Externalization of Voices. You’ll hear us doing role-reversals with Amy, and the method that “won the day” was the CAT, or Counter-Attack Technique, combined with the Acceptance Paradox. The Acceptance Paradox involves finding truth in a negative thought with a sense of peace or even humor. The CAT involves confronting the hostile voice in your head and tell it to go fly a kite, or other gentle but firm message You’ll enjoy seeing some striking changes in Amy, as her tears and feelings of intense self-doubt are suddenly transformed into joy and laughter. Those changes created strong feelings of joy for Jill and me as well. We both have incredibly fondness and admiration for Amy, and feel great joy as well when she feels joy. Here are Amy’s final scores at the end of the session.    Emotions % Now % Goal % After   Sad, blue, depressed, down, unhappy 80 25 0   Anxious, worried, panicky, nervous, frightened 80 20 0   Guilty, remorseful, bad, ashamed 90 5 0   Worthless, inadequate, defective, incompetent 100 15 5   Lonely, unloved, unwanted, rejected, alone         Embarrassed, foolish, humiliated, self-conscious         Hopeless, discouraged, pessimistic, despairing 90 5 0   Frustrated, stuck, thwarted, defeated 80 5 5   Angry, mad, resentful, annoyed, irritated, upset, furious         Other             The Joyous Dr. Amy! Sudden and dramatic change is pretty trippy, but it isn’t much good if it doesn’t last. And it won’t! Negative thoughts and feelings will always return, because no one can be happy all the time. That’s why some relapse prevention training and ongoing practice and refinement of what you’ve learned can be vitally important. In our follow-up session with Amy one week later she said she’d felt way better during the week, but did, in fact, have some relapses and had to challenge her negative thoughts again. She’d been helped a lot by the idea that it was okay to fail, to seek consultation, and learn, and that failing with patients gave us endless opportunities to learn and grow as therapists. And it was also okay not to have to listen so intently to the attempts of the negative self to put her down. In fact, our misery almost never results from our failures, but from telling ourselves that we “shouldn’t” ever fail, and from punishing ourselves mercilessly when we do. One of her most exciting statements in our follow-up session was that she discovered that even something as humble as putting the dirty clothes into the washing machine could be a joyous experience without that negative voice in her brain constantly hollering at her that she wasn’t good enough! Teaching points  It was hard, at first, for Amy to “see” how distorted and unfair her negative thoughts were. She is an extremely intelligent, accomplished, and beloved colleague, and yet most of us cannot “see” or really “grasp” that we can be pretty mean to when we’re feeling down and anxious.  I have often said that feeling anxious and depressed is a lot like being in a deep hypnotic trance, telling yourself and believing things that just aren’t true. For example, Amy is doing beautiful work with the great majority of her patients, and is doing the exact same thing with the patients who are responding beautifully as she is with the two who are stuck. So, when she tells herself she’s a failure, she’s clearly involved in All-or-Nothing Thinking. In other words, she’s thinking that if she’s not perfect, she’s a complete failure and a fraud. She also seems to have many Hidden Shoulds (e.g. I SHOULD be able to help every single patient quickly) and Mental Filtering (focusing only on the negatives) and Discounting the Positive (ignoring the positives, as if they didn’t count.)  The techniques that were the most helpful for Amy were   Positive Reframing: that’s where we pointed out the positive aspects of Amy’s Negative Thoughts and feelings. The Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT. Be Specific: Amy was Labeling herself as a “fraud” and a “failure,” and she was Overgeneralizing from two patients to her entire self and career. Jill emphasized Be Specific. In other words, focus on and accept what’s real. What’s real is that Amy has been valiantly struggling to help two patients who are stuck. She can just accept that, and get some consultation and guidance from a colleague, which would probably help her get unstuck.  So, instead of labelling yourself as “a failure” and “a fraud,” which are just mean, vague words, you can tell yourself that you have a specific problem—in Amy’s case, getting stuck with two very anxious patients. Then you can focus on getting some help in solving that specific problem—for example, by seeking consultation from a colleague. Jill said that’s what she does when she gets stuck. I used to do that every week, especially when I was first learning cognitive therapy. Getting stuck, then, can simply be an opportunity for growth and learning cool new tools. If we never got stuck, we’d never learn anything new!  The very moment Amy stopped believing her negative thoughts, her feelings instantly and dramatically changed. That change happened suddenly, over the course of about 30 seconds, and you can SEE it in her face and hear it in her voice. But it won’t last forever! Jill pointed out that the belief at the root of Amy’s problem was Perfectionism, and the idea that “I should know exactly what to do with all of my patients.” That may be a pleasant fantasy, and it might even motivate us to work hard and achieve, but it’s also a recipe for misery!  Follow-up Rapid recovery is great, but will it stick? You will hear excerpts from our brief follow-up session one week later for Relapse Prevention Training. The idea is that none of us can feel happy forever, and negative thoughts will creep back into our minds sooner or later. However, you can anticipate this and prepare for it by challenging your negative thoughts with the same techniques that helped you the first time you improved. That’s because the details will usually be different every time you’re upset, but the pattern of self-critical negative thoughts will usually be the same. And this DID happen to Amy, just as it will happen to you. But this was an opportunity for her to deepen her understanding of perfectionism and to refine and enhance her ability to respond to her negative thoughts. During the weeks following the recording of this podcast, Amy found that she experienced some resistance to using the counterattack technique. She began to feel like she was relating to her perfectionism as an enemy and attacking it—and in doing so, was discounting all the good in it, including the values that came shining through during the Positive Reframing. She found that a better fit for her, instead of the counterattack, was to disarm her perfectionistic thoughts by seeing the truth in them. In fact, you could view this as yet another form of acceptance. When she did this, the perfectionistic voice in her head naturally backed down and gave her the space to do what matters to her unencumbered by self-criticism. I thought it was cool when she described experiencing waves of joy while doing the laundry—an activity that had always felt like a chore to her before, when it was accompanied by thoughts like “I should have finished this laundry days ago.”   She discovered that without beating up on herself, something as humble as doing the laundry could be incredibly rewarding! After our follow-up meeting, I got a lovely email from Amy about the joys of giving up the need for perfection, and sent this follow-up reply to Amy: Thank you, Amy, you are the BEST! I did a four-day intensive in San Antonio years ago with a small group of about 25 therapists. As you know, I always BS and say “As the Buddha so often said . . . “ followed by something goofy or quasi-mystical or whatever, and most people seem to kind of like that and see it as fun or humorous or whatever. Well, I was doing that at the workshop, and at one of the breaks a woman approached me and said she was interested in my Buddhist remarks because she had been raised as a Buddhist in an Asian country where Buddhism is prominent. I panicked and thought I’d been found out and exposed as a fraud. She went on to say that their family gave up Buddhism, however, and she was sad. I asked why they gave up Buddhism, and she explained that her mother suffered from severe depression, and the Buddhists taught that’s because you think you “need” things, and if you’re a good Buddhist you won’t think that way and you won’t ever suffer. Since she suffered, she felt like a failure as a Buddhist, so the family gave up Buddhism. I told her that she might not be aware that there are actually two schools of Buddhism. There’s low-level Buddhism and high-level Buddhism. In low-level Buddhism, you’re not allowed to want or need anything, and you’re not allowed to suffer. That’s sounds like that was the school of Buddhism your family was raised in. But there’s another type of high-level Buddhism. In high level Buddhism you’re allowed to suffer and struggle, and screw up, and fail, and all sorts of stuff. She got animated and said, “I didn’t know that. Thank you so much. You’ve restored my faith in Buddhism, and I can’t wait to tell my mother!” Aside from my being elderly and half-demented, I hope that makes some sense in light of our work together with Jill! So, if you need any translation or explanation, Amy, I’m inviting you to join the high-level Buddhist therapist group where you’re allowed to screw up with some of your patients, or even many! Warmly, david Subsequent Follow-Up I forgot to tell you what happened to Amy’s two “stuck patients.” Well, she got some consultation about why these patients might be stuck, which is nearly always an Agenda Setting problem—the therapist is working harder than the patient due to the need to “help,” and this plays into the patient’s ambivalence. This struck a chord, and Amy was very excited to see her patients again, and both suddenly got “unstuck,” although in somewhat different ways. And that is why I call it the Acceptance Paradox. The moment YOU change, and accept yourself, your world will also change! Or, to put it differently. We often see the world as “different” or as “other,” thinking we are separated. The Buddhists see the world as “one,” and that is certainly true in therapy as well. Answers to the Quiz Question     David’s list of Distortions in Amy’s Negative Thought: “I’m failing my patients.”    1.     All-or-Nothing Thinking. This is not realistic because Amy is not stuck with all of her patients. And even though she's still far short of her hopes for these two patients, they may feel they are getting lots of TLC and support from Amy.   2.     Overgeneralization. This is misleading because she’s overgeneralizing from her two failures to her “self,” and labeling herself as “a fraud and a failure.” She also overgeneralizing to the future, thinking things will never change or improve so she should get a new career.   3.     Mental Filtering. She only focusing on the two patients who are stuck.   4.     Discounting the Positive. She’s overlooking the fact that she’s going excellent work with a great many people, and has tremendous integrity, skill, and commitment to her patients.   5.     Magnification and Minimization. She’s kind of blowing things out of proportion, although it’s always good to focus on patients who aren’t yes improving.   6.     Emotional Reasoning, She FEELS like a failure so thinks she IS a failure.   7.     Hidden Should Statement. She thinks she SHOULD be perfect!   8.     Labeling. Same as Overgeneralization. See above.   9.     Self-Blame. She’s blaming herself instead of loving herself and focusing on getting she help she needs and deserves!    Thanks for listening today! Rhonda, Amy, and David  

389: The Story of Amy, Part 2 of 2

Featured Photo is Dr. Amy Huberman The Amy Story Part 1: True Confessions of a “Fraud” and a “Failure” Part 2: The Joys of Doing the Laundry  Amy and her exuberant son, Sasha, and husband, Poppy Today’s podcast, and next week’s podcast, include a single, two-hour session with Amy Huberman, MD. Amy is a psychiatrist in private practice in Baltimore, MD. She also serves on the volunteer faculty at the Johns Hopkins University School of Medicine. Amy specializes in brief, intensive psychotherapy to help people overcome struggles with anxiety, OCD, and trauma, but today comes to us to get some help with her own anxiety. Often doing our own work can be a vitally important part of our training and growth as mental health professionals. Amy has been upset because she is stuck with two of her patients, and she’s telling herself that she’s a “fraud” and a “failure.” Although her life is undoubtedly very different from yours, the root cause of her problem might be very similar to the source of your unhappiness, especially if you sometimes get down in the dumps and tell yourself that you’re just not good enough. My co-therapist for this session is Jill Levitt, Ph.D. co-founder and Director of Clinical Training at the Feeling Good Institute in Mt. View California. Jill also serves on the Adjunct Faculty at the Stanford Medical School and is co-leader of my weekly TEAM Therapy training group at Stanford, Tuesdays from 5-7:00 pm pst.  If you are interested in joining David and Jill's Tuesday group, please contact Ed Walton, edwalton100@gmail.com. That group is now virtual and therapists from the Bay Area and around the world are welcome to attend. It is free of charge. Rhonda Barovsky also runs a free weekly training group with Richard Lam, on Wednesdays, from 9-11:00 am pst, which is also free of charge. If you are interested in joining the Wednesday group, please contact Ana Teresa Silva, ateresasilva6@gmail.com.  Because the groups are virtual, they are open to therapists from around the world. Amy has been a member of our Tuesday training group, and is a highly skilled, certified TEAM therapist. Like nearly all the mental health professionals who come for training every Tuesday, Amy has incredibly high standards and is sometimes harshly self-critical when she feels she is not living up to them. At the same time, those high standards can be strongly motivating, and this can create strong feelings of ambivalence when it’s time to change. Sound familiar? If you’re struggling with perfectionism, you might want to check out these two podcasts! Part 1. The True Confessions of a “Fraud” and a “Failure” Amy opened by saying she was anxious and telling herself: I’m about to reveal my weaknesses and my inner self—This is something I’ve never done before in such a public setting. . . I also have to confess that I’m struggling with social anxiety right now. I’m afraid that my patients might see this and think, “I don’t want to work with her! I want to work with a competent psychiatrist.” I Included that because I am hoping you will appreciate Amy’s incredible courage and gift of sharing her true inner self today! Amy described the problem that’s been bothering her for several weeks. Although she specializes in the short-term treatment of anxiety, she has been struggling with two patients with OCD symptoms who have been stuck and not making significant progress for a long time. This has triggered feelings of shame and intense anxiety which have invaded Amy’s every moment when she’s NOT seeing patients, and has even prevented her from getting restful sleep at night. She keeps ruminating and beating up on herself. You can see Amy's  Daily Mood Log Amy here.. As you can see, she was feeling intensely sad, panicky and ashamed, and rated these three feelings as 80% on a scale from 0 (not at all) to 100 (the most severe). She was also feeling worthless and defective which she rated at 100%, as well as hopeless (90%) and stuck (80%). As you know, feelings do not result from the events in our lives (in Amy’s case, the fact that two of her patients were stuck), but rather from her thoughts, or interpretations, of those events. You can see on her Daily Mood Log that she was being intensely self-critical, telling herself that she was failing her patients, that she should refund their money, that she was not competent to practice psychotherapy and should find a new career, that she “should” know how to get them unstuck, and more, and finally that she was a fraud and a failure. Her belief in all of these thoughts was super high, ranging from 80% to 100%. And if you’ve ever felt down or inadequate, I’m sure you recognize the same types of thoughts in your own thinking, telling yourself that you’re a failure, or not good enough, and so forth. During the session, Jill and David went through the TEAM acronym: T = Testing We measured her negative feelings at the start of the session so we could measure them again at the end to see how we did. E = Empathy We listened and supported Amy without trying to “help” or “save” her. The goal was to understand her thoughts and feelings accurately, while providing a sense of compassion, warmth, and acceptance. This phase of the two-hour session lasted about 30 minutes, and Amy told us how she constantly ruminated about those two patients, asking herself “What am I doing wrong, what am I missing, what should I be doing differently?” She described these thoughts as a relentless “broken record in my brain.” She confessed that her deepest fear was, “What if they kill themselves and I was responsible for their deaths?” She said this fear was almost unbearable!” I pointed out that was also my deepest fear when I was in private practice—I was never upset by treating large numbers of severely depressed patients in back-to-back sessions, and it always made me happy, since I felt I had something to offer. But if I said something that hurt someone’s feelings, I found that pain almost unbearable until I saw the patient again the next week, and could talk things over and get back on a positive track. Jill pointed out that Amy’s ruminations showed that she was a highly responsible psychiatrist who cared deeply about her patients! And while that is certainly a positive thing, the intensity of her fears had invaded every minute of her life, making her life miserable, even when she was with her family. Amy said her fears have intensified since 2020, when she transitioned away from a traditional psychiatric practice involving long-term weekly psychotherapy and med-management, to focusing on short-term intensive psychotherapy using the TEAM model. Then we asked her to grade us at the end, thinking about three categories of Empathy:  Did we understand how she was thinking? Did we understand how she was feeling? Did she feel cared about and accepted?  She gave us an A, which triggered our move to the next phase of our work with Amy. A = Assessment of Resistance In this phase of the session, we pinpointed Amy’s goals for our session and  melted away her potential resistance to her stated goal of learning to give up that self-critical voice in her brain. We asked her to imagine we had a Magic Button, and if she pushed it, all of her negative thoughts and feelings would instantly disappear, with no effort on her part, and she’d feel jubilant and happy. She said she wasn’t so sure she’d do that. Most patients say YES, but Amy is familiar with the TEAM approach and knows that negative thoughts and feelings often result from some of our positive qualities. Our strategy at this phase of the session was paradoxical: Instead of trying to help, save, or rescue Amy, and instead of trying to persuade her to change, we took the role of her subconscious resistance to change. With her help, we listed some of the many positives in her negative thoughts and feelings by asking these two questions.  What does this negative thought or feeling show about you and your core values that’s positive and awesome? How might this this negative thought or feeling be helping you and your patients?  Here are just a few of the positives we found in her negative thoughts and feelings: The Positives in Amy’s Negative Feelings    Feeling What this Shows   Inadequacy Keeps me from being overconfident     Keeps me humble, so I’m open to what I may be missing     Shows I care about constant growth and learning     Shows I’m listening     Shows I care about my patients   Anxiety Motivates me to think about things from other perspectives     Motivates me to work hard     Keeps me honest     Shows that I have high standards     My high standards have motivated me to learn a lot.    You can do the same kind of Positive Reframing with all Amy’s negative thoughts and feelings, as well as your own. The list of positives would be long and impressive! After listing these positives, we asked Amy these three questions:  Are these positives real? Are they important? Are they powerful?  How would YOU answer these questions if you were Amy? She gave a strong yes to all three questions. At the end we pointed out that it might not be such a great idea to push the Magic Button to eliminate the negative voice in her brain, because then all these positives would also disappear. Instead, she decided to use the Magic Dial to reduce her negative feelings to some lower level where she could keep all the positives but suffer much less. Here you can see her goals for how she wanted to feel at the end of her session.      Emotions % Now % Goal % After   Sad, blue, depressed, down, unhappy 80 25     Anxious, worried, panicky, nervous, frightened 80 20     Guilty, remorseful, bad, ashamed 90 5     Worthless, inadequate, defective, incompetent 100 15     Lonely, unloved, unwanted, rejected, alone         Embarrassed, foolish, humiliated, self-conscious         Hopeless, discouraged, pessimistic, despairing 90 5     Frustrated, stuck, thwarted, defeated 80 5     Angry, mad, resentful, annoyed, irritated, upset, furious         Other            As you can see, she decided to aim for fairly large reductions in all six of her negative feelings. These goals are not guarantees she will be able to reduce her feelings. In addition, the goals are not rigid, since she may be able to reduce them even further once she begins to challenge her negative thoughts. Our real aim at this phase of our work was to reduce her feelings of shame and failure so she could see that her “symptoms” were NOT the expression of what was WRONG with her, but the expression of what was RIGHT with her. Paradoxically, this often reduces the resistance to change and vastly enhances the possibility of rapid and dramatic change during the final, M = Methods portion of the session that you’ll hear next week, along with some follow-up information. The important thing we’ve hopefully accomplished is reducing Amy’s resistance so she can learn how to challenge and defeat the relentless and hostile voice in her brain that constantly puts her down whenever she fails to live up to her extremely high, and arguably perfectionistic, standards. End of Part 1  Thanks for listening today. Be sure to tune in to the exciting conclusion of the work with Amy next week! Rhonda, Amy, Jill, and David

205: How to Crush Negative Thoughts: Should Statements

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