Responses to questions submitted by listeners:
- What causes an “identity crisis?” And how do you treat it?
- Why is it so hard to find a therapist trained in cognitive therapy?
- In a relationship, should you change yourself in order to get along with someone?
When we’re feeling depressed, anxious, or angry, should we accept our feelings or try to change them?
In your Feeling Good Handbook, you suggest that the reader just allows himself or herself to be an ordinary person instead of trying to be perfect. Contrary to your opinion in the book, you're an outstanding therapist in reality. You’ve studied in one of the world’s top colleges, you’re well-educated with a doctor degree, and successful in your career and life. How can I believe your claim? I'm quite confused!
Sincerely, XXX
Existential Therapists believe that the fear of death is universal and is at the root of most emotional problems. Dr. Burns argues that the fear of death is actually quite rare, but does occasionally occur and is extremely treatable. In this podcast, David’s describes his quick, three-part “cure” for the fear of death.
Oddly, every patient he treated in this way insisted at the end of the session that it didn’t help. And even stranger is the fact that 100% of them returned the next week and announced that they actually had been cured and were, in fact, no longer afraid of death!
Can the EAR techniques help a listener deal more effectively with a defiant, oppositional child. Dr. Burns reveals a fantastically helpful secret that he and his wife stumbled across in raising their own children. If you have ever struggled in your attempts to deal with an oppositional child or adolescent, you will find this podcast enlightening!
I would love to hear about how you treat people suffering from chronic laziness ("Do Nothingism"). In particular, there seems to be a strong potential of a Catch-22 with Process Resistance: The patient cannot find the motivation to do anything, yet they have to carry out the process (do the homework) to improve.
David outlines a multi-step approach, based on someone who has ten years of unfiled papers that have piled up in his office, so that by now 15 feet of desk space is completely covered by piles of papers roughly one foot high.
- Paradoxical Agenda Setting:
- Miracle Cure Question:
- Specificity:
Little Steps for Big Feats: Let’s Be Specific: Five Minute Rule: Problem – Solution List:
“I Stubbornly Refused” Technique: David asks Fabrice to agree to an unusual phone call at 6:05 PM!
TIC – TOC Technique: David plays the role of Fabrice’s “Task-Interfering Cognitions” (TICS) that will tempt him to procrastinate, and asks Fabrice to play the role of the “Task-Oriented Cognitions” (TOCS) he can use to combat the TOCs.
David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn.
David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT.
Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby.
David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model.
- Are the scales on your Brief Mood Survey reliable and valid?
- How can I identify my Negative Thoughts when I'm upset but I can’t figure out what I'm thinking and telling myself?
- I have social anxiety and don’t want to get out of bed. I'd rather just lie in bed and watch Game of Thrones. Help me! What should I do?
- I saw an article in the paper that claimed that bacteria in the gut cause anxiety. Is this true? If not, what does cause depression and anxiety?
- Could your tools, like the Cost-Benefit Analysis, help with problems that aren’t necessarily emotional problems? Like what career to pursue, or what college to go to?
- What should you do if you feel great at the end of a therapy session, and then become severely upset again during the week?
- How does Dr. Burns deal with resistance from colleagues when he is trying to teach these new TEAM-CBT techniques? Does he run into much resistance? How does he feel about the resistance?
- Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
- Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
- Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?
In this podcast, David and Fabrice answer five challenging questions submitted by listeners:
- Galina asks whether we always have to face our fears? Isn't it okay to be anxious sometimes?
- Courtney asks how to find the supplemental written materials, tests, and diagrams if you have purchased the eBook or audio-book copy of Feeling Good: The New Mood Therapy.
- Carlos asks about the best treatment for smoking cessation. During the discussion, Fabrice asks if Paradoxical Agenda Setting is important for therapists using hypnotherapy.
- Avi asks whether humans have a dark side, with dark negative motives that sometimes compete with positive, loving motives. And if so, how do therapists help patients deal with their own negative motives?
- Ben asks what to do if you're very anxious but simply can't pinpoint your negative thoughts.
David and Fabrice answer five intriguing questions submitted by listeners:
- Joshua: How can I cope with panic attacks during job interviews?
- Dan: I feel traumatized by criticisms from my boss at work. what can I do?
- Susan: How fast can you taper off of anti-anxiety drugs and antidepressants?
- Ross: What if a patient who's been the victim of trauma or abuse asks for a male therapist? Isn't this a form of avoidance? Should patients be matched to therapists based on gender? Isn't it best to avoid the situations that trigger you?
- Sumit: I think I have "endogenous depression." Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression?
Today we answer six questions submitted by listeners like you:
- Harald: How can I find the Show Notes for the Feeling Good Podcasts?
- Kristin: How do you help patients who obsess about past traumatic events, with intrusive thoughts about a cruel ex-lover or bullying by classmates? These thoughts can feed into the idea that their life is miserable and they can’t move forward because they feel blocked by these harmful memories.
- Valentina: How are cognitive distortions, self-defeating beliefs, and feelings of depression transmitted? What you describe in your books seems to describe my mother’s behaviors when I was growing up? Could it be that depression is transmitted by the family?
- Alicia: How would you treat someone with cyclothymic disorder who cycles between euphoria and suicidal depression? He’s happy now, so how do I get him to fill out the Daily Mood Log?
- Kathy: I’m a big fan, and I have a question about “bibliotherapy.” What’s the best way to use your books and other materials to help yourself?
- Matthew: Do you ever use drugs in the treatment of depression? Are medications sometimes necessary or helpful?
David describes research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain?
And what can we do to help patients with physical pain and intense negative emotions?
In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?
In today's podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to "keep the peace," it just gets worse. His complaints escalate!
This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What's the secret of dealing with a whiner or a complainer? Is it even possible.
Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You'll LOVE this lively dialogue!
David emphasizes that there are two issues. First, can your “self” be validly judged as not good enough, as inferior or even worthless? Or, can your “self” be validly judged as more worthwhile, or even superior? And is it really true that some people are more worthwhile, or less worthwhile, than others? Do more worthwhile, or less worthwhile human beings exist?
Second, do we even have a “self?”
Fabrice talks about the history of the concept of ego. For example, Freud divided the human mind into three parts: the id, ego and superego. Do these really exist as “things,” or are they just concepts, or metaphors for talking about the mind? When you try to think about the “ego” or the “self” as a thing, that’s when you get in trouble.
David argues that if you believe that someone people are “more worthwhile” or “less worthwhile,” you’d have to define what a of worthwhile human being is.
- **Richard: **Do you have to get along with everybody? How do you deal with a sociopath?
- Dave: Positive distortions can trigger mania, addictions, narcissism, and violence--but how can you get rid of them?
- Julia: What can you do if you've been depressed all of your life and wake up every morning with your mind flooded with negative thoughts? I spend two hours trying to dispute them, but they just keep coming back the next day.
- Omhur: How would you treat "Reading OCD?" I feel compelled to read every sentence and paragraph carefully and repeatedly so I won't miss anything!
- Unnamed fan (who left a negative review on iTunes): Isn't your concept of the death of the ego potentially dangerous to people with low self-esteem who are being abused?
- Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What's the best degree? Should you go to school to become a psychologist, clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning!
- Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies.
- Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called "somatic" symptoms of depression, like insomnia or changes in appetite.
- Kevin is a therapist with a simple question: How do I get over my desire to help?
- Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn’t making any progress in the therapy.
121: Ask David — Do You Believe in Freud's Notion of Secondary Gain? Is Seasonal Affective Disorder (SAD) Real?
- Dylan asks: Do you believe in Freud’s “secondary gain,” in which patients resist change because they benefit from their symptoms?
- Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing?
- Ismail asks: Should I use the Daily Mood Log just when I’m upset, or at the end of the day, or when? Do I have to stop what I’m doing when I get negative thoughts so I can write them down and work on them?
- Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas.
- Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife?
- Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?
Mon, 31 Dec 2018 09:00:00 +0000
- Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself “booster shots?”
- Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do?
- Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good?
- Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, “My Mom thinks I should come to see you.” When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do?
- Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this “Do-Nothingism,” which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can’t do the psychotherapy homework, either! It’s a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve!
- Jim asks another related question: How about doing a podcast on psychotherapy homework? “What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks.”
Debbie asks: Can you use TEAM-CBT to help people with medical disorders, such as Parkinsonism or Cancer?
- Stirling Moorey's book on Cognitive Therapy for cancer patients.
- the first episode of live therapy with Marilyn
- You may also want to listen to podcasts 50 to 52 and 59, which also feature David and Matt working with Marilyn. Marilyn described these inspiring podcasts as mind-blowing! Mark asks: How can I help a depressed family member or friend who is passive and doesn’t want to do anything? Paul asks: How can I get over death anxiety? Sune asks: If you're super-shy, does this mean you have “Avoidant Personality Disorder?” What's the difference between garden variety shyness and a personality disorder? Sly asks: “Do you believe in the big five personality traits model? And will your therapy tools change these big five traits? I got a score of 67 on neuroticism, which means I am more prone to anger, depression, anxiety, and vulnerability, and tend to think about things in a pessimistic way. If I do the exercises in your books, and develop a more realistic outlook on myself and others, does it follow that my “personality traits” will get more or less changed?”
According to Wikipedia, the “Big Five” are often represented by the acronym, OCEAN. O = Openness to experience, C = Conscientiousness, E = Extraversion, A = Agreeableness, and N = Neuroticism
Here's an important point I forgot to make on the podcast. According to Wikipedia, here's the definition of "Neuroticism:"
People with high neuroticism indexes are at risk for the development and onset of common mental disorders. . ., mood disorders, anxiety disorders, and substance use disorder, symptoms of which had traditionally been called Neurosis."
Can you see that this is a tautology? In other words, they ask you if you tend to have these kinds of symptoms, then they tell you this is "due to" some "trait" you have called "neuroticism." But they are defining "neuroticism" as people who tend to have more of these kinds of symptoms! It's circular reasoning.
I hope you can "see" this! The reason I mention this is they make it sound like they discovered some "trait" you have which causes you to have depression, or anxiety, and so forth. But they haven't! It's just a word game. In fact, scientists don't yet know the causes of any of these problems, and "traits" do not actually "exist."
Today’s Ask David questions.
- Do depression and anxiety result from medical illnesses, like thyroid problems?
- Do we REALLY create our own interpersonal reality? What if you’re being raped? Are you saying that’s your fault? How can that be?
- I struggle with anxiety. Why is it a mistake to try to “calm down?”
- How do you deal with entitlement? I think my patients should do what I tell them to do! After all, I’m a highly trained professional!
- How do you deal with racism, sexism, and other societal barriers? What if the injustice is real and it isn’t “all in your head?”
- Jose and Bri both asked: How would you treat hypochondria?
- Christian: How would you treat an abuse survivor? I’ve heard that talk therapy is inadequate for healing trauma!
- Ted: Is there such a thing as healthy euphoria?
- Hillary: Would you do a podcast covering the treatment of mania?
- Jim: I think I have ADHD, but some doctors claim it’s not a true diagnosis. What do you think?
- Dan: What your thoughts are on LSD in the treatment of depression and anxiety?
Mon, 13 May 2019 08:00:00 +0000
Most people do not do a very good at helping loved ones, colleagues, or friends who are upset and complaining. Have you ever noticed that when you try to help or give advice they just keep complaining? This can be very frustrating--fortunately there's a fabulous solution to this universal problem.
Rhonda, Jill, and I discussed the most common errors we all make when we lose patience with someone who's complaining, and illustrated the techniques that are effective.
- Five Secrets of Effective Communication
- especially Disarming, Stroking, and Feeling Empathy, along with some compassionate I Feel Statements.
We also discussed a closely related and possibly controversial theme--is it okay to use the Five Secrets just to get someone to stop complaining, especially if you're angry with that person and they tend to complain most or all of the time? Do you always have to use the Five Secrets in a totally sincere manner?
Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom.
He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary’s classmate.
The bus driver said, “Don’t look!” But Garry watched as his friend, who was trapped under the dead horse, “bled out” and died.
Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry’s session with David, it constantly intruded into Garry’s every interaction for the next year and a half. Garry says,
“I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking.”
Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work?
- Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey)
- Guy: What’s a nervous breakdown?
- Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations?
- Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age.
- Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover?
- Brittany: I had an idea that I think would benefit a lot of us. I’d like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log? Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that!
Mon, 22 Jul 2019 08:00:00 +0000
- What can you do when you can’t identify your negative thoughts?
- Is it really true that our feelings always result from negative thoughts?
- How can I get over my public speaking anxiety?
153 - Ask David: Is it ok to touch patients? Does Depression ALWAYS result from distorted thoughts? And more!
Mon, 12 Aug 2019 08:00:00 +0000
- Kelly asks**:** Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so “professionalized” that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate?
- Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this?
- Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind?
- Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I've read for hypochondriasis try to cover the writer's back by first and foremost telling you that you should get yourself checked for real causes for your concern.
- Eduardo also asks: I've been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It's just Detective Work, and then do something about it. Is there some newer technique to dig into what's eating you?
156: Ask David: How can I cope with claustrophobia? What if the entire world thinks I am not worthwhile?
Mon, 02 Sep 2019 08:00:00 +0000
- Ann asks: Loved your podcast (on the exposure model, #26)! I have suffered from panic attacks for years - the past 2 years I've become agoraphobic and don't want to be far away from my house. So, my phobia is now "having panic attacks." Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying.
- Nathan asks: In your podcasts you mention that you conducted a "study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction." I was wondering if you could provide me with a reference to this study?
- Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this? If a person is worthwhile but the world thinks they are not worthwhile, isn't this almost as bad as not actually being worthwhile. Don't we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think?
- Robert asks: I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours.
- Robert also asks: My other question is an idea for future podcasts and it is...How about critiquing the therapeutic approach we see so often on television and in the movies?
Therapists on the Big and Small Screens versus Real Life
References for Nathan
Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012.
Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients' and therapists' shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 - 643.
- How do you interpret dreams?
- Are negative thoughts cyclical?
- How can I get over anxiety when selling?
- How does exposure work?
- Will you teach on the East Coast again?
So, the short answer to your question is—skillful listening is all that’s called for. Anything more runs the risk of getting you into trouble. But this may require a radical change in the way you communicate, as well as your personal philosophy.
DO NOT
- Give advice
- Try to help
- Try to cheer the person up
- Try to solve the problem s/he is struggling with
- Try to get the other person to think or act more positively
- Try to minimize the problem by saying it’s not that bad, or things will get better.
- Point out ways the other person may be thinking or acting in a self-defeating manner.
DO
Use the Five Secrets of Effective Communication, with an emphasis on the listening skills.
One of the most important skills is called Feeling Empathy—simply acknowledging how the other person is feeling, and asking them to tell you more, and if you got it right.
You could say something like this: “It sounds like you’re beating up on yourself for procrastinating, I’m wondering if you’re feeling
- down, sad or depressed?
- anxious, worried, pressured, or nervous?
- guilty or ashamed?
- inadequate, worthless, defective, or inferior?
- alone or lonely?
- humiliated or self-conscious?
- discouraged or hopeless?
- stuck or defeated?
- angry, annoyed, hurt, or upset?”
I find that people really like it when I ask these questions, and I let them answer each one. Then I ask them about their negative thoughts. What are they telling themselves? What are the upsetting messages?
At the beginning of every therapy session, I empathize without trying to help, exactly as I’ve been teaching you in this podcast, and in this document, and I give the other person some time—typically about 30 minutes or so—just to vent while I use the Five Secrets of Effective Communication—listening skillfully—without trying to “help.”
Then I ask the patient to grade me on empathy. I say, “How am I doing so far in terms of understanding how you’re thinking and feeling? Would you give me an A, a B, a C, or perhaps even a D?”
When they tell you, you can use the Five Secrets again, summarizing the part you missed, and then ask what your grade is, to see if you’ve improved. Usually, your grade will improve a lot.
Do NOT try to “help” until you received an A!
Then I do what’s called the Invitation Step in TEAM therapy—I ask if the other person wants help with any of the problems s/he has been discussing. You can ask the same question.
If the other person does NOT want help, but just wanted to talk and get support, your job is done. You can also ask if they want to talk some more. Most of the time, all people want is a little listening and support, and they’re not looking for help or advice.
But if the other person DOES want help, you can ask what kind of help they’re looking for. Then you can decide if you’re in a position to provide that type of help. Sometimes, the help they're looking for might not be something you can provide.
- You can read my book, Feeling Good Together, and do the written exercises while reading, so you can master the Five Secrets of Effective Communication.
David D. Burns, M.D. & Rhonda Barovsky, Psy.D.
Mon, 04 Nov 2019 09:00:00 +0000
Question 1. Why do shrinks kill themselves? Question 2. How can you find out if a friend or loved one is suicidal?
Most people who are feeling suicidal are willing to discuss their feelings fairly openly. Several types of questions can be useful.
- Suicidal thoughts or fantasies. Most people with depression due have suicidal thoughts or fantasies from time to time, and these are not necessarily dangerous.
- Suicidal urges. You can ask if s/he sometimes has urges to kill himself / herself. Suicidal thoughts or fantasies without suicidal urges are usually not especially dangerous.
- Suicidal plans. You can ask if s/he has made any plans to actually commit suicide. If so, what method would s/he use? Jumping? Shooting? Hanging? Cutting?
- Deterrents. When evaluating suicide, you can also ask if there are any strong deterrents, such as religious beliefs, impact on family and friends, and so forth. If there are no strong deterrents, the situation is more dangerous.
- Desire to live, desire to die. You can also ask the person how strong their desire to live is, and how strong is their desire to die?
- Past suicide attempts. If the person has made suicide attempts in the past, the risk of a future suicide attempt is greater.
- Drugs and alcohol. You can ask if the person drinks or uses drugs, and has ever has a stronger urge to commit suicide when intoxicated. This is a danger sign.
- Impulsiveness. Some people make suicide attempts when they’re feeling impulsive, kind of on the spur of the moment. You can ask if they every have these kids of sudden impulses.
- Willingness to reach out. You can ask if they’d be willing to reach out and ask for help if they ever have a suicidal urge.
- Honesty. You can ask if they were felt reasonably open and honest in asking your questions, or if it was difficult to answer some of the questions.
This may all sound grim and very unpleasant, but these kinds of conversations can sometimes be lifesaving, and can protect you from much greater pain later on.
1. How can I overcome my fear of blushing?
I have a awesome podcast on the fear of blushing!) You might find it helpful (Podcast #88, published on May 14, 2018.)
2. How can you get over a broken heart?
How can I help him move forward? Those good memories are haunting him?
Resources for your friend might include the book I wrote on this topic, which is called Intimate Connections. One of the themes is that rejection could never upset a human being—only distorted thoughts about being rejected.
Another great resource for him would be the chapter on the Love Addiction in Feeling Good: The New Mood Therapy. It describes a woman who had just been rejected by her husband, who was having an affair with his secretary, and she was telling herself that she couldn’t be happy without his love. The story had an amazing outcome, and might be very helpful for your friend.
3. How would you treat someone with anorexia nervosa?
I also describe the “Coercive Therapy” also called Family Therapy for anorexia, developed at the Maudsley in London, and we talk about how the same principle—getting the parents to work together on the same team, with firmness, intense mutual support, and compassionate insistence—works for almost any problem children are having.
Mon, 25 Nov 2019 09:00:00 +0000
Mon, 09 Dec 2019 09:00:00 +0000
1. Working with Abused Women
I'm a drug and alcohol counselor, working here in Los Angeles. I work primarily with women from 18 - 25 years old who have aged out of the foster care system. They are an endearing group of women, as I know you are aware (I've heard you speak of working with this population), and they just want to feel loved and worthy. However, their deep-seated beliefs of being unworthy of good things happening in their lives prevents them from attaining their goals of getting jobs, getting their children back, and gaining housing.
Despite my best efforts, the majority of these women go back out to the streets just shy of completing our 6- to 12-month treatment program. Once on the streets they return to drug dealing, prostitution, and crime. After which, if they are lucky, they get picked up and incarcerated. Many die on the streets of drug overdoses or murder.
I found this population to be particularly easy and rewarding to work with because they seemed so grateful to be getting any kind of help at all. Many of our patients were homeless, and about a quarter of them could not read or write. We gave them more than eight hours of cognitive group therapy every day in a residential treatment setting, so they got 40 to 50 hours of therapy per week. The program was very inexpensive to run, and was more or less free to the participants, paid for by some type of medical assistance insurance, as well as by our hospital. Most patients showed dramatic changes within three or four days. The average length of stay was something like a week or ten days or so.
In today's podcast, I describe a patient in one of our groups, a woman who was severely depressed. She thought of herself as "weak" and "a bad mother." She recovered from her depression in just 20 minutes or so when I used a TEAM-CBT method called "The Paradoxical Double Standard Technique.
Ten Days to Self-Esteem Ten Days to Self-Esteem, The Leader's Manual Tools, Not Schools, of Therapy, is for therapists, and we use it in all of our TEAM-CBT training programs. It is an interactive book that shows you how to do TEAM-CBT in a step-by-step way.
2. Why don’t you advocate “Wellness” or “Holistic” Approaches?
A therapist named Georgina recently emailed me and was pretty excited about her clinical work which was dedicated to “Wellness” and to “Holistic” treatment methods. I mentioned in an email that I am “intensely anti-wellness and anti-holistic.”
The quick answer to your question, which you can also hear in the podcast on “fractal psychotherapy" is that I focus narrowly on one specific moment when the patient was upset, and if it is an individual mood problem, like depression or anxiety, I ask the patient to record his or her negative thoughts and feelings at that specific moment on the Daily Mood Log. This activates just a few brain networks, out of the billions or trillions of networks in the brain, and we selectively modify those networks using techniques specifically chosen for this individual patient. There are no no-specific interventions.
Mon, 16 Dec 2019 09:00:00 +0000
- Is it possible to treat “burnout?”
- Can negative feelings can make physical pain worse?
Dave Fribush emphasizes that while the surgeon's warmth and compassion were helpful, the thing that made my pain suddenly disappear was the sudden disappearance of my negative feelings--intense anxiety about losing my teeth, as well as anger at feeling that I was being neglected. And the very moment my negative feelings changed, my anger disappeared as well.
My later research confirmed that negative emotions can, in fact, magnify the experience of physical pain, and that, on average, 50% of the pain we experience results from our negative emotions. This finding should provide hope for individuals struggling with physical pain, especially since this is a drug-free treatment not involving opiates.
1. Is it true that emotional trauma affects the brain?
I just try to accept my many shortcoming and work around them. The problem is rarely our flaws or imperfections, but rather the distorted negative messages we give ourselves; messages that generate anxiety, fear, inadequacy, shame, and so forth. 2. What’s displacement? Is it true that you have to have a good cry when something traumatic happens? You are right, Malena, that emotion is very important in therapy, since it shows that the patient trusts the But in general, I have not found it necessary to think that every patient has to cry, and it is definitely not true that crying during sessions is a panacea. 3. Why does avoidance make anxiety worse? Anxiety is not caused by the thing you fear, but by your distorted thoughts and fantasies. When you pull back instead of confronting the monster, you do not get the chance to discover that the monster has no teeth, so your negative thoughts and fantasies can quickly spiral out of control.
Mon, 23 Dec 2019 09:00:00 +0000
I might ask him what time of day he was feeling useless, and then have him fill out a Daily Mood Log for that moment, step by step. We can only help him at one specific moment. You can use a large number of techniques but must first get an A on Empathy, and then do effective paradoxical agenda setting, starting with the Paradoxical Invitation Step and then asking “what type of help would you be looking for?” then you can do the Magic Button and Positive Reframing. All of the negative thoughts and feelings on the Daily Mood Log will be advantageous and will show something about him that is awesome and positive. You should be able to generate a list of at least 25 overwhelming positives. Then you can use the Magic Dial. When you get to M = Methods, you can put the thought, “I am a useless human being” in the middle of a recovery circle, and then select a minimum of 16 methods to challenge it. You can start with Identify the Distortions. There are likely at least 9 distortions in the thought, including AON, OG, MF, DP, MAG / MIN; ER; LAB; SH; SB.
You can try, “let’s define terms,” and ask what’s the definition of a “useless human being”? You’ll find that no matter how you try to define it,
- The definition will apply to all human beings.
- The definition will apply to no human beings.
- The definition does not apply to him.
- The definition does not make sense.
- The definition is based on some kind of arbitrary cut-off points.
The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge
Thanks for reminding me that uselessness is just a meaningless concept, I needed that. And I love the idea of role-playing as a friend asking for help with defining his uselessness. I'll pace myself, though, and give us time to walk through all the steps, especially Empathy and Agenda Setting and check how it goes and what my clients wants, not I. Karolina
Mon, 13 Jan 2020 09:00:00 +0000
Question #1: Cindy asks: My suicidal daughter refuses to talk to me! What can I do?
Question #2: Lorna asks: How can I deal with my jealousy?
In addition to learning to "let go" of jealousy, Rhonda and David discuss many additional strategies for dealing with jealousy, including:
- Use of Self-Disclosure
- Positive Reframing: do you really want to give up your jealousy and vigilance?
- Cost-Benefit Analysis: Is it worth the hassle of constantly being suspicious, as opposed to simply deciding to trust and let the chips fall here they may?
- Downward Arrow: What are you the most afraid of?
- Love Addiction
- Fear of Rejection
- Fear of Being Alone
- Overcoming the fear of being alone and the “need” for this man’s love, or any man’s love, is discussed in the first section of Intimate Connections.
- Exposure: You could fantasize the two of them together, making yourself as anxious and jealous as possible, until the feelings diminish and disappear.
- Self-Monitoring: Counting your thoughts about them on a wrist counter or cell phone for four weeks. David describes his work with an intensely jealous law student after his girlfriend broke up with him so she could date another fellow in his class.
- Understand the frequent ineffectiveness of apologizing, and why it doesn’t work! This is really important. David describes a powerful vignette about a troubled couple, where “I’m sorry” was CLEARLY a way of saying “shut up, I don’t want to feel about how hurt and angry you feel.” The Five Secrets of Effective Communication are a vastly more effective way of dealing with negative feelings. David and Rhonda contrast effective vs. dysfunctional “apologizing.”
Mon, 20 Jan 2020 09:00:00 +0000
182: Ask David-Are Negative and Positive Distortions Bad? Treating an Existential Crisis. Agreeing with Unfair Criticisms
- I am confused about the terms, negative and positive distortions. Help!
- “How do you treat an “existential crisis?”
- Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse?
Mon, 02 Mar 2020 09:00:00 +0000