047: Tools, Not Schools, of Therapy
The title of David's TEAM-CBT eBook for therapists is Tools, Not Schools, of Therapy. David explains that the field of psychotherapy is dominated by numerous schools of therapy that compete like religions, or even cults, each claiming to have the answer to emotional suffering. So you’ve got the psychodynamic school, and the psychoanalytic school, the Adlerian school, the Beckian cognitive therapy school, the Jungian school, and tons more, including EMDR, behavior therapy, humanistic therapy, ACT, TMT, EMT, and so forth. Wikipedia lists more than 50 major schools of psychotherapy(https://daviddburnsmd.files.wordpress.com/2014/01/aaa-ebook-order-form-for-website-v-1.pdf), but there are way more than that, as new schools emerge almost on a weekly basis.
David argues that the fields needs to move from competing schools of therapy to a new, science-based, data-driven psychotherapy. He emphasizes that we’ve learned a lot from most of the schools of therapy, and that many have provided us with valuable insights about human nature as well as some useful treatment techniques. But now it’s time to move on, leaving all the schools of therapy behind. David acknowledges that this message may seem harsh or upsetting to some listeners, and apologizes for that ahead of time.
TEAM Therapists use a number of Paradoxical Agenda Setting (PAS) techniques designed to bring the patient’s subconscious resistance to conscious awareness. Then we melt the resistance away before attempting to change the way the patient is thinking and feeling.
I (DB) have developed 15 or 20 PAS techniques, and Jill and I used several of them in our session with Mark:
- The Invitation Step
- The Miracle Cure Question
- The Magic Button
- Positive Reframing
- The Acid Test
- The Magic Dial
I want to warn you that it may be difficult to come up with your list of Positives at first. If so, this is good, because when you hear the next podcast, you'll have many "ah ha!" moments and it will all become quite obvious to you. Then you will have a new and deeper understanding of resistance--an understanding that can help you greatly if you are a therapist or if you are struggling with your own feelings of depression and anxiety.
To learn more about Paradoxical Agenda Setting, you can read David’s featured article in the March / April 2017 issue of Psychotherapy Networker entitled "When Helping Doesn’t Help." You will see how he helped a woman struggling with intense depression, anxiety and rage due to decades of horrific domestic rape and violence.
Mon, 10 Apr 2017 05:00:00 +0000
David and Jill begin using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%.
The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought.
The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic.
David and Fabrice discuss the rationale for the Recovery Circle--you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy.
Mon, 24 Apr 2017 05:00:00 +0000
Using the Externalization of Voices, which is arguably the most powerful Cognitive Therapy technique ever created, David & Jill continue encouraging mark to challenge his negative thoughts. The goal of the Externalization of Voices is to create genuine and lasting change at the gut level.
Jill and David also use the Semantic Method and Re-attribution in this segment, and end with a brief illustration of how Mark might interact differently with his son using the Five Secrets of Effective Communication. David and Jill emphasize that this is the "External Solution," and that up to this point in the session they've been working on the "Internal Solution."
Cognitive Therapists believe that negative thoughts, or cognitions, can exist on two different levels. When you’re upset, you’ll have Automatic Negative Thoughts (ANTs)
To help you pinpoint your own Self-Defeating Beliefs, David has created two uncovering techniques called the Individual Downward Arrow and the Interpersonal Downward Arrow, and Albert Ellis, the noted New York psychologist, created a third called the “What-If” Technique.
Once they come to the “bottom of the barrel,” they will ask you to pause the recording, and see if you can pinpoint five or six or more of Harold’s Self-Defeating Beliefs, using the list of 23 Common Self-Defeating Beliefs.
Uncovering Self-Defeating Beliefs (SDBs)–For Therapists (and Interested Patients) Only!
Psychoanalysts sometimes help people discover what they call “core conflicts.” According to the highly regarded psychoanalytic researcher Lester Luborsky, PhD, an example of a core conflict might be, “My needs will never be met in my relationships with others.” If you believe this, it will tend to function as a self-fulfilling prophecy, so you’ll constantly feel hurt, lonely, and rejected, and perhaps resentful when you try to get close to others. And you probably won’t realize you’re creating your own painful interpersonal reality.
David and Fabrice will illustrate a powerful, high-speed method that to bring your own Interpersonal Self-Defeating Beliefs to conscious awareness. David has called it the Interpersonal Downward Arrow Technique. David and Fabrice will revisit the same clinical example from the last Podcast—the psychologist named Harold who felt devastated when his favorite patient unexpectedly committed suicide, but in this podcast they will examine how Harold sets up his relationships with his colleagues in a way that causes him to feel lonely, anxious, and resentful.
Interpersonal Downward Arrow: The Rules and the Roles*
The third uncovering technique is called the “What-If” Technique, developed by the late Dr. Albert Ellis. The What-If Technique can will help you identify a terrifying fantasy under the surface that fuels your fears.
The late Dr. Albert Ellis developed a technique to help individuals struggling with shyness. It’s called Shame-Attacking Exercises. Essentially, you do something bizarre in public to overcome your fear of making a fool of yourself; and you will probably discover that the world doesn’t come to end. When used skillfully, this method can be incredibly liberating.
However, there are several ethical considerations. First, before therapists can ask their patients to do Shame Attacking Exercises, therapists have to do Shame-Attacking Exercises themselves! David explains his first, terrifying Shame-Attacking Exercise in a Chinese restaurant in New York after giving a talk at a workshop sponsored by Dr. Ellis.
What is a relapse? David defines a relapse as one minute or more of feeling crappy. Given that definition, we all relapse pretty much every day. However, some people can pop out of a bad mood really quickly, while others can get stuck in these “relapses” for weeks, months, or even years.
David describes the Relapse Prevention Training (RPT) techniques he has developed, but cautions that RPT does not make sense until the patient has experienced a complete elimination of symptoms. If the patient is being treated for depression, that means that the score the depression test has fallen all the way to zero (no symptoms whatsoever) and that the patients feel joy and self-esteem.
- The patient must be informed that relapse is an absolute certainty.
- Patients have to know that the therapy technique that worked for them the first time they recovered will always work for them.
- It might be the Cost-Benefit analysis, Pleasure-Predicting Sheet, Acceptance Paradox, Double Standard Technique, Five Secrets of Effective Communication, Hidden Emotion Technique, or Experimental Technique, or simply recording their negative thoughts on the Daily Mood Log and identifying the distortions in them.
- Patients need to identify and modify the Self-Defeating Beliefs (SDBs) that triggered their depression and anxiety in the first place, such as Perfectionism, Perceived Perfectionism, or the Achievement, Love or Approval Addictions.
- In several previous podcasts, David and Fabrice have described the Uncovering Techniques that can be used to quickly pinpoint any patient’s SDBs.
- Patients need to write down and challenge the Negative Thoughts that will inevitably emerge at the time they relapse, such as “This relapse proves I’m hopeless after all,” or “This relapse proves the therapy didn’t work,” etc.
David and Fabrice illustrate step #4 using a powerful technique called Externalization of Voices. David has patients record this role play procedure on a cell phone or other recording device so they can play it and listen if needed during an actual relapse.
David describes one of the more obscure methods called “Self-Monitoring”. He thinks of it as “Meditation in Daily Life.” The whole idea is to note a negative thought that suddenly pops into your mind, and then to track it, or count it, with some type of counting device, list the wrist counters golfers wear to keep track of their scores, and then to simply let go of the thought and continue with what you were doing, instead of dwelling on the thought and getting distracted and upset.
David explains that Self-Monitoring often is not effective, but occasionally it can be life changing for individuals who are struggling with anxiety, depression, or anger.
Mon, 30 Oct 2017 05:00:00 +0000
David also emphasizes the importance of using all the four models, along with a Daily Mood Log, when treating any form of anxiety: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. To learn more about how these four powerful treatment models work, you can listen to Podcasts 022 through #028.
- 022: Scared Stiff — What Is Anxiety? (Part 1)
Anxiety, like depression, has been called the world’s oldest con. That’s because you are always fooling yourself, and buying into negative thoughts that aren’t true, when you’re feeling anxious and insecure. Dr. Burns highlights the most common cognitive distortions that trigger anxiety, and discusses the powerful role of shame in anxiety.
- 023: Scared Stiff — What Causes Anxiety? What’s the Cure? (Part 2)
There are 4 powerful treatment models for anxiety:
- Cognitive Model - distorted thoughts trigger all anxiety
- Exposure Model - avoidance is the cause of all anxiety
- Motivational Model - emphasize the role of resistance (individuals believe the anxiety will protect them)
- Hidden Emotion Model - believes “niceness” is the true cause of all anxiety in the United States, at this time.
Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.
- 024: Scared Stiff — The Cognitive Model (Part 3)
- Anxiety always results from negative thought (NTs) that involve the prediction of danger.
- The NTs that trigger anxiety are always distorted and illogical. In contrast, valid NTs cause healthy fear.
- When you put the lie to the distorted NTs, the anxiety will disappear.
- 026: Scared Stiff — The Exposure Model (Part 4)
We begin by describing the three different deaths of the ego that are required for recovery from depression, anxiety, or a relationship conflict, respectively. For depression recovery often results from the “Great Death,” A Buddhist concept that involves the discovery that there is no such thing as a “self” that could be worthless, or inferior, or judged by another person.
For anxiety, the death of the ego is quite different, and involves surrendering to the monster the patient has always feared and avoided using a wide variety of exposure techniques. David traces the origin of Exposure Therapy to teachings in the Buddhist scriptures, the Tibetan Book of the Dead, more than 2,000 years ago. David describes the amazing and hilarious phenomenon of “laughing enlightenment,” which often happens when anxious individuals confront their fears.
large numbers of creative exposure techniques that fall into three categories:
- Classical Exposure
- Cognitive Exposure
- Interpersonal Exposure
- 027: Scared Stiff — The Hidden Emotion Model (Part 5)
David explains that the Hidden Emotion Model is radically different from CBT, exposure therapy, and most other current treatments for anxiety. The theory behind Hidden Emotion Technique is that “niceness” is the cause of (almost) all anxiety in the United States at this time. In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed to want. [...] Explains the timing of anxiety attacks, so it has tremendous explanatory power. Freud said that anxiety is the mysterious emotion, that comes out of the blue, and strikes like lightning, without rhyme or reason. David disagrees, and emphasizes that anxiety rarely or never comes from out of the blue. [...] David explains that while this technique traces to the teachings of Freud, Freud might turn over in his grave and find it superficial or silly, since David simply tells anxious patients that they are suppressing or repressing something that’s bothering them, and insists they bring it to conscious awareness right away. David accepts this criticism, but also adds that the Hidden Emotion Technique works and frequently triggers complete recovery with patients who are only partially helped by the skillful use of cognitive techniques and exposure techniques.
- 028: Scared Stiff — The Motivational Model (Part 6)
The key is bringing the patient’s subconscious resistance to conscious awareness, and melting it away with paradoxical techniques. This is absolutely critical if you are hoping to see a complete elimination of symptoms in any type of anxiety.
You definitely do NOT want to lose weight. You probably DO want to be thin and attractive, and in great physical condition, but you DON'T want to lose weight. Do you know why? There are only two things that you can do to lose weight--diet and exercise. And they both suck!
David describes two new, powerful techniques he has created for resolving this dilemma--the Double Paradox and Devil's Advocate Technique. David and Fabrice bring these techniques to life for you. If you are interested in losing weight, make sure you do the two exercises on paper while listening to this podcast.
Mon, 22 Jan 2018 09:00:00 +0000
David begins with a brief discussion of the philosophy of happiness, including the ancient Buddhist idea that everything in the universe is transitory and constantly changing, including our positive and negative moods, so the idea that you will be hopelessly depressed forever, or endless happy, are both illusions. Happiness, or pleasure, are transitory, and can only be achieved at specific moments. However, you can significantly increase the number and duration of the happy periods in your life.
David briefly discusses research evidence that simply doing potentially satisfying and rewarding activities, whether or not you're "in the mood," can reduce depression and enhance feelings of happiness and joy in daily living. This simple treatment method, called "Behavior Therapy," was pioneered by Dr. Peter Lewinsohn, from the Oregon Research Institute, and has been shown to have significant anti-depressant effects.
One way of doing this is with David's famous "Pleasure-Predicting Sheet." It's pretty simple to use. As you can see from the link, it is a sheet with four vertical columns. In the first column, you schedule activities with the potential for pleasure, learning, personal growth, or helping others. You can include activities that are not overly time consuming or burdensome. In the second column, record who you plan to do each activity with. If you do the activity alone, put "self" in the second column, since you're never truly alone. You're always with your "self."
You can also compare the satisfaction you experience when doing things by yourself versus the activities you do with others. Many depressed people with the Love Addiction believe they cannot be happy when they're alone, thinking they must be loved to feel truly happy and fulfilled. David describes a woman who tested this belief, and made an unexpected discovery, after her husband rejected her for another woman. You can see her Pleasure Predicting Sheet if you click here.
Finally, David gives an example of how a depressed, perfectionistic medical professor made another unexpected discovery with a modified version of the Pleasure-Predicting Sheet.
Procrastination is one of the most common causes of unhappiness, and this bad habit is almost universal. We all put off the tasks we dread because they make us anxious, and because we're tempted to do other things that are way more rewarding. But the longer you procrastinate, the worse you feel, and this robs you of motivation. As a result, you fall into a vicious cycle where procrastination triggers negative feelings like depression, anxiety, and guilt, and your negative feelings, in turn, reduce your motivation and trigger more procrastination. A vicious cycle.
Fabrice and I are going to show you how to break the cycle and boost your happiness. To get started, please think of ONE thing you've been procrastinating on.
One philosophical principle is the approach we're going to teach you is NOT to wait for motivation. Most procrastinators think that motivation comes first, followed by productive action, but this is an illusion, because you'll probably NEVER feel motivated to do some awful task you've been putting off. If you're waiting for motivation, you'll be waiting forever!
As I wrote in my first book, Feeling Good: The New Mood Therapy, highly productive people know that ACTION comes first, followed by motivation. In other words, you have to get started on some task before you'll feel motivated. You're not entitled to feel motivated until you've start accomplishing something! Waiting for motivation is the trap that keeps your procrastination alive and prospering.
I'm going to make things simple for you using a tool I created years ago called the Anti-Procrastination Sheet! To make this podcast experiential, think about the specific task you've been putting off, like filing papers, preparing your taxes, cleaning the garage, a paper or report you have to prepare--anything at all.
The Anti-Procrastination Sheet*
David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT.
David hopes to make the actual video of this dramatic therapy session available soon right here at www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.)
- Overcoming Toxic Shame: The Story of Melanie – Feeling Good $119.00
This dramatic video features Dr. David Burns and his two co-therapists, Drs. Jill Levitt, and Angela Krumm, in a TEAM-CBT session with a colleague who has been struggling silently with hidden feelings of shame for nine years about her two broken marriages. It is, arguably, one of the most beautiful and inspiring psychotherapy videos ever produced. It comes with a booklet with exercises you can do as you watch, or you can simply watch it straight through with stopping. Originally marketed for $199, Dr. Burns recently purchased all the remaining inventory and is now offering this superb produce at a discounted introductory price. This video will be great for therapists wanting to learn state of the art treatment techniques as well as the general public wanting to overcome depression and anxiety and boost self-esteem.
Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and "Sarah," one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.
David describes watching Dr. Maxy Maultsby do a demonstration of the Double Standard Technique when he was a psychiatric resident in the 1970s at the University of Pennsylvania medical school. He was quite surprised when the patient, who was severely depressed and suicidal following a break-up with her boyfriend, improved dramatically within an hour.
The technique is based on the idea that most of us operate on a double-standard. When we are upset about some failure, mistake, or inadequacy, we tend to beat up on ourselves mercilessly. But if we were talking to a dear friend with the exact same problem, we'd be far more compassionate and realistic. Once you make the patient aware of this double-standard, you ask if he or she would be willing to talk to himself or herself in the same way he or she would talk to a dear friend.
The Devil’s Advocate Technique is another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as:
- Drug or alcohol abuse
- Overeating / binge eating
- Shopping addiction
- Internet addiction
- And procrastination, which is our problem for today.
David and Fabrice are joined by Sara Shane, a member of David’s Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.
I had a magical fantasies of what would happen once I was an “author.” The reality was quite the opposite and quite painful, with almost endless rejections accompanied by feelings of self-pity and defeat. For example, soon after publication, I learned my book was at the top of my publisher's "loser list." Then I discovered that magazines, newspapers, and TV and radio shows had no interest in it whatsoever.
If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable."
Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades. And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them.
How to select the techniques that will be most helpful for various kinds of problems, and how to individualize the treatment for each patient.
- The list of Ten Cognitive Distortions
- The Disarming Technique and Law of Opposites
- The Externalization of Voices plus Acceptance Paradox
- The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow
- The Feared Fantasy and Acceptance Paradox
- The Experimental Technique for extremely rapid treatment of patients with Panic Attacks
- My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain
- Brief Mood Survey
- Positive Reframing
- The use of extended, two-hour therapy sessions
- Examine the Evidence
- The Experimental Technique
- The Survey Technique
- Reattribution
These were among the first cognitive therapy techniques ever developed, and they were based on the work of Dr. Aaron Beck, from Philadelphia, as well as Dr. Albert Ellis, from New York. Dr. Ellis is the Grandfather of Cognitive Therapy, and he described many of these techniques in the 1950s. He called his treatment Rational Emotive Therapy, and it's still popular today. During the 1960s, Beck, who is considered the Father of Cognitive Therapy adapted the ideas of Dr. Ellis to the treatment of depression, and called his version of the treatment Cognitive Therapy.
Beck claimed that the negative thoughts of the depressed individual are the actual cause of the depression. He also emphasized that the disturbing negative thoughts of depressed patients are nearly always distorted and illogical; however, depressed individuals don’t realize that they’re fooling themselves, so they think their negative thoughts are absolutely valid. Beck also claimed that depression could be treated without drugs in many cases, and focused his treatment on challenging the patient's distorted negative thoughts.
If you’re my patient, and you want help, I will ask you what specific problem you want help with. These are the four most common problems I see: depression, anxiety, relationship conflicts, or habits and addictions. Then I’ll ask you to zero in on one specific moment when you were struggling with that problem.
- if you want help with depression and low self-esteem, I’ll ask you to describe one moment when you were feeling down. It could be any moment at all—it might even be right now, sitting in my office (or reading this text).
- if you want help with anxiety, I will ask you to identify one specific moment when you were feeling anxious, worried, nervous, frightened or panicky.
- If you’ve been having trouble getting along with a friend or family member, I would ask you to describe one brief interaction you’ve had with the person you’re at odds with, and I’d ask you to write down one specific thing they said to you, end exactly what you said next.
When you understand why you were feeling depressed or panicky or whatever at that specific moment, you will understand everything you need to know about why you get depressed, or panicky, or whatever at any moment of your life.
In addition, the moment you learn how to change the way you were thinking, feeling at that one brief moment, you will become enlightened, and you will suddenly grasp the solution to all of your problems. That’s because that one specific problem will simply repeat itself over and over, in slightly different disguises, every time you are depressed, or anxious, or arguing with a friend or family member, or struggling with temptations. So, once you understand the solution to that problem at one specific moment, you will understand the solution to that type of problem at any time in your life.
Fabrice and David link this Specificity concept to the amazing insights of the new branch of “fractal geometry.” Fractal geometry is a revolutionary form of mathematics in which a very simple formula, or shape, gets reproduced an infinite number of times.
Similarly, in “fractal psychotherapy,” we zero in on one very brief moment of your life, but the formula—or error—that caused you to become upset at that moment will always be the very same error you make every time you feet inferior or anxious or angry or tempted. And once you’ve changed at that one brief moment, you really will experience enlightenment! And your entire universe will become enlightened as well!
Fabrice provides another metaphor, that of a hologram.
- We create our personal reality at every moment of every day.
- We like to blame others for the problems in our relationships instead of pinpointing our own role in the problem.
- Intimacy, and enlightenment, require a painful death of the ego, or self. When you "look inward" for the cause of the problem, instead of blaming, you will find the answer you've been looking for--but the answer can sometimes be pretty painful.
- If you're willing to let your ego, or "self," die, you will receive a pretty awesome reward in heaven. But this heaven occurs when you are still alive!
Five Secrets of Effective CommunicationMultiple Choice Empathy
In this role-reversal of the traditional Feeling Good Podcast, Dr. David Burns and his special guest, Dr. Rhonda Barovsky, interview Dr. Fabrice Nye, your beloved podcast host, on the topic of Mindfulness and Meditation, which are currently popular with the therapeutic community.
Fabrice answers questions like these:
- What’s mindfulness? How does it differ from meditation?
- What’s the history of mindfulness as well as meditation? Did it originate with the Buddha, or did it date back even earlier?
- What are some of the goals and potential benefits of mindfulness?
- Why specific exercises can you do to develop greater mindfulness ?
- Why is mindfulness helpful? How does it work?
- Some people meditate in silence for prolonged times, like ten days, for example. What is the goal here?
- Are there any dangers of meditation?
- How does mindfulness differ from yoga, relaxation training, and self-hypnosis?
- Some people seem to love and benefit from meditation, and others find it uninteresting or even annoying. Why is this? What's the difference in these two groups of people? Is it okay not to be interested in meditation, or is something that everyone “should” do?
The goal of mindfulness seems to be learning to deal more effectively with stressful thought and feelings. Does it deal with motivation and the resistance to change? TEAM-CBT makes us aware of the incredible importance of resistance, and provides many methods for reducing or eliminating resistance before you try any Method to “help” the patient. Does Mindfulness Meditation deal with resistance, or would it best be viewed as a method that can help individuals who are already strongly motivated to invest time and effort in their personal growth?
Mon, 25 Feb 2019 09:00:00 +0000
Rhonda, Fabrice and I received a number of thoughtful emails following our recent podcast on mindfulness meditation, which seems to be quite popular these days, but there some push-back from listeners who all did not agree that mindfulness is an effective way of combating negative thoughts and feelings.
That said, I've sensed a few benefits of mindfulness which is why I've been investing my time in it:
- I think you can view meditation as concentration practice, and I've found that meditation increases my ability to concentrate
- You can reach a very calm and relaxed state in meditation where you cease to have thoughts, and this state is extremely pleasurable
- I've noticed that mindfulness increase my ability to enjoy experiences, including experiences I might enjoy less if I was having even positive or neutral thoughts.
I've also run an experiment using the PAS and CBT to remove the motivation to have distracting thoughts. (ie write down the advantages to having distracting thoughts and disadvantages of focusing on the breath, and then talk back to those) I would classify it as a highly successful experiment, after talking back to all the good reasons to think about something besides my breath my focus got dramatically better. I wonder if this technique could be used to either improve meditation or even supplant the need for it. (because it gets rid of distracting thoughts directly, while meditation is basically practice for having fewer distracting thoughts)
Perhaps you could put it like this: Mindfulness is not a specific technique for specific problems, but a general method for psychological health. If you have a specific medical condition, you'll want to get a specific treatment.
Mon, 15 Apr 2019 08:00:00 +0000
David and Rhonda discuss and old controversy: Can a self-help book can really help? Or will you need psychotherapy and / or an antidepressant if you are seriously depressed?
I never thought of my book, Feeling Good: The new Mood Therapy as a self-help book. My idea was that people receiving cognitive therapy could read it between sessions as a way of speeding up their recovery, so that the therapist could do the individual work and not have to do so much teaching about the basic concepts, like my list of ten cognitive distortions.
One day a colleague asked if I’d seen the article about my book in the New York Times. Apparently, Dr. Forrest Scogin, a research psychologist from the University of Alabama Medical Center, had studied the effects of reading a self-help book on patients seeking treatment for moderate to severe depression. In a nutshell, their studies indicated that simply reading Feeling Good may help some patients overcome depression and may help to prevent future relapses as well. This finding was a shock, but was not entirely unexpected due to all the testimonials I’d been received from people who’d read the book.
In their first study, Dr. Forest Scogin and his colleagues told patients seeking treatment for depression that they’d be placed on a four-week waiting list before beginning treatment. Half of the patients were given a copy of either my Feeling Good or a self-help book on depression by Dr. Peter Lewinsohn called Up from Depression. The researchers suggested that the patients could read their book while they were waiting for their first appointment with the psychiatrist.
The other half of the patients who were placed on the four-week waiting list did not receive a copy a self-help book. Both groups of patients were contacted each week by a research assistant who administered a test to assess the severity of depression. The goal of course was to find out if there were any changes in depression in any of the patients.
The results of the study were interesting. Approximately two-thirds of the patients who received one of the self-help books improved or recovered from depression during the four weeks, even though they received no other treatment with drugs or psychotherapy. In fact, they improved to such an extent that most of them did not even need any further treatment. In contrast, the patients who did not receive one of the books failed to improve during the four-week waiting period. As far as I know, this was the first time that the anti-depressant effects of a self-help book had ever been documented in carefully controlled research study published in a scientific journal.
Some critics challenged the study, arguing that the improvement in the patients who received the self-help book might have simply been a placebo effect. In other words, maybe it was just the reading, and the expectation of recovery, that helped, as opposed to the ideas and techniques described in the books.
To test this, the investigators studied a new group of patients who were asked to read a “placebo” book while waiting for treatment. The researchers chose a classic book by Victor Frankl called Man’s Search for Meaning. If these patients also improved, it would confirm that the effect of reading on mood was simply a non-specific “placebo” effect. This is incredibly important, because almost any type of intervention can have a placebo effect, so that as many as 35% of patients will improve just because they think they’ll improve.
Surprisingly, the patients who read the Victor Frankl book did not improve. This exciting finding indicated that a self-help book can have a specific and fairly strong antidepressant effect, but that the book had to contain sound information that was actually helpful to individuals with depression.
the following table will show you which books are best for which kinds of problems. The reading list at the end is for individuals who might like to check out the original studies by Dr. Scogin and his colleagues.
| Topic | Problem |
|---|---|
| Feeling Good: The New Mood Therapy | Mild to severe depression |
| The Feeling Good Handbook | Depression and anxiety |
| When Panic Attacks | All anxiety disorders |
| Feeling Good Together | Relationship Problems |
| Intimate Connections | Dating Problems |
| Ten Days to Self-Esteem | This is a simplified ten-step program to overcome depression and boost self-esteem. it is effective individually or in support groups. |
- Ackerson J, Scogin F, McKendree-Smith N, Lyman RD (1998) Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol 66: 685-690.
- Floyd M, Rohen N, Shackelford JA, Hubbard KL, Parnell MB, et al. (2006) Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behav Modif 30: 281-294.
- Floyd M, Scogin F, McKendree-Smith N, Floyd DL, Rokke PD (2004) Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behav Modif 28: 297-318.
- Jamison C, Scogin F (1995) The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol 63: 644-650.
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Mon, 06 May 2019 08:00:00 +0000
I recently published the results of a survey of Feeling Good Podcast fans like yourself. The findings were overwhelmingly positive and illuminating. However, there were a few criticisms as well, like the excellent and thoughtful comments Rhonda and I will address in this podcast. I appreciate negative feedback, as this provides the greatest opportunities for growth and learning.
Dr. Burns, you seem to disregard healing modalities outside of CBT. CBT is wonderful and nobody teachers it better than Dr Burns—I believe that it is a foundational practice to well-being. However, working with difficult emotions is very important and not always well addressed through CBT alone.
Thinking CBT is the answer for most issues is loaded with cognitive distortions. Example--Discounting the Positive in other practices, All or Nothing Thinking, Magical Thinking, and seeing CBT as a “cure all.” In my personal healing journey CBT has been absolutely essential--as has self compassion, learning to let things go, inner child work, mindfulness, somatic awareness and more. I have noticed there has repeatedly been a dismissive tone for other valuable practices.
Thank you, whoever you are, for this thought-provoking feedback. And you are SO RIGHT. Cognitive Therapy has value for some problems, but it is definitely NOT a panacea. In fact, no treatment is! The belief that you have THE ANSWER for everything is incredibly misguided but unfortunately, way too common in our field.
I have no doubt that many people have shared your concerns. Let us know what you think after you hear today's podcast!
There are lots of reasons why you may have trouble saying no. Some are negative, but some are actually positive, including:
- Conflict phobia. You are afraid that if you say no, the other person will get angry and annoyed with you.
- Fear of disapproval or rejection. You are afraid that if you say no, the other person will judge you, disapprove of you, or reject you.
- Perceived narcissism. You believe that other people will lash out if you don’t give in to their demands.
- Submissiveness. You believe that your role in relationships is to make others happy, even at the expense of your own needs and feelings.
- Joy / Love. Jill confesses that she often says yes to this or that request because she feels it will be fun, or because she doesn’t want to let the other person down. One example would be baking brownies for her sons when she’s exhausted. One consequences would be giving in, but resenting the person she’s saying yes to.
- Guilt. You may feel that if you say no, it means that you are somehow “bad,” and that it’s your duty to please other people.
- Achievement addiction. You say yes to almost everything because you think this or that activity will make you more productive and successful.
- Empathy--as a therapist, you always want to start with empathy, without trying to "help."
- Motivational strategies such as the Paradoxical Cost-Benefit Analysis, Positive Reframing, or even the Straightforward Cost-Benefit Analysis. This is crucial to find out if patients really want to change before using methods to help them become more assertive.
- Punting. This is a delay strategy that David uses to get himself off the hook when feeling ambivalent about a request. For example, you can say, “I’m really pleased and honored that you’ve invited me to do X. I’m going to check with my schedule and see what might be possible, and I’ll get back to you.” Then, he has a day or two to work up the courage to say “no” in a kindly way.
- Write down your Negative Thoughts. when you're feeling compelled to say yes because you're feeling anxious or guilty, Ask yourself, "What am I telling myself?" Those thoughts will nearly always be distorted. Then ask yourself how you could challenge and talk back to those thoughts.
- Fabrice, Jill and David also discuss how to say no effectively and demonstrate this skill in a role-play with Jill that is surprisingly challenging!
- They also demonstrate the Feared Fantasy, a powerful technique to help patients say no, using Jill’s example.