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!
Ask David: Featuring Matt May, MD 329: How can you deal with a “narcissist?” In today’s Ask David, we respond to a listener who requested a podcast on the topic of narcissism, including how to deal with them, so we will focus on these topics. The following show notes were prepared prior to the actual podcast to provide a structure. For more great information, listen to the podcast, as much more was covered! David What is the definition of “narcissistic personality disorder”? Narcissism involves: Grandiose fantasies and feelings, thinking that you are superior to others Lack of empathy for others Extreme self-centeredness Intolerance to criticism or disapproval Urges for revenge on anyone who crosses you. We do not know whether these are just extremes of personality characteristics that everyone has in varying degrees, or whether it actually consists of a “disorder” that is qualitatively different and distinct. But it is definitely true that all of the characteristics I have bulleted above do exist to some degree in most, if not all, human beings. How do you treat narcissistic patient? I do not treat diagnoses, just human beings. This is a radical departure from the way many mental health professionals approach their work. No matter who I’m treating, I always start with the T and E of TEAM (Test and Empathy) and then move on to A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) The main idea is to find out what, if anything, the patient wants help with. It would be rare for someone with narcissistic qualities to want help with their narcissism. Generally, they want help with a troubled relationship or with feelings of depression, anxiety, or anger. Then I would ask them to zero in on one specific moment when they were upset and wanting help, and deal with Outcome and Process Resistance. If the patient can convince me that she or he does want help, then I move on to M = Methods, and the methods would have to do with the nature of the problem they want help with. I once presented a case illustrating rather dramatic and rapid recovery in a patient I was treating for depression and anxiety. To my way of thinking, it was a great outcome. However, during the Q and A I got an angry rebuke from a therapist in the audience who pointed out that I hadn’t treated the patient’s “obvious narcissism.” This is the “great divide.” I don’t feel like it’s my calling to evangelize for any model of “ideal mental health.” For the most part, and there are always exceptions to every rule, I do not impose my agenda on the patients, but try to work with what they want to change. I might suggest possible ways we could work together, but in the final analysis it is up to the patient. I liken my role to that of a plumber. If you’ve got a broken toilet, give me a call and I’ll fix it. But I don’t go from door to door promoting copper pipes! How can you deal with narcissistic individuals in the real world? Once again, it depends on the specific moment that you want help with. However, I always like to emphasize the value of the Disarming Technique and Stroking when interacting with someone with strong narcissistic tendencies. The goal, in my opinion, might be on “dealing with them skillfully” as opposed to “changing” them or “winning.” For example, (David can give example of Erik’s friend when growing up.) What are the causes of narcissism? Scientists do not know, for the most part, what causes most of the so-called “mental disorders” listed in the Diagnostic and Statistical Manual of the American Psychiatric Association, but it seems possible, even likely, that there could be genetic and environmental causes, and the environmental causes could have to do with the past (childhood influences) and present. For example, when people begin to experience significant success, in academics, sports, or some other field, others begin to admire them and
You can reach Dr. Burns at email@example.com.
"Overcoming Toxic Shame" Join Dr. Jill Levitt and me at our fabulous new workshop Sunday, February 5th, 2023 8:30am - 4:30pm PST - 7 CE units Click here for information and registration In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her. Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients! In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING! Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world. You can reach Dr. Burns at firstname.lastname@example.org.
Rejection Practice?! It's freaking me out! Part 2 of 2
Live Therapy with Cody, Part 2 of 2 Last week we presented the first of our session with Cody, a young man wanting help with his fairly severe social anxiety since childhood. My co-therapist for this session was Dr. Rhonda Barovsky, the Feeling Good Podcast co-host, and Director, Feeling Great Therapy Center. Today, you will hear the exciting conclusion of his session, and the follow-up as well! Part 2 M = Methods We focused on cognitive work and interpersonal exposure techniques as well. I will leave it to you to listen to the podcast, as I became so engrossed in what we were doing that I stopped taking notes. However, we used a number of tools within the group, including: Identify the Distortions in his thoughts Examine the Evidence Externalization of Voices Self-Disclosure Rejection Practice The Experimental Technique The Feared Fantasy And more. Cody received an abundant outpouring of love, respect, and encouragement from those in attendance (LINK). We also gave Cody two “homework” assignments to complete following the group. Do at least three Rejection Practices in the mall and notify the training group members via email within 24 hours that he had completed this assignment. Complete the Positive Thoughts column of your Daily Mood Log. If you'd like to see Cody's complet4ed Daily Mood Log, you can check this LINK. If you'd like to see Cody's intimal and final Brief Mood Survey plus Evaluation of Therapy session, check this LINK. As you can see, there were dramatic changes in all of his negative feelings. However, he wanted to retain some anger toward his childhood friends who made fun of him. Here’s the email we received from Cody about his homework assignment. Hello groupers, I can proudly say mission accomplished! Although it took me around 7 hours to do it, I did it. A lot of emotions came up as I kept trying and chickening out. I really feel like something has changed in me, by the last person I felt almost no anxiety and now I keep asking myself why I was ever afraid of this (I hope it sticks. I know I'll need to keep up this momentum I'm sure). Having to do this email and being held accountable to you all was what drove me to the finish line. Thanks again, see you all next week! Thanks to you, Cody. You were incredibly inspiring in group and after and the work you did will touch the hearts of many people, just as you have already touched the hearts of all the people in our group! And thank you all for listening! Cody, Rhonda, and David
Rejection Practice?! It's freaking me out! Part 1 of 2
Featured pic of Cody in one of the small group practice sessions in David's virtual Tuesday training group. Live Therapy with Cody, Part 1 of 2 I recently treated Cody, a young man wanting help with his fairly severe social anxiety since childhood, during one of our Tuesday evening Stanford training groups. My co-therapist for this session was Rhonda Barovsky, PsyD, the Feeling Good podcast co-host. The full session will be broadcasted in two parts, starting today and finishing next week. Part 1 T = Testing At the start of the session, Cody’s depression score was only 6 out of 20, indicating minimal to mild depression, but his score on the loss of self-esteem was “a lot.” His anxiety score was 11 out of 20, indicating moderate anxiety, and his anger score was only 2, minimal. However his score on the Happiness test was only 11 out of 20, which is only moderately happy, indicating a lot of room for improvement. If you like, you can review his Brief Mood Survey at this LINK. We’ll of course ask him to take this test at the end of today’s session so we can see what, if impact, we made on his feelings. E = Empathy Cody described his shyness like this: “I’ve been shy for as long as I can remember and feel introverted. It started in middle school. I felt like I never fit in or connected with people very deeply. In middle school, you really want to fit in. “I wanted my friends to like me, and one day they all started to torment me. Our seats in school were assigned, so I couldn’t get away from them. I cried at recess every day for months. Then, one day, they suddenly went back to being my friends again, and I never understood why. “When they were tormenting me was the most painful moment of my life. I felt like they were judging me. “I’ve worked on my own and I’ve gotten over 90% of my social anxiety. At first, I was afraid of answering the phone or even ordering a pizza, so I got a job where I was required to answer the phone and got over it. “Now I’d like to date, but this has been a problem for me. Also, when I’m treating someone, and this topic of social anxiety comes up, I get uncomfortable. I think if I could overcome the rest of my shyness, it would boost my confidence. “The podcast you and Rhonda did with Cai on Rejection Practice (LINK) inspired me tremendously, and I managed to do one Rejection Practice. By now I’m chickening out again. I go to the mall determined to do it, but I just keep putting it off. Asking women to reject me seems incredibly frightening, and I’m afraid people will judge me or see me as a predator. I love in a small town, and most people know each other. “When I was thinking about the session all day today, I felt nervous and my stomach tightened up. Cody brought a partially completed Daily Mood Log to the session, which you can review at this LINK. As you can see, the Upsetting Event was thoughts of approaching someone at the mall for Rejection Practice. His negative feelings included the entire anxiety cluster, shame, the entire inadequacy cluster, unwanted, humiliated, embarrassed, the entire hopelessness cluster, frustrated, annoyed, and anger with himself. These feelings ranged from a low of 35% for shame to a high of 100% for foolish and humiliated and 90% for the hopelessness cluster. And as you can see, many of his negative thoughts focused on the theme of being judged by others who might see him and think he was strange, or a disrespectful jerk, and so on. He was also convinced that women would be annoyed by him, and that the word would spread so that he’d lose the respect of people he cared about. A = Assessment of Resistance Cody’s goal for the session was to feel motivated to do the Rejection Practice he’d been avoiding, and to get rid of the negative thoughts that were holding him back. He said he’d be reluctant, though, to press the Magic Button and make all of his negative thoughts and feelings disappear, so we listed what his fears mig
The Finding Humans Less Scary Marathon! Featuring Dr. Jacob Towery and Michael Luo
Curing YOUR Social Anxiety— The Ridiculously Cheap and Awesome Shame-Attacking Marathon Jacob Towery, MD
Today, we are joined by Dr. Jacob Towery and Michael Luo to promote their upcoming, two-day Social Anxiety Marathon. Jacob Towery, MD is an adolescent and adult psychiatrist and therapist in private practice in Palo Alto, California. Michael Luo is a fourth year medical student at the Chicago Medical School. More on them at the end of the show notes, but here’s the scoop. Jacob and Michael will be offering a mind-blowing, two-day marathon for anyone who struggles with social anxiety, which includes shyness, public speaking anxiety, and performance anxiety. They will both be present, along with more than ten experts in TEAM-CBT, coaching participants in the latest tools for quickly overcoming all social anxiety. And here’s the amazing thing. You can come and attend, and transform your life, for only a $20 donation to one of their four listed amazing charities. For information / registration, click here How cool is that? Don’t pass this up. It will be an in-person, hands-on training experience designed to free you from the fears that narrow your life. You will learn and participate in cognitive therapy exercises, identifying and smashing the distorted thoughts that trigger social anxiety, as well as the Self-Defeating Beliefs that trigger social anxiety like the Spotlight and Brushfire Fallacies, the Approval Addiction, and more. They will also illustrate and lead you in a wide variety of Interpersonal Exposure Techniques, including Smile and Hello Practice, Self-Disclosure (which Michael demonstrates in real time on today’s show), Rejection Practice, Flirting Training, Shame Attacking Exercises, and more. David claims that Jacob is likely the world’s top expert in Shame Attacking Exercises, and we illustrate several on the podcast. Rhonda described a Shame Attacking Exercise that I challenged her with. It was incredibly terrifying, but turned out really well! David also described the impact of self-disclosure on a wealthy and powerful businessman he treated who was so insecure that he was even terrified to be around his wife and children. People who are socially anxious nearly always try hard to hide their negative feelings out of a sense of shame, so others, even friends and family and colleagues, typically aren’t aware of how they feel inside. Michael courageously discloses his own negative thoughts that triggered feelings of social anxiety at being around Jacob, his mentor. Maybe I’ll make a mistake. I might be wasting Jacob’s time. Then he might not want to mentor me. These thoughts caused feelings of loneliness and shame. I felt much closer to Michael when he disclose these feelings. Jacob added that he was totally unaware that Michael had been struggling with these thoughts and feelings. The treatment of social anxiety is profoundly serious, because we are involved in changing the lives of people who are suffering and lonely and inhibited, but the treatment can also be fun, hilarious and of course, enlightening. Michael wraps up the show by describing the transformation this training has had on his own life. If you wish to attend, act rapidly because space is limited and will be given out on a first-come, first-serve basis. I hope you can attend, and make sure you let Rhonda and David know about your experiences! Thanks for listening today! Rhonda, Jacob, Michael, and David
How to Mend a Broken Heart. Part 2 Starring Kyle Jones
Secrets of Overcoming Romantic Rejection Part 2 of 2 In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more! 6. Do you have any tips for moving on and realizing that maybe your ex isn’t as great as you think they are? David 20 qualities I’m looking for in an ideal mate. Rhonda Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different. Fill out the form: “20 Qualities in An Ideal Mate” and review how many of these qualities your ex had. 7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who’s been cheated on in trying to get their confidence back? David YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average. Kyle Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you’ve been cheated on? Practice talking back to those. 8. How can we boost our confidence back up after a breakup in general even if we haven’t been cheated on? David SAME ANSWER. Rhonda Do things you love to do with people who love you: go dancing, go to the beach, go hear music, read, etc. Daily Mood Log on the thoughts that lead to your lack of confidence. 9. Do you guys believe in the notion that you are capable of “healing completely from your ex (aka completely being over them and all the pain the breakup brought you)” or do you believe that it’s not possible. David I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU’LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU! Rhonda You may never be exactly the same, why would you want to be? Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds). Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships. Relationship Journal to see how you have contributed to the relationship problems. Maybe do Reattribution to see what you contributed to the relationship problems and what they did. 10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations? David I DON’T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT’S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT “SEES.” Rhonda I can’t add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain. 11. Do you guys feel that you shouldn’t date for a while after getting your heart broken? David THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED. Rhonda This is a very personal decision. Have you had time to heal before getting into a new relationship? Have you had time to examine your role so you can make changes if you choose, so you won’t repeat the same mistakes in the next relatio
Recovering from a breakup
I am walking through my lover of 10 years decision to end our relationship. She brought her intentions to me after Thanksgiving through the week before Christmas. I have been experiencing waves of sorrow. This podcast has been definitively helpful to my being.
Lay listener loves this podcast
I have been listening to this podcast for a couple to three years and look forward to it each week. I love the live therapy sessions and also appreciate the insight of the guests along with David and Rhonda. I know the Five Secrets have helped me in my relationships without a doubt.
Love the questions + externalization of voices
Love love love when they give you a peak into what a therapy session would look like, especially, when they do externalization of voices. It helps me learn how to talk/rebut my own challenging thoughts!