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!
Sadness as Celebration, Part 2
#253: Sadness as Celebration, Part 2
In today’s podcast, Rhonda and David present Part 2 of their work with a young woman named Rose who has been struggling with profound feelings of grief since learning of a discouraging update on her father’s struggles with multiple forms of cancer.
A = Assessment of Resistance
At the end of the moving and tearful empathy phase, Rhonda asked Rose if she felt ready to do some work, or needed more time to talk and share her thoughts and feelings.
She said she was ready to do some work, and described her goals for the session:
I know I cannot change the facts, and I would not want to eliminate the grieving, but I would like to dial down the intensity of some of my emotions, particularly when I’m triggered.
Next, we did some Positive Reframing to highlight what was positive about Rose’s feelings. You can click here review the list of positives that we generated.
Rose’s Positive Reframing Table* Thought or Feeling
List your negative thoughts or feelings, one by one, in this column.
Advantages and Core Values--Ask yourself
What are some advantages of this thought or feeling? How might it help, protect, or benefit me? What does this negative thought or feeling show about me that is positive and awesome? How does it reflect my core values? Sadness, depression Shows my deep love for my dad and honors the contribution and impact he’s made in my life Shows the strength of our relationship Anxiety The anxiety is warranted in this situation, shows that I’m being realistic with the situation It shows my love for my dad, being worried is a way of showing care and concern It shows that I don’t want him to suffer It motivates me to connect with him and to make every moment count It makes me vigilant so I explore every possible treatment option It motivates us to think about moving to be closer to him It has motivated us to schedule another visit again in July Guilt Shows my connection to our family Drives us to visit as much as possible Shows that I don’t want to live with regret Feeling defective Shows that I’m honest about my flaws Shows I feel that I’m not doing a good job supporting others, so it means I have high standards in my relationships Shows that I’m vulnerable Lonely Shows my love for my dad and the important role he plays in my children’s life Shows how strongly that I value relationships Motivates me Hopelessness Shows I am being realistic Prevents me from getting my hopes up too high Prepares me for the inevitable Makes me value and make each moment count Might decide to discontinue the chemo if it causes problems and isn’t helpful Makes me more vigilant Frustration Shows I haven’t given up or thrown in the towel Anger
I will fight and contest this! Now you can review Rose’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you!
Goal % After Emotions %
Goal % After Sad, depressed, down, unhappy 100 50-60 Lonely, alone 80 10 Anxious, worried, frightened 100 30 Hopeless, discouraged, pessimistic, despairing 90 10 Guilty 80 15 Defeated 70 20 Defective 70 10 Angry 80 25 As you can see, she wanted to dial all of her feelings down to low levels, with the exception of her sadness, which was an expression of her love for her dad.
M = Methods
We used Explain the Distortions, the Double Standard Technique, and the Externalization of Voices, including the CAT (Counter-Attack Technique).
Here’s how Rose challenged Negative Thought #1.
1. He's goi
Sadness as Celebration, Part 1
#252: Sadness as Celebration, Part 1 In today’s podcast, Rhonda and David present Part 1 of their work with a young woman named Rose. Rose is a 38-year-old mother of two boys aged 2 and 5. She works as a Therapist at an outpatient clinic, the East Bay Center for Anxiety Relief, and is a member of our Tuesday training group at Stanford.
Rose sought help because of her profound grief after talking to her mother about her father’s recent visit to his oncologist. Her father has had many severe health problems in the past several years. He’s been a survivor, but suddenly the outlook seems bleak, and Rose feels tremendous sadness and fear, because of her deep love for her father.
In most cases, grief does not need treatment. Clearly, grieving is healthy and even necessary when you lose someone you love. However, it can be helpful to distinguish healthy from unhealthy grief.
From a cognitive therapy perspective, all feelings, including grief over the loss or impending loss of someone you love, result from your thoughts. Healthy grief results from negative thoughts that are not distorted. For example, if a loved one dies, you may think of all the things you loved about that person and the experiences you will no longer be able to share. Your sadness is actually an expression of your love.
Healthy grief, in contrast, results from distorted thoughts. For example, in my book, Feeling Good, I described a young physician who became suicidal when her brother committed suicide because she told herself; “I should have known he was suicidal that day. His death was my fault, and so I, too, deserve to die.”
This thought triggered intense guilt, and it contains many of the familiar cognitive distortions, including Self-Blame, Emotional Reasoning, Should Statements, and Discounting the Positive, and Fortune-Telling, to name just a few. With my help, she was able to challenge and crush her distorted thoughts, and her depression disappeared.
Then she was then able to grieve his tragic death. Paradoxically, the distorted thoughts that triggered the unhealthy grief had actually prevented her from grieving in a healthy way. Today’s podcast is illuminating because Rose is experiencing a combination of healthy and unhealthy grief resulting from a mix of undistorted and distorted thoughts.
The work that Rose did is incredibly inspiring, and sad. Today we will publish the first half of the session, including T = Testing and E = Empathy.
Next week, we will publish the second half of the session, starting with the question, “What do we have to offer our patients once we’ve empathized?” Then you will hear the A = Assessment of Resistance and M = Methods portion of our work with Rose.
T = Testing
Take a look at the Daily Mood Log (LINK) that Rose shared with us at the start of her session. You will see that she had very elevated scores in 8 different categories of negative feelings, suggesting she was in pretty intense distress. We will ask her to rate these feelings again at the end of the session so we can see if she experienced any changes during the session.
I’m a firm believer that all therapists should use testing at every session, and many are now doing this, but lots of therapists still refuse for a variety of reasons. I was going to say “bogus reasons,” but didn’t want to sound harsh or dogmatic!
To me, the refusal of psychotherapists or psychiatrists to measure symptoms at every session is the “unforgiveable sin!” I don’t believe it is possible to do good therapy, much less world class therapy, without Testing, for a wide variety of reasons:
Therapists perceptions of how patients feel, and patients feel about them, are not accurate. Measuring suicidal urges at the start and end of every session can save lives. Seeing how effective. or ineffective, you were at every session allows you to fine tune the th
Ask Matt, Rhonda, and David (with Dr. Rutherford Knows)
#251, Ask Matt, Rhonda, and David
(with the famed Dr. Rutherford Knows) Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions!
Today’s questions were submitted by the more than 6,000 people who registered for my free talk on July 8, 2021 on the Rapid Treatment of Anxiety Disorders which was sponsored by PESI. I was very grateful to PESI for organizing this event, since it was open to shrinks as well as the general public, and that is the same audience that Rhonda and I are trying to reach with our Feeling Good Podcast.
By the way, thank you for your ongoing support of the Feeling Good podcasts. Our four millionth download should happen in August! Please keep telling friends about the podcast if you think they might be interested.
The very shy but erudite Dr. Knows may again join us and make an occasional comment. Let us know if you like his input and want to hear more from him in future podcasts. If you don’t like him, we can quietly sweep him to the sidelines.
Here are the questions we’ll answer today:
Hello Dr Burns, excited to be here at your talk today. Could you tell us more about dependency on anti-anxiety medications (benzodiazepines like Valium, Librium Ativan, Xanax, and so forth) and how to inform the client about the dangers of addiction? If this treatment you describe for anxiety disorders is 'rapid' does it linger? Is this rapid response you describe in your treatment of anxiety disorders merely first-aid? Am I right in assuming that the sustained work of psychodynamic therapy, body work, and so forth will still be required? Can you discuss any published or ongoing empirical research on the efficacy of TEAM-CBT compared to other therapy techniques? How does Rational Emotive Behavior Therapy (REBT), developed in New York by the late Dr. Albert Ellis in the 1950s, fit into the picture? How does the cognitive distortion, Fortune Telling, apply to specific phobias? Rhonda, Matt, Rutherford, and I thank you for joining us today, and hope you enjoyed the dialogue!
Rhonda, Matt, and David (plus Rutherford)
Ask Matt, Rhonda, and David (with Dr. Rutherford Knows)
#250: How to Tell Someone, “You Suck!” Featuring special guests, Dr. Matthew May and the always exciting but pedantic Dr. Rutherford Knows, plus our podcast regulars, Rhonda and David
Rhonda begins the podcast with a wonderful email from a woman who asked how you might use the Five Secrets of Effective Communication when you have to deliver give negative feedback to someone.
Hi David and Rhonda,
I’m an avid listener of the podcast and reader of Dr. Burns’ material. I’ve been working my way backwards listening to all the podcasts, and I now own all of Dr. Burns’ books and am working my way through those, too!
I’ve especially found the live therapy on the podcast and role-play using the Five Secrets incredibly useful.
The Five Secrets of Effective Communication are like a cheat code for life. As I’ve been applying it in my own life, every conflict has had a phenomenal outcome and I end up closer with the other person. It’s incredible.
You’ve given many useful examples of using the Five Secrets on the podcast to respond to someone, for example, who is attacking you and you use the disarming technique and inquiry to hear more about how it’s been for them.
My question is, how would you use the Five Secrets to initiate a conversation where you have to be the one to bring up something that the other person doesn’t want to hear, or that it may be painful for them to hear?
I started to think about this when consulting for a CEO who needed to fire someone, but needed to keep the relationship amicable, as well as consulting with another business owner whose employee had been deceitful and she needed to have a "come-to-Jesus" talk with him.
Similarly, I’ve always struggled to bring up something that's bothering me to a spouse or loved one, because I didn't know how to initiate the conversation, and keep it from devolving into an argument (my greatest fear!).
Could you perhaps do a role play on the podcast to demonstrate using the Five Secrets of Effective Communication to initiate a difficult conversation, such as:
Firing or correcting an employee? Telling a spouse (or loved one) when you’ve felt hurt or angry because of something they did? Obviously you would still use all the same techniques (Stroking, I Feel statements, Inquiry, etc.), but I would love to hear an example. I find the role plays especially useful and would love to hear your expert wording for how you would approach this.
Thank you to both of you for all your tremendous work!
We loved this request, and model how to deliver the bad news to someone using the Five Secrets.
David mentioned that when he was in clinical practice, several women he treated were reluctant to give clear negative signals to men who were chasing them, for fear of hurting their feelings. So, out of excessive “niceness,” they ended up leading the man on, sometimes for months, and hurting him even more. It is probably far more merciful and caring to be honest with someone in a kindly way, so he or she can let go and move forward with his or her life.
Rhonda, Matt, and David illustrate David’s “Intimacy Drill.” In this exercise, the person delivering the bad news is Person A, and the person receiving the bad news is Person B. The drill involves four steps.
First, Person A delivers the bad news to Person B, trying to use the Five Secrets of Effective Communication (link). The bad news might be telling Person B that she or he has been fired, or that you’re angry with Person B, for example. Then Person A gives himself or herself a letter grade on how well she or he did. Was it an A, B, C, D, or an F? Then Person B and the observers give a letter grades to Person A as well.. Next, everyone points out what Person A did that was effective, and what was ineffective, using Five Secrets terms. For example, you might say that the Feeli
Report on the Amazing Feeling Great Book Clubs!
Podcast 249 Update on the Amazing Feeling Great Book Clubs! July 5, 2021
Today we report on the first two Feeling Great Book Clubs, with Dr. Brandon Vance and Sunny Choi, LCSW. Brandon explained that more than 200 people signed up for the groups, and that he 100 people on the waiting list for a future book club. The first two clubs have been a tremendous success.
Brandon explained why he started the Book Clubs:
It’s because these are tools in the book that people who are struggling with depression and anxiety can use to get better. Roughly 10% of the people in the world have significant mental health problems causing functional problems in their lives. That’s eight hundred million people! I have asked myself how we can spread these tools to people around the world.
Since I finished my psychiatric residency in 2003, I’ve been mostly working with individuals, but seeing factors influencing their mental health, like oppression, inequality, injustice, lack of safety, prejudice and othering, and environmental destruction with ensuing lack of resources. This has inspired my activism towards changing these things. I feel like we need to take action on those levels as a society.
At the same time, we have powerful and empowering skills people can learn on an individual level, and these skills can be taught in group settings to relieve suffering. I think we actually need an “owner’s manual” for the mind, and could teach mental health to children, right along with the basics of reading, writing, and arithmetic, as well as adults.
Some people have more access to these tools in psychotherapy, but many people in the world may not. I would love to make these tools like those in Feeling Great more accessible to people worldwide. The book, Feeling Great, does that, and I created the Feeling Great Book Clubs, as a way to reinforce those concepts, so people can come together in groups during this period of isolation, and learn these techniques, get support, and have their questions answered.
Rhonda asked several questions, including
Where do the book club members come from? Who helps them? What happens during the hour. The participants come from all over the world, including North and South America, Europe, Asia, Oceania, Africa, and the Middle East. Most are lay people, but 15% are therapists. A number of certified TEAM-CBT therapists help out voluntarily, including:
Phillip Lolonis Katie Dashtban Sunny Choi Heather Clague Brandon described the breakout groups:
The typical group starts with music, followed by meditation, and a general check-in on how people are feeling. This is followed by answers to questions members have submitted concerning the assigned reading for the week, and reviews of the chapters.
Then everyone joins their breakout groups, which are the same each week. This facilitates the development of trust and bonding among the members in each group.
There are specific instructions for the breakout groups that relate to the material in the chapters that were assigned for the week. They may discuss questions related to the chapters, or work on a skill presented in Feeling Great. For example, they may work on identifying the cognitive distortions in their thoughts. Then they may use the “Straightforward Technique” or other techniques to challenge their thoughts with “Positive Thoughts.”
Last week while reading the chapters on Fortune Telling and Anxiety, we had a check-in circle, where one member describes a mildly embarrassing experience and shares some feelings she or he had. Then the other members practice responding with a couple of the Five Secrets of Communication. For example, they may use “Thought Empathy” to repeat a bit of what the person said along with an “I Feel” Statement and say, “I’m feeling sad to hear that.” In future weeks, we will use this same format but add
David and Rhonda Answer Your Questions about Exercise, Empathy, Euphoria, Exposure, Psychodynamic Therapy, and more!
Podcast 248 Ask David and Rhonda! In today’s podcast, Rhonda and David answer some fascinating questions submitted by listeners like you! We both thank you for your interest in our show, and for your kind comments and terrific questions!
Kati asks: I notice that in your therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way? Kati also asks: Do you believe that empathy can be ‘taught’? Yiftah asks: How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? Yiftah also asks: From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective? Esther asks: You say there is no convincing or consistent evidence to support most psychodynamic claims about the causes of things. What you said resonates, but aren’t you also just making claims? I have a psychodynamic supervisor, and am struggling to choose between empirically validated treatments and traditional psychodynamic approaches. Sean asks: Burns, what can you do when you are using the disarming technique and the person keeps interrupting you? Ben asks: Since exercise improves the mood of some people who are feeling down, doesn’t this prove that physiologic changes can improve mood, as opposed to changing negative thoughts? The Answers
Note: The answers below were based on David’s email exchanges with the people who asked the questions and were created before today’s podcast. Therefore, the podcast may contain new and different information from these show notes. Hopefully, both the show and the notes will be helpful to you.
Rhonda and David
Kati asks I notice that in your live therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way.
Hi Kati, thank you for the kind comments!
It is great to get negative feelings to zero and experience enlightenment and joy. However, no one can be happy all the time, so you will have plenty of opportunities to "learn" from negative feelings again. In addition, there is a difference between healthy and unhealthy negative feelings. Healthy sadness is not the same as clinical depression, healthy fear is not the same as a phobia or panic attack, healthy and unhealthy anger are quite different, and so forth. There will bumps in the road of life for all of us at times.
* * * Kati also asks Do you believe empathy can be “taught?”
As a mum (of a 15 and a 10 year old girls) and a (HS) teacher I notice some people seem to have it more ‘innately’ than others but would also love to think it is an aspect that can be intentionally developed in others in some way. If you think like me, I would love to hear your thoughts on how that could be done (i.e. what practices or strategies would be most helpful to use with young people in particular).
I am still in awe that we can have a sort of conversation with such a brilliant and creative mind and I humbly hope you can address these two questions either in one of your podcasts or by responding to this message.
Thanks again, Kati,
With regard to empathy, it is something that can be learned, but it takes commitment and practice. A good first step is the book I wrote on this topic called Feeling Good together. In addition, there is, as you say, an "aptitude" that people have for this or any skill, with a tremendous variability in the population.
But regardless of your natural aptitude or lack of it, you can learn and grow tremendously. I started out with very po
My therapist (who I hadn’t seen in a few years) became trained in TEAM. It’s a great podcast to go along with therapy from a TEAM trained therapist. Everything just makes even more sense.
Help is just a podcast away
Such a wealth of knowledge David Burnes and his team are for all of us. I keep listening and learning every time. Sometimes even many repeated times on the same episode.
An outstanding audio complement to David Burns’ books! Reading Feeling Good Together or Feeling Great and listening to the corresponding podcasts is like reading a textbook and then listening to the author discuss chapters with a colleague. As a teacher I recognize how effective this approach is to deep learning. To those who complain about the production please remember this podcast has NO COMMERCIALS. The informal nature, rather than a slick production, enhances the intimacy of the podcast imho. It’s like sitting in your living room listening to your grandfather talk to you aunts and uncles…and realizing that he is one of the wisest men who has ever lived. I wish I had discovered David in my 20s—it would have saved me from much frustration and heartache. Instead, I only stumbled on Feeling Good recently in my late 50s and even though I’ve learned many of his lessons on my own through the school of hard knocks, there is still much to learn. The difference is, you pick things up a lot faster when you’ve experienced years of floundering around with psychological trial and error. An absolute hidden gem that should be shared with everyone!!!