Feeling Good Podcast | TEAM-CBT - The New Mood Therapy David Burns, MD

392 The Empty Nest Cure Featuring Jill Levitt, PhD  
Plus BIG NEWS! The Magical Annual Intensive  Returns this Summer  at the South San Francisco Conference Center August 9 -13, 2024 You can Review the Exciting Details Below Or click this link!  
Today we are proud to feature our beloved Dr. Jill Levitt. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and co-leader of my Tuesday evening psychotherapy training group at Stanford. She is a dear friend, and one of the world’s top psychotherapists and psychotherapy teachers.
Today, Jill joins us to discuss the so-called “Empty Nest” syndrome. According to Wikipedia, this is the “feeling of grief and loneliness parents may feel when their children move out of the family home, such as to live on their own or to pursue a higher education.“
Jill emailed Rhonda and me to explain why she thought a podcast on this topic might be of some value. She wrote,
Recently, I was working with two different women around the same age who were having similar feelings of guilt and shame about the choices they made around parenting versus working.
Jane is a 60 year old high level executive with two boys who was super successful and is now retired. She is telling herself, “
I did not do enough for my boys. I should have worked less. I should have spent more time with them. I was selfish, and worked because I enjoyed it. I should have done more for them. I’m a terrible mother. Stephanie, in contrast, is a 60 year old stay-at-home mom of four adult kids, and now that her last kid has left for college, she is telling herself:
I should have had a career. I have done nothing with my life. I am a smart woman so I should have done more. I am inferior compared to other women who have contributed to society in some way. Jane and Stephanie both struggled with feelings of guilt, shame, sadness and inferiority, and they were both telling themselves that they should have made different choices.
I’m sure your life is very different from their lives, but you may have also looked in to the past and beaten up on yourself for what you should or shouldn’t have done. Or, you may be beating up on yourself right now with shoulds, telling yourself that you should be better, or smarter or more successful or popular than you are.
In fact, according to the late Dr. Albert Ellis, these “Should Statements” are responsible for most of the suffering in the world, and there are several different types, including:
Self-Directed Shoulds, like “I shouldn’t be so klutzy and shy in social situations. These self-directed shoulds trigger feelings of depression, anxiety, inadequacy, inferiority, guilt, shame and loneliness, to name just a few. Other-Directed Shoulds, like “So and so shouldn’t be such a jerk!” Or, “You have no right to feel the way you do!” These other-directed shoulds trigger feelings of anger, blame, resentment, irritation, and rage, and can easily escalate into violence, and even war. I’m sure you can see that both women were struggling with Self-Directed Shoulds. What can you do about these shoulds and the unhappiness they trigger?
Jill explains how both women experienced rapid recovery when she used simple TEAM methods systematically, including empathy and Positive Reframing as well as other basic techniques like the Double Standard Technique and the Externalization of Voices, and more.
I, David, then described a woman he treated who fell into a depression when her two daughters went off to college. And she was perplexed, because she’d always had a super loving relationship with them, just as she’d had with her own mother when she was growing up.
When I explored this with her, a Hidden Emotion suddenly emerged, as you’ll hear on the podcast, and that also led to a complete recovery in just two sessions.
Then Jill had a sudden “eureka” moment and realized that the Hidden emotion phenomenon was

Evolution of TEAM from CBT Porn Compulsive Liars Angry Patients Who Resist Where's the App? and More! Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!
Today's live discussion was especially fun and lively, so make sure you listen to the actual live podcast.
Questions for this Ask David Podcast
Stan asks if any of my early methods have been abandoned by newer and more effective methods as CBT evolved into TEAM. Stan asks if mild porn is harmful or helpful. Rima ask how you can deal with compulsive liars. Pretika asks what to do with patients who angrily resist positive reframing. Anonymous asks several questions about the Feeling Great App.  
1. Stan asks about new approaches in TEAM for habits and addictions, as well the evolution of TEAM, as compared with the much earlier classical CBT. 2. Stan also asks if mild porno is helpful or harmful. Hi David.
I read in the eBook (I think it was) that you have radically changed your approach and have many new methods for Habits and Addictions.
I actually have many of your books such as:
Feeling Good Feeling Good Handbook When Panic Attacks Intimate Connections Feeling Good together Feeling Great eBook I wonder if you could please tell us in one of your Ask David podcasts which methods described in your earlier books you no longer recommend, because they have been superseded by more effective ones described in Feeling Great for example. I am sure there must be a lot of material that is still valid in those earlier books and which is not mentioned in Feeling Great. It would be great to know which ones you no longer recommend for the general public.
I also want to ask you about Porn Addiction. Do you think occasional mild porn use is harmful or beneficial?
I read in a BBC article that porn probably isn’t harmful for most men, and can even be positive for couples. For example, some couples start to engage in oral sex after seeing it on the internet. Porn seems a bit like alcohol, if you abuse it it will be bad for your health but if you don’t go for the strong stuff and don’t over use it, it could be OK. I think some people might misinterpret your references to porn addiction as being any kind and intensity of porn use.  Maybe these people feel anxious and shameful for using it as a result. I would welcome your clarification on this issue.
Finally, even though I know you have heard it thousands, or hundreds of thousands of times, your work is having a really positive effect on my life. I am truly grateful for all that you do.
Thank you, David.
Warm regards
Stan
David’s Reply
Hi Stan, I can turn this into a couple Ask David questions for the podcast if you like.
There have been many upgrades of the therapy ideas and techniques over the years, as we develop greater understanding of how people change, and what works and what tends not to work. In addition, I would say that we develop new methods and ideas on a weekly basis. The TEAM models lends itself very nicely to evolution, perhaps one of the strong points.
I can speak in more detail on the podcast, but here are two ideas. First, I have come to appreciate more and more that all change in emotions comes from a reduction in belief in the negative thoughts that trigger negative feelings with few, if any, exceptions. In addition, any reduction in belief in negative thoughts will case an immediate reduction in the negative feelings that thought causes.
This insight angers many people who don’t really “get” it, so I don’t push it. I find that people sometimes do not take kindly to statements that challenge their sacred beliefs. A simple example would be jogging, or aerobic exercise. Some people believe on faith or personal expe

Self-Acceptance, People who Resist, Secrets of Dynamic Job Interviews, Five Secrets with your Boss, Do Cognitive Distortions Cause Transgenderism? Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!
Questions for the this Ask David Podcast Rizwan suggests a new method for self-acceptance. Anonymous asks how to convince someone that depression is NOT due to a chemical imbalance in the brain. My father does not believe that you can change the way you FEEL by changing the way you THINK! Marc asks about tips for job interviews, as well as how to respond during periodic performance reviews at work. Brian asks if transgenderism could be the result of distorted thoughts. 1. Rizwan asks
I have a question about the Acceptance Paradox that came to my mind during our Tuesday training group on 19 Dec, 23.
As homework, will it be useful to ask clients to make a list of things which they have already accepted in life and made peace with?
At the next stage, in the session, would it be useful if the therapist asks them, "why did you accept and make peace with those things?
“Can you use the same criteria to accept other things in your lives which you are not accepting now?"
Sincerely, Rizwan
 David’s take
Yes, you can certainly try that and let us know how it works out? I do lots of spontaneous and “new” things in almost every therapy session. Some things work out, and others do not. That way, I learn from my clinical work.
One thing to be aware of is that your proposed approach might overlap with “helping,” when a paradoxical approach might have more “punch” / impact, After all, the Acceptance Paradox is arguably more of a decision, than a skill.
But try, even with yourself if you like, and let us know what you discover. TEAM constantly evolves, and you can be an important part of that process!
Best, david
2. Anonymous asks how to convince someone that depression is not due to a chemical imbalance in the brain and that you can change the way you FEEL by changing the way you THINK?
Hi David
I love listening to your podcasts. And now I am seeing differences in my life but not my father who has been depressed for around 40 years. He is on medicines and has an extreme belief that it's on the basis of chemical imbalance. He is a pharmacist by profession, and loves to learn about how chemical changes mood swings.
I am not able to convince him to read your books. He just take sleeping pills every single and sleeps all day. He is learning something about neuroplasticity which is actually the case that happens in cbt.
But he think it's some kind of thought changing therapy which cannot change the chemical in our brain. Please help David. I would love you to answer this.
Regards,
Anonymous
David’s Response
Hi, I once gave the keynote address at a research conference at the Harvard Medical School. When the department chairman introduced me, he something like, “Dr. David Burns is going to show us how you can change brain chemistry with CBT, and without drugs!” It was pretty cool!
That’s one dimension. And we could add more evidence and research findings to support our side of the argument.
But on another level, we see the underlying issue of trying to convince someone who is taking an adversarial position and content with their own thinking and beliefs, and determined to argue no matter what evidence you present.
In my experience, spending time trying to convince them is almost always a losing cause. All you do is engage in a frustrating philosophical debate, at least that’s my thinking!
The podcasts on the theme of “How to Help and How NOT to Help” might be useful, in case you are looking for help with your relationship with yo

Featured Photo is Dr. Amy Huberman The Amy Story, Part 2: The Joys of Doing the Laundry!
Amy and her exuberant son, Sasha, and wife, Alena
Last week you heard Part 1 of the Amy session, which included T = Testing, E = Empathy, and A = Assessment of Resistance. Today, you will hear Part 2 of Amy's exciting journey from perfectionism to JOY.
M = Methods We used a variety of Methods to help Amy challenge her negative thoughts, starting with the first, “I’m failing my patients.” We started with Identify and Explain the Distortions, then went to the Double Standard Technique, and ended up with the Externalization of Voices.
As a reminder, you can see Amy's  Daily Mood Log at the start of her session here..
As an exercise, see how many distortions, or thinking errors, you can find in her first Negative Thought, “I’m failing my patients,“ using the list of cognitive distortions on the bottom of her Daily Mood Log. You’ll find the list of the ten cognitive distortions if you click here.  After you’ve identified each distortion, see if you can explain two things about it:
Why is this distortion in Amy’s thought unrealistic and misleading? Why might it be incredibly unfair and hurtful? You’ll find my list of the distortions in this thought at the end of the show notes. But don’t look until you’ve made your list!
These techniques we used were effective , as you’ll hear on the podcast, especially the Externalization of Voices. You’ll hear us doing role-reversals with Amy, and the method that “won the day” was the CAT, or Counter-Attack Technique, combined with the Acceptance Paradox. The Acceptance Paradox involves finding truth in a negative thought with a sense of peace or even humor. The CAT involves confronting the hostile voice in your head and tell it to go fly a kite, or other gentle but firm message
You’ll enjoy seeing some striking changes in Amy, as her tears and feelings of intense self-doubt are suddenly transformed into joy and laughter.
Those changes created strong feelings of joy for Jill and me as well. We both have incredibly fondness and admiration for Amy, and feel great joy as well when she feels joy.
Here are Amy’s final scores at the end of the session.
Emotions % Now % Goal % After Sad, blue, depressed, down, unhappy 80 25 0 Anxious, worried, panicky, nervous, frightened 80 20 0 Guilty, remorseful, bad, ashamed 90 5 0 Worthless, inadequate, defective, incompetent 100 15 5 Lonely, unloved, unwanted, rejected, alone       Embarrassed, foolish, humiliated, self-conscious       Hopeless, discouraged, pessimistic, despairing 90 5 0 Frustrated, stuck, thwarted, defeated 80 5 5 Angry, mad, resentful, annoyed, irritated, upset, furious       Other        

The Joyous Dr. Amy!
Sudden and dramatic change is pretty trippy, but it isn’t much good if it doesn’t last. And it won’t! Negative thoughts and feelings will always return, because no one can be happy all the time. That’s why some relapse prevention training and ongoing practice and refinement of what you’ve learned can be vitally important.
In our follow-up session with Amy one week later she said she’d felt way better during the week, but did, in fact, have some relapses and had to challenge her negative thoughts again. She’d been helped a lot by the idea that it was okay to fail, to seek consultation, and learn, and that failing with patients gave us endless opportunities to learn and grow as therapists. And it was also okay not to have to listen so intently to the attempts of the negative self to put her down.
In fact, our misery almost never results from our failures, but from telling ourselves that we “shouldn’t” ever fail, and from punishing ourselves mercilessly when we do.
One of her most exciting statements in our follow-up session was that she discovered that even something as humble as putting the dirty clothes into the washing machine could

Featured Photo is Dr. Amy Huberman The Amy Story Part 1: True Confessions of a “Fraud” and a “Failure” Part 2: The Joys of Doing the Laundry
Amy and her exuberant son, Sasha, and husband, Poppy
Today’s podcast, and next week’s podcast, include a single, two-hour session with Amy Huberman, MD. Amy is a psychiatrist in private practice in Baltimore, MD. She also serves on the volunteer faculty at the Johns Hopkins University School of Medicine.
Amy specializes in brief, intensive psychotherapy to help people overcome struggles with anxiety, OCD, and trauma, but today comes to us to get some help with her own anxiety. Often doing our own work can be a vitally important part of our training and growth as mental health professionals.
Amy has been upset because she is stuck with two of her patients, and she’s telling herself that she’s a “fraud” and a “failure.” Although her life is undoubtedly very different from yours, the root cause of her problem might be very similar to the source of your unhappiness, especially if you sometimes get down in the dumps and tell yourself that you’re just not good enough.
My co-therapist for this session is Jill Levitt, Ph.D. co-founder and Director of Clinical Training at the Feeling Good Institute in Mt. View California. Jill also serves on the Adjunct Faculty at the Stanford Medical School and is co-leader of my weekly TEAM Therapy training group at Stanford, Tuesdays from 5-7:00 pm pst.  If you are interested in joining David and Jill's Tuesday group, please contact Ed Walton, edwalton100@gmail.com.
That group is now virtual and therapists from the Bay Area and around the world are welcome to attend. It is free of charge. Rhonda Barovsky also runs a free weekly training group with Richard Lam, on Wednesdays, from 9-11:00 am pst, which is also free of charge. If you are interested in joining the Wednesday group, please contact Ana Teresa Silva, ateresasilva6@gmail.com.  Because the groups are virtual, they are open to therapists from around the world.
Amy has been a member of our Tuesday training group, and is a highly skilled, certified TEAM therapist. Like nearly all the mental health professionals who come for training every Tuesday, Amy has incredibly high standards and is sometimes harshly self-critical when she feels she is not living up to them.
At the same time, those high standards can be strongly motivating, and this can create strong feelings of ambivalence when it’s time to change.
Sound familiar? If you’re struggling with perfectionism, you might want to check out these two podcasts!
Part 1. The True Confessions of a “Fraud” and a “Failure” Amy opened by saying she was anxious and telling herself:
I’m about to reveal my weaknesses and my inner self—This is something I’ve never done before in such a public setting. . . I also have to confess that I’m struggling with social anxiety right now. I’m afraid that my patients might see this and think, “I don’t want to work with her! I want to work with a competent psychiatrist.”
I Included that because I am hoping you will appreciate Amy’s incredible courage and gift of sharing her true inner self today!
Amy described the problem that’s been bothering her for several weeks. Although she specializes in the short-term treatment of anxiety, she has been struggling with two patients with OCD symptoms who have been stuck and not making significant progress for a long time.
This has triggered feelings of shame and intense anxiety which have invaded Amy’s every moment when she’s NOT seeing patients, and has even prevented her from getting restful sleep at night. She keeps ruminating and beating up on herself.
You can see Amy's  Daily Mood Log Amy here.. As you can see, she was feeling intensely sad, panicky and ashamed, and rated these three feelings as 80% on a scale from 0 (not at all) to 100 (the most severe). She was also feeling worthless and defective which s

Why Do We Resist Accepting Ourselves Other People, and the World? The Five Most Common Reasons! Rhonda and David are joined in today’s podcast by Dr. Matt May, a super popular and loved guest on our show, to discuss the resistance findings in David's recent survey on acceptance and resistance. The following is a summary of some of the statistical findings, but the actual podcast dialogue was wide ranging and tremendously engaging, and won't require a lot of statistical smarts!
We also discussed the vitally important difference between healthy and unhealthy acceptance.
Healthy acceptance is accompanied by feelings of joy, lightness, and liberation. Unhealth acceptance is accompanied by feelings of unhappiness and despair. Unhealthy acceptance is characterized by Should Statements and self-punishment for your failures and shortcomings. Healthy acceptance is an expression of self-love. The group brought the five most common reasons to life with engaging stories.
Why should you accept yourself? We are not saying that you "should," and it's really a decision. However, the statistical models the I (David) developed indicated that healthy acceptance can trigger a 49% reduction in negative feelings and a 39% boost in positive feelings, which is tremendous.
Matt told an inspiring story about two strategy for training the dolphins at SeaWorld. One strategy involved trying to shape the behavior of the dolphins with little shocks, in much the same way that some people train horses. Sadly, the dolphins went to the bottom of the pool and appeared depressed, not moving much. It was a complete failure.
Then they tried a radically different strategy--they gave a new group of dolphins fish to reward them for doing the things the trainers wanted them to do. This strategy was tremendously successful.
So, the question is whether you want to shape your own life with frequent shoulds and self-criticisms, which can have the effect of electric shocks every time you fail or screw up or fall short of your goals, or whether you want to shape your life with love and rewards. Some of us have discovered that acceptance is way more fun and vastly more effective!
Quick Bottom Line The typical survey respondent endorsed 1/3 of the 12 Resistance Scale items, and seemed to believed that Acceptance would be foolish and lead to a life of misery and mediocrity. The actual causal impact of the Non-Acceptance and Resistance scales on positive and negative feelings was massive and appeared to be in the exact opposite direction.
Findings The respondents in the Resistance survey endorsed an average of 33.8%. (+/- 0.1%) of the items, ranging from 0 to all 12. The most commonly endorsed was, “Acceptance is easy for rich and famous, but hard if you’re struggling just to pay the bills.” 47% (+/- 2%) endorsed this item.
The least endorsed was, “If I beat up on myself, people will love me more,” although 25% (+/- 1%) of the people endorsed this item, so it was fairly popular. The high scores on the resistance scale items is also pretty consistent with my experiences over the years—the people in the study, and the people I’ve worked with, have expressed MANY reasons to beat up on themselves.
You can see the list of the 12 Resistance Scale items below. I have bolded the five most often endorsed. As you can see, many people surveyed believed that acceptance is fine for people who are rich and famous, but terribly painful and foolish for people who struggle with real problems. Many respondents were convinced that acceptance leads to pain, robs you of motivation and does not make sense in a the world that’s falling apart.
If I accept my flaws and shortcomings, I'll end up with a second-rate life. If I accept my flaws and shortcomings, I’ll lose all my motivation to learn If I beat up on myself and work my ass off, people will love and admire me. It would be tremendously painful to accept my flaws and shortcomings. That would be like giving up