Do Negative Thoughts REALLY Cause Depression? An Answer--At Last!--from Research Featuring David Burns, Jeremy Karmel, Diane Spangler and Rhonda Barovsky Today, David and two dear colleagues--Jeremy Karmel, CEO of the Feeling Great Corporation, and Dr. Diane Spangler--share the amazing results of two types of research on the Feeling Great app that focus on two related and vitally important questions: How effective is the Feeling Great app? Research confirms it triggers incredibly fast and dramatic reductions in seven negative feelings: depression, anxiety, guil7, inadequacy, loneliness, hopelessness and anger. The speed and depth of these effects may substantially outstrip human therapists as well as antidepressant medications. How does it work?  What is the mechanism of action? People have argued intensely about the chicken vs the egg problem for more than 2,000 years. Do negative thoughts REALLY cause negative feelings? Or do negative feelings cause negative thoughts? Or both? Or neither? The answers are exciting! Warmly,. Rhonda, Jeremy, Diane, and David

Ask  David With Special Guest Expert, Dr. Matthew May Daily Mood Log: Does it have to be done perfectly? Somatic Complaints: How does TEAM Help?  Passive Aggression: What distortions cause it? Roger, from Australia, asks: Do daily mood logs still work if you complete them ‘imperfectly’? Roger also asks: Based on your clinical experience, what causes a reduction or complete elimination of in symptoms for people who present with somatic complaints or chronic pain? TOZ asks: Does passive aggressive behavior result from All-or-Nothing Thinking? The answers below were written prior to the show, based on correspondence with those who asked the questions. The live answers on the show will be different in many cases.  1, Roger, from Australia, asks: Do daily mood logs still work if you complete them ‘imperfectly’? 2. Roger also asks: Based on your clinical experience, what causes a reduction or complete elimination of symptoms for people who present with somatic complaints or chronic pain? Dear David, Sure, I would love to have my questions be on an Ask David! It would be okay for you to use my real name and my location as being in Australia for the podcast and show notes. I’ve reworded the questions so that they get across what I was actually trying to ask in my previous email. You might now have a slightly different response based on the new questions. I have to apologise as my wording in my previous email was confusing, even for me. Here’s a shorter version of the first question: “Dear David, I’ve got a question about doing daily mood logs as part of my psychotherapy homework. I tend to start a lot of new daily mood logs where I write my negative emotions and thoughts, as well as do positive reframing, but then get stuck when it comes to doing methods for challenging my negative thoughts, as I get caught up on trying to do the exercise perfectly. I get worried that I won’t see as much benefit from the exercise if I don’t do the steps perfectly or in order. Did you see improvements in patients who filled out their daily mood logs imperfectly? Perhaps they may have skipped steps or maybe they couldn’t crush their negative thoughts completely, but continued to move on to working with new thoughts and seeing if they could crush those.” An even shorter version of the question would be: “Do daily mood logs still work if you complete them ‘imperfectly’?” A shorter version of the question about somatic complaints and pain is: “I’ve also got a question on treating somatic symptoms and chronic pain. Some clinicians have seen people improve by doing journalling or expressive writing about life stressors such as past stressors, current stressors, and self-limiting behaviours or beliefs. Other activities which seem to be useful include writing unsent letters to people who’ve hurt you, or doing behavioural changes for self-limiting beliefs like learning how to designate free time for yourself if you have a tendency to take on too much or feel guilty about spending time relaxing and not doing work. I was wondering what you’ve seen in your clinical experience and what you’ve seen patients do which helps them reduce or eliminate their somatic symptoms and chronic pain?" An even shorter version of that question would be: “Based on your clinical experience, what causes a reduction or complete elimination of in symptoms for people who present with somatic complaints or chronic pain?" Regards, Roger He David’s reply Thanks, these short versions are a big improvement. Here are the quick answers: The critical thing is to come up with one or more positive thoughts that are 100% true, and that reduce your belief in the negative thought. If you send a specific example, it would help. There are several rules about getting workable negative thoughts as well. Perfection is never possible in the universe of daily mood logs, but excellence certainly is. A change in belief in neg thoughts is the goal. In my experience, somatic complaints, such as undiagnosed pain, dizziness, fatigue, and more, are often created or magnified by (or the expression of) negative emotions, as well as hidden emotions / problems. The average reduction of pain, for example, will be 50% if there is a dramatic reduction in negative feelings, or if the patient identifies and tackles some unexpressed problem, like anger, or unexpressed grief, or loneliness when the kids go off to college, and so forth. An average of 50% means that some people will experience a complete elimination of the negative symptoms, like pain. Some will experience no improvement. And some will experience some improvement. With regard to how or why this works, I don’t really know, and don’t think that anyone knows. But it seems like negative feelings, like depression, anxiety, anger and so forth have a magnifying effect on negative feelings. On the podcast, I can give a personal example of when I was in the Stanford emergency room, screaming in pain from a broken jaw. I can also give an example of what happens to my low back pain when I am in an especially good mood and I am out jogging. Best, David 3. TOZ asks: Does passive aggressive behavior result from All-or-Nothing Thinking? Hi David, I thought my therapist will tell me once he gets to know me that I'm passive aggressive and therefore I do things particularly anxiety disease as all or nothing black or white.  I was wondering for you not to answer my case but in general does passive aggressive attitudes or approaches result from all or nothing thinking? Thanks, Toz David’s reply. Thanks, Toz. Great question! To find out, you would have to do what I have recommended for nearly 50 years. Write down your negative thought on a piece of paper (can you do that?) and identify the distortions in it, using my lit of ten cognitive distortions. Let me know if you’ve done this. Most people refuse to do it! Warmly, david Toz replies: So I did your exercise. My thoughts were: I'm crashing.  Help I'm scared.  I'm going to die.  Help me laud.  Help me laud. Distortions:  predicting the future.  Magnification How is that? I looked up. Saw that was fine. Felt better. Then I checked my pulse.  Not too fast so okay. Toz. David’s reply to Toz, That, Toz, is totally cool! Way to go! Could also add: Emotional Reasoning. You identified two super important distortions that are always present in fear, paranoia and anxiety. Cool, cool, cool! David's comment: This is why I ask for specific examples when people ask general questions. As you can see, Toz asked about passive aggression, but his specific example turned out to be all about something entirely different: anxiety and panic. He did a great job of testing his negative thoughts with the Experimental Technique. Warmly, Rhonda, Matt,  and David

Tahn Wanders . . . and Wonders A Young Monk's Search for Peace and Happiness Today we are honored by a second visit from Tahn Pamutto, who first appeared as a podcast guest on November 4, 2024, where he described his transition from a soldier in Iraq to an ordained Buddhist monk. He also gave us a taste of Buddhist teachings, and compared them to what we to in TEAM-CBT. There were certainly a number of areas of overlap. For example, as a psychiatrist, my goal is often to help bring patients as rapidly as possible from a state of unhappiness and depression to a state of joy and enlightenment, using a number of specific psychological techniques we call TEAM-CBT. But part of this is spiritual in nature as well. Tahn’s role as an ordained Buddhist monk is similar, in part. His goal is help people who ask for guidance how to discover the cause of unhappiness, and the path to happiness, using a number of spiritual exercises, including meditation. But part of these exercises are psychological as well. Today, Tahn began by contrasting a spiritual vs a materialistic view of life, and emphasized that the materialist view cannot solve the problem of unhappiness or provide us with happiness. This is, in part, because material things are impermanent, and will all ultimately disappear. Negative feelings, like unhappiness, actually result from our thoughts--how we view the world. The world is the world, and you can accept that, or you can protest and shout angrily that things “should” be different or “shouldn’t” be the way they are, but your feelings will always result from the way you think about the world. He said that when he was growing up, all his needs were taken care of, and happiness was fleeting, so he embarked on a search for answers. Who was I, and why was I struggling with so much unhappiness? He said, “To explore and really find out who I was, I’d have to depart from my comfort. When I joined the army, it sounded great. It was all about patriotism, loyalty, honor, service, and all kinds of positive values. . . But then at some point, they say that’s time to invade this or that country, and you have to try to make that work, since you can’t challenge the mission. The Iraq war was going on, and I spend 13 months there. But if your mission is wrong, you will keep suffering, no matter how hard you try. Did the people in Iraq really want us there? Are we really doing anything that’s positive or good? And what is it that I really want to do with my life? One thing we have to recognize is two things that cannot be denied: our mortality and the existence of unhappiness. As I began to accept these two inevitable facts, I also realized that there is no quick solution, and that the reality is that our unhappiness may not end on its own. We may go to sleep, and escape for a while, but when we wake up, we will still be unhappy. We could even imagine being reincarnated and having a different body, a different religion, or living in a different time, but our suffering still won’t change. I may be a different person, but I will still be unhappy. I asked myself if and how I could train myself to accept what life brings me. . . and wondered whether is would be possible to pursue unending happiness? And if so, how would I go about it? What I do? When I was in Iraq, I applied for conscientious objector status and eventually got out on an early retirement. Then, I began looking for an experienced, humble teacher who could share their knowledge with me. I bought a backpack and some hiking shoes, and began to search so I could learn what I needed to learn. I didn’t have much knowledge of Buddhism at all at that time. I left my mother’s house in New Jersey and started walking. I walked 20 miles, but realized I was going in the wrong direction, and had to walk 20 miles back and start over, walking in the opposite direction. The first night of my journey, I got exhausted and slept on a park bench. In the middle of the night, I thought I heard loud explosions, and woke up feeling terrified, but it was just acorns falling down from the oak tree I was sleeping under. In the Army I had learned the wrong way, and that’s why I decided to search, but any old street in New Jersey probably didn’t have what I was looking for. I decided to search for the answer in Asia instead, and wandered in India, Thailand, Korea, Japan, and Taiwan. I went into Temples and Mosques. I had the romantic notion that some wise bearded man would come out of nowhere and tap on my shoulder and say, “We’ve been waiting for you, Tahn! You have finally arrived!” But it doesn’t work like that. In Thailand, there is a monastic level to society, as well as a commercial level. Thailand and Burma are certainly not perfect as countries, but have a higher than average level of happiness because the people are generous and help each other. If I wanted, I could just go and stay at a Temple. Much of their society is based on the joy of giving and receiving. People in the monastic level are living primarily on donations. I decided I wanted to become a monk. That was what I wanted to do. I learned about the importance of the “Contemplation of Death.” Most people want to avoid thinking about death. But death and the loss of all materialistic things is inevitable. You cannot avoid it, and might want to base your daily decisions on this fact. For example, you could ask yourself, “Suppose I knew that I would die this evening. What would I do today? Would I continue shopping for a couch? Or feuding with my neighbor?” If you did this contemplation every day, you might discover that you’re doing what you think you should do, rather than what you want to do. You may be pursuing materialistic goals that inevitably cause unhappiness. Let’s say you live in a small cabin, and notice some leaves on the floor. You might decide to sweep the leaves out of the cabin. Then, if you die, they will find your body on a clean floor. That would make it easy for someone else to move into the cabin. This path (the daily Contemplation of Death), he explained, is one way to get to the destination of unconditional happiness. Rhonda asked Tahn why he decided to become a teacher. He explained that he did not make that decision, but as he wandered and practiced the monastic life, people would stop and ask him questions about truth and enlightenment and the meaning of life, and so forth. Over time, he realized that because of his travels and searches, he began to gain more and more experience, and sometimes had something to offer individuals who were earlier in their journeys, and also looking for guidance. He said that the reality of being a monk is not glamourous. Our needs are really pretty minimal. We need food, shelter, clothing, and medicine if we are sick. But beyond that, the monk gets little. If you need clothes, you may have access to a pile or rags that you can sew together to make a piece of clothing, or you may have to eat the leftovers when others have finished eating. You have to learn to live on what extras might be given to you. He explained that I’ve actually been surprised by how much love and support there is in the world. I’ve been well-taken-care-of. My main interest has been to learn about the mind. Of course, we have our basic needs to survive, but what are we doing to develop spiritually? He mentioned that the monastic order is not structured, it is not a hierarchy, and you can come and go anytime you want. The Buddha accepted the strong desire of his followers to evolve into a church, as a structure to preserve the teachings, but this was a compromise. The Buddha was simply sharing something  that had already existed before he was born, something that anyone can discover, with or without a structure or system. At some point, you may say, “I quit,” and start to do what you want to do, know that your time to be alive is limited. Here are some of the questions people ask Tahn in his travels. How can I deal with my intense anger? Tahn said, "When people “find me” when I am traveling, or wandering, they often think that “this encounter was meant to happen.” He said that Buddhists do not proselytize, and there is no concept of “conversion.” He teaches people that “You are going to have to die. You’re are going to have to give it all up one day.” He asks, “What are you seeking? What is ailing you?” He tells us that the Buddha taught us the cause of all unhappiness, and how to find happiness. Anyone can find what the Buddha discovered. The goal is the cessation of unhappiness. Is never-ending happiness possible? Tahn said: We certainly know that clear days, with no clouds, are possible. The clouds are not a part of the sky, they are just droplets of moisture, and the sky is not affected by the clouds. Clouds and unhappiness are very evitable. Tahn finished by saying, “Our unhappiness is independent from our happiness.” That’s my best translation of the interview, and I’m sure I missed a lot, and misinterpreted parts as well. I do know that it was a great pleasure and honor to spend 90 minutes with Tahn. I hope you learned something and found Tahn’s story interesting. And here’s one tip that’s helped me, and it might help you on your own journey. Sometimes, when I hear a Buddhist story or teaching, it sounds nonsensical at first. I can’t “get it.” Then, a few days later, the meaning often comes, or at least A meaning, and I feel happy to have learned something kind of cool! Hope you have that experience, and apologize for any incoherence you find in the show notes, today! Warmly, Tahn, Rhonda, and David

Live work with Joshua-- The Secret of Self-Esteem I was recently a guest on the “Philosophical Weightlifting” podcast with host Joshua Gibson (link). At the end of the interview, he asked if I could give an example of some of the techniques in TEAM-CBT, so I decided to jump right into a live demonstration, in real time, which we are publishing on today’s podcast. I am very grateful to Joshua and hope you enjoy the session as much as we did! The session covers a number of topics that just about everyone can relate to, including a couple extremely common Self-Defeating Beliefs: The Achievement Addiction The Love Addiction The Inadequacy Schema (“I’m not good enough.”) It also covers some familiar territory, including the question, “Am I good enough?” It also provides an answer to the questions: “What is the secret of self-esteem,” and “what is the secret of sex appeal?” To kick things off, Joshua shares an upsetting event along with some of his negative thoughts and feelings. The upsetting event was feeling attracted to a young woman who waited on him in a restaurant, and then going to his car and wishing he’d asked for her personal information for a date. Then he courageously went back and did just that, but got shot down. Paired with this experience, his overwhelming thoughts and how strongly he believes each one are: I won’t be successful. 85% I won’t get to live the life I want to live. 70% I won’t find love. 90% I’m not attractive. 100% This is a list of Joshua’s negative feelings, and how strong each one was at the start of the session: Feeling % Now % Goal % End Anxious 95%     Sad 90%     Guilty 85%     Inadequate 90%     Lonely 90%     Embarrassed 90%     Hopeless 85%     Frustrated 70%     Angry (with self) 75%     Two things stand out when you examine this list. First, Joshua is an attractive, friendly, and personable young man hosting a popular podcast. If we didn’t have these estimates of his feelings, you would have NO WAY of knowing how he felt inside. These feelings are all very severe. So many people we greet in our daily lives are similar—looking terrific on the outside, but dying of loneliness and unhappiness within. Second, he is experiencing nine different types of similarly elevated negative feelings, and not just one negative feeling. This confirms statistical modeling I’ve done with data from the Feeling Great App. There appears to be an unknown “Common Cause” in the human psyche that activates numerous feelings simultaneously. This is like the “dark matter” of the human psyche. We can prove its existence, but don’t yet know precisely what it is! However, our goal today will be to see if we can help Joshua change the way he’s feeling, regardless of what’s causing his pain. Positive Reframing Tool Feeling Positives Frustration It has motivated me to work hard   It shows I have not given up Anxiety Keeps me from putting myself at risk   It has inspired me to face my fears and grow Sadness Shows how much I care about others   Helps me understand others who are suffering, like my mom   Shows I have high standards and high expectations Guilt Shows that I want to live up to my expectations   Shows that I have a strong moral compass Inadequacy Shows I’m honest about my flaws and eager to improve   Show I’m humble   Makes me approachable Loneliness Has helped my develop independence and autonomy   Has motivated me to reach out to close community and to create my own Embarrassment Makes me behave in socially desirable ways Hopelessness This serves as a driving force   Shows that I’m a critical and realistic thinker   Protects me from disappointment Anger (at self) Shows that I have high expectations for myself and hold myself to a nigh standard You can see Joshua’s goals for each negative feeling after we used the Magic Dial. The whole idea was to lower his negative feelings, not all the way to zero, since that would also wipe out all these positives, but lower them enough so that he would suffer less and still preserve all the many positives we listed, and more. Feelings Table with Goal column filled in Feeling % Now % Goal % End Anxious 95% 20%   Sad 90% 10-15%   Guilty 85-90% 15%   Inadequate 90% 10%   Lonely 90% 20%   Embarrassed 90% 10-15%   Hopeless 85% 20%   Frustrated 70% 20%   Angry (with self) 75% 5%   As you can see, he decided to lower all of his negative feelings if possible. Now, we’re ready for the M = Methods of TEAM-CBT. Joshua said he wanted to work on, “I’m not attractive” first. I asked Joshua how and why he came to this conclusion, since he is clearly a large and attractive guy. He confessed he had severe acne when he was an adolescent, and now has scarring that makes him look “disfigured”. Although he probably does have some scars, I asked Joshua if he thought this thought might contain some cognitive distortions. He immediately mentioned All-or-Nothing Thinking (AON). I asked Joshua to “Explain this Distortion.” Specifically, I wanted him to imagine that I was a fourth grade student, and to explain to me in simple terms WHY this thought is an example of AON, why the AON in this case is unrealistic and misleading, and why it is also unfair. He did a great job, and this reduced his belief in the thought to 50%. As an exercise, can you think of some additional distortions in this thought? Briefly stop this recording so you can write them down on a piece of paper, and then you can look at the answers at the end of the show notes. “Explain the Distortions” was an excellent first step, but it was not enough, so we went on to the Paradoxical Double Standard Technique. I played the role of a long lost identical twin or best friend who was just like Joshua. I explained that I thought I was not attractive, and asked him what he thought. He did a tremendous job, and argued that this was not really valid, and I asked if he was being honest or just trying to cheer me up. He said he was being completely honest. Then we switched into high gear, using a much more aggressive technique, the Externalization of Voices, including Self-Defense, the Acceptance Paradox, and the Counter-Attack Technique, with perhaps a couple additional techniques thrown in. He got some strong momentum and blew all four negative thoughts out of the water. We were out of time, but did take the time to rate how he felt at the end, which you can see below. Feelings Table at the End of Session Feeling % Now % Goal % End Anxious 95% 20% 0% Sad 90% 10-15% 0% Guilty 85-90% 15% 0% Inadequate 90% 10% 0% Lonely 90% 20% 0% Embarrassed 90% 10-15% 0% Hopeless 85% 20% 0% Frustrated 70% 20% 0% Angry (with self) 75% 5% 0% Answer to the quiz question above: The thought, “I’m not attractive contained many distortions in addition to AON, including: OG = Overgeneralization MF = Mental Filtering DP = Discounting the Positive MR = Mind-Reading Mag/Min = Magnification and Minimization ER = Emotional Reasoning LAB = Labeling SH = Hidden Should Statement SB = Self-Blame I was extremely grateful and honored to be a guest on Joshua’s wonderful podcast, Philosophical Weightlifting, and invited him to join our Tuesday psychotherapy training class at Stanford because of his work in coaching. If you are a mental health professional, including a therapist or coach, contact me and let me know! The classes are two hours weekly and free of charge, although some course materials are required. Thank you so much, Joshua, for sharing your “inner self” with me and all of your and our podcast fans! And thank you, all of you, for listening or watching today! Rhonda, Joshua and David The following is an awesome email I received from Jason Meno right after he listened to the Joshua session. Hey there! I just finished listening to the last hour segment of David's "Philosophical Weightlifting" podcast episode with Joshua Gibson (it starts at about 1:13:52). It was fun to see a 45-minute TEAM session in action. I thought the Externalization of Voices (EoV) that was done here that seemed to work really well, really fast. It also highlighted a lot of complex dynamics that I see David use a lot. Here's my analysis of what went down and what I think we can learn from it: Joshua's attack: Joshua's negative thought was "I'm not attractive", but when it came time for him to attack, he said, "You know Joshua, you are disfigured and because of that you're unlovable and that's an unavoidable thing you're going to have to deal with." This attack is a lot more powerful than just the thought "You're not attractive." It digs into hurtful labels, hopelessness, and frustration. When you are in the position of roleplaying as the negative voice, there's often new and subtle dimensions that come out of it. Right now we are making it easy for the user to attack the AI by just printing out their negative thoughts, but I think letting the attack be more dynamic would be a lot better. David uses Be Specific: "Can you tell me in what way I'm disfigured?" I REALLY like Be Specific. It sets things up very well. I'd love to do this as part of the EoV formula. Joshua answers: "Yes, so you had acne growing up and now you have scars as a result and that makes you look different from everyone else." David uses Paradoxical Acceptance / Humorous Magnification: "Well, thank you, wise guru. I'm enlightened now and see that I'm some kind of ugly monster who's going to scare all the women in the United States. But what you're saying is a lot of horseshit, and you know it." David's sarcastic tone belittles the negative voice's criticism, which also lightens up the absurd magnification that follows. He then quickly rejects the absurd and flows into healthy acceptance following this. David uses Straightforward Acceptance: "But it's true I'm not perfect, and I did have acne, and I do have scars, and there there's plenty of Hollywood movie stars who have some kind of fantastic looks." There's something very powerful about going from the absurd magnification into this healthy acceptance. It's kind of like framing the horrifying absurd with the moderately painful truth makes the truth a lot easier to accept. David uses Defense: "I have a lot about me that's attractive that I can be proud of, including my love, my humility. I've built a tremendous body that 99% of men would be the envy of, and 100% of women would love to touch and fondle." The self-compassion and focusing on specific strengths and pride in accomplishments seems to a very effective defense. There's also a little magnification and humor going on here too that works well. This is a lot stronger than a lot of defenses I see where people just say the thought is being distorted or unfair. David sets up the Counter-Attack Technique: "But there is one thing that's very, very unattractive about me that you didn't mention." Joshua asks: "What's that?" David uses the CAT: "That's that effing crappy voice in my head belittling me and constantly putting me down. And when I'm not listening to you, I'm feeling pretty damn happy. So, to quote the Buddha and Jesus alike, shut the f up." One of the things that seems to make the CAT really effective is when you can take the negative voice's criticism and throw it right back at the negative voice itself. In this case, the negative voice is the real unattractive quality. Awesome work David, and I'd love try out this EoV framework in the app. Best, Jason Roughly one week after the session with Joshua, Rhonda and David interviewed him for his reflections on the session and an update on how he's doing now. He said: I've reflected a lot on this, and what has changed for me. There were many things that impacted me, but positive reframing was a game-changer. For example, if I get anxious, I welcome the feeling, and tell myself, "This anxiety will help me with this project." I was getting a tattoo, and it hurt, so I told myself, "I'm glad it hurts. This pain protects my body." And, of course, people with leprosy lose the ability to feel pain, and the consequences are disastrous and tragic. He continued, I have become more accepting, and talk openly about my appearance. I've had the courage to face that fear. The theme of my life has been, "I'm not good enough." But now I remind myself that I've done all kinds of cool stuff. For example, I coached several people into the top five in the United States in power lifting. I'm way less self-critical now. I visited, and loved, the Tuesday group at Stanford. I didn't judge myself but just jumped in and did what I could do! We concluded the session with some Relapse Prevention Training, using Externalization of Voices to challenging his previous negative thoughts, including the thoughts he will have when he relapses. such as I'm not good enough. I'm a hopeless case. The therapy didn't work on me because I'm different. I'm a hopeless case. We used Externalization of Voices with role-reversals, and Joshua won "huge!" His final response was, "There's pain and joy in life. I'll feel joy and love!" Thank you for listening today. We hope you enjoy the intensely personal work with Joshua. Let us know what you think, and if it touched you if you've ever felt like you weren't "good enough!" Warmly, Joshua, Rhonda, and David  

The Story of My Life, Part 1 David is interviewed by Joshua Gibson, Host of the Psychological Weightlifting Podcast   Hi! Today will be a bit different. I appeared as a guest on a cool podcast called Psychological Weightlifting, hosted by Joshua Gibson. I kind of described the trajectory of my career, starting with my post-doctoral depression research at the University of Pennsylvania School of Medicine, with an intermediate stop at the former Presbyterian University of Pennsylvania Medical Center, where I had a run-in with a violent individual named Bennie, and culminating in my work refining TEAM-CBT in my years on the adjunct faculty at the Stanford Medical School. Joshua and I really hit it off, and at the end of the podcast, he asked me if I could briefly illustrate some of the techniques I’ve developed in TEAM-CBT. I asked if he had an negative thoughts that we might work with, and boy, was I in for a big surprise. In fact, you’ll hear all about it next week! Thanks for listening today! Joshua, Rhonda, and David

Waking Up Dreading the Day Mother-Daughter Problems Patients Who Are Afraid of Their Feelings Romantic Problems, and More Questions for today: Rose asks: I wake up dreading the day. What can I do?! Maggie integrates TEAM-CBT with prayer and asks for help with mother / daughter issues. Simon asks: “How can we deal with patients who are afrad of their feelings?” Amanda asks: “Help! I have a romantic relationship conflict! What should I do?” Aaron asks: Why are feelings of depression and anxiety correlated? In other words, why do they frequently go hand in hand? The following questions and answers were written prior to the live podcast. Make sure you listen to the podcast to get the full answers, including role-play demonstrations, and so forth.   Rose asks: I wake up dreading the day. What can I do?! Hi David, I've been reading your book, "Feeling Good," for help with my anxiety ever since my 100-year-old mom moved in with me.  Your techniques are helping, but every morning I wake up anxious, dreading starting my day.  Is there a technique to help with this? I really am working to change my thoughts from negative to more positive thanks to you. I look forward to hearing from you. Rose David’s reply In my book, Feeling Good, I urge people to write down your negative thoughts, and emphasize that it won’t work very well unless you do this. Many people refuse. How about you? What were the thoughts you wrote down when you woke up feeling upset and dreading your day. Could use as an Ask David on a podcast if you like. Best, david Rose wrote: Thanks for your speedy reply.  I'm new at this and just started reading the book yesterday, but I will start writing down my thoughts.  Thanks for your help. Maggie integrates TEAM-CBT with prayer and asks for help with mother / daughter issues. Dear Dr. Burns, I want to begin by expressing my deep gratitude for your work, which has had a profound impact on my life. Your book Feeling Good: The Workbook helped me overcome a very dark period of depression after being diagnosed with infertility. It truly transformed my mental health, and I continue to rely on your techniques—especially your list of cognitive distortions, which I use often to stay grounded. Your podcast has also been a great resource for me, and I’ve noticed recent episodes touching on the self and spirituality, which caught my attention in a special way. I felt compelled to share something personal with you. While your methods gave me the tools to change my thinking, I also found solace and strength through my faith. Prayer was an essential part of my healing process, and for me, it provided something beyond my own power. In moments when I felt I couldn’t make it through on my own, the belief that there is a God I can turn to brought me peace and comfort. Both your work and my faith were crucial in my journey. Your research and teachings helped me take control of my thoughts, but my relationship with God gave me hope when I needed it most. I believe that the combination of these two—your scientifically backed methods and the power of prayer—made a tremendous difference in my recovery. I’m also excited about your app, but as someone living in Honduras, I was unable to download it. I would love to know if there are plans to make it available outside the U.S. in the near future, as it would be an incredible resource for me and others in similar situations. Lastly, can I make a suggestion for a podcast subject?  Mother daughter issues. I really need help in this area of my life. Thank you for your dedication to helping others. I hope that sharing my experience offers some insight into how both your studies and faith in something greater can bring peace and healing. With gratitude, Maggie David’s reply Thanks, and we’d love to read part of your beautiful note, with or without your correct first name, on a podcast. If you can give me a more specific example of the mother daughter issue you want help with, it would make it much easier to respond in a sensible way! Warmly, david Maggie responded Dear Dr. Burns, Thank you so much for your thoughtful response and for asking me to clarify my suggestion regarding mother-daughter issues. I deeply love my mother, and I know she means well, but our relationship has become increasingly challenging as she gets older. One of the major difficulties I face is her tendency to offer passive-aggressive criticism, which leaves me feeling undermined. I’ve always known her to be this way—she was never very affectionate, and I’ve gotten used to that. However, lately, it feels like it’s getting worse. She’s hard of hearing, even with a hearing aid, and often adopts a “my way or the highway” attitude, which makes conversations with her exhausting. Simple moments where I hope to share something exciting are often met with dismissive or critical remarks. Here are three examples of the kind of interactions that affect me: I recently purchased tickets for a trip to Australia with friends, and her response was to ridicule my choice, saying that Spain or Italy is a much more beautiful destination. I had just bought the tickets, and all I wanted was for her to share in my excitement. I sent her a picture of a new piece of art I was excited about, and her immediate reaction was, “I liked the other one better. That one doesn’t match the color of the walls.” As I was about to leave for a party with my husband, she commented, “Don’t you think you’re wearing too much makeup?” These kinds of remarks constantly make me feel inadequate, and it’s emotionally draining. As a result, I’ve found myself avoiding calling or visiting her. However, this leads to feelings of guilt, especially because I love my father very much, I enjoy his peaceful company and wise conversation and advice, and not visiting them also affects my relationship with him. What I struggle with most is that I know I might regret not spending enough time with her as she gets older, even though she isn’t sick or dying. I just don’t know how to manage the criticism without feeling constantly undermined, and I’d appreciate any advice you might offer on how to navigate this dynamic while preserving my sense of self-worth. Thank you again for your time and for the incredible impact your work has had on my life. With gratitude, Maggie David’s reply I notice you’re pointing the finger of blame at her. If you want to shift things, it can be helpful to examine your role. I’m attaching a copy of the Relationship Journal. Please do three of these, one for each example below. You already have half of Step 1—what, exactly, did she say. To complete Step 1, circle all the feelings you think she may have been feeling. Then complete Steps 2 and 3, which should be fairly easy. Then I can take a look, and we’ll see what we can figure out, if you’d like. Also, this will not be therapy, but general teaching. LMK if that’s okay. Best, david Here are the three examples she provided, along with how she responded to her mom: Three Maggie examples of interactions with her mother (Ask David podcast) #1 Mom said: Dear, I would never have thought of Australia as a destination. I would much rather fly to Italy or Spain, filled with culture, art, and great food. Sydney would be the LAST place I’d want to visit! I replied: Well, mom, we’ve already been to those places, and we love a great adventure, and we’re really excited by the outdoors. #2 Just as we were about to leave, Mom said: “Don’t you think you’re wearing too much make up?” I replied: I probably am, I didn’t notice (and rushed immediately to my room to remove it.) #3 I share a piece of art I brought home, and Mom said: “I liked the one you had before. It matched the walls much better than this one. Why did you change it? Who is the artist?” I replied: “Well, we have to like it because it’s the only wall in the house where it will fit, so we’re just going to have to live with it.” Simon asks: “How can we deal with patients who are afraid of their feelings?” Dear Dr. David Burns, Hi, my name is Simon and I'm a clinical psychologist from Chile, sorry if my English is kind of broken, it isn't my first language. First of all, I want to tell you how grateful I am for your great work and all the knowledge you give to the general public for free. Of course I also must praise the work of the entire team working at the podcast (which I am the biggest fan from my country). I hope one day I can be a certified team cbt therapist myself in the future, but that would be a different story. I think the world needs more people with such a love for mental health and I hope I can continue to listen to your content for more years to come. Today I wanted to ask you guys some questions related to feelings. I have applied some techniques to myself and my patients and it's really mind blowing noticing how effective they are. Nevertheless, I still have one patient who struggles with accepting or permitting himself to feel his feelings. He is grieving the loss of his father and he is very good convincing me that if he does feel his sadness or anxiety (as I suggested him), he may go crazy and commit suicide. He reports good empathy from me, but I'm afraid that he may be too nice to criticize me. So, I ask for your opinion: How can we deal with patients who are afraid of their feelings? How can we build a solid relationship with our patients regarding this subject so they can finally vent these feelings? Thank you all for all the hard work and have a great day! With Love, Simon David’s answer Hi Simone, Thanks for your kind words, and may want to use your question on an Ask David. LMK if that’s okay. Here’s the quick answer. It sounds like venting feelings is your agenda. Nearly all therapeutic failure comes from well-intentioned therapists who try to “help” or “rescue” the patient. I get the best results working on the things my patients want help with. Rhonda has a free weekly group on Wednesdays at mid-morning, and I have a free weekly training group at Stanford on Tuesday evenings (5 to 7 PM California time.) You’d be welcome to join either. Best, david Amanda asks: “Help! I have a romantic relationship conflict! What should I do?” Hi Dr Burns! Firstly, I would like to thank you for your tremendous work and heart to help people who are suffering from depression & anxiety around the world. I found your book in 2021 through a YouTube video you did with Tom Bilyeu and the rest was history. I went down to our local bookstore to get Feeling Good and I was reading it everywhere I went. It saved my life and cured my anxiety! Every time I hit a roadblock, I will go back to the book and try the techniques. I also love the podcasts as they have been very helpful for me. Shoutout to Rhonda and Dr Matt May too! I currently face an issue and would like to submit it as a question for Ask David series. Please address me as Amanda. I am in a stable and committed relationship (for 8 years) but am facing issues with my boyfriend which causes resentment between us. Meanwhile, a friend pursued me despite knowing that I am in a relationship. He told me during a meetup that he felt attracted to me and asked if I will choose him if I am single. I was attracted to this guy as he is confident, funny and carefree, which are qualities that I desire and find lacking in myself. I like him but I know that he is not a good match for me because of his actions and behaviour. The actions seemed manipulative and reflected some narcissistic tendencies. At the start, he would text me frequently then the messages became short when I declined to meet up on a 1-1 basis with him as I want to protect my own relationship. He would drop me a short message every week, using intermittent reinforcement, to ask me how I am doing and then asked if we could meet up for a meal. Example 1: Guy-"Lunch?" Me-"Ok if it's with the group." Guy-"Ok." End of communication. Example 2: Guy-"How are you recently?" Me- "I am feeling better, thanks for checking in!" Guy- "Thumbs up emoji" End of conversation. If I initiate a meetup to run errands or for a meal, he would accept it readily. In a way, there is only communication and interaction when we meet up and I know this is not a healthy interaction or something that I want. Fast forward, I ignored him and he is in a relationship now but our dynamics remain the same. If I reached out to him for a meal, he would respond and behave in a caring way when we met. He offered to buy food for me when I was sick and find ways to continue to meet up. I feel that this guy is just trying to get me as it gives him an ego boost (and thrill) that I care for him even though I am in a committed relationship. In our last meetup recently, I made sure to record how I felt and noticed that the satisfaction level has gone down to about 60% as compared to  previously when I was eager to meet him. I would like to reduce it to 10% or even 0%. I also recorded my satisfaction level when I did things alone or with my boyfriend. I realized that my satisfaction/pleasure level is higher and more consistent when I do things that I set out to do on my own and there are times it is enhanced/lowered when I spend time with my boyfriend. Using the daily mood log, the upsetting event is: I will ignore this friend for a period of time then I will go back to the same communication and meetup with him. Then, I'm stuck in the same dynamic again. My negative thoughts are: I will never be able to get out of this. I am doomed. I have no power or control, he has all the power. People always take advantage of me because I'm weak. I am a loser because I keep going back. I will never be happy again since I cannot overcome this. Things will be as such. This chapter will leave a mark on my life and I will be miserable. I am a horrible person for allowing myself to fall for someone while being in a relationship. I have been re-reading the chapter in Feeling Good on love addiction and spending more time with myself to build a relationship with myself so that I can be happy alone. I am also using the cost benefit analysis to melt my own resistance so that I do not go back but I do not seem to be able to totally defeat the negative thoughts above. I hope to receive some guidance related to this on the podcast if possible. Thank you so much! Love, Amanda David’s Reply Hi Amanda, Thanks so much. There are many paths forward, but one thing that might help would be to use the Decision Making Tool since you seem to be unclear on what you want to do. That might be a good first step, or next step. You can download it from the bottom of the home page of my website, feelinggood.com. I can understand your negative feelings and confusion and self-doubt, anxiety, discouragement, frustration. I’m just speculating. There are many ways to challenge your thoughts, but some good positive reframing might help before trying to  challenge them, so you could check out your goals for each negative emotion. Including a recent Daily Mood Log, in case you don’t have one. All the best, david PS What you are doing all makes good sense, developing a relationship with yourself, doing a cba, etc., Kudos! In addition, the “25 things I’m looking for in an ideal mate” tool in Intimate Connections might also be helpful. Aaron asks: Why are feelings of depression and anxiety correlated? In other words, why do they frequently go hand in hand? Hi Dr. Burns, I am rereading When Panic Attacks, this has lead to a question. In the book you mention that one theory about why people have both anxiety and depression is that they "can't distinguish different kinds of emotions." Can you expand on this to help me better understand what this means? My interpretation now has me thinking that people are just saying they are depressed and anxious because they don't understand what each word for the emotions means. Thank you for your help, Aaron W. California---LMSW (Idaho)  David’s reply David D. Burns, MD Sure, but that is not my thinking, just a common theory that of course deserves respectful consideration and testing. To me, depression is the feeling that accompanies loss, and anxiety is the feeling that accompanies the perception of imminent threat or danger. Beck put it like this: Anxiety is like clinging by your fingertips at the edge of a cliff, fearing you will fall at any moment. Depression, in contrast, is more like thinking you have already fallen, and you are at the bottom of the cliff, broken and injured beyond repair. Here are a couple other things that might interest you. When people are depressed, they will also report feelings of anxiety nearly 100% of the time. However, when they are anxious, they will only report feelings of depression about half the time. This is because you can have some type of anxiety, like a phobia such as the fear of heights, or elevators, or flying, but not feel depressed about it. And here is one more tidbit. My research on the beta test data from our Feeling Great App indicates that all seven negative feelings we measure are strongly correlated and go up or down together, which was quite unexpected. The statistical models that simulate the data provide strong evidence for an unknown “Common Cause” that activates all negative emotions simultaneously. We are trying to figure out what that Common Cause might be. It is a bit like “Dark Matter.” Scientists have proven it’s existence, but don’t yet know what it is. And this unknown Dark Matter represents 95% of the matter in the universe. The statistical models also provide strong evidence that the Feeling Great App helps people because of its strong causal impact on this unknown “Common Cause.” Would love to include this an Ask David in a podcast. Would it be okay? Warmly, david Aaron replies Hi Dr. Burns, I would be honored if you used my question in your podcast. Please let me know when that podcast is posted! I would love to watch it. In the email you sent, are you saying that one theory is that people just cannot accurately define what they are feeling? David replies again Yes, that is one theory, and I have seen that some people, including therapists, have trouble recognizing the names of feelings that their patients are having, based on what the patient says, and also they sometimes have trouble knowing how they are feeling, using “I Feel” Statements. This is, I think, part of what has been called “Emotional Intelligence.” And, just like any skill or talent, there is a great deal of individual difference in “Emotional Intelligence,” and likely some cultural differences as well. I have heard that up until recently, the Chinese did have a word for “depression,” but when a person was appearing depressed, they were kept indoors out of a sense of shame. Thanks! david

How to Give Critical / Negative Feedback In a Loving, Constructive Way AND How to Avoid the Common Traps Today’s podcast features Dr. Jill Levitt, Director of Training at the www.FeelingGoodInstitute.com in Mountain View, California and co-leader of David’s weekly TEAM-CBT training group at Stanford. Rhonda and I are psyched, because every podcast or teaching event with Jill is almost certain to be fabulous. And this podcast is no exception! Rhonda asks members of her Wednesday training group (see below for contact information of you think you might want to join) to take turns teaching the group.  One week she was puzzled because almost no one filled in their feedback forms, and when she asked them why, they said that they had some concerns about the teaching but didn’t feel comfortable criticizing the person who taught. Some of the criticisms they share with Rhonda were: It was boring. I didn’t learn anything new. The teacher didn’t explain anything in a way that I could understand. Is this a problem that you have as well? Do you find it hard to criticize others, and keep quiet on the assumption that saying nothing is better than opening your mouth and saying something hurtful? If so, I have some good news and some bad news for you. First, the bad news. Tonight, you’ll discover exactly why and how saying nothing is actually a pretty hostile and mean thing to do. But here’s the GOOD news. You’ll also learn the secrets of how to deliver criticism in a way that’s loving, authentic, and helpful if—and that might be a big IF—that’s something you’re willing to do! A sage—cannot remember who—once said that “When you say nothing, you’re actually shouting quietly. What in the world does THAT mean? And Robert Frost, in his famous poem, Fire and Ice, wrote: Some say the world will end in fire, Some say in ice. From what I’ve tasted of desire I hold with those who favor fire. But if it had to perish twice, I think I know enough of hate To say that for destruction ice Is also great And would suffice. Essentially, Frost is saying that if you’re angry, there are two classic ways of being aggressive; you can be fiery and agitated and attack the other person, verbally or physically, or you can be cold and withdraw, saying nothing, so as to freeze the other person out. These are opposite extremes but are equally destructive. And, for most of us, difficult impulses to resist. But there’s a third alternative, which might be, according to Robert Frost, the “road less traveled by.” You can express your negative feelings, including anger, in a respectful, or even loving way. And that’s the focus of today’s show. My show notes will only give an overview, but the richness of this particular podcast is in the actual dialogue and role-play demonstrations with critical feedback. We began with an overview of some of the key techniques when giving someone negative feedback, including stroking and “I Feel” Statements, but emphasized that your tone, goal, and spirit is the entire key to how you come across, and how the other person responds. Jill told a moving and dramatic story of an interaction with her mother, who has been quite ill, and she’d been having a really hard week. Her mom sent Jill a lengthy text outlining all of her problems and ending with, “you guys don’t really know how I’m hurting,” and the implication was, “you don’t know--or care.” This was understandably hurtful to Jill. Jill’s about the most awesome daughter any mother could have. Jill wanted to clear the air and tell her mom how she’d felt, rather than keeping her negative feedback hidden. Her mom clearly felt lonely, so when Jill saw her in person, she said something along these lines: “I know you’ve been struggling, but I felt hurt and discounted when I read your note. I felt like the things I’ve done didn’t matter, and I felt hurt.” Her mom began to cry and said, “the last thing I want you to feel is that I don’t appreciate you.” This conversation was challenging, but brought them much closer together. The podcast crew discussed the important question of our mixed motivations about sharing our feelings, and our confusion about how to do this in an effective, loving way, if you do decide to open up. Rhonda confided that she’d never had those kinds of open conversations with either of her parents, and that these kinds of difficult conversations can come from a place of love. You can review the Five Secrets of Effective Communication if you click HERE. The Five Secrets are all about talking with your EAR: E = Empathy, A = Assertiveness, and R = Respect. However, there’s a lot of intense resistance to using the Five Secrets, so I promised to include my list of 12 GOOD Reasons NOT to Listen (E = Empathy) Share your feelings (A = Assertiveness) Treat the other person with respect (R = Respect) That makes 36 reasons in all! You can link to the list HERE. People want to feel understood, and the best way to make that happen is by giving what you hope to receive. And you can learn how to listen more skillfully If you read my book, Feeling Good Together, and do the written exercises while reading. You’ll learn a ton that can change your life and greatly enhance your relationships with the people you love. Thanks for listening today!! Jill, Rhonda, and David

The Feared Fantasy Festival! Featuring Jill Levitt, PhD Rhonda asked about the differences between the four Feared Fantasy Techniques and what each one is used for. So we're dedicating today's podcast to answering that question and bringing them all to life. We are honored to be joined by our beloved and brilliant Dr. Jill Levitt, the Director of Clinician Training at the Feeling Good Institute in Mountain View, California. Below I have listed the four Feared Fantasy Techniques. As you can see, each one targets a different Self-Defeating Belief. Approval Addiction: I need everyone's approval to feel happy and worthwhile. Perceived Perfectionism: I must impress others to be love and respected. People will not love or accept me if they see my flaws and shortcomings. Achievement Addiction: My capacity for happiness and my worthwhileness as a human being depend on my achievements, intelligence, success, and productivity. Love Addiction: I need to be loved to feel happy and worthwhile. Submissiveness: I must make others happy, even at the expense of my own needs and feelings. Here are the Feared Fantasy Techniques used for each SDB: Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No Practice During the live podcast, we did a deep dive on each of the four Feared Fantasy techniques, and emphasized that the goal is actually enlightenment, and it's based on the teachings Tibetan Book of the Dead that when you finally challenge and confront the monster you've feared and run away from in all of your previous reincarnations, you will discover the the monster has no teeth, and that your fears throughout all of those reincarnations were based on a cosmic joke. This can create something called "laughing enlightenment," so you no longer have to go through the life death cycle, but can go instead to Nirvana--or something along those lines! You really must listen to the podcast to "get" the impact of these Feared Fantasy role plays, and role-reversals, to see how simple, easy, and obvious self-acceptance, and enlightenment really are, and you will see and hear how we fight to protect and defend ourselves from attack, and end up feeling trapped yet again in our needs to be "special" or "worthwhile." David pointed out that when you let go of the idea that you have a "self," your suffering can disappear because you will no longer have to wonder whether your "self" is good enough, or worthwhile enough. Jill complemented this line of thinking by pointing out that the technique, Be Specific, is one important key in most of these techniques. We can be flawed in all kinds of specifics, but that will never hurt unless you generalize to your "self." No self, no problem, as some mystics have said. And that is SO TRUE! David also discussed throwing away the idea that you are worthwhile, or that you need to be more worthwhile, and described how he and his wife saved a mouse that had somehow gotten into their house, but the poor thing was terrified and heroically tried to survive, hiding out in their kitchen. Instead of trying to kill it, they fed it nuts and grapes. Eventually, they caught it in a safe trap, and set it free, and left a last meal for it outside, which it found and happily ate. It was a deep dive on Feared Fantasy and lots of spiritual and philosophical topics, and we hope you enjoyed it! Although we did not cover this topic in the podcast, there are quite a number of additional role play techniques in TEAM-CBT, too, as you know, including: to help with Self-Critical Thoughts: Paradoxical and Straightforward Double Standard Externalization of Voices to help with Uncovering Techniques, like the Individual Downward Arrow Man from Mars To help with Tempting Thoughts Devil’s Advocate Technique Tic-Tok Technique to help with Resistance Externalization of Resistance How Many Minutes? to help with the Five Secrets / Relationship Conflict Intimacy Exercise One Minute-Drill Perhaps you can think of more, too! The generous use of role-playing techniques is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. This is perhaps unfortunate because they tend to be more potent, emotional, and fast acting than many if not most other techniques. Warmly, david

Ask David: Getting Off Benzos How Does Music Stir Our Emotions? Combatting Negative Thoughts about the World Treating Schizophrenia with TEAM The Four Feared Fantasy Techniques and more! Questions for today: Mamunur asks: What’s the best way to withdraw from benzodiazepines? Gray asks: How does music evoke such powerful emotional reactions? Josh thanks David for techniques that have helped in his personal and professional life. Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Moritz asks: How do you help people with bipolar, schizophrenia, etc.? John expresses gratitude for our answer to his question on Positive Reframing, which triggered an “ah ha moment.” Rhonda asks: What are the four Feared Fantasy Techniques? The answers below were written prior to the podcast. Listen to the podcast for the dialogue among Rhonda, Matt, and David, as much more emerges from the discussions! Mamunur asks: What’s the best way to withdraw from benzodiazepines? Ask David, Bangladesh question Dear Sir, I am writing to you from Bangladesh. Your book Feeling Good is a phenomenal work, and it has greatly helped in promoting the development of a healthy mind through logic and reason. Sir, I have a question regarding benzodiazepine withdrawal, which is often prescribed for mental health disorders. Is there a specific CBT (Cognitive Behavioral Therapy) approach that can help in withdrawing from benzodiazepines? Your guidance on this would be invaluable, as many people have been taking it for years, either knowingly or unknowingly, without being fully aware of its severe withdrawal effects. Thank you, sir, for your kind contributions to humanity. Sincerely, Mamunur Rahman Senior Lecturer David’s reply Dear Mamunur, Thank you for your important question! I am so glad you like my book, Feeling Good, and appreciate your kind comments! As a general rule, slow taper off of benzodiazepines is recommended. This might involve slowly decreasing the dose over a period of several weeks. When I was younger I used to take 0.25 mg of Xanax for sleep, because it was initially promoted as being non-addictive, which was wrong. It is highly addictive. The dose I used was the smallest dose. When I realized that I was “hooked,” I tapered off of it over about a week, and simply put up with the side effects of withdrawal, primarily an increase of anxiety and difficulty sleeping. These disappeared after several weeks. Abrupt withdrawal from high doses of any benzodiazepine can trigger seizures, as I’m sure you know. That is the biggest danger, perhaps. I do recall a published study from years ago conducted at Harvard, I believe at McClean Hospital. The divided two groups of people hooked on Xanax into two groups. Both groups were switched to Klonopin which has a longer “half-life” in the blood and is supposedly a bit easier to withdraw from than Xanax, which goes out of the blood rapidly, causing more sudden and intense withdrawal effects. After this initial phase, both groups continued with slowly tapering off the Klonopin under the guidance of medical experts. However, one of the groups also attended weekly cognitive therapy groups, learning about how to combat the distorted thoughts that trigger negative feelings like anxiety and depression. My memory of the study is that the group receiving cognitive therapy plus drug management did much better. As I recall, 80% of them were able to withdraw successfully. However, the group receiving drug management alone did poorly, with only about 20% achieving withdrawal. My memory of the details may be somewhat faulty, but the main conclusion was clear that the support of the group cognitive therapy greatly enhanced the success of withdrawal from benzodiazepines. I decided early in my career not to prescribe benzodiazepines like Ativan, Valium, Librium, Xanax, and Klonopin for depression or anxiety, because the drug-free methods I and others have developed are very powerful, and the use of benzos can actually make the outcomes worse. Years back, a research colleague from Canada, Henny Westra, PhD, reviewed the world literature on treatment of anxiety with CBT plus benzos and concluded that the benzos did not enhance outcomes. Here is the link: https://pubmed.ncbi.nlm.nih.gov/12214810/. I hope this information is useful and I will include this in a future Feeling Good Podcast.   Gray asks: How does music evoke such powerful emotional reactions? Subject: Re: Podcast question: love songs Hi David, That's a really tough question. Music has a unique way of cutting straight to emotions for me, and it makes it especially hard to identify the thoughts behind them. My best way of explaining is with these two thoughts, which have to be viewed as a pair to get that emotional reaction: My life would be perfect if I had that I'm so far away from that These thoughts don't resonate quite right for me, but it's something like that, going from imagining bliss to crashing to hopelessness within the space of a moment. Thank you so much for your response. Gray David’s reply You’re right. Music can be so beautiful, especially of course, the songs we love, that it is magical and emotional to listen to! It seems more like a sensory experience, than something mediated by thoughts, but we certainly have perceptions of beauty, etc. Similar with some incredibly delicious food. Creates incredible delight and satisfaction, and no words are necessary other than “delicious!” Sorry I can’t give you a better answer to your outstanding question! Best, david   Josh thanks David for techniques that have helped in his personal and professional life. Dear Dr. Burns, I am sure you are swamped with substantive emails and fan mail, but I just wanted to express appreciation to you for all I have gained from your publicly available content. I have learned so much that I have applied in my personal life. I have also benefited tremendously in my work with clients. So much of what you say about anxiety, and especially the hidden emotion technique, has allowed clients to have in almost every session an aha moment. I have not yet been able to see a complete removal of symptoms in one session yet, but as a therapist, I too have many skills yet to improve and much work to do. So, in short, thank you so much for making your experience and wisdom available for free, and thank you for doing it in such an engaging manner. Sincerely, Josh Farkas   David’s Reply Thanks, Josh. You are welcome to join our weekly virtual free training group I offer as part of my volunteer work for Stanford, if interested. For more complete change within sessions, a double session (two hours) in my experience is vastly more effective. Is it okay to read your kind note on a podcast? Warmly, david   Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Dear Dr. Burns, First of all, I would like to thank you for all your work and your outreach. Your books have profoundly influenced my thinking and value system. I really admire how you exemplify both scientific rigor and human warmth. Finally, I want to thank you for promoting the idea of “Rejection Practice! I haven't had a breakthrough yet, but some unexpected, very encouraging experiences. I first came across Feeling Good 12 years ago when I developed moderate depression in the context of living with my ex-partner, who probably had borderline personality disorder. I tried the techniques in Feeling Good and also psychotherapy, but unfortunately without much success. I only started feeling a lot better when I began to rebuild my social life and leisure time activities (ballroom dancing, getting involved with a church, ...). Several months later, I also broke up with my ex-girlfriend. Since then, I've had ongoing mild depression. I recently tried the techniques in Feeling Great but wanted to ask you for your opinion on a couple of negative thoughts I'm particularly stuck with. My issue is that I'm normally not attacking myself, but life in general. I keep on telling myself things like "Life is just one crisis after the other," "Life is for the lucky ones," "Really good things just don't want to happen," "Life is so much suffering and so little joy," and the depression itself makes these statements all the more convincing. (Triggering events can be rainy holidays, romantic rejections, grant interview rejections, etc.) I think it could be helpful if in a podcast you could give more examples on resolving negative thoughts attacking life / the world rather than oneself. I also have many more questions for podcasts if you are interested. Thank you for reading this, and thank you so much again for all your work! With very best wishes, Harold   David’s Reply Happy to address this on an Ask David, and it would help if you could let me know what negative feelings you have, and how strong they are. I will be answer in a general way, and not engaging you in therapy, which cannot be done in this context. Is that okay? I’m attaching a Daily Mood Log to help organize your thoughts and feelings. Send it back if you can with the Event, Negative Feelings and % Now columns filled out (0-100), and Negative thoughts and belief in each (0-100). You can also fill in the distortion column using abbreviations, like AON for All-or-Nothing, SH for Should Statement or Hidden Should, MF for Mental filtering, DP for Discounting the Positives, and so forth. Thanks! If you were in a session with me, or if we were just friends talking, I would reply to your complaints with the Disarming Technique, Thought and Feeling Empathy, “I Feel” Statements, Stroking, and Inquiry, like this: Harold: “Life is so much suffering and so little joy." David: “I’m sad to hear you say that, but you’re right. There’s an enormous amount of suffering in the world, like the horrible wars in Ukraine and in the Mid-East. (I feel; Disarming Technique) It makes sense that you’d be upset, and have all kinds of feelings, even anger since there’s so much cruelty, too. (Feeling Empathy) And even people who appear positive and joyful often have inner sadness and loneliness that they are hiding. (Disarming Technique) Your comment tells me a great deal about your core values on honesty and compassion for others. (Stroking) Can you tell me more about the suffering that you’ve seen that has saddened you the most, and how you feel inside? (Inquiry) But I’m mainly interested in you right now. Can you tell me more about YOUR suffering, and especially if there’s some problem you might want some help with? (Inquiry; Changing the Focus) I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test. If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?” I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself? I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test. If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?” I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself? I ask this because your negative thoughts are very general, but I always focus only on specifics, specific problems and moments. What’s has been going on with your parents or in the past or present that you are distressed about? I’ve found that when I (or my patients) solve one specific problem that’s bugging me, everything seems to suddenly brighten up. For example, you wrote : “I asked someone out I like; she surprisingly said yes. After 10 days of not hearing from her, I messaged her, . . . “ I wrote a book about dating, Intimate Connections, because I was a nurd and had a lot to learn about dating. One idea is that waiting 10 days might not be a good idea to arrange the specifics of the date, as that might make her feel uneasy. There’s a lot to learn about dating, for example. A tool like the Pleasure Predicting Sheet can sometimes help, too. And finally, a good therapist can also often speed things up. Sometimes two heads are better than one. You seem extremely smart and willing to work hard, so there’s all kinds of room for growth, learning, and greater joy. The Feeling Great App is NOT therapy, but the tools there might also be helpful, especially since you are willing to work hard a do a lot. That’s super important. Can I use this email in my reply in the show notes if we discuss your excellent questions? And should I change your name to Harold? Warmly, david Best, david     Moritz asks: How do you help people with bipolar, schizophrenia, etc.? Hi David, You have mentioned a few times that there are only a handful of "real" psychological disorders with known causes, as opposed to just a collection of symptoms. Could you please tell a bit about how you would go about helping somebody with one of the "real" disorders (like Schizophrenia or Bipolar) using TEAM therapy? Most of the episodes with personal work seem to fall into the other category (anxiety, depression, compulsive behavior), so I'd be really curious about some examples. Best regards, Moritz Lenz   David’s Reply Hi Moritz, Thanks! Good question, and happy to address this on an Ask David. Here's the answer in a nutshell. When working with someone with schizophrenia, the goal is to help them develop greater happiness and interpersonal functioning, exactly the same as with anyone else, using TEAM. The goal is not to cure schizophrenia, because we still do not know the cause and there is no cure. But we can help individuals with schizophrenia with problems that they are having. Bipolar: in the manic phase, usually strong meds are indicated, and often at least one hospitalization. For the rest of their lives, including depression, TEAM works great. Can add more in the podcast. Best, david   John expresses gratitude for answer his question on Positive Reframing, which triggered an “ah ha moment.” Hi David and Rhonda! I have listened to Episode 415 and your response to my positive reframing question! I had a bit of a aha moment! I think I had been approaching it in the cheerleading sense and trying to encourage myself with these positive qualities rather than attaching the positives to the negative thoughts and feelings themselves! This has created a much stronger emotional response during the positive reframing section! The building up of the negative thoughts and feelings is a gamechanger! Thanks so much for the time and attention given to it during the podcast. Thanks so much again, I appreciate you folks way more than you could know! John David’s Reply Thanks, Rhonda and John. Yes, you’ve pointed out a huge error many people make when trying to grasp positive reframing. If it is okay, we can include your comment in a future podcast. Warmly, david   Rhonda asks about the four Feared Fantasy Techniques: David’s Reply Here are the four Feared Fantasy Techniques Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No Practice There are quite a number of additional role plays, too, as you know. Maybe a question about all the role plays, bc we all have: Self-Critical Thoughts: Paradoxical and Straightforward Double Standard Externalization of Voices Uncovering Techniques Man from Mars Tempting Thoughts Devil’s Advocate Technique Tic-Tok Technique Resistance Externalization of Resistance How Many Minutes? Five Secrets / Relationship Conflict Intimacy Exercise One Minute-Drill I’ll bet you can think of more, too! This is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. As you know, on average they tend to be way more potent and emotional, and of course fast impact. Warmly, david

Meet Tahn Palmetto Theravada Buddhism--the Thai Forest Tradition Our dear colleague, Jason Meno, generously invited five high-profile Buddhist monks / teachers, to appear on our Feeling Good Podcast, hoping we could feature one every week during our "Enlightenment Month."  He included his dear friend and ordained Buddhist monk, Tahn Palmetto. Happily, Tahn accepted Jason’s invitation, and we are thrilled to chat with him today about his feelings of depression as a young man in the army to his search for happiness and peace through meditation. Tahn began his journey when we was young, 20 or 21 years old. After he enlisted in the army, he was lying on the floor, staring at the ceiling and realized he was depressed. He also realized that he didn’t actually want to go to war, and saw that the best of good intentions often lead to pretty terrible outcomes. Jason and David described the basis of cognitive therapy, confirmed in Jason’s recent research on meditation, that the degree of upset from any negative thought depends on how strongly you believe it to be true. Tahn said he also realized that his negative feelings did not depend so much on what he was doing, but how much he believed his thoughts. He got out of the army and searched for spiritual teachers, and eventually settled on Theravada Buddhism, also known as the Thai Forest Tradition. He said, “I found that you can have a lifestyle that triggers feelings of unhappiness, and committed my life to achieving happiness and peace.” He said that some people who come to the monastery discover that they don’t want to commit themselves to the monastic life, and some commit to it but do it poorly. He said that your commitment will depend on how strongly you want to feel happy and enlightened. Believing that this is possible requires a paradigm switch. It is possible to have a mind that is clear, but even on a clear day, there will be clouds. The clouds, however, are only temporary. Our suffering comes and goes. If you twist your knee, it may hurt for life. But if you have a cold, you can recover completely. Even in a monastery, people have their squabbles. Within the Buddhist practice, Than explained that it is important to try to identify the disease and only then prescribe the effective treatment. Jason mentioned that some people come to the monastery but leave feeling hopeless. Others stay and are successful. Tahn explained that in Asia it is common for someone to enter the monastic life for a brief period, for example when they are experiencing grief. He said that if you grieve over the loss of a loved one, time alone will heal your grief, and once the suffering is relieved, they leave the monastic life. Rhonda asked if mindfulness meditation could be harmful to some people. Tahn explained that mindfulness does not cause negative feelings, but often reveals the presence of negative feelings. If you have a condition that prevents you from experiencing enlightenment, the condition is getting in the way. Sometimes the practice will give you the stability and the peace of mind to deal with it. If you come to the practice of mindfulness or the study of Buddhism for the wrong reasons, you might stay for the right reasons. If it does not work or help, you can always seek some other type of treatment. Tahn explained that mindfulness or Buddhism addresses unhappiness caused by mental or physical pain, and that people are often surprised by how it helps them. He believes that mindfulness meditation is “the thing” that treats someone’s stress. It treats the “dukka,” which is a fundamental Buddhist teaching that refers to (according to the internet) the “suffering” or “unhappiness” of life. It is one of the first “noble truths” of Buddhism; namely, that suffering cannot be avoided. Apparently dukka comes in three flavors: Physical and emotional pain and discomfort Suffering from the inability to accept change The profound dissatisfaction of existence. Tahn said that you develop greater resources when you meditate. Then you may have extra resources to help others: You learn to deal with everybody’s stuff. You learn to be aware of your body. This is your perspective for everything you do. It makes me happy to think about my eyeballs. When I meditate on this, it becomes funny, and I laugh. Tahn suggested that when you meditate, you learn to be aware of your body, because that is the center point of your world. This is your perspective on everything that is going on in the world. When you become aware of your body and what it is doing, you know the context of everything in your life. What does his day look like? Tahn said: I answer emails, I troubleshoot problems. Lately we’ve had a problem with scorpions. But we don’t try to kill them. Tahn talked about how Buddhism defines Truth as reality, and that the definition of happiness is “non-suffering.” There are three patterns that lead to unhappiness: Attachment, which he defined as greed and desire, especially when you seek some external object(s). An extreme example would be disregarding the needs of others or even endangering others to get the object of your desires, or an attitude of only wanting or caring for things that you like or want. Aversion which refers to feelings of aggression, anger, and hatred. Aversion’s opposite is loving kindness. When we experience Aversion, we push away (usually aggressively) the things that we dislike. If we allow our ignorance to take over, we can conjure up hatred for the things that we dislike and the people we see as blocking our desires. We saw from the meditation experiment that Jason described last week, how meditating on loving kindness brought about a reduction in people’s negative thoughts. Ignorance refers to delusion, confusion and dullness. Ignorance defuses understanding serving to confuse you and prevent you from doing something functional. This can be experienced as an inability to see the truth or reality of ourselves or the world around us. Asking questions like “Am I real” is the basis of the first two in this list. Tahn also discussed how the mind precedes the thoughts. Then we talked about the concept of the Self, in that we think that we exist. However, there is no stable “I.” All we find are temporary phenomena. For example, you don’t need to have a “self” to drive to a picnic. All you need is a car and a tank of gas. The group discussed the Buddhist concept of “laughing enlightenment.” Thank you for listening today! Tahn, Jason, Rhonda, and David