Werner Spitzfaden
Appearances
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Couldn't resist the offer. Right. Yeah. Well, I I think you're so right, David, about the continuing to to go after it. Oftentimes there are times when it's a one and done like the example. That you cited in When Panic Attacks with the woman with the elevator phobia.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
You know, that it is kind of a one-and-done, although she had been in psychotherapy for years and years, and you were able to really— 20 years of psychoanalysis. That's right. And you were able to address it in a very short period of time. But I think in some other circumstances, it really is a kind of keeping after it.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Oh, sorry. Yeah. Yeah. Yeah. Right. And, and, uh, well, that's really good to hear that background piece of it. Um, and, and, uh, uh, I totally agree with, with that. And so we had gotten to the place where I had said to Rhonda, do you feel like I'm really getting what's going on for you and how you're feeling?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, this was mid to late 1990s. We invited you to come and do a training with Kaiser therapists. And it was terrific. You actually did some teaching on how to do team CB, although team wasn't as developed as it is today. It's much more sophisticated. But you showed us how the model worked with group therapy, which was really exciting.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And, and, um, uh, at that point we, we had really reached that point of, of invitation and, uh, uh, You know that she's told me about this driving phobia and how limiting it's been for her and her life in general and and how much she's really struggling with this at this point because of the pandemic and not driving and that.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Is this a good time to start our work and kind of roll up our sleeves or is there. more that she would like to really share with me and let me know about and get support around. And Rhonda, of course, being the good therapist that she is, she picked right up. All right, let's get to it. And so we – which would be the next step of this would be the specificity.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Rhonda, can you tell me about a specific moment in time that either in the recent past or sometime in the near future that really captures your driving phobia and your anxiety? And Rhonda was right away able to identify – maybe you could share, Rhonda, what –
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Yeah. Right. And there was a particular part of that drive that became the real issue. There were several parts, but one that really drove the issue and became a big focus of our anxiety hierarchy, which we'll talk about a little bit later. Yeah. Yeah, and that had to do with this particular overpass from the 580 to the 24, and that was a very scary event.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And I think your line was, it just absolutely freaks me out.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Right. Yeah. Yeah. And again, more empathy about how scary that feels as you're driving over these curvy overpasses. And at that point, really, we launched into the daily mood log and began to focus on, of course, the specific moment in time, the upsetting event. which would be driving to and from the intensive, not only by driving but having passengers in the car.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
It was myself and Lee Flowers and Heather at one point, right? Was Lee staying at your house too?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. And so we began to do the daily mood log, of course, what kind of feelings. We developed all the different feelings in terms of the level of anxiety and, and, uh, uh, different, different emotions. So the sadness was rated at 15 and anxious, I'm sorry, 25 and anxious. Uh, I need new glasses here. Uh, anxious and frightened, panicky was all at a hundred. Um, uh, guilty.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
The one word that really jumped out was I feel ashamed, 90%. And then inferior and adequate, defective, and so forth, 85%. Alone in the process, 25%. That was very high. But then embarrassed and foolish and humiliated and self-conscious, again, 99%. And Hopeless and a bit discouraged and frightened. You know, that was 85 and then frustrated and stuck also at 85, if I'm reading that right.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And angry was definitely part of it. Annoyed and irritated, upset at 85. And yeah, and then there was, I can't read that word. Let's see. Destabilized. Destabilized. There we go.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, really true. And I think we touch on that later in the process, if I remember correctly, Rhonda. And then we began to develop some of the negative thoughts around that and asked Rhonda. So when you think about this moment in time and you're going over the bridge, what are you telling yourself? What kind of thoughts are really jumping out at you?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And maybe you could read a few of those, Rhonda.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, and my heart really went out to you, Rhonda, when I started hearing those and just connecting with you on how scary that really did feel. And you're absolutely right, David. It was one of those moments where
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Those scared feelings are so limiting and really prevent us from having and prevent Rhonda from having the kind of life that she was really wanting and to be able to feel good about what she was doing with her driving.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Well, that really, and to answer your question as well around why is this cognitive work so important, because it really set the stage for developing a different internal dialogue, right, an internal thought process. And that is really critical, especially as we start moving towards the exposure work, so that there is a different, again, a different internal dialogue going on.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
rather than telling myself that I'm an ass, right? Which is really, when you think about it, is pretty verbally abusive when you think about it. If you called another person an ass, if you do a kind of paradoxical double standard, your relationship with them would probably suffer significantly. And so to develop, you know, a good cognitive basis here and address the distortions and develop a...
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
A more beneficial and positive thought process is paramount to the process succeeding.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Nice. Yeah, and that focus was important as well. And of course, we're getting to that stage where the miracle cure and the externalization of resistance and the magic button, magic dial, positive reframe, all of those elements are here. I don't know where we are in terms of time and how much of this we can cover.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
But certainly asking that question, you know, if a miracle occurred here in our session and in the coming sessions, what would that miracle look like for you? And how would you know if things are different for you? Tell us about that stuff, Werner. Yeah, so that would be the question I would ask Rhonda. And, of course, the patient, the client would need to answer and see what comes up with that.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Huh. You know, I can picture who you're talking about, and I'll think of her name after we get done with this podcast, I'm sure, unless it pops in in the meantime. I have really good memories from back then. Thank you so much for inviting me to the podcast here.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And, Rhonda, do you remember what you came up with?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, and specifically, how would you know that you're able to drive pretty much anywhere?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, are there locations that you've been wanting to drive and you haven't had a chance to?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Okay. Okay. Yeah, and then to move into certainly externalization resistance would be another direction to go. I mean, there are lots of good reasons to not think about or not do this work and not face these anxieties. And that's something that we can look at down the road. But if there was a magic button sitting in front of you, Rhonda, and you push that magic button,
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And all of these negative thoughts and feelings would just disappear. Would you press that button?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. And I totally agree with you about that, given how painful these feelings and these negative thoughts really are and how much it's been limiting your life. I can totally agree with you that I would press that button as well. And yet I'm a little concerned we might be going too quickly here. And I'd like to just take a step back.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And I'm wondering if you'd be willing to take a look at something with me regarding all of these negative feelings and thoughts that you're having. Are you willing to do that? Sure. Yeah.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And at this point, I would introduce the positive reframe and what all of these thoughts and feelings are really saying about Rhonda that are pretty awesome and terrific, that they really reveal a set of values and desires about her. And what do you think your feelings really say about all this, Rhonda, that your sadness, what do you think that says about you that's pretty awesome?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Yeah. So you value that freedom and the ability to move through life and not be so hindered and encumbered with this anxiety. Yeah.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And same thing. What does your anxiety say about you? That's pretty awesome. And the scared feeling and the nervous feeling, what does that say about you? That's pretty awesome and terrific.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, so you really value safety and staying healthy in the process. Right. Is that right? Yes. Are all these qualities really good qualities? Yes. Yeah. Yeah. So for the sake of time here, I, I, I, I mean, we can certainly keep going. I would do something similar with some of these negative thoughts as well. And, and, um, and then ask the, the, the, the pivot question here, right.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Is that, you know, given the fact that these negative thoughts and feelings you mentioned pressing the magic button, but given these, um, positive qualities that are really kind of embedded in these negative thoughts and feelings. Um, and if you press that magic button, those would be gone as well. Rhonda, why would you want to press that button?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Yeah. Totally, totally get that. And to be able to enjoy that kind of movement without the anxiety and the worry and the high levels of trepidation that you feel about climbing into a car and
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
and um yeah so so given that uh we don't actually have that magic dial and this is a bit of a mental exercise we do however i mean magic button however we do have a magic dial that we we like to think about and that's a way of dialing down some of these feelings that that you're experiencing and and dial down the intensity of these negative thoughts and um
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And I'm wondering what level would you like to dial some of these thoughts and feelings down to? And so you've identified some goals here. And you want to take your sadness down to 15 and your anxiety down to 25. Is 25 low enough or high enough?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Okay. And then, and then also your inferior feelings, you want to get that down to, to, to five and, and, uh, you don't, you don't want to really feel ashamed anymore either. You want that down to 5%. Um, and you don't want to feel alone anymore in this process and that gets you down to zero. So, um, and, and certainly we would keep going with these feelings and, and, and then, um,
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
The next part of this would be to move into some outcome resistance here as well, right? Right. And that is that we want to issue, you know, a kind of –
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
I'm sorry, process resistance that we want to issue, you know, invitation here to that, given what we've talked about up to this point, Rhonda, you know, I'm really excited to work with you and I have some really powerful tools and approaches and methods to get you to that place of living and with greater freedom and so that you can drive and move about the way that you would really like to and not
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
develop all these alternative routes and yet i'm not sure that you would want that kind of help and and do the work that's needed after all you'd be facing a lot of anxiety and through a variety of progressive exposure exercises as well as anxiety hierarchies and developing your daily mood log and lots of homework and and finally driving in areas where your anxiety is high and um
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And so I'm wondering what your thoughts are.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
No, I love your summary. I think it really helped to consolidate, uh, what we've done over the last 10, 15 minutes. And, and, um, yeah, so at this point, we're really at, at the point of working on, on the daily mood log and, and, um, developing the distortions.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And one of Rhonda's homework assignments was to, and we worked on one or two of the negative thoughts, and then to develop the distortions. And she was quickly, she's a quick study, of course. She recognized that pretty much all 10 distortions were in play with most, if not all of the negative thoughts. And so
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
I think the two that you really wanted to work on to start with, I'm dumb for not driving on the overpass. And then the other one was, I can't do this. And so you were able to identify, and maybe we could walk through that real quick, if you could just sort of teach me.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
based on the 10 distortions and explain to me how those distortions apply to that, that I'm dumb for not driving on the overpass.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
So I feel like I'm dumb, therefore it must really be true.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And that you should be able to drive over that overpass, right? Yeah, without any problem. Right. That's right. Yeah. And then we worked on developing some using the straightforward technique at this point. We looked at how to develop a more beneficial thought. But one of the other thoughts that really caught my eye was the one that said, I'm an ass.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And we can smile about it and actually even be a little bit humorous about this one, right? Because we could do something like, well, let's define terms. That would really be a humorous kind of approach to this. But that's not the moment that really, or that's not the emotion that really captured me with that.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
I just really got the sense of how much you're down on yourself for this recurrence of this phobia and how how you're really just being harsh and hard on yourself. And not only that, but incredibly judgmental and verbally abusive.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And what jumped out at me at that point was initially I was going to do a double standard technique, and then I decided to move into a paradoxical double standard technique with a slight variation built into it. And...
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
said to Rhonda, you know, that can you imagine yourself as a little girl, that innocent little girl that's about seven, six, seven years old, and the one that's really playful and has this free spirit and is just very loving. And you were able to identify what at that moment, Rhonda, you...
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, and this technique can be used whether you use it with, let's say, a six- or seven-year-old niece that you might have that you feel a lot of loving feelings towards, right? But then you really have the sense, and I had that from you, Rhonda, I just had the sense of recognizing just how harsh and harmful those negative thoughts really have been for you.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And the other important part of this cognitive work, David, really had to do with with the fact that it created a level of agitation and anger that really promoted anxiety. And I thought that that was really, at least in my approach, was really important in that moment. And of course, we also then developed a more positive thought around that. And can you read that for us, Rhonda?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, let me clarify that. So that self-abuse creates a kind of agitation within us, right? That I'm already expressing a lot of internal anger at myself and that that really becomes a springboard for the anxiety. Not necessarily the only cause, but definitely a springboard, if that makes sense.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. The the and the other part of it is there's another book that I brought into. Obviously, when panic attacks, there's a beautiful example in there of I think it was Kim, the example of her driving phobia and panic. rubbery legs and where sweat was pouring off her hands and so forth.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
But a lot of the similar kinds of fears about bridges collapsing and so forth that I thought was very powerful as well. And with this particular event, um, example is that the amygdala also gets, you know, that's that part of the brain that signals danger.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And, um, uh, in this case, when we're that self abusive and we're that negative and lack compassion towards ourselves, it immediately starts to signal danger already. And so that's why it's such an important piece of this. Um, it's such a big trigger, um, So, yeah, so Rhonda came up with some positive thoughts, and so I'm going to ask, can you read that one, what the positive thought was, Rhonda?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. And then some of the other is that I'm so dumb for not driving on the overpass.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, so it's addressing the dumb part, right, that you're actually pretty crafty and resourceful. And so is that a good quality to have? Yeah.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Can you hear the process and outcome resistance? Yeah.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
No, it's not. Thank you for pointing that out. Yeah, the acceptance paradox is huge, right? Because Instead of arguing with these fears and with these judgments, I'm accepting that part of myself, but then shifting into a very different place with compassion and caring. Exactly.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
I'm wondering, and maybe this is not on target, but I'm wondering if somehow addressing the dumb part instead of using that judgment piece and seeing what I can say instead of I'm dumb, perhaps it would be something, well, it's true that I'm still really struggling with this driving phobia, but that doesn't make me dumb, right? Yeah. Right.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Yeah, that's that's I have to acknowledge that that's true. I have a little bias there. And yeah, I mean, I didn't like that.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
I can't wait to get up there at the end of the month.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
No, go ahead. Yeah, so the anxiety hierarchy was really, at least in terms of beginning the exposure work, I think that even developing the anxiety hierarchy was critical. By the way, there were a couple of other methods that we used also, and one of them was examine the evidence. And when I read your example, David, and when panic attacks, it's very similar. What number of
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
bridges have actually collapsed or destabilized because people drove across them today and, or even within the last week. And, and so examining the evidence in, in, in that fashion, or how many accidents have you caused in the last year, Rhonda and, and, uh, lost control of your vehicle, right? So examining the evidence on that level also became helpful in moving through this.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And then shifting into the anxiety hierarchy. And I like to do these in tremendous detail. And we chose that specific moment in time of driving from Rhonda's house to the South San Francisco Convention Center for the intensive. And
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And then more importantly is driving home from there because it would be late in the day and dark, and there was another curvy overpass that was going to be part of that picture. And so when we ran through this, it's about a 25-item hierarchy. And about 12, 14 items driving to the conference center and then another 10 or 12 returning. And all the scores were incredibly high at 75.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Well, initially when Rhonda threw out that suggestion, I was a little bit reluctant because we've known each other so well and I didn't know what that therapeutic relationship might look like. And I decided to channel David to some degree. You know the guy, David Burns? You know him, right?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
So preparing to leave for South San Francisco at 75, backing out of the driveway and heading down the street, 40. Driving down Boulevard 30, it's a familiar street for Rhonda, and changing lanes to get onto the bridge, 45, and then it starts picking up, curving around the overpass to get to the toll plaza 7.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. And then later as we go, you know, it's late when we leave the intensive at 830 thinking about heading home when it's dark 100%. And the rest of this ends up being at 100% level. 100% plus on a lot of them. Yeah. That's true. Plus, you're absolutely right.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And as we did this hierarchy and then asked Rhonda to imagine herself actually doing the drive, so we begin to move into imaginal or cognitive exposure, right, is that she's imagining herself behind the wheel. And these were all very high scores, right? And then there were two or three additional imaginal exposures.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And all of a sudden, by the third one, and this was also pivotal in my mind because I believed we were heading in the right direction about what she was telling herself during the drives. And her scores came down to 10%, 15%. The scores that she had at 100% were now at 35, 25, 45. So this was another way of measurement.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
We also, of course, did the brief mood surveys and the evaluation of therapy after each session. And before each session. And so now we're testing our anxiety hierarchy to see if we're having an impact with the treatment.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
The other part of the treatment that I thought was important is that we really began to focus on breathing exercises and grounding in the moment rather than getting stuck into fortune telling. And that was, I think, tremendously helpful with staying in the moment. Would you agree with that, Rhonda? Yes. Yeah. And so once we got done with that.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
No, we actually did. We just started with three series of imaginal exposure. And then Rhonda actually did some individual driving, but not that particular drive, if I remember correctly. Well, I knew you were coming.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, and you're bringing out a couple of the names.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Is, you know, that I had to create a certain distance from the friendship side of it while still, you know, paradoxically keeping that in mind as well. But, yeah, so we just really worked on some initial assessment and to see what was really going on and how much of a – A struggle it had been for Rhonda on several levels that she had worked on this previously.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, and there were a couple of other parts that you mentioned, Ron, that are really important about your heart pounding and being afraid of having a heart attack. And you developed some positive thoughts around that, that, you know, I'm healthy. And just because my heart rate is up doesn't mean I'm going to have a heart attack, right? So that you're able to challenge that negative thought.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And I think that that was really important there. And that the other is the reality that we can't get rid of all of our anxiety. Anxiety is an incredibly functional part of our lives. And to have that expectation to be rid of all of our anxiety is totally unrealistic, right? Right. And you were able to message that to yourself as well. So that's a super important part of this.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, so there's another book, Taming the Amygdala, which is a book that I've really come to like a lot. And they talk about the two ways, two or three ways of really allowing our bodies to not get to a place where we're – Well, some people dissociate when they're having that level of anxiety or they really struggle with it.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
But to just allow yourself to breathe in a controlled fashion rather than hyperventilating or under breathing and restricting your breathing, which a lot of people do, that you actually engage in a very conscious breath work and much like you might if you're
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
meditating in some way but but to actually allow yourself to uh to engage in that and just stay in this moment i've got control of the car that the car is working just fine uh the bridge isn't rattling under my wheels and i am i'm moving along just terrifically here um yes i'm feeling a lot of anxiety and uh and that's to be expected and i'm working my my way through it here
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And then during the pandemic, the driving phobia came roaring back. And am I capturing that right, Rhonda? Yeah. Yeah. And that it was really painful for her that there were so many issues. safety behaviors that she was engaging in and finding other routes, really avoiding certain overpasses and driving at night and a number of other... And she would experience a lot of anxiety with...
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, I totally agree. Yeah, and then from here, it was really once Rhonda drove on her own. I think the intensive was right around the corner and the work started then in terms of all of us driving together. And again, just checking in with Rhonda as we're driving, following the anxiety hierarchy.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And by the way, that hope message that you were just sharing, David, I think that became self-evident with the anxiety hierarchy and the third message. imaginal exposure. I think Rhonda was really shifted into a different hopeful place because she saw her scores coming down. And I think that that really allowed her to also push through and do that actual driving on her own.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Absolutely. That's right. It gave the message that it's possible to do this and be safe, even though I'm experiencing anxiety.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. So then we did the actual three days, three days of driving exposures in both directions. It was four days. Yeah. I thought on the fourth day we did something. Oh, no, I came back. Yeah, that's right. Four days. And maybe you could share a little bit about what that was like for you.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, so some might say that that was not therapeutic. And yet, there comes a time when flexing into compassion is also therapeutic, at least in my mind. And and so but the following day, the following three days were different stories. So maybe you could share about that.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
with breathing and asking her husband to drive for her, stopping on the side of the freeway and asking him to drive and so forth. And as we talk more through this, we also discovered that there was a fear of heights. And oftentimes with driving, there are multiple phobias that are actually in play and
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, and since then, Rhonda, the homework assignments, of course, were also part of the process. And she has identified three different driving exposures of her own. And one of the assignments was that she needed to go over that 24 overpass four times in a row. And that's something. What was that like for you?
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And it could be a fear of driving and bridges, but it also could be a fear of heights or even a fear of small spaces. In other words, if you're having to merge in freeway traffic, that you feel kind of locked in or hemmed in by vehicles on either side. So we began to sort that out a little bit more and realized that a fear of heights was definitely part of the equation. And
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. And there've been a couple of other exposures as well with driving. I think you went to Sacramento or also to, to a friend's. Right. Right.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Well, I so appreciate having worked with you, Rhonda, and I know we're still going to do a little bit more. And thank you so much again for having me on the podcast here, David and Rhonda. It's a real treat. And it was a real treat to see you again at the Intensive, David. That was just a really special four days and to watch you and Jill do the work that you did and
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
and so many colleagues that we were able to reconnect with live and in person. It was really awesome.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Oh, that's so awesome. Yeah. Thank you, David. And the same holds true. I just, uh, really, I shared a little bit with you at the intensive. I just think of you in, in, in, in a very, a big way in terms of an influence, both professionally and personally, David, you, you've made a really big difference in my life. And, and same thing with our friendship bond.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
It's been terrific and really enjoyed. Um,
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And so as we worked through that, there was just a lot of empathy. And I just felt my heart went out to Rhonda because I recognized how much she was struggling with this and how much of a battle it really was for her. Not only that, but as we began to develop the daily mood log, how... how angry she was really with herself and even in some ways emotionally abusive towards herself.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And when we go through the daily mood log, you'll be able to see what I mean by that. Yeah, so empathy, of course, became just a huge part of this and making sure that I was getting the kind of empathy scores that engendered the level of confidence that was necessary for that trusting relationship to develop and grow.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
for me and the therapeutic process to ask of Rhonda to engage in a certain process that was going to be challenging and difficult and even anxiety-provoking. And I think the empathy score is pretty much settled in the 20 range consistently. Do I remember that, Rhonda? Yeah.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah. Yeah. So, you know, as an overview.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, really good question. So safety behaviors have to do with those adjustments that the client makes to take care of themselves, but that reinforces the dysfunctional nature of the phobia. So in other words, instead of driving over the freeway overpass,
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
they would choose an alternate route that's going to take them 30 or 40 minutes longer to get to their destination so that it actually enables their phobia even further, that they're reinforcing the fearful elements of the phobia. Other safety behavior could be like what I pointed out earlier, that Rhonda says, I can't drive anymore and asks her husband to take over.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Or it could be other types of safety behaviors as well. So and then the second question, why does empathy play into this? The therapeutic alliance between therapist and client really needs to be solid and that there is a level of trust that... is part of this because I'm going to be asking the client to kind of go to the gates of hell, so to speak, right, to borrow a phrase from you, David.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
And in order to do that, that they really need to trust and believe that you understand what their challenges and what their pain is really all about. And I'm not a stranger to having phobias. I've had my own anxieties with even with performance anxiety, especially, but also with at times with flying or I had one panic attack when I was scuba diving. So I really understand what that feeling of
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
desperation is all about. There's really kind of a desperate feeling that surfaces, a really scary feeling for the client. And that when, I think when Rhonda and I really connected on that level, that it created that safe environment to move forward with this challenging topic.
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
418: Phobias, Be Gone!
Yeah, thank you. Yeah, I think that's a great summary of what's needed. And that kind of self-disclosure, I think, just goes a long way and creates a unique connection that other therapists may not be able to establish.