402: Ask David: Unfairness; Erasing Depression with Lasers; TEAM in the UK; Most Powerful Technique

Ask David Unfairness Worthwhileness Erasing Depression with Lasers TEAM in the UK What's the Most Powerful Technique? We have lots of great questions today. The answers in the show notes were written prior to the podcast, and the answers in the live podcast as we discussed these questions may differ somewhat or amplify the written materials in these show notes. We love your questions. Remember to send them to [email protected]. Special Announcement Attend the Legendary Summer Intensive Featuring Drs. David Burns and Jill Levitt August 8 - 11. 2024 Learn Advanced TEAM-CBT skills Heal yourself, heal your patients First Intensive in 5 years! It will knock your socks off! Limited Seating--Act Fast Click for registration / more information! Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field  Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. But there's some good news, too! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out! Today’s Questions Kiernan asks about “unfairness” and the connection between worthwhileness and achievement. Brittany asks: Can you “erase” feelings of sadness and depression by shining lasers in the patient’s eyes? James asks about the use of TEAM methods in the NHS in the UK Brian asks: Is positive reframing the most successful technique you have used with your patients? 1. Kieran asks (slightly edited for clarity): How would you talk back to negative thoughts like this one: “It's not fair that I can't afford quality food when there are millionaires that will have access to better food and a healthier lifestyle which has an effect on overall health and longevity'”? Or what if you feel like it’s unfair that you should have to pay a lot of money for an expensive dental treatment that you can’t afford? Kieran also asks (slightly edited by david): What if worthwhileness is not based on achievement but there are still things you would like to have and enjoy? They would buy and own things that they happen to like and not to impress others. Hi David and Ronda, and if Matt is on I have been listening to your wonderful podcast for about the last 3 years as I drive to work. It has really opened my eyes about how your thoughts create your interpersonal reality. Loved the podcasts on jealousy addiction, perfectionism, achievement addiction and many more. My questions would be: What about if someone wants to achieve more but it isn't based on worthwhileness? They would buy and own things that they happen to like and not to impress others. Let's say they wanted to be able to afford a nice house, healthier higher quality food and water. As the quality does have an effect on health especially in the US as the regulations are not the greatest. However, the fact that they couldn't afford to buy these upsets them? Thoughts: 'It's not fair that I can't afford quality food but there are millionaires that will have access to better food, lifestyle which has an effect on overall health and longevity' Or if someone has to pay for unexpected expensive dental treatment. Thoughts: 'It's not fair that I have to pay £14,000 for this treatment'. 'It should be more affordable to lower income households, as it is essential to have functional teeth' I hope I have explained this well, I would love to hear your thoughts. Keep doing what you are doing and all the best. Kieran   David’s response Sure Kieran, if you like I will make this an Ask David question for a podcast. LMK if that’s okay, and if it is okay to use your first name. Great question, and has to do with the theme of acceptance: should I or shouldn’t I? Here are the quick versions, but we can discuss in more detail on the live podcast. First, I do not find it useful to base my worthwhileness on my achievements or on my failures. I do work hard and like creating things that are helpful to people, and I enjoy earning money to support my family. I can be motivated to work hard to get things we want or need, but I don’t base anyone’s worthwhileness on how much money they have, or anything, to be honest. In fact, I could also easily accept wanting to buy something really cool, not just because I like it, but because it might impress others, or because they might find it fascinating, too! I don’t try to regulate my life with a lot of shoulds and shouldn’ts, and find that I am happier and more peaceful without lots of shoulds. In the Feeling Great App I have created a class called “Your PhD in Shoulds.” You might enjoy it! Second, you can say that it is unfair that some people have more money and resources than other people if you like. And you have every right to feel angry if that’s what you want, as well. Acceptance is more of a decision than a technique. Take the fact that lions kill deer when they are hungry. You can say, “they should not do that. It’s unfair!” But that won’t stop a hungry lion. You don’t have to LIKE seeing a lion kill an innocent deer, but you can accept it. Again, that’s a choice. The behavior of a lion is dominated by millions of years of evolution. Humans are no different. One thing that sometimes helps is to make a list all the REALLY GOOD reasons NOT to accept the “unfairness” in the world. I’ll bet you could come up with at least ten to fifteen strong reasons. Then you can ask yourself, “Given all those good reason NOT to accept the fact that some people have more and some people have fewer resources, maybe I should just stay good and angry! Why in the world would I want to change?” Also, when you find an injustice, you can use your energy being good and angry, and complain about it, or you can use your energy to do something about it. Or, you can also work to change yourself, instead of complaining about the world. I also have a new class on acceptance. It’s called, “Accept this shit? Hell NO!” You might like it as well. I am babbling so will stop. Warmly, david   2. Brittany asks: Can you “erase” feelings of sadness and depression by shining lasers in the patient’s eyes? Hi David, My husband’s boss was telling him she’s going to be doing some laser therapy to “cure” her depression. She had to undergo 9 hours of testing to see if she’d be a candidate. Apparently, they plan to shine lasers in her eyes to “erase” her sadness. Obviously, I assume this is a load of garbage. But have you ever heard of such a thing? Is this just hypnosis? Best, Brittany David’s Reply Hi Brittany, Probably. As they say, follow the money! There is a placebo effect if you believe something will help, so tons of garbage gets served up as costly gourmet food. You can read up on this on the internet I suspect. Let me know what you learn! Best, david Brittany responds to David Love your answer! I was looking into it and read they use a cold laser in the eyes which allegedly releases endorphins. I already know from you that just like with exercise and that study about the endorphin blockers, it made no difference. People just feel better because they think they are doing something good for their body by exercising. They also allege that the lasers aid damaged neurological tissue. They claim it has helped many patients but there is no data backing it up that I see. They really lost me when I read that lack of activity, stress, and maternal deprivation cause depression in the first place. Thanks! Brittany David adds As it turns out, I know two laser experts who are regulars on my Sunday hikes. Dr. Alexander Makowski is a brilliant scientist who is involved in the research and development of lasers and their marketing. Here is his email, along with some terrific links to articles about the hype of “low light lasers.” Hope you enjoy the email and links from Alex: Hi David, I'll chime in too! From a different angle. Zak knows some great doctors who are doing real work, but the general field of low-level laser/ light therapy (LLLT) for medical issues has been fraught with charlatans for some years. (David note: Zak is a laser expert at the Stanford Medical School and is currently preparing a blog on the topic of LLLT. I will include a link to her blog when it is published, likely in a couple weeks. She is awesome and also often joins our Sunday hikes!) Dr, Alex Makowsy continues Good work by Tiina Kaaru (https://www.spiedigitallibrary.org/profile/Tiina.Karu-8010) and Juanita Anders (https://www.usuhs.edu/profile/juanita-anders-ms-phd) on mechanisms behind using light to stimulate our mitochondria or deactivate infectious bacteria are well documents However, the good work done by the few was overshadowed and worse, was perverted for many years into crackpot devices using bad stats and poorly designed studies. Or sometimes just straight preying on vulnerable people. It is the great shame of the laser industry. Worse yet, some of these devices were actual lasers that led to people getting hurt. I can't recommend in good conscience that lasers be shone into eyes at any time other than diagnostic devices meant to diagnose the eye itself. It may be that some day soon a good scientific body of evidence changes my stance but not yet... The story starts in the origin of my journey into light and lasers. I got involved in this field in 2005 while taking an elective class on optics and lasers when I got a call from my mom that she was seeking a laser therapy for her fibromyalgia. My mother's desire to get her fibromyalgia treated with a "cold laser" pulled me into this field since I was taking a class with a professor who later became my doctoral mentor. A full semester of my free time disappeared as I tried to source out of print articles and do a deep dive on whether this was real or garbage. A research term paper and a conference visit later I could finally see the same trends you saw with medication. I talked her out of the potentially dangerous unproven device usage. [As you may have suspected, In fact my mom was having significant issues in her marriage and life and a very good doctor set her straight. My mom divorced and is now happily remarried, about 95 pounds lighter, no fibromyalgia or serious insomnia. If only we had known you back then she would have recovered in a session or two rather than 3 years] However, in the process, I dug into some of the real research that small doses of light can affect our bodies in ways we don't understand fully due to lack of research. Fast forward several decades and some of the best researchers survived the public scandal of LLLT and found a scientific mechanism (cytochrome c oxidase activation) to explain observed changes in mitochondrial activity. However, the scientists don't claim to cure everything or anything. Then they published this mitochondrial activation and suddenly: This, of course, proves that blogablum does in fact exist and now the truth about the panacea is available for all!! David note: “blogablum” is a fake nonsense word I made up that refers to nothing meaningful. Now continuing with the Alex email: This is a good review of the history and current evidence about it : https://www.mcgill.ca/oss/article/medical-critical-thinking/hype-around-photobiomodulation But if you want the real goods, the hard truth about cold lasers has been out there for over 15 years: Introducing the New Low Level Laser Treatment! youtu.be The following search on YouTube will reveal the secrets of the universe: "cold laser before:2009" Warmly, Alexander J Makowski, Ph.D. Dr. Matt May’s reply Hi David, Thank you for forwarding this question to me.  I am very concerned and wonder if this may fall under the category of 'malpractice'. For one, I am unaware of any FDA approved treatment for depression that involves shining lasers into people’s eyes to erase their sad memories.  For a list of FDA approved treatments for depression, you could refer to: https://www.ncbi.nlm.nih.gov/books/NBK559078/ It's possible that there is new evidence I'm not aware of, but I searched online for studies of light in treatment of depression and was unable to find any placebo-controlled trials.  This is a problem because placebo responses can be so high in the case of depression and anxiety.  There were some studies on light therapy, but nothing fitting the description of 'shining lasers into eyes to erase sad memories'. Other concerns I have relate to the high cost of such an extensive “evaluation”, as well as possible risk of shining lasers into someone’s eyes.  In the absence of evidence supporting the treatment, it seems like a high cost, and potential risk, to the patient, hence my concern for malpractice. It's pretty common for people with depression to feel a sense of desperation, especially after many failed efforts to address their symptoms.  This group of individuals are likely to be extremely susceptible to scams and purveyors of 'snake oil' (sham treatments). It's also concerning to me because the theory behind the idea of shining light into people's eyes to erase sadness doesn't make logical sense to me.  It's a potentially-testable hypothesis, but it's such an absurd hypothesis that I don't see it as worth testing or entertaining. If we are defining depression as some combination of worthless, hopeless, ashamed and guilty feelings, then the hypothesis that such feelings could be meaningfully addressed by such a crude instrument as a laser or a pill or an electrical impulse is absurd. This is because our feelings arise from our thoughts/perceptions.  I've never met a single person or patient who was suffering from depression but had healthy positive thoughts about themselves.  I've also never met someone who had patterns of negative thinking, but felt fine, up-beat and positive. The idea that a pill, a laser, a magnetic pulsation or electrical current could selectively alter the specific thoughts that cause depression doesn't make sense with what we know about the brain and thoughts and feelings.  How could a pill, for example, which crosses the blood-brain barrier and impacts every neuron in the brain, selectively target only the neurons that give rise to depressed thinking?  It's like imagining that we could carpet-bomb a city but only kill the murderers and rapists. I'd encourage all potential clients who are receiving treatment for depression or other conditions to ask their providers for literature that documents the effectiveness of the treatment and to get a second opinion if they are unsure. These are my 2-cents on the topic and I could be completely wrong about it all.  Hoping to hear from others what they think. Also, David, I saw several other people included in the invitation to respond to this question but I didn't see them cc'd.  Perhaps they were bcc'd? Wishing you the best, fondly, Matt David’s reply to Matt Thanks, yes, I have a fantastic response already in the show notes from Dr. Alex Makowski who does research and development of lasers with valid medical applications. His thrust is similar to yours. Our field is littered with junk “scientism” intended to fool and exploit people, similar to the snake oil salespeople who use to go from town to town in America selling magical “elixirs” that “cured” just about everything! But people are endlessly gullible, and con artists are still in endless abundance these days, it seems! Best, david Will add your kind and thoughtful comment to the show notes!   3. James asks about the use of TEAM methods in the NHS in the UK. Hi Rhonda, I hope you are well. I had a couple of questions for an 'ask David' on the podcast if that's okay. A bit of background.... I am Level 1 Team and have attended David's training in Atlanta. I live in the UK and have recently changed career to work in the NHS delivering CBT interventions for patients because David's work inspired me so much. The NHS uses specific interventions for particular diagnoses and because I am in training I have to try and stick to this. I do use the TEAM materials and approach when I can and have already seen some great results. The NHS uses 'Behavioural Activation' for certain patients with Depression and I just wondered what David thought about the effectiveness of this (perhaps compared to Cognitive Restructuring). I believe Beck introduced this into the CBT model as he thought it was useful. Another question was regarding treatment of GAD and whether dividing worries between hypothetical and practical, and then using a certain time to actually worry rather than letting the worries dominate throughout the day was something he thought was useful or had heard about. Thanks so much for all the great work you are all doing and inspiring people all over the world! Kind Regards James Bibby. David’s response Hi James, Thanks for the great questions. In today’s recording of an upcoming Ask David podcast, we can address: The history of “Behavioral Activation,” including the pros and cons of this approach. The history and pros and cons of “Worry Breaks.” The idea of matching a “technique” to a “diagnosis,” as opposed to learning to treat the whole patient with TEAM. The results of our latest research with the Feeling Great App, and whether it might have some value for patients struggling with depression and anxiety disorders in the UK. Best, David Matt’s Thots: Great question! I’m looking forward to discussing. There are certainly some techniques that are more effective, than others, for addressing specific negative thoughts. Meanwhile there are a number of problems that come up when we are, as clinicians, throwing solutions at diagnoses, rather than treating the human being who is suffering. Studies on the treatment of PTSD at the VA, for example, showed veterans often got worse after this approach, in which their diagnosis was matched with a method, ‘prolonged exposure’, without any agenda-setting. This just retraumatized lots of veteran! Similarly, if someone is secretly blaming, and haven’t experienced the ‘death of the blaming self’, they might be assigned ‘communication skills training’, only to see this backfire, because their intent is still to try to change someone, rather than accept them. You might tell a patient with depression that they should go exercise, only to cause them to resist you, ‘you don’t understand, I can’t even get out of bed!’. In short, most therapy fails or even makes patients worse because it doesn’t consider the good reasons to continue to blame, give up, criticize ourselves, etc. 4. Brian asks: Is positive reframing the most successful technique you have used with your patients? I can see how it would cure someone in 2 hours! Feel free to use my question and do and use my name if you wish. I'd be honored. Best, Brian David’s reply Hi Brian, Thanks. Great question! It’s one of the latest powerful techniques, but Ext of Voices might still be the “champion.” Using them in the T, E, A, M sequence is especially powerful. Positive Reframing often gets them closer, but not quite all the way to enlightenment. Externalization of voices (EOV) often gets them over the finish line, especially if you know how to use it skillfully, incorporating Self-Defense with the Acceptance Paradox and Counter-Attack Technique! In fact, you can incorporate many of my 100 techniques when using EOV, such as Be Specific, Semantic Technique, Examine the Evidence, and a host of other. Best, david Matt’s comments I agree, Positive Reframing and Externalization of Voices are incredibly powerful and it’s often what we’re doing when we see recoveries. What works for a given individual, however, is quite hard to predict, in advance and there’s a ‘process’ to therapy, such that we can’t really skip steps, except in some unusual circumstances. Some other super-powerful methods include Externalization of Resistance, Double Standard, Flooding, Feared Fantasy, and the Hidden Emotion Technique. I’m probably forgetting some. Thanks for listening today! Matt, Rhonda and David

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