Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
412: Ask David: Give-Get Imbalance; Best Anxiety Treatment; Externalization of Voices; and more
Mon, 02 Sep 2024
Feeling Down? Try the Feeling Great App for Free! 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 at FeelingGreat.com! What's a Give-Get Imbalance? What's the Best Treatment for Anxiety and Dysthymia? Can you do Externalization of Voices on Your Own? The show notes for today’s podcast were largely written prior to the show. Tune in to the podcast to hear the discussion of these questions by Rhonda, Matt, and David. And keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks! Suzanna asks: What’s a “Give-Get” imbalance? And how can you get over it? Martin asks: What’s the best treatment for anxiety and dysthymia? Eoghan (pronounced Owen) asks: Can you do Externalization of Voices on your own? 1. Suzanna asks: What’s a “Give-Get” imbalance? And how can you get over it? Description of Suzanna’s problem. Suzanna is a woman with a grown daughter with severe brain damage due to a severe brain infection (viral encephalitis) when she was an infant. Suzanna was constantly giving of herself and catering to her daughter. She explains that her daughter can be very demanding and throws tantrums to get her way, and kind of controls the entire home in this way. She can only talk a little and has the vocabulary of about a two-and-a-half-year-old. She can mostly express the things she wants or doesn`t want on a very basic level. She mostly understands what I want from her, but mostly does not want to do what I ask her to do. She can be very stubborn. And I cannot reason with her because she has her own logic and, in her eyes, only her logic is valid. Maybe all a little bit like a two-and-a-half-year-old. Suzanna struggles with negative feelings including guilt, anxiety and depression, because she is constantly giving, giving, giving and feeling exhausted and resentful. And she tells herself, “I should be a better mum.” Can you spot any distortions in this thought? Put your ideas in the text box, or jot them down on a piece of paper, and then I’ll share my thinking with you! What are the distortions in the thought, “I should be a better mum”? There are many distortions in this thought, including All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Magnification and Minimization, Emotional Reasoning, Self-Directed Should Statements, and Self-Blame. There may be one or two more, too! The first step in change nearly always includes dealing with motivation and resistance. Suzanna decided to do a Cost-Benefit Analysis, as you can see below, and a revision of her Self-Defeating Belief, as you can see below. Another helpful step might include “No Practice,” which simply means saying “no” so you don’t constantly get trapped by “giving,” as well as “giving in.” A third critically important strategy involves the mom and dad making the decision to work together as a loving team in the management of a troubled child, rather than fighting and arguing with each other, as we've discussed on previous podcasts. However, in many, or possibly most cases, the parents are not willing to do this. They are more concerned about being "right" and so they continue to do battle with each other, as well as the child who needs a more loving structure. David Cost-Benefit Analysis Self-Defeating Belief: I should be a better mum to my daughter Advantages of this belief(How does believing this help me?) Disadvantages of this belief(How does believing this hurt me?) This thought motivates me to: Put myself out. Push myself to give what I have. Find ways to advance her development. Find ways to involve her in everyday life. Invest myself into her and her life as much as I can, physically, emotionally and time wise. Try to find ways that my daughter can have a fulfilling life. Try hard to connect to her, her pain, her needs, her sadness and her frustration. Try to make her life as easy as possible. Try my hardest to see her world through her eyes and gain deeper understanding of how she feels. Try to understand what is upsetting her when she throws a tantrum. Stay healthy and fit to have energy for her. Try to make her life rewarding and meaningful. Fulfill my duty as a mum to my daughter who needs my support. I can feel good about myself. I satisfy other people’s expectations of me. Protects me from criticisms from my husband I am a prisoner to my daughter. No matter how hard I try I don`t seem to make a meaningful difference to her life and to her development. I am a “Siamese Twin” to her. I cannot move or do anything if she doesn`t want to. I reason with my emotions instead of thinking rational at times. I let my daughter get away with “murder”. I find excuses for her behaviour. I find excuses for her why she cannot behave differently. I beat up on myself when I feel I failed her. I take all responsibilities away from My daughter and make them my own. I blame myself when I cannot motivate her to do something. I blame myself when she is bored and unhappy. I feel guilty doing my own things. I feel guilty when I do not involve her in my activities. I feel guilty when I expect her to do entertain herself for a while. I cannot live my own life. I cannot be myself at times. She rules my life, and she lives my life. I feel trapped and frustrated. I feel I need to constantly entertain her. I feel responsible for her happiness. I feel responsible when My daughter is sad and frustrated. I feel exhausted and overwhelmed at times. I feel unhappy and unfulfilled. Advantages: 20 Disadvantages: 80 Semantic Method: Re write your personal value I want to be a mum to My daughter and help her along and invest myself into her. But I also want to treat myself the way I treat her. She has a “right” to live a happy and fulfilling life, but so do I. Our needs and desires are equally important and deserve the same attention and care. I can only continue to look after My daughter well if I look after myself too and take myself and my needs and desires as seriously as I do hers. There needs to be a give-get balance so that both of us can be healthy and happy and stay healthy and happy. I want to help her to slowly take new steps into independence and support her lovingly along the way. 2. What’s the best treatment for anxiety and dysthymia? Hello Dr. Burns, What method of treatment would you suggest for GAD and dysthymia? 3rd wave CBT, ACT? What is best based on science? Can you recommend some books please? thank you Martin David’s Reply My books are listed on my website, FeelingGood.com. They all describe my approach, which is a bit like CBT on steroids. But every patient is treated individually and uniquely, following a structured and systematic approach that facilitates rapid and dramatic change. I don’t recommend “methods of treatment” or “schools of therapy” based on so-called “diagnoses,” but treat the individual with TEAM. Every session with every patient is an experiment, with precise measures at the start and end of every session. The new Feeling Great App, now available, gets a mean of 50% or more reductions in seven negative feelings, such as depression, anxiety, and more, in 72 minutes of starting to use the bot. You can check it out for free! Anxiety and depression often co-exist, and the app targets both. My book, When Panic Attacks, describes my approach to anxiety, based on four models of treatment: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. If you use the search function, you can find podcasts describing those models. Also, there's a free anxiety class on this website. Thanks, Martín, for your excellent question! Best, david 3. Can you do Externalization of Voices on your own? Hi David, Long time listener of your great podcast and huge fan of your book Feeling Great. I’ve often heard you mention that “externalization of voices” is one of, if not the most powerful CBT techniques. I am just wondering if it is still almost as effective when done solo without a therapist i.e. the person takes on both the roles of positive and negative by recording themselves talking or similar? Also, have you any data comparing the efficacy of TEAM CBT work carried out solo using Feeling Great/your podcast as a guide vs. TEAM CBT performed with a trained TEAM therapist? I am very much looking forward to the Feeling Great app launch in the UK as hopefully that will be a much more effective way to do personal work without a therapist. Many thanks, Eoghan (pronounced Owen) David’s reply Thank you, Eoghan! Appreciate your support and thoughtful question. I don’t have any data on the use of EOV on your own. One could use a recording device, like your cell phone, and record your negative thoughts in second person, “you,” and try to defeat them when you play them back, one at a time. But in my experience, people nearly always need an experienced role player to do role reversals to show them how to get to a “huge” win. People almost never get a huge win when doing it for the first time, because the therapist (in the role of positive self) can model unfamiliar strategies for the patient. Generally, a hugely successful response involves a combination of self-defense, self-acceptance, and the CAT, or counter-attack technique. And sometimes other methods as well, like Be Specific, for example Radical new learning is definitely the key to success with EOV. Now, thanks to the app, everyone can practice, since we’ve trained our Obie Bot to role-play with users, do role reversals, give feedback, and so forth. Great question that I will include in the next Ask David if that’s okay! We are also exploring the combination of the Feeling Great App plus a trained TEAM therapist from the Feeling Good Institute in Mountain View, California. We are hoping that 1 + 1 may equal 3. Wouldn’t that be awesome? What I’ve found when doing research is that the results are virtually always wildly unexpected! Somethings come out great, and some things come out dismally. I always tell myself that “the Lord giveth, and the Lord taketh away!” Seems to be the rule in research! Especially when you’re wanting to be guided by the truth, and not so much by your hopes and expectations. Best, David
Hello, and welcome to the Feeling Good Podcast, where you can learn powerful techniques to change the way you feel. I am your host, Dr. Rhonda Barofsky, and joining me here in the Murrieta studio is Dr. David Burns. Dr. Burns is a pioneer in the development of cognitive behavioral therapy and the creator of the new Team Therapy.
He's the author of Feeling Good, which has sold over 5 million copies in the United States and has been translated into over 30 languages. His latest book, Feeling Great, contains powerful new techniques that make rapid recovery possible for many people struggling with depression and anxiety.
Dr. Burns is currently an emeritus adjunct professor of clinical psychiatry at Stanford University School of Medicine. Hello, David, and hello, Matt May. Hello to all of our listeners throughout the world and throughout the galaxy. This is the Feeling Good podcast, and you're listening, or you're about to listen, to episode 412. We're doing another Ask David today, and...
We're going to follow up on what we started last week. Some of our questions are related to self-esteem. I'm going to read someone's endorsement and then go back to their question. Owen wrote us something really simple. He just said, I am a longtime listener of your great podcast and a huge fan of your book, Feeling Good.
Thank you, Owen, and we did include your excellent question, and we'll come to it shortly. So let's dive in.
Yeah, so Ollie wrote a pretty interesting question. I think we could rift off this for a while. Could team therapy, team CBT therapy be helpful to someone in solitary confinement? Dear David, I'm so glad the app is finally available to the public. I was one of the lucky people who got to take part in the beta testing, and I got to personally experience what a life-changing tool it could be.
I just hope the word spreads quickly so more people can be transformed by it. Also, do you have any idea when the app might be available outside of the United States? My question for you is around the topic of solitary confinement. As I'm sure you're already aware, solitary confinement is commonly used throughout prisons around the world, despite many deeming it akin to torture.
Thanks.
By the way, we're going to call it Feeling Great Therapy for the general public rather than Team CBT because people don't quite know what it is. It really isn't CBT, although it has a lot of cognitive therapy in it. Oh, Feeling Great Therapy. Okay. Yeah. I love that. Yeah, we should have like a Feeling Great Therapy Center. Oh, we already have one of those. Cool.
I think there is one.
My answer to that question is it would depend on whether or not the prisoners would be allowed to have an Internet connection, because I think you have to have that to use the app, right? Yes. And because it's a cell phone application, we hope to have it for computer as well. Right now we have it for iPhone and for Android. But I think that could be a great thing for any prisoners who want.
There's always the danger that people are going to misuse a tool. So they may have strict rules about that in prison systems. But I think the... in some way, we're all in solitary confinement. We think we're interacting with each other, but much of the time, our ideas about what other people are thinking and feeling aren't even valid. But the app, I think, could do great for prisoners and
any kind of prison including solitary confinement because there's a tremendous amount of material there to learn and you can change the way you you you think and feel and it would be really really fun to do a study like that and because the app collects data all the time and we could find out right away
if it's helpful to people and to what degree, and also get feedback on if it should be modified to be simplified or whatever. The reason I wrote the book Ten Days to Self-Esteem was because I wanted a super simplified book
version of cognitive therapy and that book is kind of at the fourth or fifth grade level in terms of the language in it and there's just a few paragraphs in each chapter and a lot of interactive exercises to do so we might have to create a you know, like a simplified version of the app that would be suitable for teenagers or people without a lot of education.
At our hospital in Philadelphia, you know, a quarter of our patients couldn't read or write. So we just simplified the 10 secrets of, there were the 10 cognitive distortions and put everything in simple language and it worked great but what are you guys thoughts about that about using the app in prisons or in solitary confinement
Well, I don't believe you're allowed to have a cell phone in prison. So it wouldn't be appropriate to use the app in prison or to think that that's possible. But people are allowed to have books.
And I think someone who has a book, the Feeling Great book, and can follow along the team therapy structure and learning how to identify their thoughts, leading them to change their feelings and their behavior would be very, very, very helpful. for anyone in prison, wherever they are in the prison system.
And there are a lot of people who have been wrongly convicted and then released from prison and written books about their experience. And I put three on the show notes that you wrote that I've read that were pretty transformative. And most of the people, most of the time when people are in prison, they are trying to
And change the way they're thinking about their experience so that they can accept it and maintain some hope of when they are going to be released and belief in their lawyer, belief in the process, belief in themselves so that they can still maintain a sense of who they are.
I wonder if there could be a modification of the way people receive the app, like the prison could receive it and then make just that available to prisoners who desire it.
People do have access to computers. And if so, if you could make the app available on a computer, then maybe somebody could use their computer time and work on the app when it's their turn, especially if you can have one file for each person that's confidential that other people can't get into.
Yeah, right. Well, if there was any interest among prisons or prisoners or something, I could talk it up with our app team, but I don't like to chase people with things, especially things that require a lot of time and effort.
But if there was some interest in it, it would be, I think, fairly interesting, even just knowing how depressed and angry and anxious and violent and suicidal people are feeling.
Yeah, I think if I were going into solitary confinement, I would be feeling extremely grateful to have the skills and methods and tools that are in team therapy for that experience. I think there's a little bit of a paradox if we consider that solitary confinement is very similar as a situation to a silent meditation retreat.
that people would pay a lot of money to go to experience something really wonderful in their life. And I think that could be kind of confusing until we look at the cognitive model that what would shape your experience in solitary confinement or in a silent meditation is exclusively what you're thinking in those situations.
And so to have the skills to address your negative thoughts as they're coming up would be of tremendous value. Yeah.
To relieve your suffering, relieve your depression, your anxiety, your feelings of worthlessness, your feelings of rage. Right. Frustration, helplessness.
Yeah, my concern about the prison system is it's probably using that punishment as a deterrent for bad behavior. So they're not likely to want it to be a pleasant experience for prisoners. And I think we could debate whether that's an appropriate way to treat anyone is to lock them up and ignore them. I'm skeptical of that being a way of reforming behavior.
I don't think that people come out of that experience highly motivated to connect with others and feeling better about society and wanting to play by the rules. I think they probably come out more bitter or more depressed, more resentful.
So let's jump over to Susanna, who asked, what's a give-get imbalance and how can you get over it? So here's a description of Susanna's problem. Susanna is a woman with a grown daughter who has severe brain damage due to a severe brain infection, viral encephalitis, when she was an infant. Susanna was constantly giving herself... giving of herself and catering to her daughter.
She explains that her daughter can be very demanding and throws tantrums to get her way and kind of controls the entire house this way, the entire home. She can only talk a little and has the vocabulary of about a two and a half year old. She can mostly express the things she wants or doesn't want on a very basic level. She mostly understands what I want from her
but mostly does not want to do what I ask her to do. She can be very stubborn and I cannot reason with her because she has her own logic. And in her eyes, only her logic is valid. Maybe all a little bit like a two and a half year old.
Susanna struggles with negative feelings, including guilt, anxiety, and depression because she is constantly giving, giving, giving, and feeling exhausted and resentful. And she tells herself, I should be a better mom. David, you asked, can you spot any distortions in her thought, I should be a better mom?
Okay, so we should answer that, should we? Should we have the listeners just take a piece of paper and turn off your device for a minute and write down, what are the distortions in I should be a better mom? And then the question is, how is Susanna going to get out of this trap? But I can give you a follow-up. Okay.
So we're asking the listeners to turn their devices off, write down what they think are the cognitive distortions in the thought, I should be a better mom. And then after they've written off what they believe are the distortions and why those are distortions, turn back their device and start listening again.
Yeah. Okay. Okay. Okay, welcome back to the show. Did you turn your device off and write some things down on a piece of paper? No, you didn't? I can see that you didn't, but I love you anyway. What are the distortions in I Should Be a Better Mom?
Well, clearly, it's a should statement. She's shoulding on herself, right? Why don't we like should statements? Because they're commands and they're ways of beating ourselves up.
That's true. Any other distortions? Is that the only one? No. Any other distortions? I see a bunch more. Oh, a bunch more. Let's take turns.
Let's go back and forth. Yeah.
Yeah. What did you find out in that one? What distortions, Matt?
Another one that I saw was discounting the positive or just focusing on the negative, focusing on errors or times when she's upset rather than when she's being patient and loving and kind.
Yeah, and all the amazing things she's done for her daughter. Yeah. What else do you see there?
I see overgeneralization, that she's taking one moment in time when she's feeling frustrated and tired and not getting the result that she wants and blowing that up and saying, I'm always a bad mom.
Yeah, absolutely, absolutely. I'll take a turn and add— emotional reasoning. I feel like I'm not a good enough mom. So I must not be and I should be a better mom. How about you, Matt? Any others?
There's almost always all or nothing thinking hidden somewhere in a negative thought. And perhaps in this case, parenthetically, she's thinking, you know, I'm never a good enough mom or I'm always a bad mom. Yeah. I'm never good enough on some scale of awesome momness. Yeah.
And your turn. So it seems...
It seems kind of obvious that it's both magnification and minimization.
Yeah, absolutely.
She's minimizing the incredible good mothering that she's doing, and she's magnifying any errors or mistakes or challenges that she's having.
Right, and then it's my turn. How about self-blame? And why is that? She's beating up on herself because her daughter's misbehaving. Well, a give-get imbalance is a special hell for people who are overly nice, who struggle with anxiety disorders.
Niceness is, to my way of thinking, one of the major causes of all forms of anxiety because you're constantly trying to please other people and not attending to how you feel inside. And and then you can also feel like what you were talking about last podcast, the approval addiction, Matt, that I need everyone's approval.
And I always have to please other people, even at the expense of my own needs and feelings. And so you're always trying to give, give, give to others. and expecting some wonderful thing in return, which you never get. And so you end up being burned out and angry and resentful. and very anxious, as this woman, Susanna, has been feeling. And a couple tools that were very helpful to her.
One was the cost-benefit analysis, which is a motivational tool we talked about last podcast. But what are the advantages and disadvantages of telling yourself, I should be a better mom? And there's a long list in the show notes that you can read hers. But what do you folks see as some of the advantages and disadvantages?
Or you can look at the show notes and see if you can find some that make sense.
Well, it's motivating. it's a challenging situation to raise a child who has the condition that her daughter has. And so when she's telling herself, I should be a better mom, it's, it's constantly motivating her to be the best caretaker that she could be for her daughter.
Sure. What are some more advantages, Matt, benefits for her?
Yeah, I've, I've been the victim of many should statements in my own mind. And it all, it often seems like it's the, right thing to do, that I should be beating up on myself or punishing myself if I've failed at something that's really important to me. So my guess is that her value system is around being a wonderful mom.
And if she makes some error around that, she beats up on herself because at some level she believes she deserves it. She hasn't earned the right to feel good if she's not performing at a really high level as a mom.
Yeah, right. Any others you can think of, Rhonda?
Well, I imagine that she's revolved her life now around parenting her daughter. And so she has an identity about being a good mom or the best mom. And so that thought, I should be a better mom, you know, keeps her fulfilling that self-identity and that, yeah.
Yeah. Yeah, and she has a lot of benefits on the show notes. If you look at the cost-benefit analysis, I'm motivated to try to make her life rewarding and meaningful, and I try to fulfill my duty as a mom to my daughter who needs my support, and a lot of things like... A lot of benefits like that.
And then what are some of the downsides of doing this, you know, telling yourself I should be a better mom?
Well, I think to a certain at a certain point, could one disadvantage be that she beats up on herself because of that thought? We were saying that one of the disadvantages of having that thought, I should be a better mom, is that she would beat up on herself, leading to feelings of anger and resentment. And what else did you say, Matt?
Maybe guilt or shame. And then associating those feelings with spending time with her daughter would be bad for the relationship.
Yeah. Yeah. Yeah. She put, I feel guilty doing my own things. I feel guilty when I do not involve her in my activities. I cannot live my own life. I cannot be myself at times. She rules my life and she lives my life. I feel trapped and frustrated. I feel I need to constantly entertain her, and on and on. There's a long list.
And then she looked at the advantages versus the disadvantages and decided that the disadvantages are really much greater. And it turned out to be surprisingly helpful to her. Her mindset suddenly changed greatly after having struggled with this problem for years. For many years. But in addition, another point is that I pointed out to her that, well, then she revised it.
You know, you can see her revised version. What can she tell herself instead of, I should be a good mom?
So she used the semantic technique.
Yeah, just to reword it, but in a way that's not going to be so dysfunctional for you. And she said, I also want to treat myself the way I treat her. She has the right to live a happy and fulfilling life, but so do I. And she wrote a really beautiful refutation of that thought.
And then the thing that— Oh, can we read her whole writing? Yeah.
Oh, sure. You go ahead. It's beautiful. Yeah. Read it, Rhonda.
Yeah. So she rewrote that thought. I should be a better mom. And she said, I want to be a mom to my daughter and help her along and invest myself into her. But I also want to treat myself the way I treat her. She has a right to live a happy and fulfilling life, but so do I. Our needs and our desires are equally important and deserve the same attention and care.
I can only continue to look after my daughter well if I look after myself too and take myself and my needs and my desires as seriously as I do hers. There needs to be a get-give balance so that both of us can be healthy and happy and stay healthy and happy. I want to help her to slowly take new steps into independence and support her lovingly along the way.
And that was beautiful. Yeah, and it was very helpful to her. And this is a very intelligent and hardworking and giving woman. But we took it then one step further that might be of some value too. But to make a long story short before we get on to that, if you are yourself in a give-get imbalance, that means you're always saying yes to people who make demands on you.
And that can be a kind of addiction, but also a recipe for long-term unhappiness, as it was for this woman who I'm calling Suzanne or Susanna or something of that nature. And, yeah, Susanna, we're calling her Susanna. And the other dimension to it is that I reminded her that the daughter's playing mom and dad against each other, and so they don't work together as a team.
And that's where the daughter gets all of her power, by the tension between the mother and father who constantly disagree about on what strategy they should use with their daughter. And I told her, Susanna, who's the one I communicate with, that if you and your husband worked together as a team, you'd have far more power than your daughter does.
And her behavior would suddenly change in a positive way. But the reason she gets so ornery is because she has power, and all of her power comes from the disagreements between the two of you. And then Susanna told me, well, and she's very good with the five secrets, Susanna is.
And I said, you know, when you talk to your husband about the things that you're in conflict over, you could use the five secrets. And then she said, oh, I've tried that, and it wouldn't work. And I said, how much do you believe that? And she said, oh, 100%. He's absolutely impossible.
And then I pointed out to her that I had pushed her on multiple previous occasions to use the five secrets with her husband. And it was totally effective 100% of the time. And I reminded her of that. And she said, oh, my gosh, I forgot. And it's almost as if she was in a hypnotic trance, telling herself, you know, this is a hopeless situation. This is a helpless situation.
It's been going on for years. Nothing can be done. And she was just telling herself a lot of things that weren't. True, and she's a very honest person and a very open person, but you get into these spells that lead to conflict, marital conflict, and other spells that lead to panic and anxiety and other hypnotic trances that lead to depression.
But now she's suddenly kind of been born again, and she says, I've been telling myself I can't do it. Now I'm telling myself I can do it. So stay tuned, and we'll get some follow-up from this very wonderful person. But I thought that that... Give-get imbalance would be a kind of a nice concept to bring to our listeners because there are several reasons people get into a give-get imbalance.
And what are some of them, Rhonda and Matt? What are the characteristics of a person who gets into a give-get imbalance? And then secondly, what's the cure?
Yeah, so they're often very nice people. uh, anxious, um, avoidant, people pleasing, wanting to avoid any type of conflict. They value peace and harmony in their relationships. Yeah. They don't want to rock the boat.
Yeah. And it makes you feel good to say yes, because then the other person appreciates you and praises you and makes you feel special. Uh, right.
Right. And it seems good in the short term.
Yeah. And, uh, But then you don't get, typically you don't get anything much, if anything, in return. And another reason people get into it is people might say, oh, can you do this activity with us? And then you get to thinking, oh, I don't want to miss out on the fun. I've got to go along with this and, you know, go to this activity or go to that activity.
And then the solution to it is what one of the feared fantasy techniques called no practice. You remember that one, Rhonda and Matt? No, I don't remember that. You don't? Matt, we're going to do a special recording tonight because Rhonda works late and I work late. And then we're going to do a special podcast recording tonight at 830. And we'd really like you to join us. Can you do that?
I'm afraid I'll be winding down for the day. Okay. I'd love to spend time with both of you, but I'll be too sleepy.
But if you cared about us, you'd help us out. I mean, you've helped us out so many other times.
Oh, I feel guilty and bad for not showing you how much I care about both of you.
And not only that, but it's going to be really fun. We're going to be talking about something that we've never talked about ever before.
Okay.
Well, I'll have to politely decline.
Okay, well, that's no practice. It's a bit funny, but it's a good technique to practice saying no and have somebody try to talk you into something and just be kind and persistent in saying no. And that's one of the solutions to a give-get imbalance. And it's also based on the Buddhist notion or perhaps also the Christian notion or perhaps also the Jewish notion. I don't know the...
the mysticism behind all the different religions, but that we're all one. And the idea that you can make another person happy while making yourself miserable is not valid to my way of thinking, and that we either go up or down together. And so if you're making yourself miserable in order to please or serve some other person, you're probably not making them happy either.
And sometimes becoming assertive and sticking up for yourself a little bit in a dignified and loving but persistent way can actually lead to greater happiness for the other person in the long run as well, because you are not going to be carrying all this resentment and burned outness. So that's my little sermon for today, for whatever it's worth.
I loved it. I loved it. I had a couple other comments just on that pattern since I've lived it myself personally. One observation was that it seemed like resentment would kind of build up over time, like water behind a dam. If I was operating under the system, like I'll just always be nice and expect other people to reciprocate.
If I was expecting that and it didn't happen, I'd feel a little bit resentful, but I still wouldn't want to rock the boat. And so I wouldn't bring up my feelings. And then it would like build up over time. And eventually it would be like some straw would break my back and my feelings would come out in a way that I didn't like that. I, you know, it's like it was rushing out of the dam.
And so that was a terrible consequence of this rule, interpersonal rule that I had to always be nice. And the other thing that really helped me was the double standard technique, where I would imagine, would I tell someone else that they should be a better mom or a better person? Would I communicate to someone else in all these critical ways? And as a nice person, I just wouldn't do that.
And it helped me see that double standard and let go of it. And I've noticed that that works really well when people are prone to being nice, is they can just employ that tendency to help themselves.
So have you actually implemented that in your own life and not given in and not said yes so much?
Yes, I have. It's been very helpful to me. A little healthy selfishness.
Yeah, that's right. You can call it selfishness training. And sometimes we all need a little selfishness training in order to be really loving to others. Well, let's push on here. We still have two good questions. In the next one, let's use the name Marvin for the next person. I've changed it here in the show notes.
Okay. So Marvin wrote, what is the best treatment for anxiety and dysthymia? Hello, Dr. Burns. What method of treatment would you suggest for generalized anxiety disorder and for dysthymia?
By the way, dysthymia means chronic, mildish type depression.
Would you suggest third wave cognitive behavioral therapy, acceptance and commitment therapy? What is best based on science? Can you recommend some books, please? Thank you, Marvin.
All right, I'll let you folks take first crack at this one.
Well, you always say we treat people, not diagnoses. So the best treatment would be whatever works best for the person who is experiencing whatever it is they're experiencing in this moment.
And that it would almost certainly include testing, careful measurement of mood to know if you're making progress or not, as well as empathy. careful agenda setting to address motivational barriers to improving, and a whole host of methods, each of which has some small chance of success.
But we'd want to have not assumed that every person will be responding identically to different methods just because they carry the same diagnosis.
Sure. Now, Marvin's asking for some specific recommendations here. Where would he find this special kind of individualized therapy? And does it have a name?
Well, I would suggest that he start off with the book Feeling Great by David Burns.
Or When Panic Attacks by David Burns.
Yeah, that way he could get a feel for it. He's also written to me and he's in what I would call a – he sent me a long, long email that I mentioned last week. podcast that he's kind of in a blizzard of negativity, including anger and depression. And I think one very important thing is you can't get anywhere by working on a kind of an abstract level with
diagnostic terms and schools of therapy, but you have to zero in on one specific moment. I always tell people I can only help you for one five-second moment in your life, and I think Buddha had that exact same policy. You can only be helped to change yourself for one brief moment.
But according to Buddhism, what somebody told me, you would know because I haven't studied Buddhism, you might know, Rhonda or Matt, but that if you could just change yourself for one, five seconds of your life, then you'd experience enlightenment and peace. And you wouldn't have to keep being reincarnated anymore.
And I first heard that from a fellow who just came up and started talking to me on the street. When I was in Bryn Mawr, a young fellow came up and started explaining that to me. And I didn't know who he was or why he was doing that.
But then, and it didn't seem to make any sense until then, you know, days later, I got to thinking about my practice and how right on that was, that you can only change yourself for one second, two or three seconds. But all of your problems will be encapsulated in that two or three second period. So if you say, here's one specific moment I had, and then I'll be glad to help you with that.
And we can create a daily mood log and see what the situation was and what your feelings were and what your negative thoughts were and who you were interacting with. And then See if it's an individual mood problem or a relationship conflict and then come in with some specific tools first to melt away your resistance to change.
And secondly, and then if you really do want to change, then some specific tools. And we use over 140 tools in Team CBT or what we're thinking of changing the name to Feeling Great Therapy so it has an easier name. and you can eliminate your negative feelings for that one moment, then that same pattern, you'll see why you're depressed and angry and anxious.
Every time, it'll always be the same thing. The details will be different, but the basic pattern will be the same. And the method that works for you at that one moment will always work for you.
And so when I'm working with people, that's what I always do when I encounter people who have this thing I've always called the blizzard of depression, where you get so overwhelmed because the patient is telling you like 30, 40, 50 things that they're mad about or upset about, and you get kind of short of breath even listening or trying to hear the whole story.
But the solution is, you know, and this fellow is quite intelligent in fractal mathematics. I can't remember the name of it, but it's... But it's the idea that everything is captured in one brief moment, and that's true in nature. Like a tree, the leaves, it's always the same pattern repeating itself.
And if you look at a leaf with a powerful magnifying glass, the whole pattern of the leaf will always be repeated. fully represented in any tiny spot you look at. It's just the same pattern going over and over again. It's the same with our lives. And so that's the way you crawl out of, you know, a so-called blizzard of depression or anxiety.
And that actually is one of the keystones of what we call team CBT or feeling great therapy or whatever.
Yeah, it's a strange paradox, right? Because you would imagine that you would want to address your whole life to be able, rather than focus in on one moment, but realizing that our whole life is just a repeating pattern of thinking. And that if we defeat that thinking in one moment, then we have the tools to do it in every other moment. Yeah.
Which is exciting. Yeah.
It is. It's a relief, too, because if you're living in that blizzard or interacting with someone who's in that blizzard all the time, it becomes pretty unpleasant for everybody.
Mm-hmm. Well, here's our last question for today. Can you do externalization of voices on your own? Hi, David. This is from Owen, and we started off the podcast today with his endorsement. I'm going to repeat it. I'm a longtime listener of your great podcast and a huge fan of your book, Feeling Great.
I've often heard you mention that externalization of voices is one of, if not the most powerful CBT techniques. I'm just wondering if it is still almost as effective when done solo without a therapist. For example, if the person takes on both the roles of positive and negative by recording themselves talking or something similar to that.
Also, do you have any data comparing the efficacy of Team CBT work carried out solo using the Feeling Great book or your podcast as a guide versus Team CBT performed with a trained team therapist? I'm very much looking forward to the Feeling Great app launch in the United Kingdom, as hopefully that will be a much more effective way to do personal work without a therapist. Many thanks, Owen.
Well, thank you, Owen, for the kind comment, first of all, and the two great questions. First of all, we do have our first... data analysis from the latest version of the app where we're using Feeling Great AI. Our previous versions of the Feeling Great app didn't have full-blown AI, and now we're using full-blown AI, and we've actually trained our AI to be pretty much like David. We're trying to
take my identity and turn it into the the ai so so that when you're working with our bot it's pretty much almost identical to to working with david in in real time we're not doing therapy it's a self-help tool but we're trying to use all of the techniques including externalization of voices
And whether you can do this solo, we have the answer to that because I just analyzed data on something like 200 patients the first time they sat down with the app. And so we just have... from them for about the first couple of hours that they were working with the AI to see what would be the effect of that.
And the mean time that they spent on the app, the first time they sat down with it, was 72 minutes. And then we recorded the improvement in seven different negative emotions, depression, anxiety, shame, inadequacy, loneliness, hopelessness, and anger. And all of those emotions went down, I would say, to make a generalization, the mean was slightly over 50%.
They all went down approximately the same with just a few percents, but it was a little over 50% within roughly one hour. Now, if you compare that,
to psychotherapy outcome studies, which are generally just focused on one emotion, like depression, over a period of, say, three months or six months or a year, or a lot of the outcome studies, two years, you see that fewer than 50% of the patients have even a 50% Improvement, you know, after a year and we're getting that within 72 minutes.
So the answer is yes, you can do great things using the app on your own. But some people are definitely not going to respond to the app or to any single treatment. And they're a trained team therapist or maybe any therapist could help people get unstuck.
And keep in mind, never forget that the 95% of stuckness, when people fail with any type of therapy, it's because of resistance that has not been dealt with or recognized and certainly not eliminated by the therapist. People don't fail because of a lack of methods for the most part. They fail because their subconscious or conscious resistance hasn't been dealt with.
And then the answer to the externalization of voices, the app, we have trained it to do externalization of voices, and it does a nice job. The app is not yet fully enlightened, and a therapist can never bring a patient to a level higher than what you have achieved because water cannot rise higher than its source.
And the AI that we've trained, it's about maybe 60% enlightened, but it's not in full-blown enlightenment yet. But it still does a beautiful job with the acceptance paradox, the self-defense, and the counterattack technique. And we're now training the app to see if we can get it to full enlightenment, which would be tremendously exciting.
And, of course, the thing that it's not quite grasping is the same as the limitation that humans have is the full-blown acceptance. They give a kind of a partial acceptance but not seeing the full acceptance. I could give you examples or something. But it's exciting, and it does a damn good job.
And it's exciting to think what the implications might be once the word gets out and people start using the app in large numbers. So far, we're not formally announcing its release, but it is available in app stores and in the... You know, both app stores, I should say, the Android and the iPhone. And then we'll have it for computer fairly soon as well.
Cool. I have a couple of thoughts. I really like Owen's question. And I think for folks who can successfully do externalization of voices on their own, they're essentially cured, right? That would be a metric of whether or not they're ready to graduate from therapy.
And I would say that it's hard to do that on your own because it's unlikely, not only for the reasons that David mentioned, which is that there will be hidden resistance that will make it such that you wouldn't be motivated to defeat the thought, but often because when most people are trying externalization of voices, they tend towards the defense only responses.
And it's really useful to hear a therapist use the acceptance paradox or the counterattack or just Socratic technique or other methods that might be more effective or more effective in combination. And so often I recommend that my patients make an audio recording of
of successful externalization of voices that they've done with their therapist and then to play that back and then to practice on their own. And I think in other podcasts, we've mentioned versions of externalization of voices that you do on a folded sheet of paper where one side is your critical thoughts and the other side is your responses.
And I have seen that be effective for myself and for many of my patients with a little extra training. They can do externalization of voices on their own. And that's before we had the app. So I think with the app, it would be far more effective.
Yeah, I love your comments, Matt. I'll give it to Rhonda.
Well, and also one step first, one step before that is if you've identified the negative thoughts of the moment in time when you're struggling and then, you know, actually do some agenda setting with yourself where you ask yourself, what are the feelings say about you that are awesome or speak to your core values or what are the thoughts say about you that somehow give you a benefit or an advantage?
And you go through that and you can see that maybe you don't,
want to give them up completely because they are meeting some kind of a need and and that can be a fun process to do by yourself and an enlightening process to do by yourself as well as a therapist i i had some family visiting over the weekend for the fourth of july when you know right after which is when we're recording this podcast and And part of it didn't go so well on Sunday.
I felt a little depressed. And I learned from Maryland Coffee to fill out brief mood surveys and daily mood logs by myself and go through the whole process of positive reframing before I start trying to talk back to my negative thought. And it makes it a much more fulfilling and successful process.
I wonder, Rhonda and Matt, before we quit today, if we could make all this come to life by demonstrating an externalization of voices and the difference between, you know, a partially good response and the full blown and enlightened response. And if you guys are open to that, we might just need somebody's negative thought and then we could role play it.
Sure. A classic one would be something like, I'm worthless.
Okay, and that's a good one. That's real good. And then what's your core negative thought, Rhonda?
My core negative thought is I don't matter.
I don't matter. So which one should we work on first? I'm worthless. Worthless or I don't matter? Let's do I'm worthless. I'm worthless. OK, so, Matt, do you want to be someone who has the thought I'm worthless and be the positive thoughts and Rhonda and I will attack you and see if you can defeat us? That sounds great. Yeah. Okay, you want to start off now with the negative self.
We'll sound like other people, but we're all named Matt, and Rhonda and David will be the negative Matt, and we'll speak in the second person, you. And then Matt will try to defend himself in the first person, I. So we'll see what happens. Matt, sorry to tell you, but— You can start it off if you want, Rhonda.
Okay. Sorry to tell you, Matt, but you're worthless.
I think I detect my negative thoughts coming at me. And, you know, I've got a lot to do today. I don't think I have time to listen to that.
Who won that, Matt?
I felt good about that one. I tried the kind of counterattack.
So is that a small or a large win?
I felt like it was a I'm not currently suffering with the thought that I'm worthless. So it worked for me. I think there was a lot unsaid. And maybe I'd like to hear a role reversal. Maybe we could try again.
You'll be the negative and Rhonda and I will be the positives. And you can hit either version that you want, either one of us.
Hey Matt, I'm your negative thoughts and I just wanted to let you know that you're worthless.
Wow, I'm feeling really hurt and angry that you said that. And I'm curious, it's such a broad statement. Am I worthless all the time? Is there something specific about what I've done that has little value? I'm feeling like it's confusing and in general... It's really hard to relate to that. So could you be more specific about what it is that you're accusing me of?
I like that response. I think you took away the overgeneralization part that I'm, you know, worthless and defective in all ways at all times. So I like that response. What grade would you give it, Rhonda? I would give it a B. A B, okay.
Yeah, I think it could have been stronger a little.
Maybe I can be Matt's negative thoughts and attack David. OK.
Yeah. And the thing was there, this is like how the how the AI works. Rhonda is not not fully enlightened and that you had a lot of defensiveness there.
Right.
And of course, you're hurt and angry at yourself. And then, you know, all the time, all the time, some of the time. You had a good idea, but you didn't have the spirit of real acceptance. Right. So I'll give it a shot here. I'll be the positive man.
So you're positive, Matt, and I'm Matt's negative thought. Great. Yeah. Oh, hey, Matt. I'm your negative thoughts, and I don't mean to make you feel bad or anything, but I think it's important that you know that you're worthless.
Well, I've suspected that about myself for a long time now. Can you tell me what you noticed? I'm not that bright either. And so in what way did you, you were saying that I'm screwed up? Because I do make a lot of mistakes. I surprisingly, for such a worthless person, I enjoy a lot of successes and wonderful experiences in my life and with my clinical work too.
But what really do you mean when you say I'm I'm worthless, then I'll be able to respond a little better.
I like that a lot. I would give that an A. I would think that's a huge win. I like that you were able to kind of humbly accept and embrace flaws and shortcomings, and even in a joyful way, in a happy way. And that seems like, you know, at the core of the acceptance paradox.
Yeah, that's right. It's just not the words, it's the spirit. And we hope that the artificial intelligence will be intelligent enough to learn that. We don't know yet. Yeah. But, you know, it's just like a student in the Tuesday class. We have to spend a lot of time training it and explaining things to it. But let's try. You want to try it, Rhonda, on your own thought?
I don't matter.
Yeah. Okay. Well, we can. You want to start in your positive self or your negative self?
I want you to attack me with a negative thought.
And the thought is you don't matter? Yeah, okay. You want to be the negative self? You're the negative Rhonda, Matt?
Okay. Hey, Rhonda, I'm your negative thoughts, and I just wanted to give you a really important message, which is that you don't matter.
That is so true. And it's such a great, humbling experience to accept that and to realize that I'm the same as everyone else. And it's a relief and it takes a lot of pressure off me. So yippee.
I like that. How did that feel to you, Rhonda? Was that a win?
That felt really good. And that felt like a win.
A huge win?
A huge win.
Awesome. I liked it. I thought it was a huge win, too.
Okay.
Well, you know that I'm also the negative Rhonda, and I heard you bantering with that. that other negative Rhonda, and kind of winning. But the fact is, Rhonda, you don't matter.
Oh, sure, you're on the Feeling Good podcast, the host of the Feeling Good podcast, and you're a psychologist, and you have a social work degree and all of that, but just you know in your heart of hearts that you don't matter, and you better admit it, sister.
You know what? The truth is I matter to certain people. I matter to Matt and David, and I matter to my husband and my children. I matter to my friends, and I matter to myself. But I don't feel like I have to pressure myself to be any better than anyone else or to matter any more than other people matter. And it is honestly a relief to feel that.
To let go of the striving to matter in general in all ways to all people.
Who won?
I won.
Big or small? Big. Big or huge? I thought that was huge. Yeah, I thought it was huge, too. So that would be modeling with both thoughts kind of different ways of acceptance. And it's not just using the words. It's having the feel that when you go into an enlightened state, those thoughts that used to hurt you so much, they have lost all of their power.
It's like hitting home runs at the baseball stadium. in baseball over and over again, that you become kind of impenetrable through total acceptance. And it's really joyous, and it's one of the so-called great deaths that the Buddha talked about 2,500 years ago. This is the death of the special self. and giving up the idea that you are special or that you're going to become special.
And that you are, in fact, just average or in many ways below average. And it's hard to explain. It's like seeing the Grand Canyon for the first time in person. And if you've ever seen it in person, you've seen a postcard of it. You still don't know what it is. You haven't had the experience yet.
And getting self-acceptance, complete self-acceptance for the first time with a feeling of joy rather than a feeling of shame, a feeling of liberation rather than being trapped or inhibited or held back in some way. It's just a fantastic, fantastic feeling. And I think earlier, Rhonda, you were using the idea of be specific, and I didn't comment on it.
But one of the things that's been my salvation is acceptance and then also be specific. Because, you know, I don't have to accept the fact that I have some kind of adequate self because I don't even know what that means. It's just kind of nonsensical. But if you say, David, you fall short in a lot of specific ways, I'll say, oh, man, practically every way.
And it's just a miracle that people seem to love and accept me and respect me. So I'm just effing lucky that people have such low standards. But yes, there's nothing about me that couldn't be improved a lot. And just feel grateful to be alive and know other people who are, you know, trying to sell themselves as special or better than anyone. Also, there's a kind of freedom in that.
Totally.
I have a reference to another awesome quote that I think represents the acceptance paradox. This is from Zen Buddhism. Oh, neat. There was a monk who asked, what is Buddha? And Master Yunmen Unmon, probably pronouncing that incorrectly, answered, a dry shit stick. A what? A dry shit stick.
What is the Buddha? A dry shit stick? Is that the answer? Right. Yeah. Yeah, that's right. Well, once when I dropped Jill Levitoff at her house, we'd been at some function and for some reason I was driving and we were talking about this idea. And Jill was saying, I feel so sorry for these people who haven't yet accepted themselves as just, you know, below average shits. I know.
It's really a relief. Yeah. When you say things like that, people don't get it. What are they talking about? That doesn't sound any good. Right. Well, thank you, everybody, for listening today. I hope some of the nonsense that spouted from our mouths made sense or was interesting or entertaining, if nothing else.
And we really appreciate all of you and the great questions you send today on, you know, using the app and artificial or in... You know, in prison when you're in solitary confinement, what a cool question was that? And then ask about a give get imbalance and and, you know, asking, you know, you know, all kinds of cool, cool questions. We enjoy shooting the breeze and. Hearing from you.
So please keep connecting. Leave your comments on the podcast. By the way, these are all on YouTube now. So you can see us in video. And if you're thinking I look like crap the last couple of weeks, it's because I see I have this shirt. This is the same shirt I've been wearing for six or eight weeks when I go out. And it's a dress shirt. So it's really dorky. to be out jogging in this shirt.
But it's because it's light in color and because I've had three ticks got embedded in me and I had to take antibiotics and get them dug out in the emergency room and stuff like that this season. So I just didn't have time to put a nice shirt on. So this is the real David here. with this fancy shirt. You know, it has a special brown color here, which is like sweaty stain.
So I hope you're impressed with my dress shirt.
I'm wondering how many more weeks of wear you can get out of it.
Well, it's still like it's, you know, I think I could wear it for a year, another year. All right. 50 times. I believe in you. That's funny. But anyway, I was slogging just before the podcast, and I had to race in to get here on time. I'll try to wear a nice colorful shirt next time.
And thank you, Max, in the background, who's watching over us like a loving mother hen and keeping all our technology going so we can bring you video and audio now for our podcasts and other stuff that we're recording, too.
See you later, then. Okay, bye-bye. Thanks so much, Ron and David. Goodbye, everybody. This has been another episode of the Feeling Good podcast. For more information, visit Dr. Byrne's website at feelinggood.com, where you will find the show notes under the podcast page. You will also find archives of previous episodes and many resources for therapists and non-therapists.
We welcome your comments and questions. If you want to support the show, please share the podcast with people who might benefit from it. You could also go to iTunes and leave a five-star rating. I am your host, Rhonda Borowski, the director of the Feeling Great Therapy Center. We hope you enjoyed this episode. I invite you to join us next time for another episode of the Feeling Good Podcast.