418 The Fear of Driving Featuring Werner Spitzfaden, LCSW and Rhonda Barovsky, PsyD Today, we feature Werner Spitzfaden, LCSW, a Level 3 certified TEAM-CBT therapist who recently treated Rhonda, who's driving phobia returned during the pandemic because she did very little driving at that time. After you overcome any fear or phobia, it has a way of returning if you don’t continue confronting your fear. Werner describes his skillful and compassionate work with Rhonda! Werner is a dear colleague and friend with over 35 plus years of clinical experience treating phobias, such as the fear of flying, claustrophobia (the fear of being trapped in small places), and driving (especially over bridges and overpasses). He also treats depression, panic and other forms of anxiety, and works in corporate environments to improve communication and teamwork. Let's dive right in, Please take a look at Rhonda’s completed Daily Mood Log, As you can see, the upsetting event was thinking about driving over an overpass, and she rated her initial anxiety cluster at 100%, indicating extreme anxiety. She was also 90% ashamed, and 80% Inferior, worthless, inadequate, defective, and incompetent. She was also feeling 99% embarrassed, foolish, humiliated, and self-conscious, and 85% hopeless, despairing, frustrated, stuck, angry, annoyed, irritated, upset, and devastated. Her sadness was only modestly elevated at 25%. There are several teaching points. First, most of Rhonda’s negative feelings were severely to extremely elevated. Second, although she is asking for help with a phobia, anxiety often goes hand-in-hand with a wide variety of negative feelings, including shame and inadequacy. This is because anxious individuals often feel like there’s something terribly and shamefully wrong with them. Rhonda's feelings of shame are not unusual. Shame is a central feature of anxiety, whereas a loss of self-esteem is a central feature of depression. Werner added that the fear of driving often goes along with the fear of heights as well as claustrophobia. Rhonda admitted to engaging in many “safety behaviors” which typically make anxiety temporarily better but worse in the long run. Rhonda's "safety behaviors" included going out of her way when driving to avoid scary overpasses as well as asking her husband to drive her many place. As you can see, these totally understandable “safety behaviors” relieve your anxiety in the here-and-now because they are forms of avoidance, but that’s why they makes anxiety worse in the long run. The urge to avoid of the thing(s) you fear is universal among individuals struggling with all forms of anxiety. Werner emphasized the importance of empathy in the initial phase of treatment, and throughout the treatment, since trust and the courage to face your fears is so central in the treatment of all forms of anxiety and, of course, depression as well. Rhonda invited Werner and another TEAM-CBT colleague, Lee Flowers, to stay with her in Berkeley during the recent TEAM intensive that David and Jill Levitt directed at the South SF Conference Center near the airport. She drove the group to and from the workshop to face her fears and get some motivation and support at the same time. You can see many of her negative thoughts about driving on Rhonda’s completed Daily Mood Log, including these: The bridge will collapse. 95% Other cars will make the bridge unstable. 100% I’ll have a heart attack. 95% I’m so dumb for not driving on this overpass. 1005 I’m an ass. 100% I can’t do this. 100% I’ll die. 100% Lee and Werner will see me at my worst. 100% I need to study the exact route before I start. 100% I’ll get into an accident. 100% As you can see, the list includes a mixture of fear-inducing thoughts as well as self-critical thoughts and shame-inducing thoughts, like "Lee and Werner will see me at my worst." Whenever you are working with anyone with anxiety, you have to emphasize first, to create trust, warmth, and understanding. This won't cure anyone of anything, but will give your patients the courage to face their fears when you get to the M - Methods portion of your TEAM session. After you get your A in empathy, you can move on to A = Paradoxical Agenda Setting. That where you bring Outcome and Process Resistance to conscious awareness. Then you melt them away using a variety of TEAM-CBT techniques. Outcome Resistance means that Rhonda may have mixed feelings about a “cure” for her driving phobia. In other words, although she WANTS to get rid of this fear, she may subconsciously NOT want to get rid of it. Can you think of why? Take a moment to think about it, and make a guess. You’ll find the answer at the end of the show notes. Process Resistance means she may WANT a cure for her driving phobia, but may not be willing to do what it takes to defeat this fear. What will she have to do? Take a moment to think about it, and make a guess. You’ll find the answer at the end of the show notes. Werner and Rhonda described a number of TEAM-CBT M = Methods that they used to reduce Outcome Resistance, including The Miracle Cure Question The Magic Button Positive Reframing The Pivot Question The Magic Dial. To put this phase in a nutshell, Werner highlighted how Rhonda's intensely negative feelings helped her and revealed many positive things about her core values as a therapist and human being. This is a shame-reducing technique and you can use the Magic Dial to ask your patient what they would like to dial each negative feeling down to, without reducing them all the way to zero. You can see Ronda's goals on Rhonda’s completed Daily Mood Log in the Emotions Table Next, Werner worked on Process Resistance, bringing the work on Paradoxical Agenda Setting to closure. At the start of the M = Methods portion of their work, Rhonda identified the distortions in two of her thoughts (“I’m dumb,” and “I can’t do this.”). See how many distortions you can find. Wrote them down on a piece of paper and when you're done you can see the answers at the end of the show notes. Werner pointed out that Rhonda’s anger, directed against herself, had become a springboard for agitation which intensified her anxiety. Werner and Rhonda challenged some of her negative thoughts with Examine the Evidence, Externalization of Voices (illustrated live during the podcast),Double Standard Technique and the Paradoxical Double Standard Technique as well as a Fear Hierarchy, which you can see if you click here. The also did Cognitive Flooding (also called Imaginal Exposure) three times, and by the third time Rhonda could only increase her negative feelings into the mild range, whereas they had started out in the extremely elevated range. They also used breathing exercise plus getting into the here-and-now to calm herself while driving over overpasses. All of this was background work for actually driving during the intensive, and the highlight was driving home in the dark on the third evening of the intensive. For Rhonda, this was the most fearful thing of all! She said at the start her anxiety was "greater than 100%," but she felt triumphant when she arrived home. Werner gave her specific homework, like driving over a specific overpass four times, and also encouraged Michael, Rhonda’s husband, not to give in to her requests to do the driving on a planned trip to visit friends in Sacramento. I am deeply grateful to Rhonda for giving us such a raw and real glimpse into her courageous and victorious win over her intense driving phobia, and a big thanks also to Werner for being such a kind and powerful TEAM-CBT therapist, teacher!, and beloved friend! Thanks for listening today, Rhonda, Werner, and David Solution to puzzles above Outcome Resistance: If she’s “cured,” she’ll have to start driving much more, and that will include driving over overpasses and bridges. This concept will freak her out now, because she’s still afraid something horrible might happen if she stops avoiding them. Process Resistance: To overcome her fears, she’ll have to face them and experience some fairly intense fear along the way. Werner can support her, and drive with her, as he did, but she will still freak out at first when driving on overpasses and bridges. The distortions in those two negative thoughts included All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Mind-Reading, Magnification and Minimization, Emotional Reasoning, Hidden Shoulds, Labeling, and Self-Blame.
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, Rhonda.
Oh, hello, David. And welcome to all of our listeners around the country, throughout the universe and the galaxy. This is the Feeling Good Podcast, and it is episode 418. Today we have a very special guest, Werner Spitzwaden, who David and I have known for a really long time. I met you at an intensive, I think, in 2014. And then you became a beloved member of the Tuesday group.
And now you are also a beloved member of the Wednesday group.
I didn't know you were in the Wednesday group. That's neat. Werner and I go back much further, though, than what you think. Oh, wow. Really? Yeah. Tell us. When did we first meet down in Southern California? Yeah.
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.
Yeah, yeah, that's right. And there was one woman who followed up. I'm trying to think of her name, and I think she might have passed away, sadly. although she was quite a young woman, and she didn't necessarily think she had very high skills.
But then I came down for a follow-up, and she showed me the data from the beginning and end of her groups, and she'd been doing some really awesome work and getting beautiful high-speed results from the people who were attending her 10 Days to Self-Esteem group. And it was shocking to her because she hadn't been looking at the data, so she didn't realize she was hitting it out of the park.
And it was really a very beautiful thing to see. I was so, so happy for her.
Oh, that's really neat.
I think she had shaky self-confidence, and maybe the staff didn't have a lot of confidence in her either, so they gave, well, she can try this Burns group model. And then I think everyone was shocked at what beautiful results that she'd been getting. I'll never forget that.
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.
It's fun to have you on, Werner.
It is really good to have you on. And so can I tell you how it began? And we've changed the format of our Wednesday group so that— I can tell you how it began.
Oh, okay. In the beginning, God created Earth in seven days. Oh, wow. And then he created a man and took one of the male ribs and created a woman. That's how it all got started.
Oh, is that really how it started?
Well, that's what some people say.
Oh, okay. Even though women give birth, how is it that men took a rib out from a man and created a woman when it's women that's actually the birth givers? But anyway, that's another topic.
Yeah, that's complicated. We'll explain that to you after the podcast.
OK, well, we changed the format of our Wednesday group so that each person, each participant in the group is asked to teach a class. And I asked them to pick a topic that challenged them or that they really loved or that scared them, but something that they could throw themselves wholeheartedly into teaching. And so Werner said that he would teach a class on getting over driving phobia.
Because he has expertise in it and not jokingly said, well, if you need a subject, can I be your subject in the class? Because I kind of have a driving phobia. And he was like, oh, let's do some work together. And I thought, oh, do I really want to do that? Okay, I'll do it.
Can you hear the process and outcome resistance? Yeah.
Absolutely. Well, I'm excited to hear what you guys did. And I saw the daily mood log, which will be in the show notes, which is very interesting in and of itself. But tell us how scary it was and tell us what tools you used to treat this difficult, resistant patient, Werner.
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?
You're really sinking low. Yeah.
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.
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...
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
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
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.
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.
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.
Absolutely.
Yeah. Yeah. So, you know, as an overview.
Can I ask two questions before you continue? Some of our audience might not know what safety behaviors are. I thought that was an interesting thing. And that's question number one. And once you've answered that one, maybe also address why are we talking about empathy when we're talking about a phobia and exposure? Where does empathy come in?
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,
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.
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.
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
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.
I love what you're saying, and I'll make one brief comment and then shut up so you guys can get into the good stuff. But I think... What the client loves to hear, or patient, or person, whatever word we're using, is I've been there and I know how awful that is. And I can show you the way out of the woods. And as opposed to the message, yes, I have many phobias too.
I've never been able to overcome them, so I know how awful it is. But I'd be glad to help you with yours. So it has to be, you know, the empathy. And I've felt that combined with the message of hope and confidence. And I think that's a much stronger message to a client than, you know, refusing to share your feelings like some of us were trained to do during our training.
Like, you know, just never let the patient know anything about yourself. And I never understood it at the time when I was a resident, and I still don't understand it. But I think what you're saying, Werner, is really awesome and so important.
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.
And one other brief thing, as I remember, I think Edna Foa was commenting in an article or... talking to her or whatever, that some clients during exposure for OCD will use safety behaviors.
In other words, even when they're being exposed to their fears, they'll use mental things to try not to think about the exposure or the anxiety they're feeling, and that this tends to make the exposure ineffective.
And so whenever I've worked with people with exposure, and let's say it's cognitive exposure, so they're imagining something they're afraid of and they've gotten up to 90% anxious, I'll always say, that's not high enough. Can you get it to 95%? And make it worse. And then when they get it to 95, I say, okay, you've got another five points. I really want you to freak out.
Can you make it up to 100? And so I think that helps patients avoid that safety behavior of avoiding the fear. And it also paradoxically gives the patient a message that it's okay to freak out. It's okay to feel the most intense anxiety ever. We're going to survive this together as a team.
Well, you know, David, you probably remember before COVID, on one of the hikes we took, you did that with me. Yes, I remember that.
Yeah, we were up on Roos Ridge.
Yeah, and it was really helpful. And it was extra helpful because I was driving once a week to the Tuesday group and then to the studio at Moriarty.
The Murrieta Studio. That's right, I forgot. This was the Murrieta Studio.
The Murrieta Studio, yes. So that cognitive work with you was very helpful. And you kept saying, it's not high enough, it's not high enough. And I did that for the entire hike, which is probably eight miles. And then with the constant driving, I stopped feeling so afraid to drive. But like Werner said, with COVID, I just stopped driving. And then it just keeps coming back.
Yeah. With that avoidance, the anxiety will come back. It's not enough to overcome your anxiety. You have to keep after it on an ongoing basis. Right. Or it comes crumbling back in. Yep. And that sucks when that happens. And more power to you for tackling it again.
Yeah.
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.
Oh, yeah, right.
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.
She kept after it after that 10-minute cure type of thing. She kept going into skyscrapers, elevators, and high buildings and kept after it. So it wasn't, you know, I think one and done is kind of misleading information.
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?
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.
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.
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 –
Well, at some point in our discussion, Werner, you said that you were going to be coming up to attend David's intensive at South San Francisco in August. And you said, oh, it would be so great if you did the driving to and from the intensive. And Werner stayed with me in our guest room. And so that was the goal of our work together.
That was one of the goals is that eventually it would lead to me driving to and from the intensive. which is about an hour from where I live. And so the specific moment in time was really just imagining driving to and from the intensive.
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.
And I think your line was, it just absolutely freaks me out.
Right.
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.
It was myself and Lee Flowers and Heather at one point, right? Was Lee staying at your house too?
Yes.
Oh, how cool.
Yeah.
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.
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.
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.
And one tiny point here, if you look at the DSM, it looks like people have one emotion. They'll get a major depressive episode or generalized anxiety disorder or a phobia. But what the statistics from our app research showed is that there's an unknown common cause in the brain that activates seven negative emotions simultaneously, probably more than seven, but we prove that it activates seven.
And you see that here, that it wasn't just the phobia, but there was shame and anger and frustration and inadequacy a lot of emotions getting activated simultaneously and that's because of this common cause and so you may be most focused on I have a driving phobia but that's associated with the activation of a lot of intense negative emotions at the same time that's a really good point
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?
And maybe you could read a few of those, Rhonda.
Okay. Well, the bridge is going to collapse.
95.
95. Yeah. Okay. Okay. Other people or other drivers, other cars will make the bridge unstable.
Other cars will do what?
Make the bridge unstable.
Oh, yeah, yeah. I remember that one.
And that was 100%. I'll have a heart attack. I'm so dumb for not driving on the overpass.
95.
95, wow. I'm so dumb for having this problem?
Yeah, I'm so dumb for not driving on this overpass from 580 to 24.
Oh, for avoiding it?
Yeah.
Right.
I believe that 100%. Things are embarrassing. I'm an ass. I believe that 100%. I can't do this. Then the next one was not all of these are a hundred percent.
Yeah.
The rest, all the thoughts less than I'm about to say are a hundred percent. Um, so then the next one was not only will I have a heart attack, but I'll have a heart attack and die. And the other people in the car with me, like Werner and Lee will see me at my worst. I need to know the exact route before I drive anywhere. And I'll get into an accident. And I believe this one, 95%.
I'll stop on the middle of the bridge.
I can only imagine how... incredibly terrifying and overwhelming those thoughts and perceptions were. Yeah, they were really terrifying. Yeah.
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
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.
Because what I've been doing was driving about a half hour out of my way to avoid that overpass. which sometimes can really be a hassle. Well, all the time it's really a hassle to drive a half hour out of my way. And I wanted to stop doing that.
I have a question for you, Rhonda, and also for you, Werner. A lot of people, it's my perception that most therapists just want one simple thing to do. And so for a phobia, it would be, you know, exposure plus cheerleading, assuming the therapist is brave or, you know, vague talk about childhood and no exposure if the therapist isn't brave.
And if you're a full fee patient and want to talk for a long time without anything changing. Yeah. But a good therapy involves mastering many skills that come together at the same time. And certainly exposure is a part of the treatment of any form of anxiety. obviously including phobias.
But how important was this cognitive part identifying and challenging these negative thoughts as well as the empathy, the connection, the warmth that Werner was and is today demonstrating?
Well... The empathy was really important because I had to trust Warner enough to be pretty vulnerable with him and open up about literally my worst fears. And, I know Warner casually before this, but going through the empathy, I felt much closer to him. And that made it more willing to let down my facade and my sort of tough girl image and talk to him about what I was really thinking and feeling.
So that was really important.
So you opened up instead of using your karate on him?
Yeah.
She tried. And was that important to be vulnerable and human?
Yeah, otherwise it wouldn't have worked. Otherwise it would have just been a cover-up. And we wouldn't have gotten to the real issue.
Why would have the therapy not worked or been less effective if you hadn't allowed yourself to be vulnerable and real?
Because I wouldn't have shared my true thoughts. I wouldn't have shared my true thoughts or my true feelings. I would have kept them more hidden. Because if I didn't trust him, I wouldn't have been honest with him. And I couldn't have done real work if I wasn't being honest.
Okay, nice. That's beautifully stated. I hope some of our listeners picked up on that because things are not as simple as we sometimes want to think they are. And if all I have to do is learn exposure, and then I'll be an ace therapist because I'll push my patients to do exposure. And you're saying that even to do exposure, there's an important part of a warm, trusting therapeutic relationship.
And that without that, it can, could even sabotage the attempts to use exposure.
Right. If I didn't feel trusting with Werner, I wouldn't have done it. I wouldn't have done the exposure. I wouldn't have driven to and from the intensive.
I also think and would want to ask you, Lee and Werner were in the car with you, I believe. They were. Did that social structure make it easier for you to do the exposure?
It made it actually a little harder.
Made it harder to do the exposure due to the embarrassment of showing your fears?
Yes.
And the thought that they would judge you?
Yes. Yeah. Although I couldn't have done that with two nicer, less judgmental, more unconditional loving people. So it wasn't anything that they were doing. It was all coming from me.
Oh, yeah, for sure. Yeah. You know, I have a theory about that, by the way, and it's that your thoughts create your moods.
That's a good theory.
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.
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...
A more beneficial and positive thought process is paramount to the process succeeding.
Exactly.
So kindness and tenderness and gentleness can be powerful tools to overcome violent feelings.
Right. But that wasn't enough. Werner made a really good point. I mean, that was enough for me to be honest. But as we went through the daily mood log and got to the point in the process where I was challenging these thoughts, then I could create other positive thoughts that were more nurturing instead of thinking I'm going to have a heart attack.
And Warner did a lot of help to guide me with this. I thought. I'm going to have uncomfortable feelings in my body and it might not feel comfortable. I might feel fear. I will feel fear. I will feel uncomfortable, but I'm also capable of driving.
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.
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.
And, Rhonda, do you remember what you came up with?
I think I said I'd be capable of driving anywhere.
Yeah, and specifically, how would you know that you're able to drive pretty much anywhere?
Because I would drive.
Yeah, are there locations that you've been wanting to drive and you haven't had a chance to?
Yeah, like I would drive over that overpass from the 580 freeway to the 13 freeway. That one in particular, I would drive over it.
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,
And all of these negative thoughts and feelings would just disappear. Would you press that button?
A million percent.
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.
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.
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?
Well, the sadness is that I really want to have more freedom and be less dependent on other people to drive.
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.
Yeah.
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.
Well, I don't want to cause anyone, I don't want to create an accident. I don't want to kill anyone. I don't want to feel the I don't want to experience the pain or the discomfort. I want to be safe. I want to be cautious. I don't want to do anything that causes another driver to lose their control.
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.
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?
Um, because they're, they're really limiting. It's limiting my life. I have friends who live farther away from where I live that I don't go visit because I'm, I'm too afraid to drive. I have too afraid to drive there. And, um, you know, Michael's getting tired of driving all the time and he needs a break and it's limited my life.
And I want to work on overcoming that and having more freedom and control.
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
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
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?
Yeah, I don't want it too low, but I don't want it too high.
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,
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 –
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
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
And so I'm wondering what your thoughts are.
No, I want to do it. I want, I'm a hundred percent in.
Yeah. So just to comment for our listeners, uh, you, you, you went through the outcome resistance, uh, and now you're switching to the process resistance, working on those two motivational dimensions. The first was, uh, Would you want to get your emotions down to a lower level given that they show so many beautiful things about you?
And you mentioned externalization of resistance, which you could have done too, kind of like externalization of voices. Try to goad Rhonda into, well, gosh, maybe it's not such a good idea because then you're going to maybe get on a bridge and it's going to collapse. And as the Buddha so often said, that sucks. Yeah.
That would suck.
And then having gone through the outcome resistance, now the process resistance is, well, in order to be able to drive wherever you want, there's going to be a certain price to pay in terms of exposure and discomfort.
So I'll turn it back to you, but I just wanted to explain to our listeners, because sometimes it's real obvious to us, and people need a little teaching along the way to say what step we are in the process that you're doing so beautifully, Werner.
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.
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
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.
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.
I actually love this method because it just goes to see, you can see how invalid the thought is. I was labeling myself dumb. It was all or nothing thinking that it's, you know, I'm either always, you know, I'm all dumb or I'm not, you know, there was no shades of gray within it. Overgeneralizing, like from one feared moment to all moments are going to be fearful. And one time I was,
challenge that all the time I'm going to be dumb because I'm challenged. It was, it was mental filter. I was ignoring, um, all of the positives. I was just thinking about all this, the negatives and the scary part of it. I was discounting the positives. I was insisting that whatever I did correctly about driving didn't matter. Um,
It was mind reading because I was assuming that other people around me were reacting negatively to me as I was driving. It was magnification and minimization. I was magnifying the problems that could occur and I was minimizing my actually driving skills. It was emotional reasoning because I was feeling scared.
And then I reasoned with my fear and turned that into kind of attacking myself and calling myself dumb.
So I feel like I'm dumb, therefore it must really be true.
Right.
Yeah.
And it was a should statement. Like I shouldn't be worried about, I shouldn't feel dumb about driving over this overpass. And I was blaming myself. So it was self-blame.
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.
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.
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.
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...
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...
That was actually a pivotal moment in our work together because when you, you know, you expanded it actually when we were doing it together. It's you, it's you, you're a little girl. What age could you be where you're just, free and happy. And, and, and so I identified, maybe I'm about eight years old and, and I say all these mean things to your eight year old self.
And I, I just felt so protective of that little girl and sad. And like, I would never talk to a child that way. Like I, I was like, no, Werner, I can't do that. No, I'm not going to do that.
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.
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?
Before you go on, you lost me there, Werner, and just maybe you can clarify it. You were saying that you, Rhonda, had a lot of agitation and anger, which triggered the anxiety. I believe you said something like that.
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.
Okay, that's great. I'm writing that down. So that being angry with yourself about any flaw, but in this case, a phobia can actually make the problem worse. Whereas talking to yourself in a compassionate way can lower the energy. And it also probably goes along with that common cause theory that I was talking about before. before, that there's an unknown variable that we've proven it exists.
It's like the dark matter of human suffering, this one thing that causes a lot of negativity simultaneously. so that if you get agitated and increase your anger level toward yourself in this case, that that would be expected to intensify the sadness, the hopelessness, the anxiety, the loneliness, the shame, all of the negative feelings simultaneously. Yeah. Yeah. Yeah. So that's beautifully said.
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.
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.
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?
I'm being really mean to myself, and I want to be kinder to myself.
Yeah. And then some of the other is that I'm so dumb for not driving on the overpass.
Yeah. I'm really good at having other people take care of me and drive me places, but that doesn't make me dumb. I'm actually quite smart at working my way through my anxiety, even if it is through safety behaviors.
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.
Yeah.
Yeah, absolutely. Can I interject here for a minute? We're overlooking the acceptance paradox. Is that intentional?
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.
But isn't it a fact that I'm dumb having these phobias, Rhonda?
Well, I mean, honestly, it is kind of dumb. And it is a fact. And I can accept that I'm dumb about this situation. And I can also accept that I want to change it.
So who won that? I did. Was that big or small? I think that was big. Was that big or huge? I think that was huge. Okay. All righty.
Yeah. I mean, I think if you can really, for me, if I can really feel the acceptance, it's always going to be huge.
Yeah.
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.
I'll tell you how I would answer it.
Okay. Yeah.
Say, David, you're dumb because you have the fear of heights.
David, you're dumb because you have the fear of heights.
No, no, no, no. I have the fear of heights, that's for sure. And I'm often dumb about all kinds of things. You see, it's just the tip of the iceberg. The fear of the heights and the dumbness actually aren't related, but they both have their own glorious independent existences. Yeah, exactly. Yeah. So who won that one?
Yeah, that was much huger.
Yeah. I just find any attempt to minimize, you know, the self-criminal system can detract from, you know, the power.
Yeah. I mean, honestly, Warner, it bothered you more than it bothered me that I called myself dumb. Yeah. And I accept that it is kind of dumb. And? Yeah. It is something that I want to overcome anyway.
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.
I called myself an ass and I wanted to stop that more. But I did think the whole process was kind of dumb. Like I grew up in San Jose, California, and I used to drive to Santa Cruz. You have to go through the Santa Cruz Mountains.
Oh, yeah. That's a toughie right there.
It's really tough.
Highway 17.
Yeah, Highway 17. When I was in high school, at a drop of a hat, I would drive to Santa Cruz.
Oh, is that right?
I had no fear. I would drive to Santa Cruz. We'd go to the beach. We'd get a hamburger and we'd drive back. And I had no fear.
And a super fun thing to do.
Right. I had a super fun, yeah.
Go on the boardwalk and get some of that great junk food, snow cones and candy apples.
Yeah. And I have a friend now who lives in Santa Cruz that I don't go visit because I'm afraid to drive on Highway 17. Or I go way, way, way, way out of my way, which takes like about three hours.
I can't wait to get up there at the end of the month.
Uh-oh. Yeah, we're just going to go driving with me. Well, so eventually what – like this was really critical, all of the methods that were used. And I don't know if you want to go over it. Werner and I created an anxiety hierarchy too. And – go ahead, Werner.
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
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.
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
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.
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.
Man, this is creeping me out. Stop.
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.
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.
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.
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.
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.
You have to bring those things to life for me because I'm a dummy. The first thing is when you used imaginal exposure and you said by the third one, the percentages were lower that you could bring yourself to. Was that all imaginal or you did imaginal exposure and then did the drive home?
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.
And I knew I was going to have to drive home from the intensive at night and I was going to drive over the five, this overpass from five 80 to 13 to 24 from five 80 to 24. And I thought, Oh, I don't want to do it the first time with Werner in the car. And I don't want to do it the first time with at night and it's going to be dark and scary. So the Sunday before the intensive started I,
I went to this overpass, you know, and I, you know, there's two lanes. And usually when I drive toward this overpass, I'm in the left lane, which I can then swerve around the overpass and go the half hour out of my way.
Oh, yeah. Wow.
But I forced myself to be in the further right lane so that I couldn't escape. And it was during the day I was by myself. We had already done these three cognitive exposures, these imaginal exposures. And, and I had that thought, I'm going to feel bad. My heart might be pounding and I might feel yucky, but I'm still going to be able to drive. I'm still capable of driving.
So I just kept telling myself, I I'm, Even if my heart's pounding and I'm feeling bad, I'm still going to keep driving. And then I forced myself to be in the lane that I actually couldn't escape from, and I drove over the overpass.
Yeah, and you're bringing out a couple of the names.
How intense was the anxiety when you were driving over the overpass?
It was probably 90 to 100. It was pretty intense.
Mm-hmm.
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.
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.
Yeah. Even though we did great work through this, I wasn't going to be like dancing over the bridge. I wasn't going to be like, woohoo, this will be fun, let's go.
I had a couple other questions. You said you used breathing in some way and getting into the current moment in some way. I'm not familiar with what you were referring to there. I'm sure our listeners would love to hear how you use those ideas or techniques.
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.
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
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
I see. Okay, thank you. Yeah. One message, just to give a simple message to our listeners, is that there's a kind of hopelessness that's a part of depression, but there's another kind of hopelessness that's a part of anxiety. And hopelessness is the greatest trickster In the universe, really.
And that if you have a phobia or social anxiety or, you know, some intense fear, you're probably telling yourself that it would just be impossible for me ever to overcome this. And and what you're you're saying is that if we approach the problem with a nice palette of techniques, we're not just going to try to do one thing and shoot for perfection.
But we're going to do a daily mood log and positive reframing and empathy and so on. you know, paradoxical double standard technique and, and, uh, you know, work on many different levels, identify all the distortions and these, and these thoughts, and then we're going to have to, uh, you know, flooding, uh,
and gradual exposure, that we have a lot of tools and that it is possible to change the way you feel, even if the way you feel is intense anxiety or intense anxiety in certain situations. It's the message of hope through practical practice. methods that you can learn and use and implement with the help of a therapist, a friend, or even sometimes on your own. That's all.
But I just want to push that message out there because we get sometimes caught up on how effective we're being as therapists and how fun it is to see someone improve and forget about that experience. intense terror that the person who's struggling is feeling and maybe has been feeling for years and avoiding things.
And by safety behaviors, what you're really just referring to is different subtle forms of avoidance so we don't have to confront our fear because it's so unpleasant to do so.
Right. It's really unpleasant.
Mm-hmm.
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.
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.
The cognitive flooding helped with the real driving.
Absolutely. That's right. It gave the message that it's possible to do this and be safe, even though I'm experiencing anxiety.
And the third time we did it, when Werner was asking me to rate how high the anxiety was, I was really surprised that the anxiety had gone down.
Oh, yeah. Yeah.
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.
Well, driving to the intensive was nerve-wracking, but it was less nerve-wracking than I expected it to be. And I felt really proud and accomplished when we arrived at the South San Francisco Center. And I think we showed up 45 minutes early because I was so worried about getting there that I forced you and Lee to leave really early. 3.30 in the morning isn't that early.
I know.
He showed up about, well, 45 minutes early. And, and then the, so then the first night when we were trying to drive, it was time to drive home. And one of the things on my anxiety hierarchy was kind of funny, but it was kind of true as I was like, I said, I'm getting ready to drive home and And I'm too afraid to drive home and neither Warner nor Lee will drive home for me. And I hate them.
And, and so that's what that happened Thursday, Thursday. Yeah. Yeah, Thursday, it was foggy. It was really dark. I was tired. And I sat in the driver's seat and I thought, God, Werner and Lee, they're going to judge me. They're going to say I am really dumb and I'm an ass. We judge you.
Yeah.
But I couldn't, I couldn't drive home. And I just sat there in the car and, and, and I, I think I started crying a little and said, are you guys going to judge me if I can't, if I don't drive home? And they both were super loving and like, we're not going to judge you. And it is scary and it's dark and Werner volunteered to drive home.
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.
When I said I don't want to drive home, I promised that I would drive home on Saturday. Saturday was another late night. So then I had time to prepare myself. So every day I did drive there without any problem.
So I drove there easier.
easier every day yes driving there and um so by the time sunday came along it wasn't a problem whatsoever to drive and one of the things that happened was i don't normally drive the speed limit the speed limit 65 and i said to warner i'm never going over 60 i don't care I'm going to be driving, but I'm never going over 60. And Warner's like, well, can you drive the speed of traffic?
And I said, no, I'm not doing that. I'm never going over. But on Sunday, when it was my fourth time driving there, I was, I did go the speed of traffic. So I did go over. I was, I stubbornly, I went past my, my, my limit and I did drive 65, which Warner, you know.
Did you drive home Saturday night?
So Saturday night, it was still foggy and it was foggy. That's what happens in the Bay Area. I was tired, but I had made this commitment that I was going to drive home. And so I got in the car and I drove home and I was scared. My anxiety was way over 100 part of the time. And, you know, I wear contacts and sometimes I see halos around lights, like car backlights.
And I did see those halo lights around cars in front of me. And I just kept breathing and saying, I don't feel very good, but there's actually nothing I can do now. I, at one point I got, I, I said to Werner, I, I could pull, I, I could, I could pull over if you would drive the rest of the way. And Werner said, no, he wouldn't do that. So I just, I was like, okay, I better keep going.
So I, that I was not driving the speed of traffic. I drove probably slower. I definitely drove slower. Um, But I did it. And then I did drive over the 580 24 overpass and, um, So and then we made it home and I didn't kill anyone. I didn't kill myself. I didn't have a heart attack. I didn't die. I didn't fall off the side of the bridge. I didn't fly off the overpass. None of my fears came true.
And I was I made a joke and said, oh, we could have a margarita as soon as we get home. But we didn't have a margarita. We just stayed up a little bit laughing and enjoying the the work from the intensive and talking about what we all did and what was so awesome about the intensive. And two were pretty tired and then went to bed.
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?
So you kind of have to drive – I have to drive to another city. Like I have to – if anybody knows the Bay Area, I have to drive to Emeryville, which is a little bit out of the way in order to get onto that 58 – 580 overpass. So – You know, I have to drive on the freeway to get to Emeryville.
And then I get to a place, you know, and the entrances you're entering, I had to merge four lanes to the left to get on to 580. And then I had to merge four lanes to the right. to get toward the 24, that overpass. So, so there were lots of opportunities for anxiety.
It was a lot, it was, even though it was middle of the day on a Sunday, um, there was a lot of traffic when I was merging these four lanes to the left. And then there was like a little curvy, narrow curve. And then I had to merge four lanes to the right and make sure that I didn't get killed or kill anyone else when I was merging.
And then get on to the far right lane so that I wouldn't allow myself the opportunity to escape. And when I started it, I'm driving the very first time, I thought, I'm going to do it five times. You know, Warner gave me four times. As an, as a assignment, but I'm going to do it five. But one time I emerged and somebody honked at me and that kind of freaked me out.
So by the time I finished the four, I thought, yeah, I don't need to be a superstar. He told me to do four. I'm going to do four and then go home.
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.
And I think Werner talked to Michael. There's another reason I hate Werner and said, don't let Rhonda, if she pulls over and says she doesn't want to drive, don't give in. So we were going to visit our friends in Sacramento and Michael said, don't you need to practice driving? I was like, oh, did Werner tell you that?
And so I practiced driving and I drove that way and I didn't pull over and it all worked out.
Awesome. Yeah. So how are you feeling now, Rhonda, having done all of this hard work?
I don't hate Werner, and I feel really proud of myself.
Oh, fantastic.
But I also know that I have to keep driving in order to keep it up.
Well, we'll have you come down to this neck of the woods. Yeah, I want to do that. You can visit our recording studio in old Palo Alto, or you can come here to the house and come to a Sunday hike and dim some and all kinds of cool stuff.
Oh, yeah, I want to do that for sure.
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
and so many colleagues that we were able to reconnect with live and in person. It was really awesome.
Yeah. It was great seeing you. It always is, whether on a hike or at an intensive or wherever. Do you remember the first intensive you went to at South San Francisco Conference Center? I do. That was the intensive where I met Rhonda. Oh, yeah. Well, yeah, I remember that, too, because it was like a shock. I hadn't seen you since, you know, the work I did down at the Kaiser's in Los Angeles.
And yeah, and then I remember seeing you there. I said, well, that's that's awesome. You weren't coming up here for an intensive. And you're still hanging out. And I just love you, Werner. And I'm so proud of all you've accomplished, but also really care for you and appreciate your warmth and loyalty and fellowship and support over these many years.
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.
It's been terrific and really enjoyed. Um,
knowing you and now knowing you even better and feeling close and yeah and Werner I can't actually thank you enough for I feel like you gave me back my life you gave me back a part of my life that I've lost over time and um I think that as I'm talking about it sounds easy but it wasn't easy it was hard to confront these things and it was even hard to go through the daily mood log it was hard to um you know I can say it really easily when we went through the cognitive
distortions but it wasn't easy it's painful it's hard it's challenging all of the methods that we did there are lots of tears and you were a really beautiful guide and therapist for me Werner and you really gave me back a huge part of my life that I lost I can't thank you enough well it was my my pleasure and my honor really yeah thanks everybody yeah and I'm sure our
You hear all the time from podcast fans who love you and look up to you, but their love for you will be intensified 10 times after today's podcast. Really?
Oh, thank you.
Sure. Yeah, absolutely. Thank you. Thank you, everyone, for listening. Do we have any announcements about anything, Rhonda, that you can think of?
I don't think so. No trainings coming up, right?
Yeah, I think the app is out, the Feeling Great app, so you can try it for free.
David, how does somebody access it if they want to try it for free?
That's what I was just saying before you rudely interrupted me. Okay. I thought you were going to get off without telling us. Yeah. You just go to either of the app stores, and then you can try it for free and see if you like it. And then if you want to buy it, it's 27 cents a day. And if you can't afford it, we'll give it to you for free.
Just contact the feelinggreat.com at the website because we want everyone who wants it to be able to use it and change the way you think and feel. But today was a blockbuster show. And thank you so much, Werner and Rhonda.
Thank you, David. Thanks for letting us share about this on the podcast. I hope it helps other people who have phobias, too. Take care. Bye-bye. 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.