Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
422: Ask David: Getting off Benzos; Music and Emotions; Negative Thoughts about the World; and more
Mon, 11 Nov 2024
Ask David: Getting Off Benzos How Does Music Stir Our Emotions? Combatting Negative Thoughts about the World Treating Schizophrenia with TEAM The Four Feared Fantasy Techniques and more! Questions for today: Mamunur asks: What’s the best way to withdraw from benzodiazepines? Gray asks: How does music evoke such powerful emotional reactions? Josh thanks David for techniques that have helped in his personal and professional life. Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Moritz asks: How do you help people with bipolar, schizophrenia, etc.? John expresses gratitude for our answer to his question on Positive Reframing, which triggered an “ah ha moment.” Rhonda asks: What are the four Feared Fantasy Techniques? The answers below were written prior to the podcast. Listen to the podcast for the dialogue among Rhonda, Matt, and David, as much more emerges from the discussions! Mamunur asks: What’s the best way to withdraw from benzodiazepines? Ask David, Bangladesh question Dear Sir, I am writing to you from Bangladesh. Your book Feeling Good is a phenomenal work, and it has greatly helped in promoting the development of a healthy mind through logic and reason. Sir, I have a question regarding benzodiazepine withdrawal, which is often prescribed for mental health disorders. Is there a specific CBT (Cognitive Behavioral Therapy) approach that can help in withdrawing from benzodiazepines? Your guidance on this would be invaluable, as many people have been taking it for years, either knowingly or unknowingly, without being fully aware of its severe withdrawal effects. Thank you, sir, for your kind contributions to humanity. Sincerely, Mamunur Rahman Senior Lecturer David’s reply Dear Mamunur, Thank you for your important question! I am so glad you like my book, Feeling Good, and appreciate your kind comments! As a general rule, slow taper off of benzodiazepines is recommended. This might involve slowly decreasing the dose over a period of several weeks. When I was younger I used to take 0.25 mg of Xanax for sleep, because it was initially promoted as being non-addictive, which was wrong. It is highly addictive. The dose I used was the smallest dose. When I realized that I was “hooked,” I tapered off of it over about a week, and simply put up with the side effects of withdrawal, primarily an increase of anxiety and difficulty sleeping. These disappeared after several weeks. Abrupt withdrawal from high doses of any benzodiazepine can trigger seizures, as I’m sure you know. That is the biggest danger, perhaps. I do recall a published study from years ago conducted at Harvard, I believe at McClean Hospital. The divided two groups of people hooked on Xanax into two groups. Both groups were switched to Klonopin which has a longer “half-life” in the blood and is supposedly a bit easier to withdraw from than Xanax, which goes out of the blood rapidly, causing more sudden and intense withdrawal effects. After this initial phase, both groups continued with slowly tapering off the Klonopin under the guidance of medical experts. However, one of the groups also attended weekly cognitive therapy groups, learning about how to combat the distorted thoughts that trigger negative feelings like anxiety and depression. My memory of the study is that the group receiving cognitive therapy plus drug management did much better. As I recall, 80% of them were able to withdraw successfully. However, the group receiving drug management alone did poorly, with only about 20% achieving withdrawal. My memory of the details may be somewhat faulty, but the main conclusion was clear that the support of the group cognitive therapy greatly enhanced the success of withdrawal from benzodiazepines. I decided early in my career not to prescribe benzodiazepines like Ativan, Valium, Librium, Xanax, and Klonopin for depression or anxiety, because the drug-free methods I and others have developed are very powerful, and the use of benzos can actually make the outcomes worse. Years back, a research colleague from Canada, Henny Westra, PhD, reviewed the world literature on treatment of anxiety with CBT plus benzos and concluded that the benzos did not enhance outcomes. Here is the link: https://pubmed.ncbi.nlm.nih.gov/12214810/. I hope this information is useful and I will include this in a future Feeling Good Podcast. Gray asks: How does music evoke such powerful emotional reactions? Subject: Re: Podcast question: love songs Hi David, That's a really tough question. Music has a unique way of cutting straight to emotions for me, and it makes it especially hard to identify the thoughts behind them. My best way of explaining is with these two thoughts, which have to be viewed as a pair to get that emotional reaction: My life would be perfect if I had that I'm so far away from that These thoughts don't resonate quite right for me, but it's something like that, going from imagining bliss to crashing to hopelessness within the space of a moment. Thank you so much for your response. Gray David’s reply You’re right. Music can be so beautiful, especially of course, the songs we love, that it is magical and emotional to listen to! It seems more like a sensory experience, than something mediated by thoughts, but we certainly have perceptions of beauty, etc. Similar with some incredibly delicious food. Creates incredible delight and satisfaction, and no words are necessary other than “delicious!” Sorry I can’t give you a better answer to your outstanding question! Best, david Josh thanks David for techniques that have helped in his personal and professional life. Dear Dr. Burns, I am sure you are swamped with substantive emails and fan mail, but I just wanted to express appreciation to you for all I have gained from your publicly available content. I have learned so much that I have applied in my personal life. I have also benefited tremendously in my work with clients. So much of what you say about anxiety, and especially the hidden emotion technique, has allowed clients to have in almost every session an aha moment. I have not yet been able to see a complete removal of symptoms in one session yet, but as a therapist, I too have many skills yet to improve and much work to do. So, in short, thank you so much for making your experience and wisdom available for free, and thank you for doing it in such an engaging manner. Sincerely, Josh Farkas David’s Reply Thanks, Josh. You are welcome to join our weekly virtual free training group I offer as part of my volunteer work for Stanford, if interested. For more complete change within sessions, a double session (two hours) in my experience is vastly more effective. Is it okay to read your kind note on a podcast? Warmly, david Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Dear Dr. Burns, First of all, I would like to thank you for all your work and your outreach. Your books have profoundly influenced my thinking and value system. I really admire how you exemplify both scientific rigor and human warmth. Finally, I want to thank you for promoting the idea of “Rejection Practice! I haven't had a breakthrough yet, but some unexpected, very encouraging experiences. I first came across Feeling Good 12 years ago when I developed moderate depression in the context of living with my ex-partner, who probably had borderline personality disorder. I tried the techniques in Feeling Good and also psychotherapy, but unfortunately without much success. I only started feeling a lot better when I began to rebuild my social life and leisure time activities (ballroom dancing, getting involved with a church, ...). Several months later, I also broke up with my ex-girlfriend. Since then, I've had ongoing mild depression. I recently tried the techniques in Feeling Great but wanted to ask you for your opinion on a couple of negative thoughts I'm particularly stuck with. My issue is that I'm normally not attacking myself, but life in general. I keep on telling myself things like "Life is just one crisis after the other," "Life is for the lucky ones," "Really good things just don't want to happen," "Life is so much suffering and so little joy," and the depression itself makes these statements all the more convincing. (Triggering events can be rainy holidays, romantic rejections, grant interview rejections, etc.) I think it could be helpful if in a podcast you could give more examples on resolving negative thoughts attacking life / the world rather than oneself. I also have many more questions for podcasts if you are interested. Thank you for reading this, and thank you so much again for all your work! With very best wishes, Harold David’s Reply Happy to address this on an Ask David, and it would help if you could let me know what negative feelings you have, and how strong they are. I will be answer in a general way, and not engaging you in therapy, which cannot be done in this context. Is that okay? I’m attaching a Daily Mood Log to help organize your thoughts and feelings. Send it back if you can with the Event, Negative Feelings and % Now columns filled out (0-100), and Negative thoughts and belief in each (0-100). You can also fill in the distortion column using abbreviations, like AON for All-or-Nothing, SH for Should Statement or Hidden Should, MF for Mental filtering, DP for Discounting the Positives, and so forth. Thanks! If you were in a session with me, or if we were just friends talking, I would reply to your complaints with the Disarming Technique, Thought and Feeling Empathy, “I Feel” Statements, Stroking, and Inquiry, like this: Harold: “Life is so much suffering and so little joy." David: “I’m sad to hear you say that, but you’re right. There’s an enormous amount of suffering in the world, like the horrible wars in Ukraine and in the Mid-East. (I feel; Disarming Technique) It makes sense that you’d be upset, and have all kinds of feelings, even anger since there’s so much cruelty, too. (Feeling Empathy) And even people who appear positive and joyful often have inner sadness and loneliness that they are hiding. (Disarming Technique) Your comment tells me a great deal about your core values on honesty and compassion for others. (Stroking) Can you tell me more about the suffering that you’ve seen that has saddened you the most, and how you feel inside? (Inquiry) But I’m mainly interested in you right now. Can you tell me more about YOUR suffering, and especially if there’s some problem you might want some help with? (Inquiry; Changing the Focus) I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test. If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?” I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself? I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test. If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?” I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself? I ask this because your negative thoughts are very general, but I always focus only on specifics, specific problems and moments. What’s has been going on with your parents or in the past or present that you are distressed about? I’ve found that when I (or my patients) solve one specific problem that’s bugging me, everything seems to suddenly brighten up. For example, you wrote : “I asked someone out I like; she surprisingly said yes. After 10 days of not hearing from her, I messaged her, . . . “ I wrote a book about dating, Intimate Connections, because I was a nurd and had a lot to learn about dating. One idea is that waiting 10 days might not be a good idea to arrange the specifics of the date, as that might make her feel uneasy. There’s a lot to learn about dating, for example. A tool like the Pleasure Predicting Sheet can sometimes help, too. And finally, a good therapist can also often speed things up. Sometimes two heads are better than one. You seem extremely smart and willing to work hard, so there’s all kinds of room for growth, learning, and greater joy. The Feeling Great App is NOT therapy, but the tools there might also be helpful, especially since you are willing to work hard a do a lot. That’s super important. Can I use this email in my reply in the show notes if we discuss your excellent questions? And should I change your name to Harold? Warmly, david Best, david Moritz asks: How do you help people with bipolar, schizophrenia, etc.? Hi David, You have mentioned a few times that there are only a handful of "real" psychological disorders with known causes, as opposed to just a collection of symptoms. Could you please tell a bit about how you would go about helping somebody with one of the "real" disorders (like Schizophrenia or Bipolar) using TEAM therapy? Most of the episodes with personal work seem to fall into the other category (anxiety, depression, compulsive behavior), so I'd be really curious about some examples. Best regards, Moritz Lenz David’s Reply Hi Moritz, Thanks! Good question, and happy to address this on an Ask David. Here's the answer in a nutshell. When working with someone with schizophrenia, the goal is to help them develop greater happiness and interpersonal functioning, exactly the same as with anyone else, using TEAM. The goal is not to cure schizophrenia, because we still do not know the cause and there is no cure. But we can help individuals with schizophrenia with problems that they are having. Bipolar: in the manic phase, usually strong meds are indicated, and often at least one hospitalization. For the rest of their lives, including depression, TEAM works great. Can add more in the podcast. Best, david John expresses gratitude for answer his question on Positive Reframing, which triggered an “ah ha moment.” Hi David and Rhonda! I have listened to Episode 415 and your response to my positive reframing question! I had a bit of a aha moment! I think I had been approaching it in the cheerleading sense and trying to encourage myself with these positive qualities rather than attaching the positives to the negative thoughts and feelings themselves! This has created a much stronger emotional response during the positive reframing section! The building up of the negative thoughts and feelings is a gamechanger! Thanks so much for the time and attention given to it during the podcast. Thanks so much again, I appreciate you folks way more than you could know! John David’s Reply Thanks, Rhonda and John. Yes, you’ve pointed out a huge error many people make when trying to grasp positive reframing. If it is okay, we can include your comment in a future podcast. Warmly, david Rhonda asks about the four Feared Fantasy Techniques: David’s Reply Here are the four Feared Fantasy Techniques Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No Practice There are quite a number of additional role plays, too, as you know. Maybe a question about all the role plays, bc we all have: Self-Critical Thoughts: Paradoxical and Straightforward Double Standard Externalization of Voices Uncovering Techniques Man from Mars Tempting Thoughts Devil’s Advocate Technique Tic-Tok Technique Resistance Externalization of Resistance How Many Minutes? Five Secrets / Relationship Conflict Intimacy Exercise One Minute-Drill I’ll bet you can think of more, too! This is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. As you know, on average they tend to be way more potent and emotional, and of course fast impact. Warmly, david
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.
Hello, David, and welcome to our listeners around the country, the world, and the galaxy. This is the Feeling Good episode 422. And we've had a couple of episodes on spirituality, and now we're going to get grounded in reality. It's another Ask David episode, and we have Matt May joining us. Hi, Matt.
Pleasure to be here, Rhonda. Thanks for inviting me.
Of course. And I want to start with reading an endorsement that we got from someone who wrote, Dear Dr. Burns, I'm sure you're swamped with substantive emails and fan mail, but I just want to express appreciation to you for all I have gained from your publicly available content. I have learned so much that I have applied in my personal life.
I've also benefited tremendously in my work with clients. So much of what you say about anxiety and especially the hidden emotion technique have allowed my clients to have in almost every session, an aha moment. I have not yet been able to see a complete removal of symptoms in one session yet, but as a therapist, I too have many skills yet to improve and much work to do.
So in short, thank you so much for making your experience and your wisdom available for free. And thank you for doing it in such an engaging manner. Sincerely, Josh.
Josh. Well, thank you so much, Josh, for those kind comments. And I think we have a question from you, too, or maybe that's just the endorsement that I wrote. But it means a lot to get the question. Three is the Josh. Thanks, David, for techniques. And so maybe that's that that is that that third question there. But I really appreciate that.
And remember that we have a podcast on the four techniques for working with anxiety. The hidden emotion is certainly an important one, but it's only one of four. And if you want to get complete elimination of anxiety, and you may be doing this already, but you want to use not only hidden emotion model, but the motivational model, the cognitive model, and the exposure model. As well.
But thank you so much because we do share our best for free. And when someone like you writes in and says, hey, the message is getting through, thank you. That means a tremendous amount to all of us. So thank you so much.
Sweet. Okay, let's read the first one. Dear sir, this is from Mamunur. Sorry, I apologize if I'm spelling your name wrong. Dear sir, I'm writing you from Bangladesh. Your book, Feeling Good, is a phenomenal work, and it has greatly helped in promoting the development of a healthy mind through logic and reason.
Sir, I have a question regarding benzodiazepine withdrawal, which is often prescribed for mental health disorders. Is there a specific cognitive behavioral therapy or a team CBT approach that can help in withdrawing from benzodiazepines?
Your guidance on this would be invaluable, as many people have been taking it for years, either knowingly or unknowingly, without being fully aware of its severe withdrawal effects. Sir, thank you for your kind contributions to humanity. Sincerely, Amuner.
Well, it's fun to get a note all the way from Bangladesh. It seems impossible, but life has gotten so amazing with all kinds of wonderful and awful as well, unexpected things happening all around the world. I'll give my answer quickly and then see what additional things Matt might have or... You, Rhonda, might have.
But there was a study, and this was, you know, it was a good 20 years ago, but it's still vivid in my mind. I don't even remember the reference to it, but I'm sure it exists somewhere on the web. But it was a study done at Harvard. And the conventional thing in going off of benzodiazepines, that's drugs like Xanax, Librium, Valium, Ativan, and that type of thing.
They're all so-called, used to be called minor tranquilizers. is that a lot of them, like Xanax, go in and out of the blood very quickly. And so when it goes into your blood, you just feel wonderful. And all your cares are gone. And if it's evening, you can fall asleep and wake up feeling terrific. But the problem and your anxiety is improved or goes away completely.
But then when it goes out of your body, you go into a kind of withdrawal, which is the opposite. The anxiety comes back and you get insomnia. And the conventional wisdom was to convert patients on Xanax to a long acting patient. benzo like Klonopin, which has a long half-life, so it goes out of the blood very slowly, so you don't get those sharp withdrawal dips, which happen quickly and intensely.
And so they randomly assigned... People who had dependency on, I think it was Xanax was the one that they were using. And they first switched them over to Klonopin. And there were two groups, random assignment groups for the patients. And one group just got the traditional Xanax.
withdrawal, slow withdrawal, like over a period of weeks, you know, switch them to Klonopin and then slowly withdraw the Klonopin by expert psychopharmacologists at Harvard. And the other group got the same exact pharmacologic treatment, but they also had a group cognitive therapy group every week.
And the upshoot of it, as I recall, and I don't recall the details exactly, but there was a massive difference between the groups. And most of the patients, a good 80% of the patients in the cognitive therapy group were able to withdraw successfully from benzodiazepines. And in the pure psychopharmacology withdrawal group, only like a minor percentage
fraction of them like 20 percent or 25 percent only were able to to to withdraw and so the moral of the story was that the cognitive therapy support greatly at least in that one study that i saw enhanced the success in withdrawing from benzos and i've also had some uh personal experience with this, not with that exact approach.
But when Xanax came out, the drug companies make a lot of claims initially for drugs that turn out not to be true. six months after the drug has been on the market. And when Xanax came out, they claimed it was not addictive and that it was helpful for depression and anxiety.
And so I thought, you know, sometimes I was having trouble getting to sleep at night, so I thought, well, I'll take the smallest dose, a one-quarter milligram of Xanax, and I would fall asleep, you know, quickly. and wake up the next morning feeling fantastic with no side effects or anything. And I thought, man, this is a magic bullet, this drug.
But then after being on it for a number of weeks, I realized that I was getting addicted to it and wanted to take two of them rather than And one of them. And I thought, this sucks. This is not good. And so I stopped taking them. And I went into withdrawal, which lasted about three weeks. And the withdrawal consisted just of, you know, anxiety and difficulty sleeping.
But I just kind of toughed it out because I understood that that was just, you know, the natural chemistry happening in my brain. And after that, I was fine. And I think I probably did a gradual. I probably went from a full pill to a half a pill for a few days and then to a quarter pill for a few days and then no pill.
And that was after using it for a short period of time. So it sounds like pretty quickly you felt addicted.
Yeah, and then there was one pill I took once. I didn't do a lot taking this kind of pill, but another one came out that was touted for sleep. And it was also a more potent benzo that put you right to sleep. And I took one pill on one occasion, and I went into severe withdrawal from that. It put me to sleep, but as it went out of my blood, I got really wired up, something pretty intense.
It was awful. And so I never took it again. Matt, you might remember the name of that.
Was it temazepam? Restoril?
No, uh-uh. I don't remember the name of it. Klonopin or Klonazepam? Did you say Klonopin?
Klonopin or Klonazepam?
I was just talking about Klonopin, the study at Harvard. Oh, okay. Maybe you didn't tune into that, but I'm very familiar.
I was kind of spaced out there for a second.
Yeah. David, you're very boring. Yeah.
Not at all. No, you're describing a very typical experience with benzodiazepines, often prescribed for sleep or for anxiety.
Yeah. So I don't prescribe them for anything. My colleague, Henny Westraw, a number of years back, and I think I put this reference...
Yes, in the show notes, but she reviewed the entire world literature on treating anxiety, and she concluded that benzodiazepines not only are not effective in the treatment of anxiety, they always make anxiety worse because you just get dependent on them, and then they make it almost impossible to recover anxiety.
And she said the most effective treatment for anxiety is cognitive therapy with no medications. And that's how I've always treated anxiety for the past 25 or 30 years. So now I will shut up and give it over to my better angels, you might say, Rhonda and Richard.
Well, I had a similar experience when I was going through a bit of a crisis about four or five years ago, right before COVID. And I went to my primary care physician who was not a psychiatrist. And it actually wasn't my primary care physician. Somebody was standing in for her. And within three minutes, he offered me a benzodiazepine. And I was shocked. Like, really? Hmm. No.
And I thought that wasn't so true anymore, but they seem to be being prescribed pretty frequently and regularly. But I don't have that much experience with benzodiazepine withdrawal. It seems like that's a medical, like you just described, David. It needs to be medically supervised in my understanding.
But I've worked with a lot of people who are getting off SSRIs or they've been taking them for 20 years or a long period of time and they want to get off of them. And their psychiatrist referred them to me so that they could learn how to challenge and defeat their negative thoughts.
So they had the tools so that when they were tapered down off of their medications, they still had a means to overcome their depression. So it does seem like there's a place for it. team CPT when you're getting off medication, whatever it is.
Great. What do you think, Matt?
Yeah, I love what both of you are saying. I really appreciate the personal experiences, David, that you're sharing, that oftentimes people are prescribed a benzodiazepine for sleep or anxiety. Frequently, I see people who have gone to their emergency department, with a panic attack, thinking that they're having a heart attack. They're given some Ativan. They feel better.
Maybe they're prescribed 30 days of Ativan. And then they leave the hospital feeling temporarily a lot better. But then they get hooked on the benzodiazepine. A lot of people don't know what a benzodiazepine is. And so I think it's helpful to just describe that. What is that?
It's a drug that affects the GABA chloride channel ion in the brain, meaning that there's a natural substance in the brain called GABA and that binds to a chloride ion channel and it opens the channel up. Chloride comes into the neuron and it basically depolarizes that neuron and it ceases to function. The result of that is that you can start to feel a number of things.
You can feel extremely relaxed, calm, and at peace. It can address anxiety symptoms acutely. You can even feel a little bit high because it releases, it takes the break off of the dopamine receptors in the brain. So it's a very addictive drug because it affects dopamine
And in the long term, there's a rapid tolerance that develops where you need more and more of the drug to achieve the same amount of reduction of anxiety. So I'm frequently seeing patients who come in after being seen in the emergency department, prescribed a month-long course of benzodiazepine. that works the same way as alcohol. It binds to the same receptor as alcohol, the GABA receptor.
And now they've gotten a little bit hooked on it. They've still got the same problem that they came to the emergency department with. They've still got their anxiety, but now they've got a new problem. They're hooked on Ativan or Klonopin.
Or Xanax.
Or Xanax or some other medication like that. And so they still need the treatment for the initial problem that they presented with, whether it was anxiety or panic attacks. But they also need strategies for how to get off of a medication that they've become addicted to, physiologically addicted to. Yeah.
And so one of my messages to emergency doctor physicians is don't prescribe a month-long course of benzodiazepines for anxiety. Let psychiatrists handle that because it can actually create a new problem where there was really a solution in the first place called cognitive behavioral therapy. You can learn about that.
You can read David's books, When Panic Attacks, and you can get excellent treatment for panic and anxiety. without going down the side track of getting onto a medication that is highly addictive and hard to get off of. If you've already gotten onto it, go ahead David.
Go ahead and I'll wait.
I think the question was about, okay, what's the best way to get off of it if you've gotten onto it? The answer to that is complicated because it would depend on the individual. their circumstances, and the medication that they're on. So one answer might be immediately go cold turkey off of benzodiazepines. That's frequently the correct answer. Really? Yeah.
If you're a young, healthy person who's only taken it for a few days, and you recreationally partied on Xanax, Alprazolam, for a couple of days, and you realized, huh, This has caused me a lot of problems. Like I broke up with my girlfriend, my friends got angry with me, I acted in ways that were irresponsible, I spent too much money. Xanax does all of these things.
Benzodiazepines, they take the break off of our dopamine receptors and they cause us to do things, it's called disinhibition, where we'll behave in radically bizarre ways. And the best thing to do if you're driving down the road and you've got a bag of pills of Xanax and you've just partied for a couple of days, you're a healthy person, you don't have seizures, just get rid of it immediately.
Stop cold turkey. That's often the best plan. An extreme alternative version of that is that you've been on a benzodiazepine to stop your seizure disorder. You've got seizures and if you go off of it, you're going to have more seizures.
And so the plan would be not to go off of your benzodiazepine at all, but to find a new medication that helps you treat your symptoms, prevents you from having seizures, without all of the side effects of a benzodiazepine. So the correct answer actually depends on the individual, the circumstances, and the specific medication involved. And we could write a whole textbook about that.
But I think we lead back to the team model, which is we want to get more information. Like, what are your circumstances? What are your goals? And how long have you been taking a benzodiazepine? Do you have medical circumstances that might predispose you to having a seizure if you acutely go off of a benzodiazepine? So I can't give a general correct answer to a nonspecific question.
But there are some key guidelines that help guide us. And one of them is the half-life. David, you referred to that. which is if you are on a short half-life medication like Alprazolam and you're trying to get off of that, that's going to be a lot more challenging than if you're on a long half-life agent like Chlordiase, Epoxide, or Valium.
You can essentially, for most people, be on a dose of Valium that has a super long half-life and just stop taking it. And it will linger in your bloodstream and in your cerebrospinal fluid for a very long time. And you don't have to worry about crashing or a strong whiplash effect where you get rebound anxiety, etc.
Well, just to cut to the chase here a little bit, if you're on high doses of benzodiazepine, certainly don't try to treat yourself, but do it in conjunction with a medical doctor. What's the best way for you to taper?
One other thing that you said that took me aback a little bit, you said, if I heard correctly, that if someone comes into the emergency room with a panic attack, instead of giving them a 30-day dose of benzos, you should refer them to a psychiatrist for CBT. And I don't think there are – there's only one psychiatrist in the United States who's good at CBT. And he doesn't do CBT anymore.
He does team, which is awesome. And his name is Matt May. But I don't think there's a lot of psychiatrists who would – use psychotherapy rather than just more drugs.
And if I was in an emergency room, I'd want to be able to refer people with anxiety or depression to psychologists and clinical social workers and people who have expertise in team CBT or traditional CBT rather than people who were trained mainly to prescribe medications.
Yeah, if we can avoid that detour along the route of cure, because it just adds a new problem for most people, that most people then get hooked and they now have anxiety, but they also need to get off of an addictive substance.
Awesome point. Let's look at Gray's intriguing question about music. And thank you for that detailed expertise, Matt. Much appreciated.
Yeah, thanks, Matt. Okay, this is what Gray asked. Hi, David. This is a really tough question. That must have been a response to another dialogue between the two of you.
No, it wasn't.
No, he just started it off as this is a tough question. Okay, let's see how tough it is. Music has a unique way of cutting straight to emotions for me, and it makes it especially hard to identify the thoughts behind them. My best way of explaining is with these two thoughts, which have to be viewed as a pair to get the emotional reaction. My life would be perfect if I had that.
I'm so far away from that. Thank you so much for your response. And what does that have to do with music?
Well, I'll give my answer first because it's very short. Usually I give my answer last. But I agree with Gray that music can be beautiful, especially the songs we love, the certain songs for each of us just fill our heart with so much peace or sadness or beauty. And And that can be a magical and emotional experience.
I don't think we have to look for thoughts in the form of sentences to explain our reaction to music. I'm not aware of thoughts triggering the reaction to music. I once asked Beck, you know, aren't there perceptions other than like a sentence with a negative or positive thought that can figure our emotions? And he said, yes, cognitive therapy is not about thoughts. It's about perceptions.
And, for example, in anxiety, the perception that makes you anxious might be a picture in your mind. Let's say you have a fear of elevators. You may picture that elevator closing off. And so you're terrified of elevators, thinking that the walls are going to crush you or the oxygen is going to disappear or you're going to get trapped. And you kind of picture this.
And I thought that was very liberating that cognitive therapy is all about, it should be called perception therapy. And I guess you could say that music is a kind of auditory perception that can move our hearts or anger us to warfare, you know, that there's a lot of kinds of emotional reactions to music.
And that's about all I have to say, because I don't have expertise in this particular area, but I thought it was a really neat question.
Matt? Yeah, I like the question too. I can't claim to be an expert on it. There was a book, Music and the Mind, that I read some time ago, and it did resonate with me, to use a musical term. I have some guesses about it. I'll maybe identify two things that I think might be going on with music. So one is rhythm. All music has a rhythm.
And I think human beings are exposed to that early in life, actually while they're in the womb, because sound transmits so clearly through solid matter and liquid, that an unborn child can hear the heartbeat of their mother. And that heartbeat varies according to circumstances that are also related to her neurophysiology. So I think we get an early exposure to music that may be very specific
and create profound emotion. And I think as a species, we've evolved to be very social, that the most important cues that we could be picking up on in our surroundings are related to other people, their facial expressions, their voice, their intonations. And we hear that from a young age, too. We hear the voice of our mother before we're born.
And music has both of those components, both rhythm and melody. And so I think it is easy for us to anthropomorphize or hear another person when we're hearing a frequency. Certain frequencies sound sad, a minor note. Certain sound happy, a major note. And everything in between. And so we pick up on those, we learn those from a very early age.
And I think that when we hear music, we imagine either that emotion is within us or it's coming from outside of us, that we imagine a person speaking to us, talking to us. And it makes a lot of emotional connection to us because of those experiences and those attachments and connections. Those are just guesses. Those could all be wrong.
Again, I haven't seen a lot of science on that, but there are some books about it that might be interesting to people.
Maybe that book is good. When I hear a question like that, I have a very powerful answer. I don't know. Yeah. When people try to explain things in words that don't make any sense to me, I'd rather just say, I don't know. There's a lot of things we don't know. And just because we're a psychiatrist or a psychologist or whatever doesn't mean that we have special insights into everything.
But, David, I also like the sentence, I like bullshitting.
Yeah, that's right. There we go.
So I'm happy to do that all you'd like and ask all the questions you'd wish for me to answer in a bullshit way.
Last week we interviewed the Buddhist monk and we talked about attachment as a source of pain or a way of getting in the way of our happiness. That one, his first thought, my life would be perfect if I had attachment. whatever it was I had, is a perfect example of attachment and a source of pain because they have this desire for something that's outside of themselves.
And without that, whatever it is, they can't feel happiness. Instead of turning inwardly and being happy with who they are, with the relationships, the people in their life, or the love that they could be generating.
Right. That's a beautiful Buddhist thought. But what does it have to do with music? I know.
It has nothing to do with music. It's just like independently of the thought. Yes. It's just bullshit. Exactly.
Yeah. Okay. Well, let's bullshit on some other topic. By the way, I see that Josh's question, that was the beautiful endorsement you wrote, was the third question.
And I have an additional partial answer for Josh, and that you'd be welcome, because you are a mental health professional, and all strengths who are listening, whether you're a pastoral counselor, a psychiatrist, psychologist, social worker, whatever, if you're doing clinical work, You'd be welcome to join either my Jill Levitt and my Tuesday group at Stanford or Rhonda's Wednesday group.
And soon Kai Chen will be co-teaching it with me.
Oh, in November.
Yeah. We're in November when this is published.
So, yeah. And then your group is once every other week. No, no. It's every week.
Oh, sorry.
Did you think we were talking about you, Rhonda?
I thought you were talking about me and I was just going to like blur out some more information because I actually want people to come to my group.
Yeah. Well, you can give that information in a minute. But when is your group meet, Matt?
It's really not that important, but I do meet every other Monday with Jacob Towery in person at Palo Alto University. It's an awesome group and really love the people who are attending and love teaching with Dr. Jacob Towery.
So we'll put the contact information for all three of us. And Rhonda, you can add the contact information for your group, who is Anna Teresa. Is she still the contact person? Yes. Yeah. And we'll put that in. And then ours is Ed Walton for our Tuesday group for 5 to 7 p.m. That's the Stanford group. And Matt, you'll see his website and email too in the context.
So if you are a shrink, we would love to have you join us for a period of time or a long period of time. And we practice team CBT techniques. Okay, on to question number four.
Okay, this is from Harold, who's asking about how do you respond to negative thoughts about the world as opposed to self-criticisms? And he gives the example, the world is filled with so little joy and so much suffering. And dear Dr. Burns, first of all, I'd like to thank you for all of your work and your outreach. Your books have profoundly influenced my thinking and value system.
I really admire how you exemplify both scientific rigor and human warmth. Finally, I want to thank you for promoting the idea of rejection practice. I haven't had a breakthrough yet, but some unexpected, very encouraging experiences have occurred. And I'm going to jump around because it's super long.
I recently tried the techniques in Feeling Great, but wanted to ask you for your opinion on a couple of negative thoughts I'm particularly stuck with. My issue is that I'm normally not attacking myself, but life in general. I keep on telling myself things like, life is just one crisis after another. Life is for the lucky ones. Really good things just don't want to happen.
Life is so much suffering and so little joy. And the depression itself makes these statements all the more convincing. Triggering events can be rainy holidays, romantic rejections, grant interview rejections, etc. So I think it would be helpful if in a podcast you could give more examples on resolving negative thoughts attacking life or the world rather than oneself.
I also have a lot more questions for the podcast if you're interested. Thank you for reading this, and thank you so much again for all your work. With very best wishes, Harold.
Okay, I'll let you two take first crack at this, and then I'll come in at the end. If you like, if you want to answer it. I have some thoughts on that. How about you, Rhonda?
I have no thoughts. No, go ahead, Matt.
You've achieved, achieved enlightenment. I'm very jealous of you.
Okay, Matt, take it away. What's your thoughts for Harold?
Well, sure. Harold, I really appreciate the question. The, if you're upset a lot about, you know, thoughts about the world, um, I would invite you to consider whether there might be should statements attached to those thoughts. You listed a couple of different thoughts. And at times, those will be very just true statements about reality. There's just a lot of suffering in life, for example.
And the question I have is whether or not you're also telling yourself that it shouldn't be that way, that there shouldn't be so much suffering. If so, then there would probably be some help for you, and we could probably help address those as should statements the way we would any other self-directed should statement.
Only the path would be a little bit harder, because addressing a self-directed should statement, like I should be better, leads to immediate resolution of guilt, shame, pressure, etc.,
However, if it's outwardly directed, if you're saying the world shouldn't be this way, then you're not going to experience an immediate relief from guilt, but you're going to experience something different, which is an acceptance of the world around you, and you won't be as outraged or angry. And a lot of times people want to feel outraged and angry because it gives them a sense of purpose.
In fact, one of the main things that seems to draw people's attention is outrage. If they're presented with information that causes them to feel very upset, they're more likely to interact with it. They get kind of hooked on ideas that the world shouldn't be this way. And they'll keep clicking and focusing their attention on that.
It's a very addictive substance is blaming and saying the world shouldn't be this way. So it's actually a little bit more challenging to defeat than an internalized, oh, I'm the problem, I shouldn't be this way kind of thought. But the same methods are effective.
You could use the semantic technique, the Socratic technique, and talk back to all your reasons to get focused on this idea that the world should not be this way.
That's great. I love your answer, Matt. That's brilliant. I might add that if some of our listeners are interested in taking a look at the Feeling Great app, we have a class in there called Your PhD in Shoulds and talk about specific techniques to get rid of self-directed shoulds like I shouldn't be so screwed up, I should be better than I am, etc.
Other directed shoulds, when you're telling yourself person X, Y, or Z is a jerk, he shouldn't be that way, he's got no right to be that way. And then world directed shoulds, which is kind of like the ones you have, life shouldn't have so much suffering and so little joy. So that's my first point. My second... I mean, you really hit the nail on the head there, Matt.
That was brilliant, what you said. I loved it. The second thing, I wrote back and told Harold, if he were in a session with me, how I would respond to him, or if we were just friends talking. And that's the... The Maury anti-moaner technique that is described in Feeling Good.
When someone is just complaining, complaining, complaining, I respond with the disarming technique, thought and feeling empathy, I feel statement, stroking and inquiry. I don't try to help the person. And I give some examples in the show notes. Like if you be... In fact, let's just demonstrate it.
I'll be Harold and one of you can be the friend and modify how to respond to a complainer using the five secrets. Does either of you want to give it a try?
I'd be happy to.
You know, life is just so much suffering and so little joy. That's so true.
Yeah, there's a tremendous amount of suffering in life. And I've been thinking about you a lot recently and the suffering that you've been experiencing. And it seems really outrageous to me and preposterous that you'd be experiencing so much of that and so little joy after how much you've put in, how hard you've been trying. I'd be feeling pretty pissed off and angry if I were you. Yeah.
And I wonder how you're doing. Could you tell me a little bit, a little more? I'm really glad you're talking about this with me.
Okay, what grade did you give yourself?
Somewhere around, and that's a great question. I don't know. I don't think my grade really matters, just yours.
what grade did you give it ronda you matter matt and your grade matters i would give that an a absolute 100 i wonder if you could add a little more stroking oh that's a great idea and then it could have been a class but i was i was just like melting with warmth and compassion and
Yes, I agree. And I thought that you didn't try to help. You were just a good listener. And the big mistake that everyone makes, except for you, Matt, and a few other people in the world, is they try to help the person or encourage the person or solve the problem. That forces the whiner, the complainer, just to keep going. To keep complaining.
So that's how I would handle it on an interpersonal level. What I also said to Harold, and let me go back to my notes here, is that this is nearly always a hidden emotion problem.
When someone is obsessing about the meaning of life or some vague thing, there's often something real in their life that they're upsetting about, that they're not confronting, they're not dealing with, and instead they're just kind of complaining about life in general. And the solution is often to find the thing that you're really kind of upset about.
And I exchanged a couple emails with Harold, and what turned out is he had made a kind of a common error in dating and got rejected. And what it appeared to be is that he was talking to some woman, and was saying, you know, would you like to go out sometime?
And she said, yes, but when he tried to pin her down, she said, oh, I have to check my schedule, and I'll get back to you in about a week or so. And he agreed to that. And she's really giving him the runaround, and he's falling for it. And I don't mean to blame women. Women will do that. Men will do that.
But that's something you don't want to fall for, that kind of thing, and get out of that situation. Because what happened then, that she just made him wait a week, and then she didn't contact him, and then he contacted her back. And then she said no at that point. And so he just kind of had a week of his life scooped out. And you don't want to give someone that kind of control over you.
And, you know, when people are having trouble with dating, you know, I sometimes suggest the book... intimate connections, which he'd actually said he'd read three times, which I was really, really proud of him.
And then maybe get a colleague or something, a therapist or a friend who's pretty good in the dating arena and learn a bit more about dating strategies, because there's a lot to learn about it and to focus on the real problems in your life. But there's a lot of other techniques one can use in addition to the ones we've talked about here.
I want to say that I admire Harold because he's put in tremendous effort into his personal recovery efforts. And I've never met anyone who put in that kind of effort who didn't get really good results that just really trying will eventually open the door you're looking to. You're looking to get open. But it can be frustrating.
I know I was really lame in the dating world myself for a long time and everything I did was incorrect. and eventually I kind of found a mentor who was, you know, well, let's say a shameless womanizer, so everyone will hate me for saying that, but he was. He was Palo Alto's, you know, most famous womanizer, and women used to say how awful he was.
All he cared about was sex, but he used to go around just picking up women, All day long. And behind his back, they'd tell him, talk about how awful he was. But when he was around, they always wanted to be around him. And he was having a pretty good time.
And he took me under his wing and kind of gave me a lot of pointers and tips on how you date and what that world is like and what works and what doesn't work. That was the thing I loved most. the most when I was in clinical practice because 60% of my patients were single and didn't know how to get into the dating scene.
And I learned so much from that fellow who in my book I called Bill to disguise his identity, but his real name was Michael. But I couldn't find him. You know, I know his last name, but I want to ask permission. And I called up a lot of people with his name, but it wasn't the same guy, so I never knew what happened to him. But we made a weird friendship. He lived with his mommy.
He said he was a mommy's boy, and he had a part-time job at Bloomingdale's selling men's clothing, and he had a motor scooter. not a car that he rode around on. But there was something about him that women just found absolutely irresistible. And I kind of learned eventually how that works.
So there is a lot to learn, and sometimes if you're too sincere and too nice, you get shot down, and that's true if you're a guy or a lady. And...
That explains a lot for me, David. Thank you. I appreciate that.
Talk about that.
You helped me a lot just to identify my own niceness and to change sort of the way that I approached dating and interacting with other people in general. Just to be a little bit more selfish was okay. And I really appreciated that one of the most important lessons you taught me is it's okay to get rejected. Yeah. And in fact, you prescribed that to me. You said, go get rejected a lot.
And I did so. And that was the most liberating experience of my life to realize that a single rejection actually doesn't cause any harm in the grand scheme of things. In fact, 10 or 20 rejections doesn't cause any harm in the grand scheme of things. It's perfectly okay to get rejected. And after I did that and experienced that, then I felt much more free and liberated. And my anxiety went away.
And it just occurred to me, gosh, it's a matter of time until I find someone who's really appropriate for me. And linking that to the hidden emotion, That perhaps the person asking this question is suffering from is maybe they're getting distracted by world events and getting upset with the themes that are in the world rather than acknowledging that they felt a little rejected. Yeah. And angry.
And angry. And that's a very painful, upsetting set of feelings. And oftentimes nice people don't want to acknowledge that they feel angry or upset. They want to distract themselves with politics or other things. But I love that you were able to delve a little bit deeper with this person and get to where their real suffering is.
Yeah. Well, it was a joy working with you, Matt. It's always been a joy knowing you as a friend and working with you as a colleague and formerly as a supervisor when you were a psychiatric resident. And it was just so much fun. And it's still so much fun.
But I'll never forget the night that you had gotten over all this anxiety and being jerked around by women and the shoe suddenly was on the other foot. And I remember you came to me once and said, David, I'm in terrible condition and I need your help. And I said, well, what's the problem? And you said, I got confused and made a mistake and I have three dates scheduled for tonight.
Yeah, there was a little bit of an overcorrection error on my part. You helped me there as well. Thank you.
Yeah. I mean, I don't want to sound snarky. I just want to say that I've been up since 430 because I'm having people over dinner and I jumped up.
Oh, yes, that's right. Happy New Year. Happy Rosh Hashanah.
Yeah. So maybe I'm not thinking correctly because I'm sleep deprived. But we start – but there are some people who sincerely are worried about the world events or politics and has nothing to do with hidden emotion or dating or anything else. But they're just basically interested in the world and worried.
But maybe those people aren't having negative thoughts and turning the negative thoughts against themselves. Is that what you're saying?
Those can be just standalone negative thoughts that would respond to other methods than the hidden emotion. The hidden emotion would be just one of many different methods that could be helpful for someone who's upset about world events. And we could just ask, like, gosh, why wouldn't you want to be upset?
There are so many world events right now that are affecting, you know, are just horrifying to consider, right? And it seems very appropriate to be concerned about them. And so to side with, gosh, that seems like an appropriate emotion to be feeling and to look at all the reasons to feel that would be one first step.
Yeah, and getting to a place of acceptance, maybe.
Well, what is the overwhelmingly main, massively important thing to do to help someone who's complaining about world events? Because there's plenty of world events to complain about. So let's say in the empathy phase, someone's upset about politics and the Ukraine and Palestine and Israel and Putin and Alzheimer's.
all the awful things in the world, big and small, and you've empathized, and they give you an A in empathy. What is the overwhelmingly most important key to successful treatment, Rhonda, with that person?
I mean, issuing an invitation to see what they want to work on.
Absolutely. That's it. And you don't get hooked into, you know, throwing help at people just because they're talking about problems. You know, if a miracle happened in today's session, what miracle would you be happy hoping for? Right. And we certainly can't end the war in Ukraine or, you know, cure the political quagmire in the United States.
But we have all kinds of ways to work with someone, but it depends on what they want help with.
Yes. Thank you for clarifying that. Yeah, I appreciate that. Let's go on to the next one. Okay. Are you guys ready for the next one?
Yeah, it's a good one. And the next one is a great one. I'll be right back. Okay.
Okay. Hi, David. You've mentioned a few times that there are only a handful of quote-unquote real psychological disorders with known causes as opposed to just a collection of symptoms. Could you please tell us a bit about how you would go about helping somebody with one of the real disorders like schizophrenia or bipolar disorder using team therapy.
Most of the episodes with personal work seem to fall into the other category, anxiety, depression, compulsive behavior.
I'll give you my answer right now. I have to take a pee, and so I'll be right back to give my answer.
Well, I have to say, in over four years of doing these podcasts, this has never happened before. Okay, you guys.
Yeah, I'm back. I think it just made us seem more human, but that's just my point.
Yeah, we can keep that in.
Well, it's a short question, so let's push ahead.
So do you want me to read? Do you want to just push ahead and answer it?
Yeah, now we're going to go on to question number five from Maritz.
Okay. You've mentioned a few times, David, that there are only a handful of real, real as in quotes, psychological disorders. with known causes as opposed to just a collection of symptoms. Could you please explain a bit, tell how you would go about helping somebody with one of the real disorders like schizophrenia or bipolar disorder using team therapy?
Most of the episodes on the podcast with personal work seem to fall into other categories, such as depression, anxiety, compulsive behavior. So I'd be really curious about some examples. Best regards, Moritz.
Okay, I can give a quick first answer, but I have to correct one thing. You said real psychological disorders with known causes. All psychological disorders have unknown causes, but there are real brain disorders like schizophrenia and bipolar that are really due to some biological error in the brain that we don't yet know.
And at my hospital in Philadelphia, we developed a large cognitive therapy program for the people in our inner city neighborhood. And there were many of them had schizophrenia or bipolar. including some needing hospitalization kind of involuntarily because they were so severely out of control. But when I've worked with people with schizophrenia or bipolar disorder,
I've worked with them in the same way I would work with anybody. I don't try to treat schizophrenia. Sometimes people with schizophrenia need to have neuroleptics if they're in a state of acute, severe paranoia or psychosis. But the things that I would be helping them with, say, as an outpatient, is exactly the same. Is there something that you would like help with?
And generally it's with their moods, in which case we'd pull out a daily mood log and write down their negative thoughts and the event and the emotions and identify the distortions and talk back to those thoughts. And I've worked with many, many people with schizophrenia, but I'm not trying to challenge their delusions or paranoia, just give them a greater sense of self-esteem.
People with bipolar, I've treated many people with bipolar disorder, And again, during the acute phase, they may get so, of mania, get so psychotic that they need one hospitalization to understand what they're dealing with and to get on some kind of mood stabilizer like lithium is the one I used. I think they're using some other medications that work fairly well.
But they need the same help as anyone with the feelings of depression. It seemed like bipolar patients often had a lot of perfectionism and all-or-nothing thinking and thinking they had to be so great to be loved or to be worthwhile. And I found that helping them with that was life-changing for many of them. And some of my most patients I look back most fondly had bipolar issues.
And and and before I learned cognitive therapy or team therapy, I for a while I ran the lithium clinic at the VA hospital in Philadelphia. And all I had was drugs, drugs, drugs to offer. And those poor guys were going in and out of the hospital like a revolving door. And I can't remember a single one of them who seemed to have a decent adjustment to life, to be honest with you.
There was a lot of alcoholism and a lot of unhappiness and a lot of pills that we were prescribing. And once I started doing my outpatient practice, I still got bipolar patients, but they did just fantastic because I had something to offer them by way of psychotherapy. I also would say that working with people with schizophrenia or bipolar, for all of us, the therapeutic relationship
is important. We all want someone to feel fond of us and to care about us and to approve of us and accept us. But I think that's especially true with schizophrenia and bipolar, that the kindness and warmth that you extend to people with schizophrenia or bipolar, many of them will never forget you. And it means so much. But you also want to have technical skills.
And let me say finally that at our hospital in Philadelphia, we had an inpatient unit for people with extreme psychotic episodes. And one of our clinical social workers created a series of cognitive therapy games. We didn't have team therapy yet at that time, but we had cognitive therapy And he created about 40 games. And he would have the patients on the inpatient unit play these 45-minute games.
Like instead of group therapy, you get together with a group and you kind of play a game designed to illustrate some aspect of cognitive therapy. Like there's the paranoia game and the high George game and things like that. And they really enjoyed playing those games, and they would learn about, like, the cognitive distortions, like mind reading, for example, the paranoia game.
He would have all of them sit around a circle and give them an envelope with, if there were 12 patients with 12 pieces of paper, and say, I want you to write down one nice thing about each person here, and then fold it and hand that piece of paper to them. And then when someone gives you a piece of paper, put it in your envelope, don't read it.
And so they're all busy, you know, writing down nice things about each other and handing them around. And so it's not like typical, you know, inpatient treatment. Now, keep in mind, they're seeing a psychiatrist, they're getting medications that they might need, but they're playing these games all day long.
And so they hand them around, and then he would go around to them one by one and say, do you think you know what people said about you on those slips of paper in your envelope? And they'd say, oh, yes, I know exactly what they're saying about me because I can hear people's thoughts. and say, okay, what do you think they're saying about you?
And this one woman said, they're saying they think I'm a prostitute and they're scheming to try to get my gold. And then George said to her, how strongly do you believe that? And she said, I know that's, because I know that's what they're thinking because I can hear their thoughts. And he said, why don't you take and read them out loud one by one.
And then she took out the first one and it said, you know, Rose, I want you to know that you're the person on the inpatient unit who's helped me the most, even more than the doctors and nurses, because when I'm upset and I talk to you, you really listen. God bless you, Rose. I can't thank you enough.
And every piece of paper had some beautiful comment by someone, and tears came to her eyes because when people have schizophrenia, they're often hard to relate to, so they don't hear a lot of affectionate and kind comments from other people. We get kind of frustrated with people with schizophrenia, and we argue with them about their hallucinations and delusions.
And this was a very different way of connecting. And we didn't have the goal of curing anyone with schizophrenia, but just helping them develop joy and self-esteem given their severe condition.
biological problem and I used to see they would show me letters that they got from families or patients who had been discharged from our inpatient unit just saying and they were often written in kind of broken English you know not very extremely articulate but things like God bless you for the helping me so much or helping my my son so much on the inpatient unit and things like that and
And the neighborhood really, really appreciated our programs. They even had a feeling good day every six months at the hospital. They'd give out feeling good T-shirts. They started a feeling good jazz band. And it was quite the thing. But it was really based on bringing compassion to a group of people who had very few resources.
And probably a lot of rejection experiences.
Oh, yeah, absolutely.
Anything you want to add, Matt?
I thought that was a beautiful answer.
Me too.
I've almost forgotten the question. Treating schizophrenia.
Well, the question is just how do you help someone with bipolar or schizophrenia, so-called real brain disorder, as opposed to just depression or anxiety? Right, yeah.
So I think it's true that people... All people have multiple problems. So one might be they've got schizophrenia or bipolar, but then they'll also have other problems in their life, just like anyone else. They might have social anxiety. They might be feeling down about themselves, judging themselves, etc.
So we would treat that in the same way, but we would also want to treat whatever biological problem that was affecting their brain. Schizophrenia and bipolar, there's a lot of evidence-based treatments out there to help folks with the symptoms related to that. There are other biological problems that exist that affect the brain.
But we would also want to treat – mostly we're treating the person with those problems and trying, as you said, David, to identify what are their goals, what are they hoping for. And then we can come up with a long – list of methods that could be helpful to them and help resolve those problems. It might include medication or other methods that they could engage with.
But yeah, to have a diverse set of skills and tools to offer somebody to address both the biological, psychological, social components to their suffering would be important.
I had a young teenager referred to me who had one of the... severe brain disorders more in the area of limited intelligence. I'm trying to think of which one. It might have to do with your brain getting squashed during the birth process. I'm not sure. But she had very, very limited intelligence.
mental functioning, and she was in a high school, but in the special classes for people with severe mental, you know, cognitive impairments. And she had been getting all A's, but she got mad at her teacher, so she refused to study for some quiz, and she got an F. And And then she became suicidal because she flunked that quiz. And her parents brought her to me.
And I asked her, just as I would with anyone, you know, what are your thoughts? What are you telling yourself? And she said, because I flunked that test, I'm going to flunk everything from now on. And that's just the same kind of thought that anyone would have. She just put it in her own words. But, you know, it's an overgeneralization, all or nothing thinking, discounting the positive thinking.
You know, mental filtering, fortune telling, emotional reasoning, self-blame, you know, should statements, all of that stuff. But I worked with her in a very simple way. I just said, the issue here is what grades did you get, you know, in your quizzes before this one? She said, I always got an A.
And, um, and then I would ask, uh, do you, do you think it's possible that if you start studying again and maybe talk to the teacher, what you were so mad at him about that, that then you could start getting A's again. Um, and, and, and then she would say something like, are you saying that I, it's not necessarily true that I'm going to flunk everything, uh, for the rest of my life.
And I said, yeah, that's what I've been hinting at, uh, And then she would say, could you explain that again? I'm trying to understand this. And we'd go through that 30 times in a row, the exact thing. And then by the end of the session, she said, are you saying that even though I flunked this one quiz, it doesn't mean I'm going to flunk all of my quizzes from now on?
And I said, that's what I've been trying to hint at. And she said, oh, I got it. I'm feeling so much better now. And so it was the same thing. It's just presenting things in a way that people can understand.
And again, it was sad because the goal wasn't to remove her severe brain damage, whatever it was that caused her very tragic and horrific cognitive impairment, but it was just to give them the gift of self-love and joy and self-esteem.
And it was using exactly the same kind of techniques, but delivering them in a way that someone can understand that takes into account who the person is, what is their social functioning, what are their religious beliefs, their religion, their race, their social structure. How can you explain these things in a way that someone will understand from their point of view?
The principles are always the same.
I love what you're saying there, David. It reminded me of something that was helpful to one of my patients who had pretty intense feelings of paranoia. And their experience was that they couldn't. explain different coincidences that were occurring to them, that it seemed unlikely that they were just coincidences. And then I recalled a statistics class that I took in medical school
where the teacher was looking at a case, an unusual case, where an individual had been struck 17 times by lightning. Wow, that's weird. It was really weird, and the teacher asked, well, why did that happen? Was it something with their physiology? Were they different in some way, etc. ? and the class took all these guesses which were in fact wrong.
The correct answer is that statistically speaking, if you take the number of human beings on planet Earth and the frequency of human beings being struck by lightning, that there will be a few people who are struck 17 times by lightning. If you just run the math, it would be a more bizarre
more weird set of circumstances, more likely to be a conspiracy theory if there was nobody who was struck that many times by lightning. There actually wasn't anything different about this person. They didn't have a different physiology, higher sodium levels in their body, nothing like that.
They just happened to be that one person who got struck 17 times by lightning, which was predictable according to statistics. And realizing that, the person I was working with, came to terms with the fact that, gosh, there are just a lot of coincidences around us. A lot of things happen.
And it would be more unusual and more unlikely and less easy to explain if there were just no coincidences at all. So sometimes just explaining things, like you said, in a way that makes sense, whether it's mathematically or at an interpersonal level, can help folks who are struggling with a negative thought, including paranoia.
Yeah. Well, you guys are just totally brilliant. And it's a pleasure to listen to you and even share the screen with you. We've been talking now for an hour and 20 minutes. So shall we say bye till now? The rest of the questions for later?
We can. One is just John expressing gratitude to us for our answers on positive reframing, which I have in the show notes that people can read if they like. That was from a previous episode. Okay, why don't I read that? Well, I was going to say we could skip it and go on to the last question, number seven.
No, because that's kind of a complicated question.
It's actually not at all complicated, number seven.
I mean, the question isn't complicated, but the answer is going to be long-winded.
No, it's only 30 seconds.
Okay, I'm going to stop you in 30 seconds. So Rhonda asked about the four feared fantasy techniques.
What Rhonda is this?
That would be me.
Okay.
Give me 30 seconds. Go.
Yeah, I love your, okay. I love your questions, Rhonda. And you want to know what are the four feared fantasy techniques. And there's four of them. For the approval addiction, they're for self-defeating beliefs. And if you're working on the approval addiction or perceived perfectionism, then you do the I judge you feared fantasy technique.
If it's the achievement addiction, you do the high school reunion feared fantasy. If it's the love addiction, you do the rejection feared fantasy. And if it's submissiveness, you do no practice. And now you know the answer.
Okay, and that was 30 seconds.
And we could go on much longer on this and other role-playing techniques, but it is Rosh Hashanah, the first chapter. day of the Jewish New Year, if I understand it correctly. And our love goes out to everyone who's celebrating Rosh Hashanah. You won't hear this until much later. It'll be like four or five weeks from now.
But we still want to send our love and warmth and best wishes to all people in our podcast fans and people all around the world of the Jewish faith. Our love and Our hearts are with all of you. And we're so sad at so much trauma now in the world affecting Jewish people and the country of Israel. And I at least want to express my love and support.
Thank you so much, David. That's really appreciated.
Yeah, me too. Okay.
See you next time.
OK, goodbye, everybody. Thank you for listening. We really appreciate all of you. We love all of you. And we're so glad you join us here on the podcast, sending your questions and criticisms and your praise. And and we just we love having the dialogue and turning it into a dialogue.
Or a trialogue.
Yeah, that's right. Trialogue. Yeah, that's right. OK, so.
Okay, fellow trial loggers, have a good one. 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.