Dr. David Burns

Yeah, that's complicated. We'll explain that to you after the podcast.

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.

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.

You're really sinking low. Yeah.

You're really sinking low. Yeah.

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?

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?

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 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.

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.

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.

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.

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.

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.

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.