Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

236: Ask David: Does "objective truth" exist? Is TEAM as effective as you say? Shame Attacking, Codependency, and More!

05 Apr 2021

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Upcoming Workshops The Cognitive Distortion Starter Kit With David Burns, MD A One-Day Workshop on May 5, 2021 Click here for more information including registration! 8:30 AM to 5:00 PM West Coast Time: 7 CE Credits Bringing TEAM-CBT to Life in Real Time Two Live Therapy Demonstrations with Drs. David Burns and Jill Levitt REGISTRATION CLOSES AT 5:30 PM PACIFIC TIME ON SATURDAY 5/15/21. NO EXCEPTIONS. Live Online Workshop with David Burns, MD and Jill Levitt, Ph.D. Click here for more information including registration! May 16, 2021 | 7 CE hours. $135 8:30 AM to 4:30 PM West Coast Time Binoy asks: How does one know that a thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling one? What is the basis? Binoy also asks: Is there something called “objective truth” that we can all agree on? Kristina asks: I have been labeled codependent in therapy. Is it a true label? . . . Do you believe in highly sensitive or empathetic people that can feel others energy? Fabrice asks: What do you think about this definition of the “self?” Don asks: Is TEAM as effective as you say? Binoy asks: I live in an Arab country and some of the things on your list of Shame-Attacking Exercises could get me arrested. Is there a better way to overcoming anxiety? * * * Binoy asks: Hi David, I just listened to podcast 079: “What's the Secret of a "Meaningful" Life? Live Therapy with Daisy." One of the questions that came across my mind is, how does one know if a negative thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling distortion? What is the basis? Hi Binoy, thanks! Excellent question I might address on a future Ask David podcast. However, I would need you to give me a specific example of a thought you want help with. Specifics typically lead to illumination, whereas abstract thoughts sometimes lead to endless pontification. Binoy also asks: “Hi David, I did listen to the podcast #20 on “The Truth About Antidepressants.” I wish everyone agreed that there is something called objective truth. This is a question about truth or the existence of objective truth. Is the popular ideology that there is nothing called objective truth (everything is relative) correct? How can we talk about truth in a way that will help us be on the same page? So, I hope to hear from you again! Hi Binoy, this is also an abstract question, best answered through specific examples. For example, I can explain the concept of controlled outcome studies to test a drug against placebo, but even there you can find lots of ways to challenge any scientific study. We can also talk about distorted negative thoughts that trigger negative feelings like depression and anxiety. These thoughts are not really true. but we always focus on one specific thought at a time, and only from someone asking for help. I do not pontificate about “truth” in some abstract sense! All the best, david * * * Kristina asks: I have been labeled as codependent in therapy. Is it a true label? Hi Dr. Burns, Thank you so much for all your services and help that you offer Dr. Burns. It has been life changing and I’m just starting to help myself out of this anxiety and depression. I wanted to ask how you feel about the terms, codependency and boundaries. I have been labeled codependent in therapy and is it a true label? Do you believe in highly sensitive or empathetic people who can feel others’ energy? Thanks again for all you do! Thank you, Kristina Hi Kristina, I had to look up the term. According to dictionary.com, someone who is codependent “is in a relationship in which one person is physically or psychologically addicted, as to alcohol or gambling, and the other person is psychologically dependent on the first in an unhealthy way.” David and Rhonda can mention: the “codependency” and compulsion to “help” or “rescue” that often gets therapists into trouble with patients. This is a kind of addiction that therapists have, and is the main cause of therapeutic failure. that I work with specifics more than labels. For example, if a patient wanted help with “codependency,” I would ask him or her to describe a specific time on a specific day when this seemed to be a problem. Then I’d figure out what was going on, and find out if it was an individual mood problem or a relationship problem. After empathizing, I would find out what, if anything, the patient wanted help with, and then I’d bring the resistance to change to conscious awareness. My research on empathy indicates that even therapists are not accurate in sensing how their patients feel. The same is true, I believe, of the general public. People vastly overestimate their capacities to understand how others are thinking and feeling, and this is super easy to demonstrate with simple experiments using rudimentary statistical analyses. David * * * Fabrice asks. What do you think about this definition of the “self?” Hi David & Rhonda, Start with this: When I refer to my "self," I am speaking of the sum of my experiences and the trails they have left in my mind, my body, and my life circumstances, as well as the material things that are associated with me, beginning with my body, symbolized by the name printed on my ID card. This "self" has certain characteristics, including past actions, habits, patterns, qualities, flaws, etc. So, the first question is, how can you say that this "self" does not refer to anything? I know very well who I am, and I am distinct from any other "self" that presents him/herself to me. The second question is, based on the previous definition, why can't I pass judgment on the different attributes of that "self"? If that self has never been able to solve a linear equation, can't I call it "bad at math?” If that self almost always turns in its assignments after the deadline, can't I call it "slow" or "procrastinating?” And so on. I agree that passing negative judgment on a self can lead to that self having some unpleasant emotions, but that doesn't mean that those judgments are meaningless. I suspect that some listeners were turning over thoughts like these in their minds. I hope that gives you something to sink your teeth into. I'll try to be more specific about future episodes. Take care, Fabrice Nye Hi Fabrice, Thanks! When I get time to redo the deleted chapter on the “self” from Feeling Great, I can perhaps include these questions, although I did pretty much cover them in several of the later chapters in Feeling Great on the impossibility of judging the “self,” as opposed to things we think, do, or say. My problem is that people don’t “get” or “grasp” what I’m trying to say. Below, you seem to think I believe the “self does not exist,” and you have some excellent attempts to define it and prove that it does exist. At least that’s my take on it. My position is radically different. To me, the statement “the self does not exist” and “the self does exist” have no meaning. The statement, “I don’t know if the self exists” also has no meaning to me. This is language that is “out of gear,” so to speak, as Wittgenstein might say. You can press on the accelerator all you want, but the car won’t move forward when it is not in gear. But most people, nearly everybody in fact, have tons of trouble grasping this. You probably “get it,” I don’t know! I am just referring to your email, where you say the self is such and such. Nouns do not always refer to “things” that could “exist” or “not exist.” Still, when I say this, it goes in one ear and out the other, I’m afraid! And that was why Wittgenstein was intensely lonely and frustrated, and often depressed, and perhaps why he never attempted to publish anything during his life. You can certainly say, “I’m not very good at math. In fact, I’m below average at math.” This means that your math skills are below average. Does it also mean that your “self’ is below average? Many of my skills and attributes are below average, but that does not upset me or threaten my feelings of self-esteem for two reasons: I don’t believe that my worthwhileness as a human being depends on anything. I don’t believe that “worthwhileness as a human being” has any meaning. I don’t believe the statement, “the self exists,” has any meaning. What would it be like if “the self” didn’t exist? What are we actually talking about? But if I judge my “self” to be “inferior” or “worthless” or “below average,” that type of self-critical thinking can cause a lot of emotional pain, and can, in extreme cases, even lead to suicide, thinking that “I am not good enough.” david I asked Fabrice if he wanted to comment on my response above, and if I should include it in the show notes. He gave a really cool answer: Hi David, Yes, you can absolutely include it. From your response here, you ought to make it clear that your point is that the language is not meaningful, therefore the word, "self," is not meaningful. But you may need to delve deeper into this. If you do that, you're going to end up at the same place the Buddha ended up when he discovered the ultimate emptiness of things. Of course, he didn't talk about "things," since that's meaningless too, just emptiness. Fabrice Nye By the way, you may enjoy Fabrice’s new podcast. Here’s the link: https://podcasts.apple.com/us/podcast/peace-at-last/id1496573038 The following email might also help. Hi Rhonda, Here is the other Ask David with the remainders from our last one. If we use this one, let’s please be sure to include your through about your “self” as “a mom,” “a psychologist,” and so forth, and how I responded to it, as I thought that was really helpful. We can judge and talk about what we DO, and not what we ARE. We can use the word, “self,” in a variety of ways that are meaningful. For example, Behave yourself. This means stop behaving badly. Just act like yourself on the date. This means don’t try to impress your date. Instead, show an interest in him / her. Why you write, try to tune I on your true “self,” and stop acting so fake. This means you need to change your tone of voice when you write. Share more of your feelings and vulnerabilities. All these uses have specific meanings. They are not metaphysical or philosophical claims, just attempts to influence someone’s thinking, feelings, or behavior. “Self” is just a sound that comes out of your mouth. It is not an esoteric or metaphysical “thing” that could “exist” or “not exist.” Aristotle thought that nouns were descriptions of “things” that existed in some ideal alternative reality. For example, he thought that tables are just imperfect examples of some perfect essence of “tableness” that exists somewhere. This erroneous view of language gave rise to most of the problems in philosophy, as well as most of our emotional problems of feeling we have a “self” that isn’t important, or isn’t worthwhile, or isn’t good enough, and so forth. d * * * Don asks: Is TEAM as effective as you say? Hi Dr. Burns, I feel compelled to say, with the greatest respect and affection, that the very concept of successfully treating my lifelong battle with depression, anxiety, and ocd within a few hours seems, at face value, far too good to be true! Is it really possible? I've endured countless disappointments and treatment failures from many, many therapists, all of whom wasted months or even years of my time, essentially to no avail. Tell me again: Is short term treatment, as described, as potent as TEAM promises. It's just so hard to believe! DBs Comment: Don went on to describe chronic severe mood problems and recent intense feelings of anxiety due to medical problems in his family. Hi Don, Good questions. Here are some thoughts. Effectiveness depends on the skill of the therapist, and TEAM is challenging to learn. I’ve been at it for more than 40 years, and have used T = Testing at every session with every patient. This has been my greatest teacher—my patients. Some of my students have achieved high levels of skill, and they are the ones who have put in tremendous effort to learn. There are not yet many of them, sadly, and that’s why I’m working on an app. . . . So I can make these tools available to large numbers of people who are suffering. We will be starting a new beta test in a few weeks. It is in progress, and very labor-intensive to develop, but if it works, it will be fantastic. An inexpensive way to find out if TEAM is for you, and you have perhaps done this already, would be to read Feeling Great and do the written exercises while reading. Then you’ll find out if you like the new methods, and if they are helpful for you. I assume you’ve already read Feeling Good and done the exercises. Is that correct? The results I report are the results of my work with patients, using TEAM. I only report truthful things, and don’t fabricate results! I am analyzing a huge data base of thousands of TEAM therapists at the Feeling Good Institute, but it is a naturalistic study, and interpreting the results is challenging for a variety of reasons. The mean reduction in depression scores in a large number of severely depressed individuals in four or five sessions was 59%, which is excellent. It is little bit hard to interpret that result because when patients recover, they drop out of treatment, so the mean depression score in the data you analyze at any session is the mean of those who are still in treatment who have not yet recovered. Therefore, the analysis is potentially biased in a negative direction, if you see what I mean. My published research shows that psychotherapy homework is crucial to success. Some patients are strongly opposed to doing homework, and they are likely served better by therapists who do not believe in the value of psychotherapy homework. The rapid recovery I see is in the treatment of depression and anxiety. Relationship problems are much more challenging to treat due to the intense resistance people have to looking at their own role in a problem instead of blaming others. Habits and addictions can be slower and more challenging, too, since the temptations to give are so pervasive and powerful. Thanks! I hope this information in helpful for you. Here’s an afterthought. Sometimes when people ask me if this will really work, they are actually skeptical or even annoyed, and expressing resistance or a lack of enthusiasm for the treatment techniques I have created. I do not try to sell patients on anything, and feel strongly that people should find an approach they are enthusiastic about, even if it is radically different from the methods I have developed! I strongly applaud skepticism and critical thinking, but it is also true that trust and TEAMwork are vitally important dimensions of successful treatment. If a patient is putting up a wall and resisting, that must be dealt with first before there is any chance for success. The approach to resistance is radically different from answering questions as I am doing here. I hope that makes sense! Here’s the type of thing I’m saying, or trying to say. If you’ve been burned in the past, and had negative therapeutic experiences, it would make sense that you’d be reluctant to trust, or to hope, or to collaborate, for fear of being let down yet again. I would want to bring this issue to conscious awareness at the start of therapy with anyone who has strong feelings of skepticism, and anyone who is saying “prove it to me” when we start therapy. Almost all the patients I’ve treated have had months, years, or decades of failed therapy in the past. But that’s not so crucial. The crucial question is, can we work together with some trust and enthusiasm and teamwork? And are you willing to do what will be necessary for a positive outcome? This might include doing regular psychotherapy homework, being willing to use Exposure techniques for anxiety, like OCD, and so forth. Lots of people don’t want to do homework or use exposure, and they may have other objections to the treatment, which I honor. I don’t try to persuade or twist arms, since those approaches are doomed to failure. Not sure if this makes sense, or if I’ve expressed my thinking clearly. david * * * Binoy asks: I checked the list of shame attacking exercises you have suggested for social anxiety. I live in an Arab country. Some of the things on the list could get me arrested. Is there a better way to overcoming anxiety? Hi Binoy, Perhaps you can tell me what Shame Attacking Exercises would get you arrested! Since I’ve listed more than 100, perhaps you could choose ones that will not get you arrested! In addition, I never throw techniques at people based on a diagnosis or problem, but work systematically using T, E, A, and M. In addition, I use four treatment models, and more than 50 techniques, when I am treating any form of anxiety. There is a free anxiety class on my website. Check it out!

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