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

(featured photo shows David, his wife Yvonne, and son, Joey, when young)
Meet the Incredible Dr. David Antonuccio, Part 2 of 2
Shrink, Songwriter, and Hero
Today we continue our conversation with my dear friend and esteemed colleague, Dr. David Antonuccio, a true scholar, clinician, researcher, musician, and champion of scientific transparency.
The Nicotine Patch Study
David revisited his landmark research on the nicotine patch, a costly trial involving roughly 600 participants who were randomly assigned to receive either a real nicotine patch or a sham patch. The goals were to assess safety and efficacy.
The safety data looked reassuring. However, the efficacy findings were unexpected: the placebo patch worked just as well as the active nicotine patch in reducing smoking. The sponsoring company published the safety data but refused to publish—and refused David access to—the efficacy findings, which showed no advantage for the nicotine patch. You can check the link to the NEJM article here. 
David writes: "Notice the 48 week follow-up data were excluded in this paper despite the fact that they were available. That really annoyed me. I also now believe that the original version of the paper was ghostwritten and ghost analyzed by the industry folks.in other words.  I'm not sure that the authors ever had access to the "raw" data before they were analyzed."
This was important because there was a decrease in smoking DURING the study among those wearing the patch, and getting their "fix" of nicotine that way. . . but what happened AFTER the study? 
David writes: "Here is the link to the follow up paper that emphasized efficacy and included the 48 week follow-up data."
Notice that this paper was not published until three years later, when the Nicotine Patch had already been heavily advertised and sold on the market. This early experience in his career revealed the tension between marketing interests which focus on sales, and scientific interests which focus on truth and transparency—a daunting and frustrating pattern that would emerge again and again in his career.
Expert Testimony in a Tragic Criminal Case
David then described expert testimony he provided in a deeply troubling legal case. A 72-year-old woman, happily married for 50 years and a respected kindergarten teacher, had recently been prescribed Paxil, along with Ambien and Ativan.
She abruptly, and without memory, woke up in the middle of the night and stabbed her husband 200 times and was subsequently arrested for homicide.
There was no jury trial; instead, a plea bargain was used to determine sentencing. Dr. David Antonuccio was called as an expert witness in her defense. He described Dr. David Healy's research documenting a significant increase in both suicidal and violent urges among some patients taking SSRIs, especially Paxil. He argued that this woman's bizarre behavior was consistent with a drug-induced dissociative or fugue state.
Based in part on David's testimony, the charge was reduced to manslaughter, and the judge sentenced her to time served, allowing her to return home to her children.
For more on this topic:
David Healy's Research on SSRIs and Homicidal Urge
SSRIs Called on Carpet Over Violence Claims
Black Box Warnings and Patient Rights
David also emphasized the urgent need to revise Black Box warnings to reflect the full range of possible toxic or dissociative effects of psychiatric medications—not just suicidality. He has long advocated for a Patient Bill of Rights to ensure scientific transparency and informed consent.
A Surprising Conversation with Dr. John Nash
David shared a fascinating personal story about calling Dr. John Nash, whose life inspired the award-winning film A Beautiful Mind. In the movie, Nash's recovery from schizophrenia  is portrayed as medication-dependent. However, Nash told David directly that this was not true—the medication narrative was added to the script, possibly out of concern that portraying his recovery without meds might discourage viewers from taking prescribed medications.
Nash said: "What saved me was the support of family and friends."
Music, Truth, and "Buzz"
David is also a talented songwriter. One of his songs, "Buzz," addresses the emotional and ethical issues surrounding electroconvulsive therapy (ECT). The inspiration came from a man in the Midwest who was legally ordered to undergo ECT against his will. A widespread public outcry ultimately convinced the judge to rescind the order.
Forgiveness and "In the Air Tonight"
One of David's favorite songs is Phil Collins' "In the Air Tonight," which he sees as a deeply spiritual musical meditation on forgiveness—a theme David considers one of the most powerful psychological forces we possess. David explains that the Phil Collin's song is about forgiveness, but more indirectly and specifically about the songwriter's inability to forgive.
And yes—David sang it live for us on the podcast!
You might be interested in this chapter that David coauthored on
the science of forgiveness
Thank you for joining us today. And heartfelt thanks to you, Dr. David Antonuccio, for your gifts of enlightened skepticism, ethical courage, incisive scientific thinking, and soulful musical talent.
David, Rhonda, and David

Stories from a Giant and Gadfly
Discover the Protest Music of RainFall!--
like "The Antidepressant Blues!"
Today, we are delighted to spend some time with a dear friend and highly esteemed colleague, Dr. David Antonuccio. David is a retired Clinical Psychologist and Professor Emeritus in the Dept. of Psychiatry and Behavioral Sciences at the University of Nevada, Reno, School of Medicine.
In addition to his academic work, David had his own clinical practice for 40 years. He has published over 100 academic articles and multiple books, primarily on the treatment of depression, anxiety, or smoking cessation. Since his retirement from practice in 2020, he has been making music as part of a duo called RainFall, with his musical partner Michael Pierce. Their music can be found on Spotify, Apple music, and Soundcloud, among other streaming services.
I first became familiar with David when a colleague recommended his article entitled: "Psychotherapy versus medication for depression: challenging the conventional wisdom with data," which was published in Professional Psychology: Research and Practice way back in 1995. The article blew my socks off.
In the first place, he had come to the many of the same conclusions I had come to, that antidepressants had few "real" effects above and beyond their placebo effects. However, he also had incredible insights into some of the problems and loopholes with drug company research studies on antidepressants, so I tried to get as many colleagues and students as possible to read that article.
Here is the article link
Although I had never met David, he became my hero. One day, while I was giving one of my two-day CBT workshops in Nevada, I was singing his praises and urging participants to read that classic article, but, unexpectedly, some people started chuckling.
At a break, I asked someone why people had been laughing. They said, "Didn't you know that David Antonuccio is here attending this workshop? He was out visiting the bathroom when you were singing his praises, so he didn't hear you!"
And that's how we met!
I couldn't believe my good fortune in meeting this brilliant and humble man in person. And to my good fortune, we became good friends right off the bat and eventually did a lot of fun professional work together, like our exciting conference challenging the chemical imbalance theory of depression which we called the Rumble in Reno.
I was also proud to be included as a co-author in a popular article with David and William Danton reviewing the brilliant work of Irving Kirsch. Kirsch had re-analyzed all the data on antidepressants in the FDA archives and concluded that the chemicals called "antidepressants" had few, if any, clinically significant effects above and beyond their placebo effects. In that paper, we also emphasized the ongoing power struggle between the needs of science and the needs of marketing. Science is devoted to discovering and reporting the truth, based on research, regardless of where it leads, while marketing, sadly, is ultimately loyal to the bottom line, even if deception is required.
Here is the link to our article:
And here is the full reference:
Antonuccio, D. O., Burns, D., & Danton, W. G. (2002). Antidepressants: A Triumph of Marketing over Science? Prevention and Treatment, 5, Article 25. Web link: http://journals.apa.org/prevention/volume5/toc-jul15-02.htm
I was sad when David retired from his clinical, teaching, and research career a number of years ago in order to spend more time on creating and recording music because, a passion he'd put on the shelf during the most active years of his career. I felt we'd lost an important and courageous leader in the behavioral sciences, and felt an emptiness, like an important pioneer was suddenly missing.
The following link provides a highly readable brief overview of
David's career focus and interests.
I was thrilled to learn just recently that David has partly resumed his role as gadfly of the behavioral sciences, rejoining the fight for science, ethics and for truth, regardless of where that leads or whose feathers are ruffled.
And now, we sit down together to reminisce about his personal life and experiences with many of the greats in our field, like Dr. David Healey, Irving Kirsch, and others who have also stood up for the truth, based on their research, in spite of intense opposition from the establishment.
And, today David also brings us his music, with his colleague, Michael Pierce, RainFall.
Some of his music has psychiatric / psychological themes, like his "Antidepressant Blues,"
Some of David's music has humanistic and political themes. He said:
Here's a song we just released yesterday that i will assume would not be relevant to the podcast. It is called Final Embrace and was inspired by a heart-breaking international wire photo of a Salvadoran immigrant father hugging his daughter, both deceased, in the rio grande in 2019.
Here's the link to the original news story.
David's two-man group, RainFall, wrote and recorded the original acoustic version of this song in 2020. He explains:
We decided to record a more dynamic updated version of the song with some electric guitar chords, electric bass, and drums. We are calling it "Final Embrace Electric". The story is still heart-breaking, and it still makes me cry to sing it.
Here is a link to the new version of the song,
And here are the heart-breaking lyrics:
Final Embrace Electric (For Oscar and Valeria)
By RainFall (David Antonuccio and Michael Pierce)
I'm sorry I couldn't help you
I'm sorry you lost your life
You took a deadly risk
I'm sorry for your wife
What were you supposed to do?
Stay home and watch your family die?
Or take a chance at freedom
Reach for the sky
Some say you should have known better
They say that you are a criminal
But they don't know your fear, your pain, your hunger
For them it's the principle
Some say we were here first
It's not our problem
Despite your dire thirst
We're full, no more asylum
Let's ask them what they would do
If their family were faced with danger
If they're honest, they'd take the chance
Hope for kindness from a stranger
You tried to get in the front door
But it was slammed closed
So you swam the deadly current
Despite the perilous flow
You never lost your grip
Though the river was not crossable
Only another parent can know
How that is even possible
Everyone can tell you loved your daughter
Even in that place
You never let her go
It was your final embrace
I'm sorry I couldn't help you
I'm sorry you lost your life
You took a deadly risk
I'm so sorry for your wife
Everyone can tell you loved your daughter
Even in that place
You never let her go
It was your final embrace
Your final embrace
It was your final embrace
It was your final embrace
 
Thank you for joining us today. Stayed tuned for Part 2 of the David Antonuccio interview next week!
David, Rhonda, and David

"Doctor, why won't you ever tell me how you really feel?"
Therapist Self-Disclosure--
Featuring Dr. Carly Zankman
This week, Dr. Carly Zankman joins us to discuss a really interesting and controversial topic—self-disclosure by a therapist. When is it helpful? And when is it an ethics violation?
When I was a psychiatric resident, my supervisors (mainly psychoanalytic) cautioned me NEVER to share my feelings with patients. This felt really awkward at time, but is there some wisdom in that advice? And if so, what IS the wisdom? How does it work or help?
And if that rule—never sharing your feelings or personal life--is too rigid, then when and how should we share our feelings and personal experiences with our patients? What is the goal, and what are the best practices?
As most of you know, I have often been extremely critical of what I was taught as a psychiatric resident, thinking the teachings were based more on tradition than on science or data. And when it came to never share your feelings, I sometimes used to think about this issue along these lines: Let's assume that one of our jobs is to help our patients become more vulnerable and genuine, by sharing how they really feel inside instead of acting fake and always presenting a happy or professional face to the world.
That goal seems reasonable, and it's a prime goal of a great many therapists. But how are we supposed to accomplish that goal by acting fake and hiding our own feelings? That just did not seem to make sense to me!
But there are lots of traps when it comes to sharing your feelings. What if the patient is attracted to you, or vice versa? What if you do not like the patient, or feel turned off by them or annoyed with them?
In today's podcast, we will try to sort out some of these questions, with help from the vivacious and brilliant Carly Zankman, Psy.D. (INSERT CARLY'S BIOSKETCH AND BRIEF DESCRIPTION OF HER TEAM CBT CLINICAL WORK IN MOUNTAIN VIEW, California.
Carly described being taught similar things in graduate school, cautioning the students against opening up in a personal way during sessions. However, one of her supervisors listened to one of her sessions with a patient, and said, "the greatest gift you bring to therapy is just opening up and bringing your own, genuine and authentic self into the room."
Carly described being taught similar things in graduate school, cautioning the students against opening up in a personal way during sessions. However, one of her supervisors listened to one of her therapy sessions with a patient, and said, "Your greatest gift is bringing your own, genuine and authentic self into the room," and from that point forward, everything shifted in how she viewed her role in the therapeutic relationship.
Carly describes working with a patient recently and receiving a 19 / 20 on the Empathy scale at the end of the session. Although 9 out of 10 therapists would say that's a terrific, near-perfect score, on our scoring key it is rated as a failing grade. That's because the patient is telling you that you didn't quite "get" something about them, or didn't quite connect with them in a completely warm and supportive way.
Carly's patient was a 40 year old recently re-married woman with a new baby, and struggling with a lot of regret, guilt, shame, depression, and anxiety. Carly decided on a hunch it might be a good idea to share her personal story, since she saw this woman as a mirror image of herself.
Carly asked the patient if she wanted Carly to share her story, and this patient lit right up and was excited. It turned out to be tremendously helpful and was what she needed to believe Carly's empathy was real and not phony. The patient said that in the past she'd had many therapists, but none of them had ever share their personal experiences or feelings.
Why was that so helpful? How does it work? And what are some red lines that you do NOT want to cross as a therapist? These are just a few of the ideas we discussed on today's podcast.
We listed and briefly discussed a few of the many situations where it might NOT make sense to share our feelings or experiences with patients.
Rhonda pointed out that if you've had a traumatic experience and you're feeling quite depressed, anxious, or angry, and have not yet had the chance to do your own personal work, it would not be the best idea to share it with your patient, because you might be using the patient as your own therapy or support network.
You also would not share
feelings of sexual or romantic attraction to a patient
strong personal feelings of unresolved depression, anxiety, or anger
Some feelings you might share with your patient, but only if you have the great therapeutic skill to do so in a helpful, illuminating way, such as feelings of dislike or anger toward the patient.
We also discussed the danger of therapy degenerating into a paid friend relationship, and asked how that differed from the work of Dr. Irvin Yalom, the famous Stanford psychiatrist who taught us that developing a genuine human relationship between the therapist and patient IS the goal of therapy.
Finally, we exchanged ideas about the model of therapy as a "corrective emotional experience," and none of us seemed to take kindly to that model of therapy.
Thanks for listening today!
And thanks for the illuminating information from our brilliant and bubbly guest, Dr. Carly Zankman!
Thanks for listening today!
Carly, Rhonda, and David

Helping a Loved One with Schizophrenia
Treating OCD! My Hands Might Be Contaminated!
How To Mend an Angry, Broken Heart
The answers to today's questions are brief and were written prior to the show. Listen to the podcast for a more in-depth discussion of each question.
Here are the questions for today's podcast.
Joel asks: How can we use TEAM CBT to help a patient or loved one struggling with schizophrenia?
Jean asks: Since CBT won't work with OCD, should we use exposure or the Hidden Emotion Technique instead?
Jim asks: When someone has objectively hurt you, like your partner has had an affair, how do you get over that pain? 
And here are the answers.
Question #1 
Dear Dr Burns,
I learned from you that the foundational principle of CBT is that our emotions, and ultimately our behaviors, are rooted in thoughts or beliefs. Are there emotional and/or behavioral disorders (perhaps like schizophrenia) that are rooted in abnormal neurobiological brain pathologies, rather than in distorted cognitions or self-defeating beliefs? And if so, is TEAM CBT relevant to helping those suffering from these "psychoses"? 
With much gratitude, respect, and affection,
Joel
Question #2
Dear Dr. Burns:
I'm curious if you have thoughts about the problem of talking back to the obsessive thoughts in OCD. 
Thank you,
Jean
Question #3
Dear Dr. Burns:
When someone has objectively hurt you, like your partner has had an affair, how do you get over that pain?  I am not having thoughts that I did anything wrong, or there is something the matter with me, I feel sad, hurt and confused and angry.
Jim
Thanks for listening today!
Matt, Rhonda, and David

Live Work with Madeleine
I'm Helpless! Part 3 of 3
Today, we are pleased to present the live and unedited follow-up session with Madeleine, a loving mother who became terrified when she realized that her oldest beloved daughter might be in mortal danger during her hear abroad while in college. 
Part 3 of 3
We were a bit rushed near the end of M = Methods in Part 2 because of a mistake that I (David) made. I forgot that we had extended this webinar by 30 minutes, so we wouldn't be rushed at the end, so I wrongly concluded we were running out of time when we weren't!
In order to complete our work, we scheduled Part 3 several weeks later to do the following critical pieces of the work with Madeleine.
Additional work with the Externalization of Voices to make sure she could knock all of her self-critical thoughts out of the park.
Cognitive Flooding, using the magazine article she was triggered by to prompt the anxiety. The idea is to make yourself as anxious as possible for as long as possible, until the anxiety and panic eventually loses its punch and becomes boring. This will be one of the first times we have illustrated this technique live in a video-recorded session.
Any other loose ends that may have emerged since our first session with the wonderful Madeleine!
We did some cognitive flooding, urging Madeleine to close her eyes and describe her most terrifying fantasy involving her daughter's abduction by a sociopathy. We encourage her to make herself as anxious as possible, and within minutes she was at 100% and sobbing. Then we did some "memory" rescripting as we had promised her at the start, and part way through there was an unexpected surge of anger, that seemed to come from out of the blue, although the circumstances of the fantasy were clearly more than enough to trigger rage. 
Using the technique called "Affect Bridging," I asker her whether the anger she was now feeling might trace back to some earlier traumatic event in her life, perhaps when she was young, and this was confirmed. She described a profoundly troubling indecent involve her mother and dad shortly before they got divorced. 
There was a tremendous amount of emotion packed into today's follow-up session, almost non-stop, in fact. We look forward to seeing Madeleine's end-of-session Brief Mood Survey and Evaluation of Therapy Session. Jill and David assigned follow-up homework for her, including 15 minutes per day reading the terrifying article from People Magazine that had initially triggered her in the beauty salon. 
We want to thank you, Madeleine for your courage in being so open and real, and for giving us all a unique opportunity for some incredible learning, and also the chance to get to know you at a deep a genuine level!
Thanks for listening to these three podcasts. We hope you enjoyed them and learned something useful and helpful, especially if you've also been struggling with feelings of depression and anxiety, or if you're a mental health professional wanting to take a deeper dive in to how TEAM CBT can sometimes produce extremely rapid healing, even from severe feelings of depression, anxiety, and despair. 
Madeleine, Jill, Rhonda, and David
Following the session, Madeleine sent us the following feedback on the session via email:
Hi Jill and David,
Completed after session yesterday, but in my state of emotional fatigue, forgot to hit send!
Brief Mood Survey after session:
Depression: 3 / 20 (minimal)
Suicidal urges: 0 / 12 (none)
Anxiety: 8 / 20 (mildly elevated)
Anger: 9 / 20 (mild/moderately elevated)
Happiness: 12 / 20 (low)
Relationship Satisfaction: 29 / 30 (nearly perfect)
Evaluation of Therapy Session
Empathy: 20 / 20 (perfect score)
Helpfulness: 20 / 20 (perfect score)
Satisfaction: 8 / 8 (perfect score) 
Commitment: 8 /8 (perfect score)
Neg feelings: 4 (high, range = 0- 4)
Difficulties with Q: 2 (medium, range = 0- 4)
What did you like the Least: exposure was pain. It feels very heavy and exhausting. And i understand, necessary to healing.
What did you like the Most: David's "bridging" my affect states to discover my rage source. Jill's keeping us on track and making connection from my present worry about daughter's safety to past feelings of betrayal, losing trust, and resulting anger in my dad, a trusted figure. You both hit the nail on the head so many times in the session to uncover the deeper, ugly, messy, dark pools that lie within me i choose to keep safely sealed tight and out of the light.
Postscript: I just completed day 1 of exposure in re reading the awful article. All the anxiety and fear resurfaced along with new feelings of revenge, determination, appreciation for the authors who are perhaps trying to help the family by publishing this. Ick.
Best Regards,
Madeleine 
Again, a big thanks to you Madeleine, and we will watch closely as you continue your courageous daily exposure work, and look forward to the day when you have won this battle! 
Warmly, david