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

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

Live Work with Madeleine
I'm Helpless! Part 2 of 3
Today, we are pleased to present the exciting conclusion of our work with Madeleine, a loving mother who fears that her eldest daughter might be in mortal danger during her year abroad. Last week, you heard about the T = Testing and E = Empathy phase of the live work with Madeleine, a mother feeling intense panic and helplessness and inadequacy because she fears that her daughter could be in grave danger of abduction and worse. This week, we will focus on A = Paradoxical Agenda Setting, using the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial to see if we can melt away her resistance to change.
You can see the Emotions table of the Daily Mood Log Madeleine during the Magic Dial portion of the session if you
Click Here
As you can see, she wanted to reduce her negative feelings somewhat, but thought she still wanted to keep them fairly elevated, since she still sensed that her daughter might be in real danger, and clearly did not want to abandon her.
This is one of the significant refinements in TEAM CBT. First, we want to bring the patient's resistance to full conscious awareness. Second, we want patients to full grasp that their negative thoughts and feelings do NOT result from some "defect" or "mental disorder," but rather from what is most beautiful and awesome about them as human beings.
After the Magic Button, David and Jill went on to the final, M = Methods portion of the TEAM session, using tools such as Identify and Explain the Distortions, the Double Standard Technique, and the Externalization of Voices, with the Acceptance Paradox, the Self-Defense Paradigm, and the CAT (Counter-Attack Technique). We will, of course, do numerous role reversals to see if we can get Madeleine to a "huge" victory over her many distorted thoughts.
You can see the Daily Mood Log Madeleine prepared at the end of the session if you
Click Here
As you can see, the reductions in negative feelings were dramatic, but in several areas (anxiety, inadequacy, frustration and anger), Madeleine's negative feelings were still minimally elevated. That is one of the reasons we decided to schedule an additional session together several weeks later to see if we could intensify Madeleine's responses to her negative thoughts, and hopefully due some Cognitive Flooding to complete her "treatment."
At the end of these show notes, you will find an email from Madeleine after the session that includes her end-of-session scores on the BMS and EOTS. You will also see comments submitted by many participants who attended the webinar live.
This email below from Madeleine following the session shows her end of session scores on the Brief Mood Survey as well as the Evaluation of Therapy Session at the end of her session with Jill and David.
Hi David,
Yes, here are my BMS & ETS score totals after the extended session. Please let me know if you have any questions. A relapse prevention session would be nice; however, I hesitate to accept your offer as you all are so busy. Please know that I am practicing the PTs and keeping the NTs in check for now.
Thank you again a million times over😊. Yes, Feel free to use the recording however you like. Like I said, it's the least I can do to contribute to your generous and vitally important work. You are both very inspiring in so many ways. Much gratitude, Madeleine
Brief Mood Survey (BMS)
Depressed 0 / 20 (complete elimination of depression)
Suicidal 0 / 12
Anxious 2 / 20 (near-complete elimination of anxiety)
Angry 0 / 20
PF 36 / 40 (dramatic improvement in Positive Feelings)
RS 29 / 30 (large improvement in Relationship Satisfaction)
Evaluation of Therapy Session (ETS)
Empathy 20 / 20 (perfect)
Helpfulness 20 / 20 (perfect)
Satisfaction 8 / 8 (perfect)
Commitment 8 / 8 (perfect)
Neg feelings 1 (0 – 4) (uncomfortable at times!)
Difficulties w/ answering the questions honestly 0 (0 – 4) (no difficulties)
What did you like the least? Crying and blathering in front of all those people. Fortunately, I wasn't able to see any faces except yours😉
What did you like the most? Jill's "smooth as silk" empathy skills, David's laser sharp questions, Jill's rephrasing & untangling of the PT to "unlikely," David's having me write powerful PR stuff down, Jill & David's EOV - so strong, David counterattacking my neg thoughts with "sociopath," Jill's double std delivered in a very gentle way. I never felt rushed!
Feedback for Madeleine from the chat during the session
Comments for Madeline:
Madeline!!! I want you as a therapist. Your ability to show how to feel and describe the feel is courageous and admirable. Thank you.
Thank you for sharing Madeline, I can completely relate with you as a mother when we worry and has no control on their actions
Definitely relate to Madeleine and appreciate her vulnerability.
Thank you for your transparency, Madeleine. We appreciate it and can empathize
I totally relate. My children are 30 and 32, I parented in the 90"s;  i was trying to break the abuse cycle, so i missed nurturing their emotions and building their self esteem. My children give me so much grace and say how much they love watching me as a grandparent. I am so proud of the grandmother I am!!!! I am so grateful to be a part of their journey and blessed to have a second chance at creating that safe space for all of them.
wow.  this event really open up the deeper pain in your life.  Feel honored that you are opening up to us.
I'm so much appreciating Madeleine's being vulnerable and her sweetness and maternal care/nurturance and how David and Jill are working with her.  Helpful learning experience.  Thank you all.
Thank you Madeline! It was brave and kind of you to share your story for today's demo!!
Shows she is courageous n strong woman
I am in awe over how Madeleine's resistance to looking at inadequacy actually brought out the most amazing positives and core values. Beautiful!
I also just got the chills
She is great mother
She is caring person cares for others
Madeleine is so incredibly courageous sharing her story here being so vulnerable too I appreciate how real this is and thank you all for the work you do for helping Madeleine through this and for providing 
this very inspirational training :)
As a mother and also deep empath, much of what she is sharing definitely resonates. 
I hope she's able to continue working with her struggles and strengths to heal and feel better sooner than later 💗
Madeleine, it means so much to hear you. I was in trouble with an abusive boyfriend when I was college aged. I would have given anything to have my mother give me support at that time. I felt completely alone navigating the relationship and unable to get out. I needed an "adult in the room". Just hearing and seeing you right now is huge for me. Your daughters are lucky to have you! It's clear that you have their back and I'm sure they know it. I feel like you bring your whole heart to being a mother, truly beautiful and awesome! Thank you so much for volunteering today.
Hi Madelyn, I'm also a mother like you. I am a sensitive person like you and worry about how evil the world is. I worry for my daughter's future. My daughter has a beautiful sensitive, innocent soul. The fact that we feel this way shows that we are kind emphatic people. The only way not to suffer about these issues is to be a sociopath, to be part of the satanic community that is responsible for the ugliness in the world. I don't want to be part of this evil community. It is our political systems responsibility to spread the stoic values that make just, reason/logic driven people, brave, kind and educated driven people. As for myself, I'm proud of who I am and find peace and comfort in studying stoicism. I believe that if we all learned about stoicism our world would be a much better place.
And there's just as many Creeps and Sociopaths in your hometown as abroad. What's increasing her safety is knowing she has an open line of communication to her mom. That kind of girl is not such a target. Creeps are looking for girls without strong roots, without "backup". Girls with a a major insecurity to fill. Your type of parenting is exactly what's made her safer. Just to add to externalization of voices if we're allowed or supposed to!
In case Madeline sees this chat, I feel compelled to share that I studied abroad in the spring semester 1998, in Jerusalem at Hebrew University.  I turned 21 that semester (as did my group of new friends).  Hands down it was the most formative and important experience of my life to build trust in myself, feeling able to navigate the unexpected, land somewhere totally new and make new friends and figure things out.  My worried mother heard all kinds of yucky things in the news that was happening there (things that I never saw).  We navigated our safety, traveled on weekends and breaks.  And since, I have regularly offered the recommendation, both solicited and unsolicited, about the incredible merits of studying abroad,  Of course, our mama-bear hearts will be called to protect our babies.  And, sounds like your girl is gritty and brave, open to new experiences, adventurous, and eager to experience life!
Madeline's empathy and compassion and  counterattack stating "I taught her to see the Beauty in the world "is profound and amazing and reverberates for coaching and self empathy! Wonderful Madeline, David and Jill!
Thank you Madeleine for being so vulnerable, honest, and open to aid our learning.  SO touching and relatable.
M's standard for herself and parents is so very high and unattainable! She is doing way more than most by just caring this much.