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

David Burns, MD
Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
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  • 446 Gender-Affirming, Life-Saving Medical Care, featuring Stanford's Dr. Rachel Sewell
    446 Who am I? Medical Help that Saves Children’s Lives Featuring Dr. Rachel Sewall: “I want to shout from the mountain tops!” Today we hear from Rachel Sewall, M.D., a Stanford pediatric endocrinologist who provides medically necessary care for transgender and gender diverse young people. She says that her work is highly emotional, with extreme highs and lows. People view this population with great fear and considerable ignorance as well. Valid medical information is powerful and important. Seeing how people view these young people is constantly on my mind. She says: When I was a medical student, I didn’t have clear goals for what type of medical practice I would pursue. However, during my work in the emergency room, I realized, as did my colleagues, that I got very excited when working with children, so I decided to focus on pediatrics. I knew I’d be an advocate for LGBTQ+ young people. A colleague implied that they are rare, but I realized that wasn’t true. In fact, surveys tend to underestimate the percent of trans individuals and LGBTQ+, do to underreporting due to feelings of shame and fear, but the surveys still suggest a trans population around 2% and an LBTQ+ population around 15%. So, together, we are likely looking at roughly 20% of the population fall into one or both of these two categories. As a first-year medical student, I did research on hormones. These are chemical messengers telling our bodies to do things. Figuring out the actions of hormones is like a complicated puzzle (Rachel explain a little, pleaee. I also went to a camp for kids with Type I diabetes. It was a perfect marriage for me! (Rachel fill in why please). My work with children and teens is a combination of medical and emotional support. More than anything else, these kids want to be listed to and respected. And the highs and lows I experience, as I mentioned earlier, can be extreme. Many begin sobbing when I talk to them, because they’re so grateful that someone is listening! Reviewing basic definitions, your gender is usually assigned at birth, due to your sexual organs. They say, “Hurray! It’s a boy!” Or “Hurray! It’s a  girl!” But as your identity and sense of our gender evolves, and it may not be the same as the gender assigned to you at birth. Gender identity begins to form around 18 months to 3 years old, but can emerge at any time later as well. Most of us “know” our gender identity by the time we are 5 or 6, but it can also emerge during puberty as well, or even later. They may suddenly say, “this is not whom I am.” And some, of course, say “I am neither male nor femail.” That’s where the terms cis and trans come from. Cis means that your assignment at birth and your gender identity—your sense of who you really are—can be the same. If so, you are a cis male or a cis female. But if they are not the same, you are a trans. For example, a trans male was born with female genitalia but a male identity evolved. And a trans female was born with male genitalia but a female identity evolve. Many trans individuals experience great distress when taking showers, since they may feel repulsed when they see that they have the “wrong” genitals. Gender identity has overwhelming power. Some have told me, “I just want to tear my skin off!” Sexual preference and gender identity are not the same or linked in any particular way. Sexual preference simply refers to who you love, sexually and emotionally, and want to partner with. Rachel continued, Hormonal interventions can be life-saving. If you are a trans male, having periods can be profoundly disturbing, often to the point of triggering suicidal urges. Helping these kinds and their periods via hormonal interventions can bring enormous relief. They often say, “Dr. Rachel, you saved my life!” I almost always work with the family, and my goal is for the family to learn to function as a team, all working together to provide love and support for their child, so they can say, “this is my child and I love and accept them unconditionally!” I emphasize that there is no right or wrong on their gender journey. Metabolic and surgical interventions both have their place in treatment. The time to go public with who you really are is an important social and cultural decision, and this also varies tremendously. But regardless of age, gender-affirming medical care can always make a tremendous difference in your life! Rhonda and I are deeply grateful to Rachel for giving us this wonderfully patient and clear education in a field that was not even covered, to the best of my knowledge, when I was a medical student at Stanford. We hope your voice today, Rachel, will be heard by many, and will hep to bring greater peace, acceptance, love and understanding to our many podcast fans. Thanks! Rachel, Rhonda, and David
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  • #445 Awesome Interviewing Secrets featuring Dr. Kyle Jones
    Secrets of Superb Interviewing-- How to Be Everyone's Number 1 Choice! Today we feature our beloved Kyle Jones, Ph.D, a clinical psychologist who suggested we might do a really cool podcast on the interviewing skills featured in Chapter 16 of my Feeling Good Handbook. Rhonda and I are absolutely delighted to welcome Kyle for his third appearance on to the Feeling Good Podcast. (Rhonda had to excuse herself after introducing this episode because she was not feeling well) In that chapter on interviewing skills, I listed the five basic principles of successfully interviewing for a job, for admissions to a school, or really almost any type of interview at all. I have to warn you that these ideas may be unfamiliar, and will definitely be quite different from what you've been taught about winning interviews. #1: Be personable and friendly. Don't try to impress the person who's interviewing you! #2 Make them sell themselves to you. #3 Be honest, but present yourself in a positive light. #4 Don't get defensive. #5 Punt when you don't know the answer to the question. To illustrate the first idea, I told a story from Dale Carnegie's book on How to Win Friends and Influence People, in which he describes his interview with a wealth and powerful man in the hopes of soliciting a donation  for the Boy Scouts of America. This was back in the era many years ago when the Scouts were still very popular. The receptionist who made the appointment warned Dale Carnegie that he would have only 15 minutes, and emphasized that her boss was 100% meticulous about time. He started exactly on time, and ended exactly on time, whether or not you were done, so he better talk fast once the interview started. When the time came, and Dale Carnegie entered the office, the receptionist again reminded him that he'd be kicked out after 15 minutes no matter what! As he walked in, Dale Carnegie spotted a trophy fish proudly displayed on the wall above the rich man's desk, and asked, if the wealthy man he'd caught it. himself, The rich man said he had caught it in lake so and so. Dale Carnegie got excited and said, "I fish there too. Where, exactly, were you fishing on the lake when you caught this fish?" The man told him where his favorite fishing hole was, and they become engrossed in a vibrant conversation about the joys of fishing. Suddenly, the office door opened, and the receptionist appeared and said the time was up. On the way out, the wealthy man said, "Oh, I forgot to ask you what the purpose of the interview was." Dale Carnegie said, "Oh, I'm sorry, I forgot to mention that I am trying to raise money to support the Boy Scouts of America." The man replied, "You'll receive a check in the mail tomorrow for a million dollars." And those were the days when that was an enormous amount of money. What's the moral of the story? Relate to the person who's interviewing you as a person, and show an interest in them, instead of pitching your talking points and trying to impress them. People usually make decisions influenced greatly by how much they like the person they are talking to. Don't try to be impressive. Aim for friendly, real and human. How do you do this? Well, let's say that you have an interview with a law firm, hoping to get hired, and you're just out of law school. I used to be the shrink for the University of Pennsylvania Law School, and at the time there were too many law school  graduates looking for too few job openings, and almost no one was hiring. They referred despondent and panicky students to me who'd had a string of rejections. At the time, the top firms had at least 50 to 100 top notch candidates for every position. Was there any hope of starting their careers? I told them to do some research on the person who was going to interview them, or on their firm. Find something interesting about them. Then, at the start of the interview you can say something like this: "I'm so excited to meet you because I've been following your work for some time. I was amazed and blown away by your strategy in the X, Y, and Z case, and I was wondering if you're still using that approach in litigation and how it's been working out? I'd love to hear more about your work, and how you came up with the approach you're using, and what you like the best about this firm." This will get them to talking about themselves. DON'T try to impress them with how great you are . That will just bore them, or turn them off, and it will certainly put you under pressure to perform. This pressure will probably make you anxious, and your  anxiety and insecurity will show. Instead, impress them with how great THEY are. They'll love you! I trained the students in this doing role-playing of imaginary job interviews. Every student I trained in this approach became the #1 choice at every firm they interviewed at! This approach is not just for law students, it's for every type of job, as well as interviews for college, graduate school, and more. Here's the underlying idea. People don't really care much about you. They care about themselves. This is true of all of us. So, use this to your advantage, and you'll suddenly be super happy and glad you were OTHER centered and not SELF centered! Does this mean you should hide your own skills and accomplishments? Of course now. You can answer questions about what you offer with humility and integrity. But that alone will rarely be enough. #2 Make them sell themselves to you. Let's say you're applying for graduate school, and it's very competitive. Again, they have 100 brilliant candidates for every position. Suppose the interview says something challenging, like "As you know, all the top candidates in the Unites States apply to us here at Harvard. Most of them were #1 in the their college classes and several have already been nominated for Nobel Prizes. Why should we be interested in you?" This, of course, is absurd, but I'm taking the worst imaginable question in an interview. Yikes! This sounds impossible, right? How in the world could you respond? Actually, it's easy. You can just say, "Gosh, I don't know if I'd be a good fit here. That's what I'm hoping to learn today. Maybe you can tell me what you're looking for in a top notch candidate. What kinds of candidates have gone on to be stars, and what types have been disappointments? Then I can give you a better answer on whether or not I might be a good fit. Although I love your company, and I'm so impressed with your own career, I wouldn't want to accept a job unless I was convinced I could really contribute to your firm." Is this realistic, or just some David fantasy? During my senior year in college, I was planning to go to graduate school in clinical psychology, since I'd majored in philosophy and psychology seemed like a way more practical career.  However, my college adviser said that medical school would be a far better choice because medications were becoming more and more important in treating mental illnesses, and only psychiatrists could prescribe drugs. I told him that I'd never had any interest in being a medical doctor, and wasn't even a premed student, so there was no way I could get into medical school. I hadn't even had a single biology class in college. He said "That won't be a problem I don't think. You've got the gift of gab, and they probably won't even notice." So, I applied to a number of medical schools and landed an interview at Stanford, and several others. My interview was with someone in the Anatomy Department which was located in the basement of the museum on campus. I went down the stairs and into a room where I met the man who was interviewing me. I said, "It's a bit dark down here. Is this where the medical students dissect their cadavers?" He said, "Absolutely. But it's actually pretty awesome down here. In fact, my laboratory his just down the hall. I said, "Oh, could I see your laboratory? I'd love to take a look and find out what kind of research you do." He seemed excited and as we walked into his lab I noticed all kinds of fancy equipment and read the name on one of them, so kind of photometer or something. I had no idea what it was, but said, "Oh, I see you have an X, Y Z photometer. (or whatever it was). Do you use this in your research?" He said, "Oh, absolutely, it's extremely important in my research." I asked him about the research he did. He excitedly started explaining it, and for the most part I had no idea what he was talking about, but kept expressing interest and asking him for more and more information. I was terrified that he'd ask me questions about my undergraduate work and my research, which of course did not exist. I'd never done any research! Just philosophy classes and such. Well, we had quite the conversation, but after a while he suddenly looked at his watch and said, "Oh, my goodness. We were only supposed to talk for 15 minutes, and we've been talking for nearly two hours. I have to rush over to the medical school quad for an important meeting I'm almost late for. Why don't we walk over in that direction together?" As we were walking out of the basement, he said, "Oh, my goodness, I forgot to ask you who you are and where you're from." I said, "Oh, I'm David Burns from Amherst College." He said, "Well, David Burns, I want you to know that you're the kind of young man we need at the Stanford Medical School.!" I said, "It's really kind of you to say that, but I'm afraid I won't be able to come to the Stanford for medical school." He said, "That's nonsense? Of course you can come! Do you think Harvard is going to make you a better offer? We'll top anything they offer." I said, "Oh no, sir, that's not it. You see, my father is a minister, and we don't have much money, and I've heard that attending medical school would cost more than one hundred thousand dollars. And he believes that borrowing money is a sin." He said, "David Burns, I'm the head of the admissions committee, and that's where I'm headed right now. And I'm going to tell them that you're the #1 choice for admission this year. And you won't have to pay a thing. We'll pay for tuition, room, board, books, expenses, everything. It won't cost you one cent to go to Sanford medical school." I said, "Oh, thank you so much! That's an offer I can't refuse!" I got my acceptance letter two days later and the rest, as they say, is history. But to spell it out. Why was I accepted to a top-flight, highly competitive program when I had absolutely NO credentials? Because I expressed an interest in him, and I was friendly, and I believe that meant a great deal to him. And I'll always be grateful for his help. My wife and I returned to Stanford almost 30 years ago, where I've served on the voluntary (unpaid) faculty at the medical school, teaching  and doing research and continuing to develop TEAM CBT. I turned out to be a terrible medical student, and dropped out for a full year on two different times because I just wasn't the "medical" type. I had very little aptitude or interest in medicine. But I did end up as a psychiatrist, and came to love medicine and healing people who were suffering, and doing research. And my voluntary work is my way of trying to repay my tremendous debt to Stanford! And I'll never forget the kind gentleman who interviewed me. Kyle and I jammed on all five examples, including many additional stories to bring these ideas to life. Kyle used this strategy when interview for his internship in psychology, and it worked like a charm. I would say that I've taught many people how to use these ideas, including family members, students, and colleagues. The impact has been nothing short of incredible. That probably sounds over the top, and I "get it." But the stories are true, and the ideas can change your life. Remember what the Buddha said, 2500 years ago: "Selling yourself sucks! So, Stop it, and do what works!" Warmly, Rhonda, Kyle, and David Contact information Kyle is a superb TEAM CBT therapist who practices virtually throughout California. Here's his contact information:  Dr. Kyle Jones
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  • 444: I'm angry! Live Work with Sunny, Part 2
    I’m angry! A Once-UndocumentedImmigrant Speaks from the Heart-- Live Work with Sunny, Part 2 Last week you heard Part 1 of the Live work with Sunny, who’s struggling with radically conflicting emotions. On the one hand, he has finally achieved his dream of an incredibly happy and fulfilling life, but he is frequently plunged into profound despair, fear, and anger because of the increasingly adverse political climate for people who are “different”—in gender identity, sexual orientation, nationality, political beliefs, skin color, and more. And he is shocked, fearful, and angered by the mean-spirited treatment so many are receiving—and which Sunny has endured throughout much of his life as well. Today, you will hear about how we set the A = agenda for our session with Sunny, along with the M = Methods we used. You can find Sunny’s goals for each negative feeling at the end of the Positive Reframing, and at the end of M = Methods, if you Click here His scores on the Empathy and Helpfulness Scales in the Evaluation of Therapy Session were perfect. Here are some of the take-home lessons from this session with Sunny. 1.  Unhealthy negative feelings result from distorted negative thoughts, like “I’ll be miserable forever.” Healthy negative feelings, in contrast, result from thoughts that are realistic and, for the most part, undistorted. Healthy negative feelings do not usually require any kind of “treatment,” but skillful empathic listening and support will nearly always be appreciated. 2.  Empathy can be very powerful, and it is absolutely necessary for a meaningful therapeutic relationship, but empathy alone is not enough to change the way someone feels. 3.  Finding compassion for someone who has harmed you, while extremely challenging, can also bring you peace. 4.  Emotions such as anger, sadness, and anxiety are important protective instincts. And one can feel these emotions and be compassionate and loving at the same time. 5.  As a therapist it can be tempting to either assume that you can’t help a patient because their feelings are “normal,” or to try to cheerlead or problem-solve for a patient to cheer them up, but the TEAM-CBT model allows us to collaborate with the patient, understand when and how they want to change, honor their resistance to change, and offer them the tools they need to change in a way that honors their values. Thank you so much for listening and joining us. Rhonda, Jill and I are deeply indebted to you, Sunny, for your courage and vulnerability last week and today, letting us into your world on such a personal level. We love you and will always be grateful to have you in our lives, both professionally and personally! Sunny, Rhonda, Jill, and David
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  • 443: I'm angry! Live Work with Sunny, Part 1
    I’m angry! A Once-UndocumentedImmigrant Speaks from the Heart-- Live Work with Sunny, Part 1 Sunny Choi is a beloved member of the TEAM community. He grew up in Hong Kong before emigrating with his family to the United States when he was 11 years old. He graduated from UCLA with a major in engineering, completed a master’s degree in Engineering Management at Stanford, and developed a successful career in high tech Silicon Valley companies. However, he left his work to pursue additional graduate training in clinical social work because he discovered that his strongest call was to help individuals who were being marginalized by American culture and suffering. He then obtained an MSW degree with a specialty in Community Mental Health from California State University. We were fortunate when Sunny discovered and joined our free Stanford TEAM CBT training group, and blossomed into an expert TEAM therapist and beloved colleague and friend. Today, Dr. Jill Levitt and I worked with Sunny because he requested a session to work on his own troubled feelings concerning the recent political developments. He emphasized that he wanted to do personal work, rather than focusing too heavily on the current political controversies and battles. You can find the Daily Mood Log (DML) that Sunny prepared just prior to his session if you click here As you can see, at the top of his DML, he described the upsetting event as tearing up when he was teaching a class and discussing a case of a transgender Mexican American man, and he began reflecting on his own memories of growing up as a gay male and undocumented immigrant. Sadness and anger were the two strongest negative feelings (rated 70 and 80, respectively on a scale from 0 to 100), although he was also moderately anxious, guilty, rejected, hopeless, and frustrated. You can also see the ten negative thoughts he recorded on his DML, and how strongly he believed each one, on a scale from 0 (not at all) to 1000 (completely.). During the session he added three more thoughts: 11.  I (shouldn’t be) living such a happy and pleasurable life when others are suffering. 70% 12.  I should be helping others more. 80% 13.  I have to figure out the correct way to be thinking and feeling. 50% At the start of the session, he said that he felt vulnerable and nervous discussing such personal feelings, memories, and thoughts. He also said that after doing much personal and professional work, he was generally happy and loving, but felt profoundly disturbed when he thought about so many people who are suffering. He said, “Many of my clients are being deported. And those who are gay are worried that they’ll lose access to their medications.” These were the kinds of thoughts that triggered his feelings of guilt. During the empathy phase, Jill mentioned that she felt honored to be talking to Sunny today and proud to be a member of a community where you can reach out when you’re suffering. She added that she felt torn, as I did, because it seemed to us that many of his negative thoughts were realistic, and not distorted, and that it makes sense to feel sad, anxious, worried, and angry. For example, his first negative thought on his DML was, “The world is much more unstable and dangerous now.” Sunny emphasized that most of the time he does feel happy, especially when involved with friends and family, and doing the things he loves. But then he gets confused and guilty, wondering if it is right to feel happy when things are looking so dark for so many people. It certainly makes sense to feel unhappy when, as Sunny said, some of his clients and friends have lost their jobs and people in the LGBTQ+ community are afraid they’ll get deported. And we’re all afraid to speak up and talk about diversity, which has become a dirty word that can get you into trouble. And when Sunny thinks about this, he feels profound sadness and compassion. But as previously noted, this has caused confusion for Sunny, and he struggles with feelings of guilt about the fact that he is truly happy so much of the time. He’s happy about his beautiful life, his marriage, and more—this, in fact, is his happiest he’s ever been. Here’s how he puts it: “I used to be undocumented. The experience and the hostility and bias I confronted traumatized me. And when I heard Trump talk about all the ‘murders and rapists’ invading our country from Mexico, I became tearful. I feel angry—they don’t think we’re human. “I want people to be more compassionate. . . . To say we’re rapists and criminals, it’s not okay. . . it’s mean, and it’s very harmful to mental health. . . . It’s like repeatedly poking at someone who is recovering from a terrible wound, and it hurts.” Jill was touched, and found Sunny’s vulnerability heart-warming, beautiful, and refreshing. Rhonda reminded us that unless we are Indigenous Native Americans, all Americans are descended from immigrants. In my own case, all my ancestors came from Sweden in the late 1800s during the potato famine. Sunny pointed out the European immigrants have not been discriminated against in the same way as the Africans, Asians, Latinos, Islamic, and dark-skinned individuals: “Let’s be open. It’s racism. I felt it right from the start.” Sunny gave us an A+ on empathy, and then we worked to set the agenda for the session. What did Sunny hope to get from the session? What did he want help with? What changes was he hoping for? He said: “Maybe my feelings are appropriate, but some may be too intense. My goal is to find peace; to have hope, and to try to do something to help. . . I want to feel proud of who I am and what I stand for. I want to try to be loving and compassionate, even to people who don’t have the same beliefs and values. . . . Although that can be incredibly challenging!” When you listen to today’s podcast, you will hear the T = Testing and E = Empathy portions of the session. Next week, you will hear the A = Paradoxical Agenda Setting and M = Methods portions along with the conclusion, including the final T = Testing to evaluate his end of session scores on the Brief Mood Survey and Evaluation of Therapy Session. Thank you for joining us. Rhonda, Jill, Sunny, and I appreciate all of you!
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  • 442: Eliminate Anxiety Fast: The Awesome Hidden Emotion Technique
    Ask David: The Awesome Hidden Emotion Technique Featuring Matthew May, MD with Rhonda and David The following answers to Ask David questions were written prior to the live podcast where Matt, David, Rhonda, and others discuss the questions in real time. Their answers may differ from Dr. Burns responses listed below. 1. Michael asks: How did you invent the Hidden Emotion Technique? It’s been incredibly helpful to me! Hello, Dr. Burns, Your lifelong work continues to be invaluable to me and so many others, and I apologize if this question was answered on a previous podcast. To my knowledge, it hasn't been. I was wondering how you discovered or created the hidden emotion model? I recently struggled with inexplicable death anxiety that came on every night since college started back up, and I was at a loss, until I remembered the hidden emotion model and wondered if there was something I wasn't acknowledging? Sure enough, I discovered I was actually quite resentful of my new schedule not allowing me to easily fit the gym into my schedule unless I wanted to forgo valuable sleep. Once I had addressed this resentment, the death anxiety vanished. I would love to know how this wonderful technique became part of your phenomenal practice! -Sincerely, Michael Polus. David’s reply You can read all about it in When Panic Attacks, when I learned about it accidentally based on an interaction with a patient who was stuck. Perhaps we can answer it on a podcast. Thanks! david   2. Janie asks: How can I help a patient who ruminates? My client ruminates, that is she experiences repetitive thoughts about conversations and gets stuck in the negative feelings that come from dwelling on those thoughts and conversations. She has referred to it as repetitive thinking about conversations that were distressing in some way. She replays the conversation in her head, and evaluates and re-evaluates her responses. She then plays the conversation using possible different responses she COULD have used and worries whether these would have been better responses. The first individual is a friend where the friendship is very challenging and interwoven into many parts of my patient's life. My patient ruminates about conversations and wonders over and over if she said the right thing or wonders how the friend took what was said. It is a loop that my patient often gets stuck in for long periods of the day. The second individual is my patient's husband. With him, she ruminates about how to say things to him so she can motivate him to be involved in the ways she wants him to be. We will work on these relationships using the 5 secrets eventually, but first she'd like to work on the rumination because it takes up so much of her time. How can I help her? David’s Reply I would recommend TEAM CBT in a step-by-step manner. I do not, in general, like to throw techniques at people based on a description of a problem. Motivational techniques to reduce resistance and bring resistance to conscious awareness. Paradoxical Cost-Benefit Analysis Dangling the Carrot / Gentle Ultimatum / Sitting with Open Hands The Hidden Emotion Technique What If / Downward Arrow Technique ERP (Exposure plus response prevention) Many other techniques inspired by methods a and b above (TEAM CBT) Feared Fantasy: confronting her worst fear Five Secrets of Effective Communication Work on acceptance: she is perfectionistic and self-critical Hidden Emotion: anger Thanks for listening (and reading the show notes), David, Rhonda and Matt
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