Podcast 224 Ask David January 11, 2021

Ask David featuring more challenging and interesting questions.

Josh asks: What are the most effective types of psychotherapy homework assignments?
Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! And Joe asks: Would you say that the secret to overcoming OCD is willpower?
Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain?
Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks.
Clarity asks: Is it too late to be a beta tester for your app?
Simon asks: Is there a podcast that you can recommend for general depression, and how to find out what is wrong?
Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt!

*** * ***

Josh asks: What are the most effective types of psychotherapy homework assignments?

Hi David, thanks for all your work. It has been very helpful.

You mention That doing homework is essential to recovery from anxiety and depression. Any homework you recommend? I am going to buy a few of your books and have the worksheets from the Neil Sattin podcast. Anything else that will benefit?

Josh

Hi Josh,

It depends on the type of problem you are working on. I can work up an answer, perhaps, if you want to tell me!

I did not hear from Josh, but Rhonda and I summarize the best kids of psychotherapy homework for:

- depression
- anxiety
- relationship problems

*** * ***

Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working!

Hi David,

I love your work on the podcast. I have not yet found a copy of any of your books in Lahore (where I live), but I have grown to understand your philosophy through your podcasts.

Episode 162 disturbed me a little. I suffer from severe OCD and its cousin, depression.

And the "high-speed cure" in the title really attracted me.

But I had buyer's remorse.

Why? Because it does not work like that for most people. The guest on your show, had a few exposures, and BAM, cured.

I have tried exposure many many times, and it very minimally helps in lowering the threat of the obsessions.

I feel that this was a Magic Pill kind of account, and at the risk of judging a person's pain, I think your guest had a relatively mild (as compared to me) OCD.

I would really love it if you could talk about Pure OCD (the type I have), and how it can be resistant to exposure. The intrusive thoughts/obsessions continue to be extremely, EXTREMELY, painful. This "high speed cure" idea seems dismissive of the seriousness of my condition.

Please keep up the great work. And I hope to read your books one day.

Thanks

Hassam

(Therapist in training)

Thanks Hassam, sometimes, therapy is much harder, as you say! Good point.

I often get slammed when I present patients who recover rapidly, especially patients who have had incapacitating symptoms for years or even decades of failed therapy. This is disappointing to me, as my goal is to bring hope to people that rapid and meaningful change IS possible.

To be honest, I don’t like it when I get slammed for presenting cases of rapid recovery. Some people think I am a con artist! Yikes!

Of course, everyone is different, and some people will be more challenging to treat. One thing I learned when I was in private practice is that you can never tell ahead of time who will recover rapidly and who will take much more time.

I’ve had patients I thought would be super easy to treat who responded much slowly than I predicted, and many who I thought would be nearly impossible to treat who responded almost overnight.

You’ve mentioned that exposure has been of limited value for you. I totally agree and saw that early in my treatment of anxiety that exposure alone is often quite ineffective.

That’s why I argue so strongly that exposure is not a treatment for OCD or for any form of anxiety. It is just one tool among many I use in the treatment of anxiety. I use four very different treatment models with every anxious patient:

1. The Cognitive Model
2. The Motivational Model
3. The Hidden Emotion Model
4. The Behavioral (Exposure) Model

Unless you understand and use all four models, the prognosis might be somewhat guarded, as you’ve discovered. In contrast, when you use all four strategies, your chances for success increase tremendously. For example, prior to using Exposure in the episode you listened to, I spent about 25 minutes with Sara using the motivational and cognitive models, which really helped.

Focusing on one method alone will often not be terribly effective, especially if you’re looking rapid, complete, and lasting recovery. However, occasionally one method will work, so therapists and patients alike get focused on some single approach they’ve learned, thinking they’ve found “the answer.”

There’s a great deal of information on the treatment of anxiety disorders using these four models on my website, www.feelinggood.com.

I often urge listeners to use the search function on my website, and everything will be served up to you immediately. You can learn all about these four powerful models.

In addition, if you were looking for more techniques, you might want to take a look at my book, When Panic Attacks, which describes 40 potent anti-anxiety techniques. You can order it from Amazon.

My psychotherapy eBook, Tools, Not Schools, of Therapy, might also be helpful for therapists who want to learn more about the treatment of depression and anxiety with TEAM. It is an eBook, and order forms are available on my website, www.feelinggood.com, in the resources tab, and also in my store.

Thanks for your excellent question!

david

And Joe asks: Would you say that the secret to overcoming OCD is willpower?

In reply to Joe.

I use four treatment models in the treatment of all anxiety disorders, including OCD. Certainly, the willingness to use Exposure is required, but Exposure is only one of many helpful methods for OCD. You can search for anxiety treatment on my website, and you’ll find many good podcasts. Also, there is a free anxiety class on my website. My book, When Panic Attacks, is another great resource with more than 40 techniques to combat all forms of anxiety, including OCD. You can find all my books on AMAZON, or on the books page on my website.

david

*** * ***

Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain?

Hi Dr. Burns,

It says in your book, When Panic Attacks, p. 49, 3rd paragraph, you said that there's not a shred of evidence that there's any chemical imbalance for any psychiatric disorder. Does that include schizophrenia or bipolar or OCD? Haldol works for me for schizoaffective....controls dopamine in brain?

Ted

Hi Ted,

There are likely one or more biological factors that contribute to schizophrenia as well as full blown bipolar disorder (with true manic episodes.) We do not yet know what those causes are.

However, the brain is not a hydraulic system of chemical balances and imbalances, or perhaps more like a supercomputer. I am not aware of any neuroscientists who believe in the crude “chemical imbalance” theory. We simply don’t know what the causes are.

Meds can definitely help with the symptoms of schizophrenia and mania as well. This tells us nothing about causes. Aspirin can help with a headache, but headaches are not due to an “aspirin deficiency” in the brain. Computers often crash, but I’ve never heard of a computer problem that was caused by a “silicon imbalance” in the chips.

Hope that helps. Psychotherapy can definitely help with feelings of depression and anxiety, but is not a cure for schizophrenia or mania. I would hate to have to treat any psychiatric problem with drugs alone! I like to treat humans, not “diagnoses,” but it can helpful to be aware of diagnoses like schizophrenia, or schizoaffective, or bipolar I, for example.

Hope that is helpful! And just my thinking, too, not “written in stone.”

david

*** * ***

Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks.

Hi Brian, Thanks!

One point is that people are often looking for “formulas” or general solutions to buzzwords like “stress.” The key to TEAM is to focus on one specific moment, and to work with it in an individual way, never using non-specific solutions like exercise, meditation, deep breathing, dietary changes, and so forth.

But as you can see, this is tough for many people to grasp. The failure to understand the importance of specificity is one of the big problems in our field, and it is a problem for therapists and patients alike. There are no very good solutions in the clouds of abstraction, because we are all unique.

I asked Brian for specific examples, and he wrote: “Work pressure, obnoxious bosses, nagging family members, drug addicted family members, and inability to pay bills are a few.”

I responded,

Thanks, these are all totally unique with different solutions. Perhaps you can focus on one and provide a couple details. david

Brian responded,

Thanks. Whichever one you think is best. Stressful thoughts. Also how to change stressful thoughts when they're automatic.

Hi Brian, There an infinite variety of "stressful thoughts," and they all have unique, non-overlapping solutions. Could you tell me about one thought you had at one specific moment?

david

During the podcast, I made some additional comments on dealing with stress using TEAM:

Stress is a fairly non-specific word for feeling upset or distressed. I like to use and measure specific emotions in my patients, like depression, anxiety, guilt, shame, inadequacy, hopelessness, frustration, anger, and so forth. But for some people, “stressed” may be more acceptable than words like “depression,” which may carry more stigma.
However, there is a somewhat specific meaning to stress, which means overwhelmed by having too much to do and not enough time to do it all. This can sometimes result from taking on too much, and having trouble saying no. Reasons for this difficulty being assertive include:
- Conflict Phobia
- Excessive Niceness
- Submissiveness / Pleasing Others
- Fear of missing out on something cool and exciting to do
NY TV story on “stress” and my ten distortions
General tools for dealing with patients who feel “stressed out.”
- Daily Mood Log
- Relationship Journal
- Brief Mood Survey
You can take a thought on a DML and do a downward arrow—you will typically come to several common Self-Defeating Beliefs, such as
- Perfectionism
- Perceived Perfectionism
- Approval Addiction
- Submissiveness
- Worthlessness schema
- Conflict Phobia / Anger Phobia
- Superman / Superwoman
Specific Tools
- Positive Reframing
- “No” Practice

*** * ***

Clarity asks: Is it too late to be a beta tester for your app?

Hi Clarity, Thanks! You can sign up at www.feelinggood.com/app

*** * ***

Simon asks: I have a question for you. I am very depressed at the moment, and I don't know what is wrong, or I have difficult to find out what thought is giving me the down-feeling ☹ Is there a podcast that you can recommend for general depression, and how to find out what is wrong?Thanks for the sooooo great in inspiration.

Thanks Simon. I will include your question in an upcoming Ask David, but here’s a start. Focus on one moment you were upset, and tell me how you were feeling and thinking at that specific moment, and record the information on a Daily Mood Log. If you listen to live therapy on the Feeling Good Podcasts, or read one of my books, like Feeling Good or Feeling Great, you will get a step by step introduction to TEAM therapy. Thanks! d

PS There is at least one podcast on how to identify your negative thoughts and generate a Daily Mood Log. You can use the search function on the website to find those or podcasts on any topic, but here’s the link since the search function is not working properly at the moment so I’ll have to fix it. (https://feelinggood.com/2018/03/05/078-five-simple-ways-to-boost-your-happiness-5-you-can-change-the-way-you-feel/)

PS PS I want to thank Simon for creating time codes for all 50 techniques on podcasts 93 (https://feelinggood.com/2018/06/18/093-fifty-ways-in-fifty-minutes-part-1/) and 94 (https://feelinggood.com/2018/06/25/094-50-methods-in-50-minutes-part-2/) entitled, “Fifty techniques in fifty minutes.” His time codes allow you to find the description of any techniques of interest.

*** * ***

Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt!

Hi David,

I hope this is the right address to which to send an "Ask David." I am a huge fan of your work and cannot thank you enough for making your therapy techniques so accessible. And thank you for taking audience questions!

I am in the process of learning TEAM and notice myself getting more skilled, slowly but surely. There are times I hear you help patients recover in a single session. So far, I have not found myself able to help patients that quickly. I've felt disappointed about this, and it's led to anxiety and self-doubt ("I need to learn TEAM faster so I can help my patients as quickly as possible," "This should be happening quicker.").

I am wondering how logical it is for me to expect myself to help patients recover in a single session. Is it reasonable to assume I may have to practice TEAM for some time and go through several training experiences before I can help patients change that quickly?

Thank you again!!

Stephanie

David and Rhonda discuss ways of improving over time and reducing the pressure on yourself if you are a therapist.

224: Ask David: TEAM Treatment for Stress, Severe OCD, "General" Depression, and more!

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

224: Ask David: TEAM Treatment for Stress, Severe OCD, "General" Depression, and more!