エピソード

  • 448: Ask David, featuring Adam Holman

    448: Ask David, featuring Adam Holman
    2025/05/12
    448: Ask David, featuring Adam Hollman Relationship woes--what should I do? How can animals have feelings if they can't think? How often should I fill out the Daily Mood Log? Why can't husbands express their feelings? Today we are joined by Adam Holman, LCSW. Adam has recently left his full time clinical practice in Arizona to join our Feeling Great app team here in San Francisco. I think you’ll be delighted by his warmth and wisdom. Although he works with us full-time, he still practices one day per week and specializes in X depression, anxiety, and screen addiction(e.g. video game addiction and more.) He has appeared on two previous Feeling Good Podcasts, # X and # Y. We are delighted to have Adam as the honored guest on today’s Ask David podcast! Here are the questions for today’s Ask David. They were all written before the podcast. If you listen to the podcast, you will get much more information and perspective. The Questions Hello Dr Burns. I hope you are doing well. I participated in the webinar held on 18th of April. It was a good experience for me and I would like to thank you and your team in arranging for that. Far asks: if You have a relationship problem, but also feel inadequate. Should you use the Daily Mood Log for the internal problem of inadequacy and the Relationship Journal for the actual dialogue? Moritz points out that animals, who don’t think in words, still have intense emotional reactions, including fear and anger. For example, when a deer spots a predator, like a cayote, it feels terror and instantly runs to get away. Doesn’t this prove that terrifying events can cause feelings directly? In other words, that makes it seem like thoughts or cognitions are NOT necessary to feel emotions. What do you think? Rob asks: How often do you fill out your own daily mood journals? Do you do one every day? Would you be willing to share recent examples of your own journals with podcast listeners? Brittany asks: Why won’t my husband share his feelings? (Or, we could ask, why can’t men express their feelings?) The Answers 1. Far asks: If you have a relationship problem, but also feel inadequate. Should you use the Daily Mood Log for the internal problem of inadequacy and the Relationship Journal for the actual dialogue? Hello Dr Burns. I hope you are doing well. I participated in the webinar held on 18th of April. It was a good experience for me, and I would like to thank you and your team for arranging it. May I ask a question? When there is a relationship problem it should be addressed by the relationship journal and interpersonal downward arrow and not by the cognitive method as far as I know. What about when there is a relationship problem together with strong feelings of depression and frustration as a result of an internal dialogue of being inadequate and defective. Should this component be addressed by the cognitive method and straightforward technique? Thanks a lot. Far Kom David’s Reply This one just came in, so we’ll answer it live. 2. Moritz: Are thoughts REALLY necessary to have emotional reactions to events? Hi David, first of all, thank you for the podcast, and in particular for answering my question about how you help people with schizophrenia or bipolar disorder, which came out a few weeks or months ago. I just finished listening to episode 430, where you stated that that negative thoughts can cause negative emotions (this part I'm totally on board with), but also hypothesized that probably only negative thoughts cause negative emotions. Did I understand that correctly? (If not, please ignore the rest of this email, it won't make any sense). I'm kinda confused about this claim. This is totally not my area of expertise, but I'm under the impression that fear is much older and more "primitive" than (at least conscious) thought, from an evolutionary point of view. It would seem unlikely that an old evolutionary feature in the brain would only be triggered from a newer feature. My other source of confusion comes from my own comparison with animals. It is my impression that basically all mammals show some kind of fear response, but we don't attribute thoughts to all of them, never mind full-blown self-reflective, conscious thoughts. So at least in the mammals with simpler brains, it seems likely that fear (and other negative emotions) could be triggered pretty directly without going through negative thoughts first, and it would also be quite surprising if we didn't all contain the same mechanisms, since we share most of our neural architecture with all mammals. Do you think these considerations are valid, and if yes, are they compatible with your approach? After listening to your podcast, my own mental model of negative emotions is something like this: stimuli can cause negative emotions directly; this happens in all mammals when the stimulus goes away, negative emotions also ebb and go away after a certain time, unless something keeps them alive in ...
    続きを読む 一部表示
    1 時間 8 分
  • 447: Perfectionism Update, Featuring Adam Holman

    447: Perfectionism Update, Featuring Adam Holman
    2025/05/05
    Perfectionism Update Featuring Adam Holman

    Today we are joined by Adam Holman, LCSW. Adam has recently left his full time clinical practice in Arizona to join our Feeling Great app team here in San Francisco. I think you’ll be delighted by his warmth and wisdom. Although he works with us full-time, he still practices one day per week and specializes in X depression, anxiety, and screen addiction(e.g. video game addiction and more.) He has appeared on two previous Feeling Good Podcasts, # X and # Y.

    We are delighted to have Adam as the honored guest on today’s Ask David podcast!

    Today’s questions come all the way from North Macedonia!

    Dear Dr. Burns,

    Thank you so much for your kind response. I’d be truly honored if my questions could be considered for a future episode of your Ask David podcast. Your work has been a key influence in my research on perfectionism and its cognitive-behavioral aspects.

    Here are a few brief questions I’m currently exploring:

    1. How has your view of perfectionism evolved since Feeling Good?

    2. What strategies have you found most effective for challenging perfectionistic thinking in therapy?

    3. Is perfectionism often rooted in a fear of not being “good enough”?

    4. How does it typically manifest in academic or professional environments?

    If you happen to include any of these in a future episode, I’d be grateful if you could let me know so I can tune in.

    Thank you again for your time and for the lasting impact of your work.

    Warm regards,

    Mitko Toshev

    Doctoral Student

    Faculty of Pedagogy

    University “St. Kliment Ohridski” – Bitola

    North Macedonia

    David’s Reply

    Yes, this will make for an excellent podcast with a refresher on perfectionism, featuring questions from Mitko and a spirited discussion with Adam, Rhonda and yours truly! We had an in depth discussion of all the latest bells and whistles in the treatment of perfectionism with TEAM CBT. This included the two very different but complementary approaches to treating depression or any of the 23 common Self-Defeating Beliefs.

    So, if you’ve ever struggle with the thought that you’re not good enough, or that you SHOULDN’T have made this or that mistake, this podcast will be right up your alley!

    Thanks, Mitko!

    david
    続きを読む 一部表示
    53 分
  • 446 Gender-Affirming, Life-Saving Medical Care, featuring Stanford's Dr. Rachel Sewell

    446 Gender-Affirming, Life-Saving Medical Care, featuring Stanford's Dr. Rachel Sewell
    2025/04/28
    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 Sewell, M.D., a Stanford pediatric endocrinologist who provides medically necessary care for transgender and gender diverse young people. She shares how in a time when there is a lot of inaccurate information being spread about this vulnerable population she will continue to advocate for them by providing education and accurate information, including by being a guest on this podcast.

    She says:

    When I was a medical student, I wasn’t initially sure what type of medical practice I would pursue. However, I always knew I’d be an advocate for LGBTQ+ patients . As a first-year medical student, I trained and worked in the emergency room. I quickly realized, as did my mentors, that I enjoyed and was excellent at working with children, so I focused on pediatrics. That summer I had the chance to do research in endocrinology which is the study of all hormones. Think of hormones as messages that travel throughout our bodies delivering important information. Hormones are responsible for so many important functions including keeping our bones healthy, helping us grow, using the energy from our food, and causing kid bodies to change into adult bodies.

    My work with transgender and gender diverse children and teens involves providing evidence-based holistic care with a skilled team of clinicians. More than anything, my patients want to be respected, heard, and allowed to thrive. . In providing them care,I bear witness to intense conversations, emotional highs and lows, as well as the purest examples of joy. Throughout it all, it is my privilege and pleasure to provide them gender affirming care.

    During this episode we reviewed definitions of gender identity vs the sex assigned to someone at birth. We review the common times when young folks share their gender identity with the people in their lives as well as what it means to be cisgender vs transgender. We discuss sexual orientation and gender identity and how these are complicated and independent aspects of everyone’s sense of self.

    Rachel continued,

    Medically necessary care for transgender and gender diverse patients is life-saving. Imagine, you know you are male but your body has a period every month. This can be profoundly distressing and results in gender dysphoria. Gender dysphoria is the intense discomfort that results from your identity not aligning with your body and negatively impacts people’s everyday lives. Now imagine being told that there are safe and effective ways to avoid experiencing that distress. I have had numerous patients say that the care they receive has saved their life.

    When people hear gender affirming care it often leads them to think of care provided to transgender and gender diverse people but everyone deserves access to gender affirming care. Because it is simply a model of care that recognizes the importance of and validates people’s identities and experiences. Other examples of gender affirming care include being able to take a medicine to help prevent hair loss on your head or undergoing a breast reconstruction surgery after having breast tissue removed in the fight against cancer.

    When discussing possible ways to support a patient’s identity I tell families that there is no one size fits all. Everyone’s journey is completely unique. For some patients, having their legal documents align with their chosen name is the most important thing. For others, they alter their gender expression, aka the way they present themselves to and interact with the world around them with things like hair changes, makeup, clothes etc. to align with their identity. For some folks it is important to pursue hormone therapy. And for some they will end up pursuing surgical interventions when they are adults. I also discuss that the timing of sharing your gender identity if it does not align with your sex assigned at birth varies tremendously. But regardless of age, gender-affirming medical care always makes a tremendous difference in peoples’ lives!

    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
    続きを読む 一部表示
    1 時間 3 分
  • #445 Awesome Interviewing Secrets featuring Dr. Kyle Jones

    #445 Awesome Interviewing Secrets featuring Dr. Kyle Jones
    2025/04/21
    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...
    続きを読む 一部表示
    59 分
  • 444: I'm angry! Live Work with Sunny, Part 2

    444: I'm angry! Live Work with Sunny, Part 2
    2025/04/14
    I’m angry! A Once-Undocumented
    Immigrant 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
    続きを読む 一部表示
    1 時間 11 分
  • 443: I'm angry! Live Work with Sunny, Part 1

    443: I'm angry! Live Work with Sunny, Part 1
    2025/04/07
    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 ...
    続きを読む 一部表示
    1 時間 3 分
  • 442: Eliminate Anxiety Fast: The Awesome Hidden Emotion Technique

    442: Eliminate Anxiety Fast: The Awesome Hidden Emotion Technique
    2025/03/31
    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

      1. 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.

      2. Motivational techniques to reduce resistance and bring resistance to conscious awareness.

      3. Paradoxical Cost-Benefit Analysis

      4. Dangling the Carrot / Gentle Ultimatum / Sitting with Open Hands

      5. The Hidden Emotion Technique

      6. What If / Downward Arrow Technique

      7. ERP (Exposure plus response prevention)

      8. Many other techniques inspired by methods a and b above (TEAM CBT)

      9. Feared Fantasy: confronting her worst fear

      10. Five Secrets of Effective Communication

      11. Work on acceptance: she is perfectionistic and self-critical

      12. Hidden Emotion: anger

    Thanks for listening (and reading the show notes),

    David, Rhonda and Matt
    続きを読む 一部表示
    51 分