Inside the Therapy Room: Live with Dr. David Burns

What actually creates change in therapy—and what quietly gets in the way?

 

In this live, unscripted therapy demonstration, world-renowned psychiatrist and author Dr. David Burns, creator of TEAM-CBT, invites you inside a real therapy session as it unfolds moment by moment. Together with Dr. Jill Levitt, you’ll observe how empathy is built, resistance is dissolved, and breakthroughs emerge in real time.

Rather than theory or scripted examples, this training shows exactly how expert therapy works in practice—where every word, question, and response matters.

Through live clinical work, teaching commentary, and Q&A, you’ll learn how to apply the most effective CBT strategies directly in your own sessions—or in your own life.

 

What You’ll Learn:

 

• How real-time measurement and symptom tracking guide effective therapy

• Common empathy errors that block progress—and how to avoid them

• How Positive Reframing reduces resistance and increases motivation

• Cognitive and behavioral techniques that lead to rapid emotional shifts

• How Testing, Empathy, Agenda Setting, and Methods work together in TEAM-CBT

 

Ideal for therapists, counselors, and anyone curious about what truly helps people change—this training offers a rare, behind-the-scenes look at therapy done at the highest level.

 

SUMMARY:

 

IN THIS VIDEO:

 

Jill Levitt: We are just waiting another minute or two to start the webinar, but it takes a little bit of time for everyone to join from the waiting room. So we are just getting it opened up now, and we will start speaking in about a minute.

 

Mike: Just to confirm, Jill , on my other screen it looks good. You and David are spotlighted, and we can see the PowerPoint screen really well.

 

Jill Levitt: Thank you.

 

Dr. David Burns: So, Hiral can see and hear us, but we cannot see them for a while, right?

 

Jill Levitt: Exactly, until we start talking. David, did you hear what I said about taking a bathroom break after empathy?

 

Dr. David Burns: Yes. Did you hear me say I can hear you?

 

Jill Levitt: Nope.

 

Dr. David Burns: I was way over by my printer, and this is a directional mic. But yes, absolutely, I had the same exact thought this morning.

 

Jill Levitt: Perfect. Okay, I am going to wait. All right I‘m going to get started. Well, welcome everyone to Inside the Therapy Room Live with David Burns. I am Jill Levitt, and I am really excited to be presenting this half-day workshop alongside David. It is really a unique opportunity to see David and myself as a humble sidekick working with our volunteer this morning. And so we hope that you will learn a lot and that it will touch your heart, and that you will be able to relate and connect and learn a lot as a therapist and a human being today. So, we are actually going to start by asking you about who you are, and then we will introduce ourselves and the Feeling Good Institute and get started with the presentation. So, I am going to run a poll and our question is: just tell us about yourself. Are you a member of the general public? The first option is: I am not a therapist, I am a member of the general public. Are you a therapist that is enrolled in All Access or the FastTrack course?, or are you a therapist joining us who is not currently enrolled in one of those courses? We just like to know kind of where you are coming from and who our audience is. So, I will give you just another minute, and then I will end the poll and share the results so we can all see who is in our audience.

 

Jill Levitt: Okay, I am going to share the results. If you did not get a chance, it is okay. So David, we have 61% are therapists not currently enrolled in the FastTrack course, 16% are therapists enrolled in the FastTrack course, and 24%, so about a quarter of our audience is not a therapist and a member of the general public.

 

Dr. David Burns: Okay. And we have roughly 200 people in attendance.

 

Jill Levitt: 300 people in attendance.

 

Dr. David Burns: 300. Oh, okay. Great.

 

Jill Levitt: And quite often, from my experience, many people will roll in the first 15 minutes of the presentation. First, let me introduce you all to David, who maybe needs no introduction, but David Burns is a world-renowned psychiatrist, CBT legend, best-selling author, and the creator of the Feeling Great app, which David is going to share a little bit more with us about at the end of the presentation. And in addition to being incredibly creative as a clinician and an author, David is just an amazing mentor and supporter of all of us who have been working with him and striving to learn these TEAM-CBT tools for many years. It is always a total honour and pleasure to present with you, David.

 

And let me tell you just a little bit about who we are at Feeling Good Institute. Our mission at Feeling Good Institute is to help therapists deliver better outcomes so that patients can recover faster and more fully. We train and certify therapists in TEAM-CBT, which is this framework that we will tell you about today that was developed by David Burns. We offer a structured five-level certification path that really reflects the depth of the TEAM-CBT model. And FGI, or Feeling Good Institute, began in 2014 with a shared frustration that led to a shared vision. Back then, the only way to learn TEAM-CBT was to study with David at Stanford or if you were lucky enough to catch him on one of his intensives. The model David was teaching all of us was so incredibly powerful but was not accessible to so many therapists. And so we set out to change that and to make David's tools, techniques, and training style more accessible to more therapists. We wanted to be able to support therapists all over the country and all over the world to learn these tools really well and to help more patients.

 

On this slide, I just want to share with you—it might surprise you to hear this—but it turns out that experience alone does not make therapists better. Just seeing more patients and doing more sessions throughout your career does not necessarily lead to better outcomes. And we know this based on psychotherapy research studies. We have a couple references at the bottom of the slide. If anything, many therapists get less effective over time. So, the question is, what does work? What helps us as therapists to become more effective throughout our careers? And It turns out that, just like other skills like playing basketball or learning the piano, learning, practicing, getting feedback, and repeating that cycle over and over again is what actually leads to change in behaviour and to better skills. At Feeling Good Institute, we do not just teach techniques, but we replicate David's training style, which is built on this foundational idea that you only get better through practice and feedback. And we double down on that philosophy and have integrated deliberate practice into all of our trainings so that therapists have an opportunity to learn, practice, get feedback, and actually get better.

 

And I’ll just say at the end of our session today, I will tell you a little bit more about a new programme that we have just developed called CBT All Access. It is a new subscription programme that gives therapists everything they need to build strong, effective TEAM-CBT skills with practice, feedback, mentorship, CEs, and community. And so I will tell you more about that at the end of the workshop when you’ve kind of seen the model and may be have gotten excited about it. It will tell you more about how you can learn more. So, at the end of the webinar today, David will share information about the free Feeling Great app, and I will share information about next steps if you would like to continue to learn and grow with us.

 

I want to let you know, because many people will start asking in the chat box, how do I get my CE? If you registered for the paid option for this workshop today, then you will receive an email today with a link to complete the mandatory CE survey. If you just attended for free, you will not get the CE survey. After you complete that survey, you will get your CE certificate within one week. So, you don't get it instantly, but we'll send it out to you within a week. And if you did not pay for CEs and you realise you really want them, you can actually change that registration today. So Mike will put the info on how to do that in the chat box. And you can also scan this barcode and that's how you can actually change your registration so that you can get CEs. It's not too late because we've had people send notes in the chat box asking. So now we've moved on from kind of our preamble and now I would just want to share with you learning objectives for today. We definitely want you to learn a lot about using measurement, empathy skills, assessing resistance, and we are going to hopefully model lots of TEAM-CBT methods today as well. So, our plan is to teach for about 45 minutes, then do a live demonstration for about two hours, followed by teaching highlights, Q&A, and learning more. We will be with you until one o’clock Pacific time today. So, I will do a quick overview of the TEAM-CBT model, and then I am going to turn it over to David to share some information with you about testing and we'll kind of be off to the races.

 

What you are going to be watching and learning today, we hope, is the TEAM-CBT model. TEAM-CBT is not a manual for doing therapy, but rather it is a framework for how all effective therapy works, based on these four steps. The T is for Testing. We use measures of symptoms and the therapeutic alliance at every session with every patient so that we can track progress over time. We can track progress within sessions and across sessions to hold ourselves accountable. And we can also get information after each session about how we did so that we can repair alliance ruptures and make sure that we are really connecting with our patients. The E in TEAM stands for Empathy. You will see David and I, hopefully fingers crossed, do a good job with empathy with our volunteer today, really connecting before jumping in with powerful methods—listening, supporting, and having warmth and connection. David has created a whole toolbox to teach therapists empathy skills. The A in TEAM stands for Assessment of Resistance. We acknowledge that a lot of people feel ambivalent about change. There are a lot of really good reasons to stay the same, and so we try to honour that, really connect with our patients, see the world through their eyes, and understand and even bring to life all the good reasons not to change and not to do the hard work of therapy. Paradoxically, that often leads to a reduction in resistance and a boost in motivation. Finally, the M in TEAM stands for Methods. This is probably what many people think of when they think of CBT, which are the cognitive, behavioural, and other kinds of methods that really bring about meaningful change. So, hopefully, you will see the whole model from start to finish today. And then there's many ways you can actually learn how to do all these different steps with your patients.

 

Dr. David Burns: I want to add to that, if we can go back.

 

Jill Levitt: Sure.

 

Dr. David Burns: This is a sequence that we go through in every therapy session. You will see us going through it in a step-by-step way and in just that order. We are hoping to sell you on this approach because it has been so effective, and we love being effective. We love seeing changes in people. But a lot of people maybe come to our free Stanford weekly training and think they will take a little of this and blend it with a little of that, and kind of try this piece and try that piece. And that actually does not work very well, if at all. You could think of this as open-heart surgery. It is a sequence where each piece is massively important and leads to the next step. And so if this approach interests you, you might want to consider jumping in with both feet and really learning how to do it in just this sequence. It is challenging to learn but can be with the majority of patients enormously rewarding. And as Jill mentioned, I have not created a new school of therapy called TEAM-CBT. And I am against all schools of therapy. I think they have made some contributions to our understanding, but they have come with a boatload of pretty severe problems. I think we need to restructure our field around science, measurement, and assessment.

 

But team is really my understanding and our understanding based on research and clinical experience. These are the essential ingredients of all therapy. So we're saying that testing is necessary for all effective therapy. It's not some optional thing for you know number crunching nerds. It's something that opens the door to a profound new vision of your patients and how to work with them. The same is true with the E of Empathy, the A of the Assessment of Resistance, and the M of Methods. These are all critical pieces. Now, at the M of Methods is where we're using a variety of methods to help patients crush their distorted thoughts, for example. And I've developed 140 roughly techniques for crushing negative thoughts, for helping people experience rapid and hopefully profound changes in how you feel and what your value systems are. But in the M of Methods, I've drawn inspiration from at least a dozen schools of therapy. We're not promoting any one school of therapy at all here. The goal with the M of Methods is to see the patients symptoms go to very low levels, possibly all the way to zero. But anyway, that's what team is and one neat thing about it is that if you're willing to use extended, you know, double sessions, that would be a 2-hour rather than a 1-hour session, you can often see a complete or near complete elimination of symptoms. This isn't always possible, but in my experience, it's possible, you know, roughly 90% of the time. So essentially you can complete an entire course of psychotherapy in one session the first time you meet with a patient and but this does require a high degree of therapist skill. You can't just meet with somebody for two hours and then shoot the breeze and expect a miracle to happen. in those two hours you're using every minute really much like doing open heart surgery, every minute has a purpose and every moment is critically important to the outcome. But it's tremendously exciting because well personally I don't charge for therapy. I haven't for a good 35 years. I haven't charged anyone for any type of psychotherapy or whatever. And so my only really payment is the reward of seeing somebody have a dramatic change and go from tears or anger or inadequacy to joy and peace and connection with others. And when that happens for my patients, it happens for me personally. And so that's the greatest reward of all. But it not something that comes easily. It's taken me decades to develop these techniques and to develop a deep understanding of how people change. And that's we're going to bring you an overview of it. We'll try to make it look real easy. And once you know how it is real easy, but it's challenging to learn. But the rewards of learning can be great.

 

Now the T of Testing is something that you know doesn't appeal to a lot of therapists. They think they don't need testing. But I've developed ultra reliable new scales for measuring depression, anxiety, suicidal urges, anger, all kinds of things, happiness as well. And these are short scales that are highly reliable, extremely valid, but where you can see exactly how someone is feeling. And you can put the time frame any way you want. Like the Beck depression inventory is over the last two weeks, including today. How have you been feeling? And that always struck me as nutty because my feelings change all the time, and I'll bet yours do too. So when you say, "How have you been feeling over the last two weeks?" that just like tutti frutti nutty stuff and all the scales that have followed have followed that psychotic thing and I've wondered why there's such a lack of critical thinking in our field because the whole thing is misguided the brief mood survey it's like an emotional X-ray machine and when you go to an emergency room and you're measured we're measuring everything in medicine in the here and now we want to know what is your temperature right now? What does the X-ray show right now? What is your blood pressure right now? Not what has been your blood pressure over the last two weeks including today. And this is a way more powerful form of measure. So before patients start the session, before Hiral started today's session, she took the brief mood survey and we know exactly how depressed she was, how suicidal, how anxious, how angry, how happy her how she feels about her marriage very accurately how she's feeling right now. And my philosophy is the goal of therapy should be to change people right now, today, not in six months, not in two years. When I was a psychiatric resident, we never measured anything. And it was a travesty. And we never had any way of knowing if we were being effective.

 

We just encouraged people to talk. That's what my supervisor said. It's all emotion is the total answer to get them to cry and be angry and express their feelings and there weren't any tools for change and it just went on endlessly. I never saw any patients recover completely or even improve much if at all when I was a resident and my philosophy has changed that if we're delivering something and we don't know what we'll be able to do with her we'll aim high and see what we can do but the goal she has been suffering she's a beautiful young woman and she's been hurting in ways that maybe you've been hurting thinking she's not good enough as a mother and she has a you know a beautiful vivacious son who's almost four years old but thinking you know maybe I'm a failure as a mother and she's got really high standards and if a miracle happened maybe she would experience some joy, some relief, some self-love, self-acceptance today but we'll find out at the end because I'll have her take the same test she took at the beginning. How are you feeling at this moment, to see what has been the change within the session? And if you have the guts and courage to do that and I would say very few if any therapists have the courage to do this therapists are scared. They don't want to see the truth of what's going on they'd like to rest in the vagueness of, I think I'm helping and I don't need to measure anything. I know how my patients feel. But my research at the Stanford inpatient unit and throughout my career has shown that's not true. You don't actually know how your patients are feeling. And the in the study I did of this at the at Stanford, I'll just be very short, but I measured the accuracy of experts after a two or three hour interview with patients about their feelings. A structured called the SCID interview supposed to be the gold standard for interviewing patients on their feelings.

 

And then I ask the interviewer and the patient to turn your backs to each other and ask the patients to fill out my brief mood survey. How are you feeling right now? How depressed are you? How suicidal? You've just spent two or three hours with this expert talking about your feelings. So, how do you feel at this moment? And ask the experts. They didn't know that I was going to do this. How what's your guess of how that patient is feeling right now? You just spent 2 or 3 hours asking that patient only about their feelings. So, how are they feeling at this moment? How depressed? How suicidal? How angry? How anxious? And also, how do you think you came across empathically? And had the patients rate them. And to make a long story short, then I just put the data in the computer and it was a simple matter to see how accurate these therapists were. And everything was under 10% accuracy. The accuracy on depression was 3%. The accuracy on suicidal urges was zero. Can you imagine that? You spend three hours with a patient and you have no idea how suicidal they are or aren't. The accuracy on anger was zero. The accuracy on empathy or on anxiety I think was like three maybe 5% or something. just almost no accuracy at all and on empathy was 9%. These therapists had no idea how they were coming across to their patients. So that there's two glaring failures that you have and probably other therapists have is number one, you don't know how your patients are feeling unless you're using these kinds of instruments. You don't know how effective you are within therapy sessions and between therapy sessions. You have to have the data in an emergency room. You have to have the data to know what's going on with, you know, pinpoint accuracy. Your guesses, you know, are of some interest, but they're not going to be very accurate. But secondly, not only do you not know, and this sounds harsh, but we have solutions to all of these things for you if you're courageous and willing to try the solution. But you don't even know that the therapists don't even know how shitty your understanding is. Excuse me, the word. I didn't say that because I don't say those things in public workshops. However, and that was an attempt at humor, and I'm looking at Jill's face to see if there's a smile, and there wasn't, but now there is. But at any rate,

 

Jill Levitt: I smile on command.

 

Dr. David Burns: It's like a double failure. Not only do we not know how our patients feel, we're like the blind leading the blind, but we don't even know. We think the lights are on when we're in the dark. And this is a very simple way to transform your clinical practice almost overnight and suddenly see how effective you are as a therapist and where your patients are at. So let's go on and so I've kind of mentioned this we can go on to the next slide. Now the you want to go over take over on the E of Empathy, Jill?

 

Jill Levitt: Sure. I can say a little bit and you're welcome to jump back in again. But yeah, the E in TEAM stands for Empathy and that is you know, as David pointed out, many of us think that we're very empathic and in fact that's what kind of brought us to the field most likely. I know I thought that way about myself as well. And then we can learn maybe from testing that as David described that our patients maybe aren't feeling as empathized and that happens to David and I, in workshops as well where we ask how are we doing in empathy and we hear that we're missing something.

 

Dr. David Burns: Might happen today.

 

Jill Levitt: Absolutely. But what I will say is the toolbox that David has created which is called the Five Secrets of Effective Communication. It's in your handout on page 10. Kind of a really beautiful framework for connecting with patients. And generally, if we are really tuned in and focused on doing an excellent job of empathizing and nothing more, maybe it takes around a half an hour with a new patient. And you'll see us probably spend that much with our patient volunteer today. And of course, empathy is necessary, right? So, we can't just jump in and throw methods at patients without really understanding them. And yet, it's not sufficient for change. If we only spent all of our therapy sessions listening, understanding, connecting, supporting, our patients are not going to stop having panic attacks or suddenly be over their social anxiety or their major depressive disorder. Right? So, necessary but not sufficient for change. And the toolbox again that we use is the five secrets. So, we're using thought and feeling empathy where we're really tuning in and listening and stroking where we're expressing warmth and care toward our patients and inquiry where we're asking our patients to open up and share more. We also talk about empathy as the zero technique, which is, let me have you explain the zero technique, David, and then I can come back and add some color.

 

Dr. David Burns: Well, during the empathy phase, I want to go with my patient to the gates of hell. I want to the patient to express negative thoughts, negative feelings and to experience those. My job is not to try to cheer the patient up or make an interpretation or to be helpful to the patient at all. I'm going to give the patient nothing because that's what the patient wants most, want someone to perceive what they're saying and show that you can understand their words, their feelings, and how they're feeling inside. Maybe they they're feeling incredibly lonely, but they haven't mentioned that. Or they're very angry, and it's causing their the main complaint is anxiety, but there's tremendous anger going on that's getting in the way. And they want you to understand that their thoughts. They want you to understand their feelings and they want you to do that in an atmosphere of trust, warmth, and acceptance. And that's what we're giving the patient nothing, but we're at the same time, if you can learn to do that skillfully, you're giving the patient everything.

 

Jill Levitt: And this sounds much easier than it actually is in practice because we and other therapists that we work with feel so tempted right off the bat to jump in with advice giving or cheerleading. And so we'll share with you this acronym we came up with on the next slide which we kind of like. It's we say do not preach. So on the previous slide you saw the dos of empathy. This is the kind of the do nots, right? So when your goal is to connect and empathize and understand a patient, you want to resist the urge to problem solve, to rescue your patient, to educate your patient, psycho education, and teach them, to give them advice on the problems that they're struggling with. You don't want to cheerlead and cheer them up. And most importantly, but all of this falls in this category. You're not trying to help them. You're really trying to tune in and understand them. And as David says, if you can resist the urge to do all of these things, you know, during the empathy phase of therapy, then you're actually giving your patient so much, right? They kind of open up and they're ready to then move to doing the work of therapy.

 

Dr. David Burns: Yeah. Yes. And just one last thing to find out there's two ways to find out how empathic you are. One is to take the empathy scale I've developed to have the patient do that after the session and we'll have Hiral do that after the session. But that's incredibly sensitive to the slightest therapeutic failures and it's very easy to get a failing grade on that empathy scale, which is good. We encourage failing grades because when you process the way you're failing with your patient, that's where the breakthroughs come. The not knowing that is the unforgivable sin to my way of thinking. But in addition, what we're going to do with Hiral today as after we've empathized for 20 minutes or 30 minutes or whatever, we're going to ask Hiral who's a very smart, honest person to grade us in three areas with a letter grade A, B, C, D, F, and thought empathy. How good did we do her in understanding your negative thoughts that are eating away at you? How effective were we at acknowledging all of your negative feelings? And there going to be many of them and intense. And then third, did we do that with an atmosphere of caring? Did you feel cared about by us? Did accepted? Was there a feeling of trust? And then she'll give us three letter grades. And I've had a lot of times where I got two A+es and a B. And then it's a simple matter to say, "Wow, on the acceptance was only a B or on the feelings was only a B. Tell me the part I missed." And then the patient will gladly fill you in on where you're missing the boat. And it's easy to get those grades up to an A. So this is a very quantitative kind of therapy but at the same time we believe it's impossible to be tender and warm and caring or genuinely empathic without the measurement. The world is filled with therapists who fancy themselves as to be fantastically empathic and wonderful listeners and most of them aren't that you're just fooling yourself. But once you start measuring your errors will come to the surface right away. And if you have the courage to examine yourself and to see when patients are not happy with how you're coming across and that requires the death of the therapist ego team is kind of a spiritual philosophical approach as well as very practical measurement based scientific approach. But to use these tools requires humility and the death of the self because you find out about all of your shortcomings every time you do therapy. And that can be a tremendous opportunity for learning and growth and catapulting your therapy skills to a worldclass level. Or you can run away from it and hide and continue doing what you're doing without assessment and kind of continue working in the dark and pretending it's way better than it probably is. Back to you again, Jill.

 

Jill Levitt: Okay, so the A in TEAM stands for Assessment of Resistance or sometimes we refer to it as Agenda Setting. So you might have heard one or the other, but essentially here our goal Assessment of Resistance is really kind of the bridge that brings us in therapy from empathy only where we're listening and understanding to doing the work of therapy. And rather than jumping just from listening to here are some methods, we actually pause and we connect further with our patients. We ask questions to really understand what might be going on from a resistance perspective. So one type of resistance we often times see is outcome resistance. That's the idea that often times while patients do want to feel better, there are some good reasons for them to want to stay the same. A highly anxious person might be reluctant to give up their worrying or their anxiety because they feel like it really protects them or it shows their really high standards. And so we ask questions and hopefully you'll see some of that done today. Does the patient really want the outcome that they're asking for? What are good reasons not to change? And that's kind of the outcome resistance piece. And then there's something very different that's called process resistance. That is even with highly motivated patients who convince you that they really want to change. Therapy can be really hard work, right? We're going to have to do all the homework that our therapist is asking of us. We're going to have to face our fears if we're feeling highly anxious. We're going to have to learn to communicate in a different kind of authentic way if we're having conflict. A lot of responsibility, a lot of work, and is the patient willing to do the work required to get there? And so there's a whole kind of sequence of work that David's developed in TEAM-CBT where we can assess and reduce resistance. And paradoxically by putting a voice to these kinds of things by really joining the voice of our patients resistance, good reasons not to change, good reasons not to do the work. We put our patient in the role of actually arguing for change. And that's kind of what assessment of resistance is about.

 

Dr. David Burns: Yeah. And if we can just go back to that slide for a moment. The TEAM is quadruply paradoxical. Every level that at the team we're hoping for failure because that's a chance to improve our relationship with the patient and at the empathy we're hoping for failure because then we'll find out what we're not tuning into and can correct that right away. And in assessment of resistance, you're not we're bringing out all the good reasons why the patient really isn't going to want it changed. And those are very real valid reasons. People don't come in with a clean slate of I want to lose weight. I want to get over my depression. I want to get over my anxiety. We always have mixed feelings. And so at this phase as a therapist, you have to give up your identity as the helper and become the patient's resistance and to argue with compassion and persuasion and reality why the patient really should not change. And paradoxically, that's the thing that unlocks the tremendous motivation within the patient. And so that's what I mean when I say that team is non-linear. We can teach you these things as a step by step thing, but you always at each step you have to understand something much deeper than just the words on the slide in order to be able to do it. Often something and you will have to change before your patients can change.

 

Jill Levitt: Exactly. Right. That's a nice segue to this slide. What in you will have to change is that urge to kind of push your patients to change. And some therapists, myself included, we kind of pride ourselves on being pretty, you know, assertive and aggressive and kind of pushy in therapy, but there's probably a time and a place for that. And yet, when you're setting the agenda with your patient, what you actually have to do is stop pushing them to change and kind of take a step back and paradoxically put them in the role of arguing for change. Then you won't be having a patient who digs their heels in like you can see in the slide. And we also I think we'll just briefly talk about this now and I'm sure you will see us do this exercise with our volunteer today. But one of the really kind of pivotal parts of addressing outcome resistance is what's called positive reframing. And we're just mentioning it now so you can flag it to yourself and watch it and pay attention when we're doing this today. But the questions here are we're asking our patient, you know, what do your negative thoughts and feelings show about you that's positive and awesome and what are some benefits or advantages of those negative thoughts and feelings? And the paradox here, right, is that rather than thinking that, oh, we need to help you get rid of these thoughts and feelings that are so pathological. Instead, we're thinking there are some really good reasons to hang on to them. And in fact, they show some really beautiful things about you. And David, I think you can comment about positive reframing. This slide might help.

 

Dr. David Burns: Yeah, Jill, the whole goal of positive reframing, you see our culture says that depression and anxiety and then the crappy DSM developed by the crappy American Psychiatric Association. See, my wife said, "Now that I'm old, I can say what I really believe." All these thoughts I've been suppressing and hiding for years. But yes the our society says these are mental illnesses and DSM there's now I think over 200 you know mental disorders you don't have shyness you have social anxiety mental disorder that's what the American Psychiatric Association would have us believe and all of this creates feelings of shame you feel defective Patients are always telling me, "I'm feeling defective. There must be something wrong with me." And that's why people go to psychiatrists and psychologists. Please fix me. I'm defective. I'm having all of these symptoms. And what we're trying to do here is turn all of that upside down and show you with proof, not with that your symptoms are not the expression of what's wrong with you, but what's right with you. And I want you to take pride in your anger and rage at your family that you're thinking, "Oh, I'm not supposed to feel this way." And maybe at your child or at yourself or to take pride in your depression, what it shows about you that's genuinely beautiful and awesome and your anxiety. And the paradox is I'm trying to sell you on not changing. And it's not a gimmick. It’s got this has to come from the heart and be genuine. And the moment I can sell you on the idea that I can't see any reason why you should change in that very instant, you'll change. You'll desire develop a tremendous desire to change. So that's how positive reframing can help. Again, it's a linear technique because we can teach you how to do it, but it's getting at a kind of a nonlinear process that has some power or magic associated with it.

 

Jill Levitt: You want me to Oops. Sorry. Do you want me to do this one then?

 

Dr. David Burns: Yeah, sure.

 

Jill Levitt: You're pausing, yeah. So the M in TEAM stands for Methods. And we're coming to the end of our presentation in the next couple of minutes so we can switch gears and kind of talk to our volunteer. But just to do a brief overview in the next few slides of what methods might look like. It's David mentioned this already pretty detailed that the M in TEAM stands for Methods and that we use many methods hundreds of methods drawn from greater than 12 schools of psychotherapy. So the point is it's not only one you know school of therapy and if you've done skillful assessment of resistance meaning you've walked through the model, you've using measurement, you've empathized, you've addressed resistance quite often you'll see that you only need a few methods that are really targeted to what the patient is struggling with to bring about meaningful change. But there definitely are times, right, even with accurate resistance where we'll need to try a variety of different methods that can be useful. I can keep going or you want to jump in here?

 

Dr. David Burns: Well, the cognitive model is that thoughts, not events, trigger negative feelings. Epictitus claimed this 2,000 years ago. Thoughts, negative thoughts are the cause of depression. People have been arguing about it for 2,000 years and a lot of therapists won't accept it. But we recently did a a statistical model of this with 7,000 patients and have proven for the first time using something called Structural Equation Modeling that negative thoughts are in fact the cause of depression. And the second idea is that the thoughts that cause depression and anxiety are distorted. That’s kind of the 20th century addition to the thinking of Epictitus. Like you're fooling yourself when you're saying I'm a failure as a mom or I'm not as good as I should be or you know I'm a hopeless case. Things will never change. And those are the familiar 10 distortions that I created in 1978. That list, I can remember the very night I created it at the suggestion of one of my patients and I put it in feeling good. And that's the idea that it's not true what you're telling yourself. You're involved in all or nothing thinking, overgeneralization, self-blame.

 

Jill Levitt: Yeah, I was going to say we have a slide about the cognitive distortions in two slides. You want me to go to that one?

 

Dr. David Burns: Well, I'd just rather finish up the slide I'm on. We'll get to them in just a sec. I'm sure you're familiar with the distortions already, and we'll give you a couple slides on that. But the last part of it’s a three-phase thing, is the very moment you change the way you think, you can change the way you feel. And a lot of people don't understand this because when I work with people and they recover, it's usually at a moment, like a 15-second moment where they see something they haven't seen before, and their thinking changes. They realize it's not true that I'm a worthless human being or whatever they've been telling themselves in that very moment the feelings change and again this is radically different from other schools of therapy as a resident I was taught that it takes months or years for people to change and you shouldn't expect it while you're treating them and I said man that this is a pile of horse shit we're being taught here this doesn't do anybody any any good and talk I was just so delighted and excited to discover ever cognitive therapy. Although I was incredibly skeptical at first, thinking this is just This is too good to be true. But I found out these these ideas are true. And now we've proved them through research. And we've learned how the art of helping people change these thinking patterns.

 

I think we've kind of covered this already. But yeah I think the cognitive model just to go back is that a lot of people have trouble getting it, the idea that your thoughts create your emotions that's happening right now some of you are probably feeling pissed and saying David sounds like such an arrogant you know why doesn't he shut up or something and so that thought is creates anger and others are thinking Wow, this is very different and exciting. And so you're feeling kind of a sense of joy. Others are thinking, let's get on to the live demo. Enough preaching. You know, your thoughts create your feelings at every moment. But it's so basic that people don't see it. And then if a lot of people if they hear it, they don't believe it. they have this absurd notion that so many therapists believe and teach if they're teaching in graduate schools that emotions cause thoughts and we finally proven that's not the case. But they're simple ideas but they're hard to get. You have to get them experientially for the first time to see the truth in yourself. And once you see it, then it's a that's an experience.

 

Jill Levitt: Yeah.

 

Dr. David Burns: And then these are the 12 distortions, all or nothing thinking and should statements and emotional reasoning and so forth. And we'll be using these today, so we don't need to dwell on them too heavily right now.

 

Jill Levitt: In the handout packet on page five. And we will, as David said, we will likely be doing the method, identify the distortions and explain the distortions with our volunteer today. So you'll get more familiar with these for sure. And then the necessary and sufficient conditions for emotional change, right? When we use cognitive therapy to help patients to challenge and change their distorted thinking, the new thought that they come up with, which we call the positive thought, has to be totally true. Right? We're not interested in trying to help patients to come up with some new thought that this kind of a little bit of BS or sort of believable or they don't really believe. Right? The point is to come up with a new positive thought that's completely true to the patient in order for it to be effective. And at the same time, that new positive thought also has to make the negative thought completely untrue, right? Because a positive thought could be, you know, completely true but unrelated to the negative thought or not really have an impact on the negative thought. And so the positive thought has to be true and has to make that original negative thought untrue.

 

Dr. David Burns: Can we give an example of this Jill because this is a lot of intellectual stuff on a slide and can you think of an example that might bring this home to people. You could too if you.

 

Jill Levitt: Sure. I mean I have to think for a minute. Do you have an example in mind?

 

Dr. David Burns: Well, an example I've posted on the internet was a woman was the most depressed and anxious patient I'd ever seen as an outpatient. I call her Terry and she'd had panic attacks for and crushing depression for 10 years and nobody had been able to help her. And you can see I've posted a video of the six minutes when her life changed. And you can actually see the 15 seconds when she suddenly saw that all the things that she'd been telling herself for the previous 10 years like during panic attacks, I'm about to die and I can't breathe deeply enough and that type of thing where she suddenly saw and believed as much as the fact that there was skin on her hands that those thoughts were rubbish and they weren't true. And at that moment you see her uncontrollable laughter tears sobbing pleading please Dr. Burns I can't do this I can't stand this and suddenly turns to laughter and that was the 15 seconds that really changed her life but she stopped believing that thought because she saw it was rubbish. You have to go and check it out on our feeling great channel and it has all the explanation and so forth, but it's an actual video from an actual therapy session and brings this to life in a very realistic meaty way, not just some intellectual conceptualization. Well, an example would be let's take a caveman you know 50,000 years ago and it's night you know the evening is coming on it's getting dark and he hears a twig snap and he has the thought “oh my god it could be a tiger“ well that thought which he believes this is I'm in danger creates intense panic and that's just about how long it takes for a negative thought to create negative feelings. And he in panic he turns and looks and he sees that just his wife who is walking to the somewhere and she's has stepped on a twig. And then he suddenly realizes that thought is not valid. And in that instant his feelings change and that's exactly what we're trying to do in therapy.

 

Jill Levitt: Great. Much better than words on the page. I agree. So, yeah, now that was kind of an overview of the model and our goal is now to introduce you to the volunteer that we're going to be working with today. Her name is Hiral. And David and I have never worked with Hiral before. We've actually never met Hiral before about 15 minutes before 9:00 this morning when we had a chance to talk with her. And we have her daily mood log though. We asked her to complete a partially complete a daily mood log just to articulate kind of an event that was distressing her and we have that in the handout packet and I also will share it on the slides to get us started. And we'll bring Hiral up on video and audio. Mike is going to help us to do that. Should I start? Yeah, I'm just I'm also aware David that if we stop sharing screen people kind of prefer that because they can see you and Hiral and I larger. So should I stop screen sharing and we'll talk with Hiral and refer people to page four in the handout packet rather than the slides.

 

Dr. David Burns: Sure. Yeah, I'm glad to follow your lead, Jill.

 

Jill Levitt: Okay. We'll try that and then if we decide to bring up the daily mood log so that we can all look at it as a group then I can always go back to sharing the slides. So, David I guess actually should we ask, should we just go over Hiral's brief mood survey first and then we can ask Hiral to tell us a little bit about herself and what she's been struggling with.

 

Dr. David Burns: Sure. But first of all, here all thank you so much for joining us. And how are you feeling at this moment?

 

Hiral: I'm feeling very nervous.

 

Dr. David Burns: Thank you for telling us that. And tell us about that nervousness that you're feeling right now. How strong is it? And what are the thoughts associated with that?

 

Hiral: I think I'm feeling that I hope I don't make fool out of myself in front of so many people who are you know here to learn

 

Dr. David Burns: And how would I make a fool of myself

 

Hiral: I think by making mistakes.

 

Dr. David Burns: So, it sounds like that there's a kind of a voice inside of you that's a little bit perfectionistic and telling you make mistakes and I can imagine that creates a lot of an anxiety right now. But I'm wondering if it also creates a feeling of loneliness that here we are two people and I would like to care about you and Jill would like to care about you, but I'm wondering if that pressure that you're putting under yourself also leads to feeling alone.

 

Hiral: Yes, it does.

 

Dr. David Burns: And can you tell us about feeling alone? or lonely right at this moment?

 

Hiral: Yeah. I mean, not only this moment, I think it's been forever because I think when you're thinking so much about what others will think, I think you just end up feeling lost and disconnected from everybody and what's happening right now.

 

Dr. David Burns: Yeah.

 

Hiral: You're not able to focus also on anything.

 

Dr. David Burns: If I understand correctly what you're saying, and I don't always get it right. So, let me know when I don't, but that it's been a long time in your life that this feeling is something that's with you a lot. And maybe the feeling of alone and disconnection is something that's with you an alot. and when I realize that about you, I just want to share that I feel a kind of sadness because I know that you're a beautiful vulnerable person, but that you're, you know, holding a lot in and hopefully we can, you know, connect with you. And I love your smile right now. What are you thinking just at this moment?

 

Hiral: Yeah, I'm just thinking that yeah, you're just getting things right that I'm not able to speak as much as I would want to right now.

 

Dr. David Burns: Yeah. yes, exactly. And we'll try to I'll try to get you to speak in spite of that reluctance and if we do the dam will break open and the waters will flow. I'm sure. But let's do our business. But thank you for that. I loved what you just said, her all the brief mood survey the most the scores go from 0 to 20 and on the depression test your score this morning just before starting was 11 and that's a moderate level of depression and but two of the symptoms were a lot and that's sad and down in the dumps and discouraged and hopeless and some of the other symptoms, low self-esteem and loss of motivation and loss of, you know, pleasure and satisfaction in life were elevated, but not quite so severely. But that's way more than enough depression to take the joy out of life inspite of the fact that there's a lot of potential sources of joy with a beautiful little smart little boy, spunky little guy and you know your training and your certification exam coming up and how great it would be to unleash that beautiful Hiral who's hiding behind all of this stuff. And that's the kind of miracle we're hoping for. No suicidal urges. The anxiety was slightly stronger even than the depression. 14 out of 20. That would be certainly moderate heading and to the severe. And four of the five anxiety symptoms were a lot like anxiety and worrying and tense and nervous and so forth. So you're experiencing you know depression and anxiety both in pretty big doses. And then another thing that Jill you pointed out is that the anger is quite strong also and will be an important part I think of what we deal with this morning. It's as strong as the anxiety and it's for 14 out of 20. So that you're know a moderate to severe level of anger. And if we didn't do this test, we wouldn't be aware of that you're having these feelings and exactly how strong they are. And we can't guarantee anything, but our goal depending on what your goals are would be to see if we can cause some shifts in today's session.

 

Now, the happiness there, this version of the happiness scale also goes from 0 to 20 and your score was 08. Now on this one, a 20 would be the greatest happiness. And so the eight shows very little happiness in terms of feeling, you know, happy and joyful only somewhat and hopeful only moderately. There's nothing here that's a lot or extremely. So, that of course relates to the depression that you know that you know you're feeling down and you're not feeling a lot of joy and reward. And then another thing that came up here is with your husband. The relationship satisfaction scale goes from 0 to 30 and your score was 10 and indicating some level of dissatisfaction with all five areas of the relationship. And I'm sure that will play a role as well in what's going on. And then if it makes sense to you, Jill, I'll turn it back over to you and we can do a little empathy and then we can do the daily mood log. We should probably do it early to give users a feel. And if you look at that page in your handout for you can see here, R's the daily mood log with a lot of self-critical thoughts. But can why don't you take us from first base to second base here, Jill?

 

Jill Levitt: Yeah, that sounds great. And yeah, I'd rather I'd like to just hear a little bit in an open-ended way from her all so that we feel like we know who she is and a little bit about the context in kind of an open-ended fashion. And then as part of empathy, we can also turn to the daily mood log where Hiral took a few minutes to try to think through what some of the thoughts that are driving these feelings. But yeah, tell us about you know you Hiral. You're sent out an email requesting a volunteer and you sent me an email saying you'd love to get some help. So tell us a little bit about what you're looking for help with and the some of the context.

 

Hiral: So I think the biggest help is that I really want to feel relaxed while I'm doing whatever. I mean even if it's playing a role of a mother I want to just feel relaxed and happy and not just worry about his future or his behaviors and even if I'm you know preparing for my level three or you know attending some classes I just want to feel as if you know I can do it instead of thinking that “oh! you know I'm just way behind other colleagues of mine” just because you know my entire focus is on my son and like nurturing him up because I also feel you know so behind in this race when I come across colleagues, who have younger kids than me and I feel “oh my god if they can do it”, why can't I do it and so I don't feel happy even like you know while I'm attending to my son and if I'm you know doing something for myself I feel that you know I'm not doing enough for my. So either ways I'm not happy.

 

Jill Levitt: Yeah. So, and again, happy to hear more, but what I'm hearing you say so far and what you shared with us a little bit is you have a little boy, right, a almost four year-old son, and you're feeling just a lot of pressure to be an excellent mother and to do a really good job nurturing him and caring for him and raising him well. And so, you're often feeling not good enough, right? You're questioning yourself and you're not able to enjoy your time with him because you're feeling so much pressure to be an excellent mother and to raise him perfectly. And then that bleeds a little bit into your professional work as well, where it sounds like you're training and learning the this model, the TEAM-CBT model. You're getting ready for a level three certification exam and you're also not feeling good enough there. You're comparing yourself to your colleagues, it sounds like, and thinking, I'm not as not doing as much work as they are. I'm not as prepared as they are. And the same thing in the parenting. I'm not I'm behind my friends who have children this age. I'm not as good of a parent as they are. And that's really zapping a lot of kind of joy out of your life. Is that am I getting you and happy to hear more of that too?

 

Hiral: Yeah, that's true. I mean, yeah, I think I feel soo tired the whole day despite not doing anything physically so much engaging. So yeah, I just feel tired and then yeah, I just feel I'm just moving in some kind of a circle or a loop and the loop is not getting done. I mean it's on it's just going on and on. I can I'm not able to sleep well. Know even if I try so hard to just relax it is very difficult. I mean it's not it's not that easy to even relax on Sundays as if you know I'm just being too harsh on myself or you know. Yeah.

 

Jill Levitt: Yeah. I was going to ask you when you said you feel so tired the whole day and you're not able to sleep very well, you're not able to relax and tell us more and again we can look to your daily mood log for sure but tell us more about why that is. You know when you is that you ended by saying I'm just so hard on myself. So is that it feels like you're in this kind of loop of self-criticism?

 

Hiral: Yeah, I think see I'm a kind of a person who likes you know to have peace and harmony and some kind of order in the house and when I see that people elder to be they are not understanding that what exactly is needed to be done in the house and you know I'm also being a young mother I'm also struggling so much you know to like to manage my own emotions, overwhelming emotions and you know to also to not get triggered by his behaviour and you know also then you know the unsupportive family environment. So I think that is why I feel so tired that you know it's it seems like you know if I try to do if I try to save one boat I think I'm missing the other two ones and if I'm taking care of the if I'm taking care of myself and my son then I think I'm not able to take care of the family and I also really think that it's very important for me to take care of myself first and my son because he's dependent on me but at the same time. It also seems that we are also dependent on our parents. So that is that is making things very difficult for us.

 

Dr. David Burns: Can you tell us more about that here? Sounds like and this kills me when I think about you all the pressures on women in all societies really that you've got to be this perfect mother and then you know wife and family and then you know the professional demands you're trying to do all of these things you know, in a really high level way and just constantly beating up on yourself and never getting a chance to enjoy anything. And can you tell us more about that? And especially the anger because you're carrying a lot of anger, you know, kind of toward loved ones and so forth.

 

Jill Levitt: And you might want to share with us and the audience just where you're located and a little bit of a kind of cultural background as well just because I think it would be we would be remiss to not acknowledge that too.

 

Hiral: Yeah. So I'm from India and there's this state called Gujarat. So I'm from Gujarat basically and like we still live in a joint family where I have my husband who is an only child and we have our own family business but still you know my husband is very I mean despite being so independent at work we still have to you know be dependent on my father-in-law for the finances and everything. So and apart from even that I think there's this huge generation gap also which we are dealing with and also I mean we come from a background where you know like not exactly background but his family such that it's very rigid when it comes to adapting to new things or you know even a acknowledging the fact that you know someone can have different you know thoughts and opinions and approaches and perspective towards life. So I think it becomes more challenging, frustrating and irritating for me to you know accommodate their needs and at the same time to you know accommodate my son's needs. So and yeah so and plus also like my own house is not in the city. So you know the reason why I feel so lonely is because there is sometimes there is just no space for me to even you know talk to my parents openly or you know talk to my friends because I'm not working right now. So I don't get to go out so much often. Only time I go out is to pick up and drop my son or I have started work working out recently. So it is at only that is the time when you know I get some time for myself where I can connect to my friends or connect to my parents. So yeah so it just feels too much to handle at the same time and it is also affecting my mental well-being and physically also. I mean I have like hormonal imbalance and a lot of things going physically.

 

Jill Levitt: So, Hiral, I had one question that I did it wasn't clear on and then I can reflect a little more on what you said. So, are you and your husband and your son living in the house with your in-laws as well?

 

Hiral: Yes.

 

Jill Levitt: Yes. Okay. But not your parents, correct?

 

Hiral: No.

 

Jill Levitt: Right. And so, you're saying like, you know, it feels like you're having to address the needs of your husband and your husband's parents and your son. And so, there's just a lot that you're really in very much giving to a lot of people. And trying to take care of the needs of a lot of people in the home. And at this point, you're raising your son and not yet not back to work or not yet practicing. Though you've been studying and you're kind of on that road. But it feels like even maybe it would be really helpful and connecting to be able to talk to your parents and talk to your friends, but right now you've been really stuck at home caring for your son and just feeling a bit trapped. And it sounds like you've making a bit of progress on that you've just started going to the gym, working out, taking care of yourself more, getting out of the house to drop your son places, and finding small pockets of places to connect. But you're definitely feeling, you know, that you need more of that and that's kind of making you feel more down and stressed as well.

 

Dr. David Burns: And to add one more little thing, you mentioned that your father-in-law, not to be critical of him or his wife, but that they're a little rigid and slow to capture on to new perspectives. And I can recall when my wife and I moved back to California, where we now live after 20 years in Philadelphia, we were was great because we were close to you know, my in-laws, my father-in-law and my stepmother-in-law. But we were like to hang out with them and go to movies and stuff, but their values and understanding of life was so radically different. Even the thing of emotions and talking about emotions was something they you know seemed kind of alien to them and you know my mother-in-law, stepmother-in-law, couldn't imagine how a human being would ever be depressed. And so the it was and they thought when you go to the doctor, you do what the doctor tells you. You know, you're there's no critical thinking. And it was just a completely different philosophy. But we loved being with them and we you know we weren't with them all the time. But I can imagine very well if we were trapped living with them in the same house it would have been enormously uncomfortable.

 

Hiral: Yeah. And because I think they are also expecting us to live the way they are living which is absolutely not fair and they so like their life is like you know only the four walls of the house or the four walls of the office and I'm someone who loves exploring you know I love adventure but then and plus the city from where I come I have like lot of friends and you know my life was very happening. So now that you know I've come to another city I have been married since 8 years now and I have been I have I am mother since 4 years. So like for me also it's a huge adjustment. So one of the reasons why I also feel angry so much is that you know when others when like I'm trying to accommodate to someone else's needs and when it's their time to reciprocate and understand that you know even my needs are supposed to be taken into consideration or you know even I have to be taken care of. I think when that understanding doesn't come from very closed ones, I think then you feel then you know I mean where do you go? So it's like that.

 

Dr. David Burns: So you're expected to take care of their needs but you don't see a lot of people trying to take care of your needs.

 

Hiral: Yeah.

 

Dr. David Burns: Is that right?

 

Hiral: Yeah. That's right.

 

Dr. David Burns: And then in addition, your life as you know it, want to know it is you love adventure. You love things that are happening, excitement. You have a lot of friends. And now a lot almost all of that's kind of cut off for you. So you're almost in kind of a prison.

 

Hiral: Yeah.

 

Dr. David Burns: It's good to see you smile, but I can imagine it's a very painful thing and I'm sure hope we can find at least step one and getting some relief on this thing because it sounds just awful for you Hiral.

 

Hiral: Yes, it is.

 

Dr. David Burns: You don't even have time with yourself.

 

Hiral: Yeah, not as much. So I just feel guilty of you know taking some time out for myself. It's now that I've started working out or taking care of my health is only since the time I've gotten to know that you know okay if I don't take care of myself I might end up getting you know getting into a severe illness related to my menstrual cycle and all of that. So only that is something which is you know making me think of taking care of myself because I know as it's never going to be enough you know no matter how much I do for my in-laws because they are never satisfied with whatever I do. So it's like even if I do something for them they will never appreciate and a acknowledge and even if I don't do something for them of course then there is this lot of criticism and there is this lot of disappointment that I see on their faces and in their behaviour.

 

Dr. David Burns: That sounds like a one-way street.

 

Hiral: Yeah it is.

 

Dr. David Burns: Give, Aaron Beck used to call it a give, get imbalance. Giving and never getting anything in return. Is that right?

 

Hiral: Yeah, that's right.

 

Dr. David Burns: I'll give it back to you, Jill.

 

Jill Levitt: Yeah, I was going to ask I mean I two things that I think would be helpful for us to do at this point, David. One is we could check with Hiral and ask how we were doing on empathy and ask her to give us a grade. And the other thing is that perhaps before or after that, maybe it makes sense to do it before it is to go over her daily mood log with her. I'm kind of hearing, you know, two areas of work or two areas of distress that Hiral is having right now. And one is this kind of what we think of as an individual mood difficulty, right? Being really hard on yourself and self-critical, feeling not good enough as a mom and in your work and as a student, even as a daughter-in-law. So, there's kind of that piece which I think we could explore a lot more and maybe bring to life more looking at your daily mood log together. And then there's kind of a separate separate topic that might be related a bit but that I think actually would be a separate focus which has more to do with relationships and some of the anger and resentment and frustration and loneliness she's feeling as related to her in-laws and husband and kind of situation in life. So, my guess is yeah, I hear it in these kind of two different categories. And my guess is that well, we should make sure that we're understanding her correctly, but maybe go down the road more of the individual mood and the being hard on herself and turn to her daily mood log to bring that to life more. What do you think, David?

 

Dr. David Burns: Yeah, I see it as like two battles to be won here, the individual and the interpersonal.

 

Jill Levitt: Exactly.

 

Dr. David Burns: And they both have solutions and a lot of great things that can be done. But I think if we start with the daily mood log and the way you're criticizing yourself.

 

Jill Levitt: Yeah.

 

Dr. David Burns: That would be a tremendous first step. All the while acknowledging that there's still some relationships and husband and family issues that need to be dealt with in a skillful way.

 

Jill Levitt: So, how does that sound to you, Hiral? Can we maybe walk the audience through your daily mood log and have you look at your thoughts and feelings with us and kind of focus more on that aspect of it, the kind of self-criticism and being hard on yourself.

 

Hiral: Yes.

 

Jill Levitt: Yeah.

 

Dr. David Burns: So, let's do the daily mood log first and then we can do the empathy.

 

Jill Levitt: Exactly, I agree. Yeah. Do you want to take the lead on that, David?

 

Dr. David Burns: Yeah. But feel free to chime in.

 

Jill Levitt: Let me just tell the audience to turn to page four in the handout packet. That is actually where you have Hiral's daily mood log. And without seeing her at all, we just asked her to think of a moment in time and put that at the top and circle the feelings that were coming up for her and write down the negative thoughts that she was having as she was feeling that. And this is kind of what she shared with us. So David, maybe you can walk us through it. you know.

 

Dr. David Burns: The upsetting moment. And we always try to focus on one moment because all of your problems will be embedded in any one moment when you're upset. And so, we can use the daily mood log to understand what's going on as well as to trigger some hopefully fairly profound changes. But you know my heart went out to you all when I read this one cuz we have a new baby in our family. My son and his wife have a beautiful little boy who's just 9 months old. But he came down they live about an hour from here and they brought him to have us babysit for a few hours while the two of them went to a spa and took a little break. And he had kind of a meltdown because mommy was gone, and he just screamed and it was it was you know and it went on for a good hour and a half and it was uncomfortable to try to figure out what to do or how to think about it but you and your mother-in-law took your son for a vaccination and this was on January 3rd and he had a meltdown and you were really affected by it and you were feeling down and unhappy 100% anxious 100% guilty and ashamed 100% inferior and effective 100% lonely that 80 embarrassed and self-conscious 100, hopeless 100, frustrated 100 and annoyed and irritated 80% and I just want to point out that again getting these measures is not a trivial thing at all because if you went to the Stanford psychiatric inpatient unit and tested any of the patients there, they would not have score scores higher than this. And that means that the distress that you were feeling at that time and probably still feel a lot of the time is so severe as to be almost hard for people to imagine, you know, if they haven't experienced something similar. Does that make sense Hiral?

 

Hiral: Yeah.

 

Dr. David Burns: That it's really like being in an emotional hell. And then what are the thoughts that are triggering it? And number one, you were tell and this is so eyeopening here speaks to your pain as well as what's really beautiful and awesome about you. You're telling yourself I'm not a good mother and that's 100%. And then you identified a bunch of distortions and that I'll ignore for the moment. But you know, all or nothing thinking is certainly a huge one for perfectionism. And then a should statement that often goes hand in hand with self-criticism and all or nothing thinking I should be able to handle my son well. And you also believe that 100%, I'm failing as a mother 100%. And I will ruin my son's future if I'm unable to handle and nurture him well 100%. And then you added a few additional ones that I added to my daily mood log just by hand and if you're watching you can add to yours also. Number five, I should always know everything. That was 80% that's why you were feeling overwhelmed before the we began you know put more pressure the idea here for ous to help you relax and be with you and support you but that you have to know everything and get it just right and again I felt sad seeing what pressure that you're on and then my family will judge me if and blame me if I ever make any mistakes and that's 100% and I'm sure that triggers guilt and shame and anger and frustration and resentment as well and that I should always be able to protect my son from you know some any physical attack like if another angry child were to attack him when they're playing, but also to protect him from any emotions. And can you think of any additional thoughts we've had since we started her or Jill that we could add?

 

Jill Levitt: The only other one I captured what she said in the very beginning of our work just now, I shouldn't make any mistakes.

 

Dr. David Burns: Yeah. And we didn't have that already.

 

Jill Levitt: No. I mean, you could say it's similar to I should always know everything, but it's not.

 

Dr. David Burns: Exactly. Yeah. You know, that's a good one. I shouldn't make any mistakes. And when you tell yourself that, how believable is that? Hiral?

 

Hiral: I think 80%.

 

Dr. David Burns: 80%. Okay. That's a powerful one. Yeah. I have a question for you Jill because I know from my own history I you know I struggled with a lot of perfectionism on multiple levels early in my career Hiral, but did you ever Jill but you did? Yes. The first time we worked together it was on perfectionism.

 

Jill Levitt: Yeah absolutely. Which one did you want me to share? I mean, when I first time that I ever did personal work with David in the early days of the Tuesday group back when we met in David's living room, I was sharing my being very hard on myself. I think the example was around clinical work, right David?

 

Dr. David Burns: Yeah.

 

Jill Levitt: I mean I struggled with it related to clinical work and patient care as well as parenting but yeah being very hard on myself and feeling not good enough and self-critical and perfectionistic and then I also did another bout of personal work around parenting stuff where my son who was yeah probably a similar age maybe a little older six or something was being kind of mean to his brother kind of went through a period of time where he was being mean to his brother. And I was honestly really worried that I wasn't doing a good enough job parenting him and he was going to end up being like a sociopath because he wasn't showing enough empathy to his younger brother when my older son was about six and his little brother was about three. And I struggled with that a lot thinking what am I doing wrong that he's not being more empathic and kind to his brother. Yeah. I said to David that when we were chatting right before this session, I said to David, I even had one of those thoughts this morning when my younger son, who's now 18, was talking about wanting to eat less because he wants to look super fit. And I started to worry in my mind if he would have an eating disorder. Because I happen to be reading a book right now about eating disorders to help one of my patients. And so that was top of mind. And I thought, damn, what am I doing wrong that now my 18-year-old is obsessed with body image? And so I can really relate to so much of what you're sharing. And I suspect so many people in our audience can too.

 

Dr. David Burns: And then a question for you because this relates to you also Hiral is that the personal work that we're doing today is has a double goal. One of course is to bring you some relief and joy to make your life a lot more worth living and to see if we can find a way to bring that about. But secondly is we're trying to pave the way for really people to be develop superb therapy skills and now you Jill have developed teaching and therapy skills that far eclipse my own and I'm you know proud to say that and but to what extent was your own personal work played a role in evolving to this amazing level that you're at today.

 

Jill Levitt: Yeah, so I mean my the personal work that I've done with you and others over the years has been so impactful in my journey and I think I've always felt that we have to practice what we preach, right? And so if I'm struggling with perfectionism, then I need to work on it. And I think doing my own personal work as I hope is the case for you Hiral as well it also kind of gave me it so much of a deeper understanding of the model and how it works. Actually, David recalls sometimes, and this is a tangent, so I don't want to take up too much time, but there was a time early in or I don't know how long ago, maybe 10 years ago or something, where I was doing some personal work with David and a group, and we he kind of went from empathy, testing, and empathy to methods. And we had a great session, and at the end, I said, "Oh man, I think you skipped agenda setting." And I felt a little I felt like I missed out on this opportunity to actually feel proud of my symptoms. And that was when David started to think”oh, maybe everyone can benefit from addressing resistance”. And so, yeah, I mean, the bottom line is that doing personal work is not only incredibly helpful to us personally as human beings, but also helpful in learning the model.

 

Dr. David Burns: And the reason I'm sure is obvious, but a high percentage of the patients you treat in your career, Hiral, will also have this belief I'm not good enough. And so your personal work will become as valuable as your training some sometimes more. So in any way, should we get our empathy grades at this point?

 

Jill Levitt: Yeah, I think let's check in with you Hiral and ask you and David maybe you can ask those questions but yeah this is we've spent a good amount of time so far maybe 40 minutes connecting with Hiral going through her daily mood log and listening and now we'll check in and ask her all how we're doing on empathy and figure out if we're ready to move forward.

 

Dr. David Burns: Yeah. So the three if you could grade us in three areas you can tell us you know whatever you want to tell us too but the first one would be thought empathy and what that means is how accurately have Jill and David understood how you're thinking your negative thoughts that are going through your mind. The second area is to what extent are we understanding your negative feelings, your depression, your anxiety, your guilt, your anger, your discouragement, your shame, your embarrassment, your loneliness and then third is to what extent and this is the big one and maybe the toughest one in a sense to what extent have David and Jill created a sense of warmth and trust and connection and acceptance that you feel accepted and cared about in a genuine way. So if you can grade us in those three areas.

 

Hiral: Yes. So I think for the first two it's “A” and for the last one I don't know because I don't know how relevant I am for most of the people who are watching me because the reason why I'm thinking this is because there are people who you know have like probably different kind of culture and family background and setup. So I don't know if you know what I'm making what I'm speaking is making sense to them. So that is why I just feel I don't know I mean when the third thing comes.

 

Jill Levitt: The third question though was David to what extent are you feeling you Hiral feeling a sense of acceptance from Jill and David a sense of warmth isn't that right David?

 

Dr. David Burns: Yeah

 

Jill Levitt: To what extent do you feel like David and I are providing you with a feeling of warmth and empathy and trust.

 

Dr. David Burns: Or maybe you're also thinking that we have a different family background around. So maybe we're not able just like the people in the audience. So tell us more about that.

 

Hiral: Yeah, I think I feel I really feel when I talk about my family background or something like that, my family issues, I think I'm talking about some third world issues because there are so many other things that people might be facing or I think, Yeah. So I just feel that you know like these are very basic issues like nowadays hardly anybody would be feeling or this is what actually I feel in my mind. I'm not sure about anyone else in the audience.

 

Dr. David Burns: So, are you feeling maybe that we don't really get the fact that you're struggling with like say family issues that are heavily woven into your culture and maybe we won't get what you're saying and all the pressures on you so that you're still feeling a little bit alone and lonely even with David and Jill.

 

Hiral: Yes.

 

Dr. David Burns: Is that right?

 

Hiral: Yes.

 

Jill Levitt: Yeah. I wonder David, I have a couple thoughts here, but Hiral, I wonder if it might be meaningful for you if I read a couple of things the people are saying in the chat around their feeling connected with you. And it's a unique situation, David, because it's not just you and I, but she's feeling like she's got this audience of people who maybe don't understand. Would it be useful for me to share that with her?

 

Dr. David Burns: That's a good that's a good thing. And I have a direction also. So

 

Jill Levitt: Okay. Why don't do you want to tell me what you're thinking first or you want me to share it?

 

Dr. David Burns: Yeah. Well, what I'm thinking is that Hiral you're keeping a lot inside all the time. Even as though you're like a pressure you know and that I'm wondering if there are some times when when you feel tearful or even when you're talking to David and Jill and feel like it would be awfully nice to let the defenses down and let some feelings of sadness and loneliness flow and share you may not this may be way off base. But that’s kind of and that's kind of similar to what you were thinking Jill. Does that make any sense?

 

Hiral: Yeah. So even while I'm talking I do feel like crying but then I also in the back of my mind I feel this is not a real therapy session. So you know I should not be talking too much or you know I don't want to take away too much time in speaking and you know talking about my story. So yeah.

 

Dr. David Burns: So there are times that you're feeling like you'd really like to cry and then you kind of tell yourself maybe I'm not performing well enough or I'm taking up too much time or something of that nature. Can you tell us what we what you're thinking and feeling when you kind of want to cry here? Tell us what that's like. What you're thinking and feeling when you're feeling vulnerable and alone.

 

Hiral: I think right now I want to be more productive.

 

Dr. David Burns: Just let those tears come. I have Hiral. I have a virtual hug for you. You know that's bad therapeutic technique because we're not allowed to touch a patient. But I'm just feeling really close to you right now when you're sharing those tears. Yeah. And I'm grateful, you know, for what you're doing. And then I felt sad when you're crying and saying I want to be more productive. You know I guess I want you to be a lot less productive and just be more like this. This is the beautiful side of you to my way of thinking.

 

Jill Levitt: And there's no expectation of you not sharing your tears to the contrary. We want this to feel as real as possible, right? This is not scripted. This is not therapy, but it is a real live, you know, session, right? And so, we want you to be able to be real and vulnerable, even though I can imagine that's actually really hard. Do you want to just share with us what's coming up for you now as you're feeling kind of more vulnerable or more emotional?

 

Hiral: Yeah. So I think it just feels that you know I don't want to do anything no performance and you know just sit aside and just not think anything and just watch some good Netflix stuff and you know just chill and not worry about the world what the world is thinking or what will happen if I'm not around my son or my family.

 

Jill Levitt: Yeah.

 

Hiral: I just want to be by myself, not giving anything to anyone apart from myself.

 

Jill Levitt: You feel so burdened, it sounds like, right, by the thoughts and feelings, right? I mean, burdened to take care of your son, but truly what's feeling like such a burden is this kind of talk track that keeps saying you're not good enough. You need to be doing more. That's worrying about him. and you're feeling like I just wish I could tune that all of that out and watch Netflix and chill and not be thinking and worrying. Is that am I getting you right?

 

Hiral: Yes.

 

Jill Levitt: And that's so resonates because you shared earlier that you do feel so tired and overwhelmed by constantly beating yourself up and measuring yourself against others and worrying that you're not doing enough right. And so you I hear you saying I really want to be able to tune that out and just kind of be present and not feel so burdened. I am getting you right?

 

Hiral: Yes.

 

Jill Levitt: Yeah. I just want to say I think that's so unbelievably relatable for so many people whatever the context to feel like it's their their mind that's their own worst enemy and that if they could just kind of turn it off and be in the moment and relax and enjoy you know that's the bliss that they're after. I think that's so unbelievably relatable actually. And David, I also wanted to share with her all because I do think it's, you know, it's fair because you're really putting yourself out on a limb here, just that so many people when you said you were worried that this is some other unique kind of problem that people couldn't relate to just the chat box which I don't want you and David focusing on because it's very distracting and I'm going to close it as well but is you know the chat box is basically saying this is very relevant what you're sharing about your life your challenges with your in-laws your husband the demands of life so many people saying I relate to the psychological pressure from in-laws and self-criticism. And despite the cultural differences, most moms can understand, difficult family dynamics that make us feel unheard, unseen, and alone. So many people saying what you're describing is so relatable, so human, and also that they're so honored that you're being so open and vulnerable. So, I won't go on and on, but we got lots of messages in the chat just saying that people are feeling so connected to you and so honored to hear your story.

 

Dr. David Burns: How are you feeling right now, Hero? You kind of opened up a little bit and seem a little quiet. I'd just love to hear what you're feeling and thinking right now.

 

Hiral: I'm thinking after hearing the chats, I think I'm being more productive. That's what I'm thinking. I'm sorry, but I can't, you know, unwire myself. I mean,

 

Dr. David Burns: Yeah.

 

Jill Levitt: Right.

 

Dr. David Burns: That's beautiful because you really are Yeah. You gave us a huge gift here, right?

 

Jill Levitt: Right.

 

Dr. David Burns: And you've made the biggest contribution so far to the workshop. By the way, you watch Netflix. You like to watch Netflix on television by yourself?

 

Hiral: Yeah.

 

Dr. David Burns: Don't you think that's kind of shameful?

 

Hiral: No, it's not.

 

Dr. David Burns: I used to have a rule. I guess I still do that every because there's so much anti- television propaganda all the time. And so my position is every human being needs to watch 20 hours of television per week to maintain mental health. And it's certainly a rule that I follow.

 

Jill Levitt: It was actually my New Year's resolution to try to watch more TV this year. So I'm not actually kidding. So to just as you said create time to chill right and so yes again very relatable right very relatable

 

Dr. David Burns: I also want you to know Hiral that what you did just now and kind of sharing those feelings and letting the tears flow I'll never forget that Hiral and if we were in the same orbit like you know like if you were here in the United States and attending the Tuesday group and stuff, every time I would see you in person, I would see that Hiral and feel close to you.

 

Hiral: I think the reason why I'm not able to open up so much is because like nobody's cared so much. So I mean nobody bothers, nobody's like really willing to understand how I'm feeling. I mean I'm almost invisible and unheard. So it's so when you guys are, you know, paying so much of attention on my feelings and everything, it's like, you know, I'm not the voice inside me is just saying, no, you're not important. So you know don't you know they're not connecting with you like you know they just doing their part. So it's so hard to even believe that you know somebody can care for you so much because I'm so used to being unheard and unseen and feeling so unimportant in my own life.

 

Dr. David Burns: Yeah. That it's really hard for you to accept that somebody could care about you.

 

Hiral: Yeah.

 

Dr. David Burns: It doesn't seem believable.

 

Hiral: Yes.

 

Dr. David Burns: Yeah. Right. Well, I think that's the most important thing that you've said and I sense that about you the within 15 seconds of meeting you earlier before the workshop began and I didn't feel close to you and it was very troubling to me and I you know I thought about these things at that time and how this getting locked up and not believing anyone could care about you is another huge dimension of it that keeps you kind of trapped and unhappy that the voice. How are you feeling right now in terms of the letter grade on the acceptance.

 

Hiral: Yeah I think now I'm really ready to accept that yeah I mean there is some connection being formed I mean I really want to believe so I think I've moved towards 80%. I would not be able to grade but

 

Dr. David Burns: Yeah that's great thank you for that. Let me ask you this question now. Suppose that this was a very good experience for you here I guess tonight. It's tonight in your part of the world there. And at the end you had the thought, "Wow, that session with David and Jill was really kind of life-changing." What would happen? What would you be hoping for by the end of today's session?

 

Hiral: I think I just hope to feel more relaxed and just feel comfortable in my own skin.

 

Dr. David Burns: Okay. Great. And then I'm wondering Jill if this might be a good time to take that five minute bathroom break for folks and then when we come back and you know five minutes or should we give people 10 minutes?

 

Jill Levitt: Yeah. I think what we'll Yeah. What we'll say is we've, you've seen us do testing with a brief mood survey. You've seen us do empathy. And David just asked something we call the miracle cure question, which kind of starts to lead us in the direction of agenda setting or assessment of resistance. What miracle what you know what is her all looking for help with? And that's to feel more relaxed and comfortable in her own skin. And so we're going to do a quick we'll do a I don't mean we'll do a pause so that everybody can go to the bathroom, stretch their legs, and it's kind of easy to give everyone a 10-minute break, which means we'll start up again exactly at 11 a.m. Pacific, and then we're going to move forward with the rest of the model. Does that sound good? I think that's what people ask for in the feedback, a 10-minute break to just use the bathroom and stretch their legs. So, do not log off or anything like that, anyone. Just stay on and use the restroom if you need to. And then we will start promptly at 11:00 a.m. Pacific. Okay, David, you're back with us. So, just unmute yourself because you're still muted. We can see you, but we can't hear you yet.

 

Dr. David Burns: Yeah. Matt Melanie just got back from an MRI that she'd read dreaded at Kaiser of her shoulder. So I was just welcoming her back home.

 

Jill Levitt: Got it.

 

Dr. David Burns: She survived.

 

Jill Levitt: Okay.

 

Dr. David Burns: How are you doing, Hiral?

 

Hiral: Yeah, I think I'm just trying to accept all the love and warmth which I'm not supposed to.

 

Dr. David Burns: Well, hopefully it will evolve. But yeah, that's one of our you know, a goal that's kind of emerged since we started working together. And we're going to stick with our original goal of helping you with this self-critical voice in your brain, but I'll also be having my eye on that interpersonal dimension. And as a teaching point, I don't know how many therapists would have measured, you know, an a what's the letter grade on warmth and acceptance. I think, no one therapist in a thousand would do that. And yet it was crucial. You didn't want to criticize us. And yet it was necessary to bring that out. And it's impossible to get close if you haven't acknowledged I'm not feeling close. I want to feel close to you, but I can't. And what's going on with you and let letting you be real. And that's an unfolding process over time. And that's a beautiful thing. And I thought the way you handled that was really, you know, gentle and beautiful and I appreciated you greatly. Although it might be hard for you to accept or believe that or to experience that, but I think that loneliness that you have is very powerful, a very major component but will help you get over your loneliness with yourself today as a kind of a first step get into a little maybe a little bit of self-love

 

Jill Levitt: And if go ahead did you want to say something.

 

Hiral: Hopefully fingers crossed.

 

Jill Levitt: And I wanted to say one other thing at the teaching point that I think is important which is so many times when we're connecting with our patients and the outset of therapy, but it could really be at any point in therapy and the patient will share many different things with us. And part of the art of doing effective therapy is also focusing sessions and trying to figure out what direction to go in. And so I wanted to just articulate that, you know, with what Hiral shared with us, there's really at least two potential directions we could go in. And one is this direction that we've decided to go in and in large part also based on what you're asking for help with, which is I want to feel less anxious. I want to feel calm. I want to feel at peace with myself. And so that means we're going to work on our daily mood log and your negative thoughts and your perfectionism and, you know, anxiety about your son. But surely there's a whole other direction we could go in and that you could go in the future in therapy or personal work around your relationship with others, right? And around not feeling close and not feeling important. And there's kind of a whole other relationship piece that we could conceptualize and work on. So I only say that to say we recognize, you know, as therapists that there's always many roads we could walk down and we'll we in TEAM-CBT kind of pick one for today and say let's make some really good progress in this one area knowing a different day we could work on a different sort of conceptualization. So with that in mind, we should move forward, right, David?

 

Dr. David Burns: Yeah. And one last teaching point is that the we're failing with you on the warmth and acceptance although we're being partially successful but that failure is the greatest success so far in the session, because it's so critically important and the problem isn't the failure but the shame or the judgment, but the failure that's happening is very exciting and very desirable. Does that make any sense? It probably sounds like from an elderly, demented, babbling man. That doesn't make any sense.

 

Hiral: Yeah. So, I'm just wondering Yeah. I'm just confused right now. Why do you say that it's so precious? I mean, because you're failing right now. We want to be connected so that we can move ahead, right? So, how does this failure make?

 

Dr. David Burns: Yeah. Well, we're going to move ahead and regardless and probably the connections will continue to evolve, but that the working with you without bringing that failure to conscious awareness you would make the therapy very superficial.

 

Hiral: Right.

 

Jill Levitt: Yeah. It's not that we must fail, but that if we are failing, recognizing that we're failing and bringing it to conscious awareness brings us gives us an opportunity to correct and to connect.

 

Dr. David Burns: See, the goal of TEAM is to fail at T and E and A and M to fail at every level. That's what we're hoping for because every time you fail, that's your chance to go deeper. And I was just trying to make that point. So but anyway, let's push ahead here. You said that your goal. Was to feel you more you hope to feel more relaxed without all that chatter going on in your brain and the self-criticism by the end of the demonstration. And let's imagine Hiral that we have a big red magic button and if you press that magic button you'll instantly become joyful and relaxed with no effort at all and thank you. So, those negative thoughts and feelings will instantly disappear and your dream will have come true instantly. And so you'll walk out of here just feeling incredibly happy and relaxed. Would you press that magic button?

 

Hiral: Yes, for sure.

 

Dr. David Burns: For sure. I'm glad that you said that. That's what everyone says. Well, you know, we don't have a magic button, Hiral, but we do have magical techniques and I have no doubt if we work together we can and will bring that result about but I don't think it would be such a good idea.

 

Hiral: Why?

 

Dr. David Burns: Why? Well, because there might be some really beautiful and awesome things that are hiding within all these self-critical thoughts and feelings and maybe we should list some of them before we get too cute about making them all suddenly disappear. Could you would you be willing to take a few minutes and take a look at some of them?

 

Hiral: Yes.

 

Dr. David Burns: And you might want to make a list of positives, but in the handout, don't we have a place

 

Jill Levitt: Page of your handout packet is a blank positive reframing table. And so, Hiral, you and the whole audience can follow along as well and we can all be writing this down together.

 

Dr. David Burns: Yeah. And it's on page six of the handout if you have that to refer. I've got mine here. And in the left column, we're going to select thought or feeling. And you gave us eight or nine, maybe even 10, I don't remember, negative thoughts and at least nine negative feelings. All very intense. And if you like, you can just choose any one of them to get us started that you'd like to take a look and see what some of the positives are. And there's two questions here that we're going to ask about each negative thought or feeling that you bring up. One is what are some advantages or benefits to you of having this negative thought or feeling? Like what when you tell yourself so you won't.

 

Jill Levitt: I'm not a good mother.

 

Dr. David Burns: Yeah, I'm not a good mother. I'm failing as a mother. What are how does that help you? That’s number one. And then number two, what does that thought or feeling show about you and your core values as a human being that's positive, beautiful, and awesome? So those are the two things. What are the advantages to me? And what does it show about me? So if you'll choose any negative thought or feeling that interest you, we can see what we can come up with.

 

Hiral: I think I'll choose this one. My family will judge me and blame me if I make a mistake.

 

Dr. David Burns: Okay. So, let's write that in the left hand column. Thought number one. My family will judge me and blame me if I make a mistake.

 

Jill Levitt: Yeah and blame me if I make a mistake.

 

Dr. David Burns: And so let's look at these two questions and then we can look write the answers in the right hand column and then if you run out of paper I have a I just use a clipboard with extra paper just so we have a it's important to record these things on paper but number one, what are some advantages or benefits of telling yourself that my family will judge me and blame me if I make a mistake? How will that thought help you?

 

Hiral: I think it will make me more cautious towards my own actions.

 

Dr. David Burns: Okay. Would you write that down? Makes me more conscious yeah toward my own actions. Is that true?

 

Hiral: Yeah

 

Dr. David Burns: Is that powerful?

 

Hiral: Yeah, it is.

 

Dr. David Burns: Yeah it is that important?

 

Hiral: Yeah, it is.

 

Dr. David Burns: Yeah. Great. Beautiful. What are some other advantages or benefits of that? Or to ask the other question, what does that show about you and your core values as a human being?

 

Hiral: I think it also helps me to slow down a little. I mean, when I'm being cautious, I can really slow down a little.

 

Dr. David Burns: Well, write that down. I love that as number two on the list of positives helps me slow down a little. Is that also important?

 

Hiral: Yes.

 

Dr. David Burns: Is that powerful?

 

Hiral: Yes, it is.

 

Dr. David Burns: Is that real?

 

Hiral: Yes.

 

Dr. David Burns: Yeah. Beautiful. What else does this thought show about you and your core values as a human being that's positive?

 

Hiral: It also helps me to prioritize and focus on quality rather than quantity. I mean rather than doing too many things at a time, it helps me to prioritize.

 

Dr. David Burns: Put that down. Helps me focus on quality versus quantity. Yeah, that's a good one. I love that

 

Jill Levitt: And what is it? Yeah, David asked you too think about what does it show about you and your value system? I can think of lots of things that I want you to think about it when you tell yourself, you know, my family will judge me and blame me if I make a mistake. What does it actually show about you and what you value? What's important to you?

 

Dr. David Burns: And just as an aside for a teaching point, if it's hard for the patient to see it at first, you're in really good shape because that when it comes, it will be like a new brain circuits getting fired up.

 

Jill Levitt: What were you going to say, Hiral?

 

Hiral: Yeah. So I think what it really shows is that I value having a good life a value creating life where you know I'm just not doing anything randomly or just because you know others are doing it but I'm doing it because it makes a lot of sense to me.

 

Dr. David Burns: So I value a good life. Is that what you said?

 

Hiral: Yeah. Right. Good and meaningful. Good and meaningful life.

 

Dr. David Burns: Yes. I like that. And meaningful. A good and meaningful.

 

Jill Levitt: But you also said like it's something about you said like being thoughtful. And I wonder if some of the values are in there like it shows that I'm conscientious, right? There's something about you said like I slow down. I'm thoughtful. Quality over quantity. So would that would that be accurate to say it when you're worried about your family judging you and blaming you and worried about making a mistake, it shows that you're extremely conscientious and thoughtful and thorough?

 

Hiral: Yes.

 

Jill Levitt: Is that true?

 

Hiral: Yes.

 

Dr. David Burns: That you have high standards.

 

Hiral: Yeah, I think that.

 

Dr. David Burns: So we've added two more. The first is that I value a good and meaningful life and that I have high standards. There another really important one. You are saying in that thought my family will judge me and blame me if I make a mistake that's a negative. And what is the positive that you'd be hoping for from the family?

 

Hiral: I think to just accept me and let me be.

 

Dr. David Burns: Is that true that you want acceptance from your family?

 

Hiral: Yes.

 

Dr. David Burns: Well, put that down that I want acceptance.

 

Jill Levitt: Well, it shows that I value acceptance, right? Like in other that's the direction I was thinking as well, David. When I tell myself my family will judge me and blame me if I make a mistake, it's really showing that it's supremely important to me to get my family's love and approval and acceptance. Is that is that true?

 

Hiral: Yeah, that's true.

 

Dr. David Burns: So that's two. One is I value acceptance and that I also that I want love and closeness with the family. Is that true?

 

Hiral: Yes.

 

Dr. David Burns: Okay. Now, let me just ask about these last few that we've put down here that I want. Love and closeness with the family. Is that real?

 

Hiral: Yeah.

 

Dr. David Burns: Is that powerful?

 

Hiral: Yes.

 

Dr. David Burns: Is that important?

 

Hiral: Yes, it is.

 

Dr. David Burns: Yeah. And that would the same be true of acceptance?

 

Hiral: Yes.

 

Dr. David Burns: And would the same be true of high standards? Are my high standards real?

 

Hiral: Yeah, they are real, but they're causing a lot of problem for me.

 

Dr. David Burns: Oh. Oh, yeah. We're only looking at the positive side here, but we can look at the negative side because all of these things have a dark underbelly as well. But you know your high standards have there been any positives associated with your high standards.

 

Hiral: Yeah. I think because of my high standards or because of my high values people are easily able to connect with me though you know it's like it's just news being giving but they are someone who are who feel that you know they can confined in me or like they feel that you know we can always go to her.

 

Dr. David Burns: Yeah. So add that to your list. It's easy to connect with me. So that's quite an impressive list you got from that first thought. Do you want to try another thought or an emotion?

 

Hiral: Yeah, I think thought

 

Dr. David Burns: A thought. Yeah, the thoughts are make them more unique to you. And lately we've trended more toward positive reframing of thoughts than feelings. Although both are powerful and easy tools. Give us another thought.

 

Hiral: So I like to choose I'm failing as a mother.

 

Dr. David Burns: Okay. Write that down. I'm failing as a mother that like when my when my child has an implosion, an explosion what are some advantages and benefits of that thought? How is that thought helpful to you?

 

Hiral: I think it encourages me to do better as a mother.

 

Dr. David Burns: Yeah, write that down. Encourages me to do better as a mother. Is that true?

 

Hiral: Yeah. Because the only reason why I have I'm sitting here is for my son that you know I really want to give him the best version of me. So that is why I've decided to you know volunteer. Yeah.

 

Dr. David Burns: Can we add that as a second one? It chose I want to give my son the best version of myself. And by the same token is that then a reflection of my love for my son?

 

Hiral: Yeah.

 

Dr. David Burns: Would you add that? Shows my how much I love my son.

 

Jill Levitt: And again, of course, it shows your high standards, right, Hiral? that you know if I observe him doing something suboptimal and I'm telling myself I'm failing as a mother that I have really high standards for myself right I need to be the perfect mother is that true?

 

Hiral: Yes

 

Dr. David Burns: Yeah so I'm failing as a mother so far it encourages me to do, to be a better mother you know to learn and grow. It shows that I want to give the best version of myself to my son. It by the same token, it shows my great love for my son. And it's also an expression of my high standards. And are these things we wrote down are these true?

 

Hiral: Yes.

 

Dr. David Burns: Are they powerful?

 

Hiral: Yes.

 

Dr. David Burns: Are they important?

 

Hiral: Yeah, very much.

 

Dr. David Burns: Yeah, that's awesome. Do you want to try another thought or feeling?

 

Hiral: I should be able to handle my son well.

 

Dr. David Burns: Okay, put that one down. Should be able to handle him my son better. Did I get that right?

 

Hiral: Yes.

 

Dr. David Burns: And then what are some advantages of that thought? Would these be similar to the previous thought?

 

Hiral: I think it helps me to keep exploring more and more or keep trying new things which is something that I love doing and I don't get to do considering the kind of a setup I am in right now. So it's like the challenges he throws on me is really it helps me evolve also I think as a human being.

 

Dr. David Burns: Yeah it helps me explore more and more. It helps me evolve. I love that.

 

Jill Levitt: Yeah I saw you actually kind of light up when you said that. Like there is definitely something about learning how to be a better parent that's really appealing to you, right? And exploring more and learning more and then at the same time sometimes you feel a little stuck and unable to try new things because of your environment. But that's it definitely speaks to your desire to want to learn and grow.

 

Hiral: Yeah. I think Yeah. He's the biggest source. I mean the way he throws the challenges on me. So I think because of him I've learned so many other things which I'm not like acknowledging or yeah I've learned so much.

 

Dr. David Burns: Well let's add that I've learned so much. Well that's awesome. Or is there another thought or feeling you'd like to do this with?

 

Hiral: I think I should know everything.

 

Dr. David Burns: Okay, put that down. I should know everything and then what are some advantages of that? Some benefits of that? I can think of one by the way. Yeah. Well, let's say we had some woman here who's pretty average and she's a mother. Would you expect her to know everything?

 

Hiral: No.

 

Dr. David Burns: So the fact that you expect yourself to know everything, doesn't that show then that you must be this incredibly brilliant person? It gives an image of yourself as being, you know, way way better, a cut above.

 

Hiral: Yes.

 

Dr. David Burns: Can we put that down as number one? Show I'm you know super in and intelligent.

 

Hiral: Yeah.

 

Dr. David Burns: And then what are some other advantages of that or what does it show about you that's positive and awesome?

 

Hiral: I think which also means that when it comes to parenting, I'm not behind any other mother or it's not about behind. I mean, I'm just doing good and I'm just open to receiving you lot new things from my environment.

 

Dr. David Burns: Yeah. I'm not behind and it shows I'm learning constantly. I think that's what you said, absorbing things.

 

Hiral: Yeah, I'm open to learning things.

 

Jill Levitt: I have one other thought here. It probably relates to so many of the things, but definitely this one, I should know everything. Hiral, does this reveal you to be an arrogant know-it-all or does it reveal you to be kind of a humble person who's always wanting to, you know, see her own flaws and improve as a person?

 

Hiral: Yeah, I think improve as a person and also someone who can always have something to give to when you know someone is coming for help. So yeah, I think both.

 

Jill Levitt: Yeah. So give shows me as a very giving person. We got the wanting to learn and grow, but I was also kind of sneaking in there this idea that shows that you're very humble. Because you're not walking around thinking I know it all. You know, let me tell you how to be the best parent ever, but rather you're like how can I do better? And that shows you to be pretty humble. Do you agree?

 

Hiral: Yeah.

 

Jill Levitt: Is that true?

 

Hiral: Yes. Yeah.

 

Dr. David Burns: Is that a part of your value system? Humility.

 

Hiral: Yes, it is.

 

Dr. David Burns: Is that powerful?

 

Hiral: Yeah. Very.

 

Dr. David Burns: Is that real?

 

Hiral: Yes.

 

Dr. David Burns: Yeah. Be beautiful. Well, I'm running out of paper here.

 

Jill Levitt: Yeah. My only thinking I do think we might be ready to move on. The only question I had is maybe it would be helpful. We could do since anxiety is her strongest, we could just do some positive reframing of that or guilt or shame one of the emotions maybe as a change or we can just move forward. David?

 

Dr. David Burns: Well, would there be a one of your negative emotions from your daily mood log that we could do some positive reframing because you're had a hundred on depressed, anxious, ashamed, and inferior and inadequate and embarrassed and hopeless and frustrated. And then you had 80% on lonely and 80% on angry, irritated, upset. Would there be one of those that you'd like to do some positive reframing on?

 

Hiral: I would like to do from my DML. I would like to choose the guilt one.

 

Dr. David Burns: The guilt. Okay. Put the guilt down. And what does that show? What are some advantages of your guilt? And what does it show about you that's positive and awesome? Oh, I just thought of some.

 

Hiral: Okay. So I think my feelings of guilt always reminds me to like you know behave I mean behave well or you know become a better person or be good to others.

 

Dr. David Burns: Yeah. Put that down reminds me to be good to others. I love that. Does that seem real?

 

Hiral: Yeah.

 

Dr. David Burns: Is that important?

 

Hiral: Yes, it is.

 

Dr. David Burns: Powerful.

 

Hiral: Yeah.

 

Dr. David Burns: I had another one. Does your guilt show that you're, you know honest and willing to examine your own role?

 

Hiral: Yes.

 

Dr. David Burns: Well, then put that down. Does it show as well that that you're willing to be accountable rather than just blaming everyone else? Put is that important?

 

Hiral: Yeah.

 

Dr. David Burns: Put that down. Any other feeling that you'd like to take a look at?

 

Hiral: I think hopelessness.

 

Dr. David Burns: Oh, yeah. That’s a good one. That was one of the hardest ones for me to figure out when I first was the second hardest actually when I created positive reframing. What are some really wonderful things about hopelessness? Aaron Beck said it's the worst emotion of all, but what are some beautiful things about hopelessness? And how does it help you? And what does it show about you that's positive and awesome?

 

Hiral: I think it it always makes me feel grounded or aware of the reality.

 

Dr. David Burns: Oh yeah. Realistic and grounded, because there are things going on in the environment right now which are undesirable.

 

Hiral: Yeah.

 

Dr. David Burns: As well as within yourself.

 

Hiral: Yes.

 

Dr. David Burns: So, is that seem real?

 

Hiral: Yes.

 

Dr. David Burns: Powerful?

 

Hiral: Yes.

 

Dr. David Burns: Important?

 

Hiral: Yes.

 

Dr. David Burns: What are some other tremendous advantages of feeling hopeless? Can you think of any way that protects you or helps you?

 

Hiral: No, I think it helps me to move on actually to not just like it helps me to not give up actually. I don't know. It's so contradicting but yeah it motivates just do something about it. I mean just not

 

Dr. David Burns: Yeah. Do something right.

 

Jill Levitt: Yeah. To be productive, to be proactive, to try something new. Yeah.

 

Hiral: Yeah.

 

Jill Levitt: Does it also I don't know for me being hopeless would sort of protects me from trying and getting disappointed also.

 

Hiral: It protects me from boredom actually.

 

Dr. David Burns: Protects from from boredom. Yep, that's a good one.

 

Jill Levitt: David, I think we should based on time. I we're going to run out of time and not have time for methods if we don't move forward.

 

Dr. David Burns: Yeah.

 

Jill Levitt: Yeah.

 

Dr. David Burns: So, yeah, that's right. So we you've given us well I've got 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 30 positives in these negative thoughts and feelings. And the thing is that if you press that magic button and all your negative thoughts and feelings disappear, all these positives will go down the toilet right along with your negative thoughts and feelings. Why? in the world would you want to do that? Because I'm not able to live in the present moment and it has become so difficult for me to see things the way they are. I mean little small things and I get triggered and I feel oh you know what if my son ends up being like always rude or whatever. So I just don't want to live in the future. I want to live in the present moment and just take each day at a time.

 

Dr. David Burns: Well that's a beautiful powerful argument. If you'll turn to your daily mood log on page four. I have a suggestion. Could we think in terms not of pressing a magic button and making all of these completely disappear because there is a lot of value in your negative thoughts and feelings. They show really tremendous things about you that we don't want to get rid of. And maybe we can have it both ways by thinking about a magic dial in instead like you're down and unhappy 100%. Would be there. What would be a percentage that you might be willing to lower that down to by the end of our demonstration where you would be feeling a lot less pain, but you'd still maybe keep some some of that down feeling because there are things to feel a little down about. And but it would you'd preserve all those beautiful qualities about yourself. What would be a good goal for the feeling down at the end of the demonstration?

 

Hiral: I think 20%.

 

Dr. David Burns: Yeah, 20. Okay. Put a 20 in the goal column. Now, is that high enough for you? Is that enough?

 

Hiral: I think 20. Yeah. 20 is fine.

 

Dr. David Burns: Okay. And then how much? So I've got written 20 in the goal column. We can't show this on the screen because we don't know how to type and have it appear on the screen. But how anxious, worried, nervous, and frightened would you like to feel by the end of the demonstration? That was 100%. What would be a healthy amount?

 

Hiral: 5%.

 

Dr. David Burns: Five. Okay, put a five down. Beautiful. How guilty, bad, and ashamed would you like to feel? It's a was a hundred.

 

Hiral: Yeah, I think fives.

 

Dr. David Burns: Okay, that I love these fives. how inferior, inadequate, and defective? That was a 100. Like overwhelmingly high. What's a good amount of defectiveness for tonight?

 

Hiral: I think 10%.

 

Dr. David Burns: 10. Okay, great. And then how lonely do you wish to feel? That was 80.

 

Hiral: I don't want to feel lonely at all.

 

Dr. David Burns: Put a zero there. How embarrassed and self-conscious would you like to feel?

 

Hiral: Zero.

 

Dr. David Burns: Okay, put a zero there. That was 100. How hopeless do you want to feel?

 

Hiral: I think 10%.

 

Dr. David Burns: 10. Okay, great. You put a 10 on the hopeless in the goal column. How frustrated? That was a 100. What's a healthy amount of frustration?

 

Hiral: No, I don't want to feel frustrated at all. I mean,

 

Dr. David Burns: That's a zero.

 

Hiral: Just too much. Yeah.

 

Dr. David Burns: Zero. Okay. And then how about annoyed, irritated, upset?

 

Hiral: Zero.

 

Dr. David Burns: A zero all the way. You don't even want five.

 

Hiral: No, I've been upset for a quite long time now. I'm done being upset.

 

Dr. David Burns: Okay. Beautiful. Now let's see if we can bring about some of these changes and if you could select one of your negative thoughts. You had the four original ones and then we had at least four additional ones that there's like I shouldn't make any mistakes was number eight and I should always know everything. And is there one of those thoughts you might like to work on first because they'll all be perfect for our purpose?

 

Hiral: So can I work on I should always protect my son from being emotional and physically harmed.

 

Dr. David Burns: Okay, that's number seven. I should always protect my son from physical or emotional suffering. Are there any distortions in that thought?

 

Hiral: I think all or none thinking because I'm saying always.

 

Dr. David Burns: So yeah. And then it's not only all or nothing but maybe overgeneralization.

 

Hiral: Yeah

 

Dr. David Burns: Both.

 

Hiral: Yeah. Overgeneralization actually.

 

Dr. David Burns: Yeah. What else?

 

Hiral: So there's this should statement also that you know I should be protecting my son all the time.

 

Dr. David Burns: Yeah.

 

Hiral: Yeah. Statement.

 

Dr. David Burns: Perfect. Put should in the distortion column. And I use abbreviations but I forgot to add them to the checklist of cognitive distortions. But I use like for should or overgeneralization. Any others that you see?

 

Hiral: I think I'm not sure but emotional reasoning that you know I constantly feel that you know my son is not safe and I have to protect him.

 

Dr. David Burns: Oh yeah, I love that emotional reasoning.

 

Jill Levitt: What about self-blame?

 

Hiral: Yeah, that if I'm not around him, he might like, you know, he might end up getting hurt or he'll not be safe.

 

Dr. David Burns: So you know would that be fortunetelling?

 

Hiral: Yeah, actually fortune telling.

 

Dr. David Burns: I thought of another one like discounting the positive. Have you ever protected your son so far?

 

Hiral: Yes. So, but yeah, I'm also discovering the positives that when he's around his friends, he feels so happy because he

 

Dr. David Burns: Yeah, I love that. Yeah, put that put that down.

 

Jill Levitt: Right. Like you're discounting the positive of the situation. Like even if his friend pushed him and he got hurt, he might still choose to have a play date, right? Even if he or even if he feels a little sad, he might still have had a wonderful day. So there's some discounting the positive part of all or nothing too. Yeah.

 

Hiral: Yeah.

 

Jill Levitt: When I said self-blame, the specifics that I meant was to say like if I wasn't there and my son got pushed by a friend, I'm still blaming myself for not having protected him. So that was that self-blame is blaming yourself for something you weren't entirely responsible for.

 

Hiral: Yeah.

 

Jill Levitt: Yeah.

 

Dr. David Burns: Oh, okay. Now, there might be a couple other distortions too, but you've got a great list here. It's all or nothing was your very first one and then overgeneralization and then should statements and discounting the positive emotional reasoning, self-blame, for fortunetelling, quite a few distortions. Now, how can you think of any way to talk back to that thought? Something you could tell yourself instead of I should always protect my son.

 

Hiral: I think he's not my only responsibility. I mean my husband and my family members they are also equally accountable and responsible for his like wellbeing. So, I just don't have to take the entire burden of his well-being on my shoulders.

 

Dr. David Burns: And how much do you believe what you just said?

 

Hiral: 100%.

 

Dr. David Burns: Okay. Write that in the right hand column. My the whole family is responsible. It not all on my shoulders, I think. Isn't that what you said

 

Hiral: Yes.

 

Dr. David Burns: Yeah. And then if that's 100% true, then does that lower your belief I should always protect my son?

 

Hiral: Yeah, but it comes down to only 50%.

 

Dr. David Burns: Okay. Well, that's good. put a line through the 100 and put a 50 right under it in that percent now column and would you like to lower it down further?

 

Hiral: Yeah, definitely.

 

Dr. David Burns: Oh, okay. I'll put it over in your camp here, Jill.

 

Jill Levitt: Well, I think that clearly the goal would be to move to methods, right? We did we tried one method which is identify and explain the distortions and the straightforward technique. We could call that two methods, right?

 

Dr. David Burns: Yeah. So I think we just need very quick quickly to move it from 100 to 50%. So you're moving really fast.

 

Jill Levitt: Yeah. Just in sort of that straightforward technique, right? But the question we come up with now is what method should we move to next? Right. So, we could move in the direction of externalization of voices, for example, or we could do the double standard technique, which is more of a they're both cognitive therapy roleplaying techniques, but one is a little more compassion based and one is a little more maybe direct. So aggressive.

 

Dr. David Burns: Aggressive.

 

Jill Levitt: Sure. So, should we ask her all, which she prefers? Either one, I think, could be effective. We're asking her all. We wouldn't necessarily ask our patients. I mean, we could ask, do you prefer a more gentle compassion-based method or a more aggressive method? But also, we know Hiral knows some of these methods. So, what would you like to do, Hiral?

 

Hiral: I think externalization of voices.

 

Jill Levitt: Okay.

 

Dr. David Burns: Okay. Great. Awesome. You want to set it up, Jill?

 

Jill Levitt: Sure. Yeah. So, we're going to try this method that's called Externalization of Voices. And I'll set it up slightly so the audience knows what we're doing here, right? So Hiral, we're going to do kind of a role-playing method here where you and I are going to play two parts of yourself. And in this case, I'm going to play kind of negative or self-critical her and I'll go I'm going to kind of hit you with your negative thought. I should always protect my son from physical and emotional harm. And then I'm going to have you play the role of your kind of positive or rational thought. I'm going to have you kind of argue back against this self-critical thought. And you can use any number of you can use any kind of response and be as creative as you want. But a couple of ideas for you is that you can kind of talk back to the negative thought using what we call self-defense. You know, argue with it and poke holes in it and disagree with it. You can argue back with some self-acceptance and humility and agree with aspects of the negative thought or even combine the two. And then last, there's another method that's called the Counterattack technique where you can just kind of take issue with the fact that your mind keeps bullying you in this way and bully the bully. That's kind of what we say. And you can do any combination of the three. And what we'll do is we'll give you a chance to respond in the positive thought and then we'll stop and see how you're doing. And if you need a role play for David or I to model a response, we'll just keep practicing back and forth till we can really crush this negative thought that's been plaguing you so much. How does that sound?

 

Hiral: Good.

 

Jill Levitt: Okay. All right. So, who am I?

 

Hiral: You are the negative voice of Hiral.

 

Jill Levitt: I am negative Hiral. And you are?

 

Hiral: The positive Hiral.

 

Jill Levitt: Yeah. Exactly. Perfect. So yes, you know Hiral I just wanted to remind you that you should always protect your son from physical and emotional harm. You must be perfect in that regard.

 

Hiral: Yeah. I think he's dependent on me. So true. But at the same time also have to teach him. Also teach him certain ways of protect himself also because I'm not going to be there with him all the time. So yeah, I mean I there's no way I can always protect him and always be with him so that he is safe and sound.

 

Jill Levitt: And who won that? Was that you or me?

 

Hiral: It was me.

 

Jill Levitt: And was that big or small?

 

Hiral: Yeah, I think it was big.

 

Jill Levitt: Was it big or huge?

 

Hiral: I'm really confused. I mean, it was big. I don't think it was huge.

 

Jill Levitt: Okay, wonderful. So, this was a good start. So, big, not huge. And so, did you want to do a roll reversal or did you want to try it again or did you want to hit David or me with it?

 

Hiral: Yeah, I think I can do it with David. Okay.

 

Dr. David Burns: Okay. I'll be the positive and you can be the negative and suck it to me.

 

Hiral: Okay.

 

Dr. David Burns: I've just been waiting.

 

Jill Levitt: So David, just for the audience, Hiral is going to hit David with this negative thought in the version just like I did. And David's playing the role of positive Hiral. So he's going to respond in the I version in the voice of the positive Hiral. Go for it.

 

Hiral: Yeah. So you know what Hiral you should always protect your son from being harmed in whatever ways emotional or physical it's your job.

 

Dr. David Burns: Yeah. Well that's a wonderful loving thought for sure and I certainly always want to protect my son at every opportunity that I'd have. You know, I can't protect him at every moment for the rest of his life. And I'll also be wanting to teach him how to protect himself emotionally and physically. But there is so that not the threat. I think I'm doing a good job there. But there is a threat that I do need to protect him and myself from. It's a bigger threat.

 

Hiral: What is that?

 

Dr. David Burns: That’s your constantly peppering me in my ear, putting me down, telling me I'm in danger, telling me I'm not good enough. And that unhappiness actually makes it harder for me to give him the kind of love that he wants. So, you can take a hike and as the Buddha said as well as the great Indian teachers from 4,000 years ago, you know, stick it where the sun don't shine.

 

Jill Levitt: And who won in that exchange? Was that the negative or the positive?

 

Hiral: I think the positive

 

Jill Levitt: Was that big or small?

 

Hiral: No, it was big. It was huge.

 

Jill Levitt: It was huge.

 

Hiral: Yeah.

 

Jill Levitt: Okay. And what David, Do you know what how David won huge. Hiral?

 

Hiral: Yeah. I think the last piece of information where he's saying that you know it's just your thoughts and you like you know you just shut up and you just focus on what you're doing. Just keep loving your son and just acknowledge the fact that you're you're doing a good job. So that's

 

Dr. David Burns: Yeah, that's great. Now let's see if you can do it. Are you ready? Who do you want to attack you? Who's the most brutal opponent?

 

Hiral: You.

 

Dr. David Burns: Okay, could I talk to you for a minute, Hiral?

 

Hiral: Yeah,

 

Dr. David Burns: I know that Jill and David were fooling you just now to to, you know, give up on those self-critical thoughts, but I'm going to tell you the way it really is, Hiral. And you can't deny this without getting involved in a lot of self deception and that you should always protect your son from physical and emotional danger. And that's just a fact of the universe. That's a mother's job. And better do that, too.

 

Hiral: Yeah. I think I'm already doing my job when when he's in front of me or I'm probably teaching him the best things and like probably teaching him the best values also. So I don't think there's anything else that I can teach him. And also I think the biggest important thing is for him to learn and grow. It's also important that he falls, he fails and he learns things on his own because he's someone like me. He would want to always explore and experiment and learn. So I think I'll have to let him be the way I want to want my parents to let me be. So yeah.

 

Dr. David Burns: Okay. So who won that?

 

Hiral: Me and I see this coming.

 

Dr. David Burns: Big or small?

 

Hiral: Big.

 

Dr. David Burns: Big or huge?

 

Hiral: Huge.

 

Dr. David Burns: Huge. And how did you get to huge?

 

Hiral: I think the part where you know I said that I should just let him be and just let him learn certain things rather than just me teaching him and me taking the burden and pressure of taking care of him.

 

Dr. David Burns: Yeah. What's the best thing that he can learn from his mother? The one thing

 

Hiral: I think just loving herself and just taking care of she or a he. Sorry.

 

Dr. David Burns: Your child. It's a he or a she?

 

Hiral: It's he. So I would want him to learn self love.

 

Dr. David Burns: Self love and so is the best way to learn self love to learn how to turn off that negative voice in your head.

 

Hiral: Yeah.

 

Dr. David Burns: And so in order to teach him self-love that I would have to teach myself self love.

 

Hiral: Yeah.

 

Dr. David Burns: And so the best thing I can do for him is to turn off that voice in my own head. Is that what you're saying?

 

Hiral: Yes.

 

Dr. David Burns: To heal myself and that's my best way of he healing my son.

 

Hiral: Yes.

 

Dr. David Burns: Okay. Do you want to jump to another you want?

 

Jill Levitt: I just wanted to say I love what you said oral and part of why it's cool is David won using the counterattack technique but you actually won with something else. Right.

 

Dr. David Burns: That's right.

 

Jill Levitt: And that's really cool too and but it's sort of one in the same. The David was more aggressively saying, "I don't need to listen to your bullshit." And you're really saying the same thing, though, right? The best thing that I can do for my son is let him be and sort of trust him and show him love and show myself love and stop with the incessant self-criticism. So anyway, just I thought that was really beautiful. But David, you were asking,

 

Dr. David Burns: Is there another I was gonna say, can we see if we can roll down some more of your negative thoughts using externalization of voices now that you're on a roll?

 

Hiral: Yeah.

 

Dr. David Burns: And I'll be the negative and then Jill can be the negative. We'll take turns. And can I just start at the top of of your list?

 

Hiral: Yeah. Okay.

 

Dr. David Burns: Could I talk to you for a minute? Hey, Hiral.

 

Hiral: Yeah.

 

Dr. David Burns: I know you beat down, you know, that David on that last thought about your son, but there's one here that I'm going to hit you with now that you will not be able to argue with or defend yourself because it's just a truth of the universe, and that's you're just not a good mother.

 

Hiral: I agree at times I am not at my worst but also a lot of times I do things that makes him feel loved and I think it also teaches him that he can very much have you know two different feelings. I mean he's like I'm teaching him to be okay with the fact that you can you know be the good version of yourself and also the best version rather than just focusing on being good and rather than just trying to please everybody else and like neglecting your own needs.

 

Dr. David Burns: Who won?

 

Hiral: Me.

 

Dr. David Burns: Big or small?

 

Hiral: Big.

 

Dr. David Burns: Big or huge? Huge.

 

Hiral: Huge.

 

Dr. David Burns: That’s awesome. I'll concede to Jill because she has one that you will not be able to argue with.

 

Jill Levitt: I was high-fiving you, giving you a virtual high five. Awesome.

 

Dr. David Burns: High five. Yeah. Here's my high five.

 

Jill Levitt: It's great to see your momentum going. But Hiral, you are failing as a mother.

 

Hiral: I knew this was coming.

 

Jill Levitt: Okay.

 

Hiral: Yeah. So like I said a lot of times I do fail and yeah I think when I'm failing I'm also learning to be more humble and just telling myself that please do not expect him to know so much even if he understands a lot of things way ahead than his age because you are also someone who fails despite being so elder to him. So I think it's okay to fail at times and again get up and then fail again. I mean this is how life is otherwise we wouldn't be human beings. I mean, there's no such thing as having like 100% in like 100% grade in parenting or something like that. So, I think yeah, and what I'm teaching my son is to not be perfect at all because it is so tiring to be perfect and there's no such thing as perfection.

 

Jill Levitt: And who won that, you or me?

 

Hiral: Yeah. Me.

 

Jill Levitt: Was that big or small?

 

Hiral: It was huge.

 

Jill Levitt: It was huge.

 

Dr. David Burns: Are there any thoughts left? We could go over all of them, but look at the at your there were eight negative thoughts. And are there any that I can attack you with that still seem potentially threatening?

 

Hiral: I think I will ruin my son's future if I am unable to.

 

Dr. David Burns: That was my next choice. You know, Hiral, this is a fact that you're going to ruin your son's future. In fact, you already have to a great extent if you are unable to handle and nurture him well. And you are unable to handle and nurture him well. So, his future is doomed.

 

Hiral: No, I don't think so because if I look back at my own journey, so I've grown as a human being that kids always don't rely and depend on their parents and what they've learned from their parents. I mean I've learned and unlearned so many things. So eventually he'll also like you know he'll also learn and unlearn a lot of things when he grows up in life and he will have full freedom to explore and choose the path he wants to walk on. So I mean it's is all his future is always going to be in his hands. My only job is to help him. Yeah just my only job is to you know just support him and be with him irrespective of you know how he is doing or where he is in life. So yeah I mean I'm nobody to decide his future or yeah his future is not in in my hands. It is in his hands.

 

Dr. David Burns: Who won?

 

Hiral: Me

 

Dr. David Burns: Big or small?

 

Hiral: Big.

 

Dr. David Burns: Big or huge?

 

Hiral: Huge.

 

Dr. David Burns: Huge. Beautiful. And how did you get to huge?

 

Hiral: I think the fact that you know like when the time that you know I realize that you know I'm just carrying unnecessary too much of burden on my shoulders and eventually kids grow up and then they choose their path and like because we were allowed to choose our path so I mean we will also give the same thing to our kids so then why worry I mean we are even if I'm not working the fact that I'm a good human being. So, you know, I'm doing well. I mean, yeah, but I'm just discounted everything and now that I'm talking I'm just recollecting and everything is coming up. So, yeah.

 

Dr. David Burns: Yeah. Awesome.

 

Jill Levitt: It's amazing, Hiral. I'm so I mean, I have chills actually just hearing you talk. I just want to say I'm so moved by the beauty of what you're saying and you know I'm hearing you talk back to all these negative thoughts but really like on such a deep level of acceptance of your son as a human being who's going to be who he's going to be and I don't need to take so much responsibility for his every move and that sounds very freeing but also what a beautiful parenting philosophy you know that you're just realizing that the burden of all of this like control and criticism and perfection is so unnecessary and you just you look so much freer to me like just sort of embodying this philosophy it's amazing to see

 

Dr. David Burns: In fact let's see how you are feeling now but I just have a question do I sense a book coming from her?

 

Hiral: No

 

Dr. David Burns: Okay let's go back to the daily mood log here and well, are there any negative thoughts that we need to

 

Jill Levitt: Yeah, that's a good question. Anything else we need to conquer here on your daily mood log that we haven't yet? Any other negative thoughts that are still kind of niggling?

 

Hiral: Not really, but I think I would like to try this one. I should know everything.

 

Dr. David Burns: Yeah, you know, Hiral, you should always know everything. I'll show you how to answer that one first. You be the negative, Hiral and I'll be the positive.

 

Hiral: Okay, Hiral, you should know everything.

 

Dr. David Burns: I know. And I do.

 

Hiral: How is that true?

 

Dr. David Burns: That was my attempt at humor. It didn't work.

 

Hiral: No, I just wanted Yeah. Okay.

 

Dr. David Burns: Yeah. Okay. You know, Hiral, you should always know everything.

 

Hiral: Yeah, I think I like knowing everything, but I also know that I don't know becauseI just prioritize certain things in my life. So, and it's okay. I mean, there's no need. And of course it at times I do feel lonely because it becomes very difficult for me to connect with people of my age but then again that's okay because their values and my value system is really different and the way they look at life and the way I look is also very different. So then I just have to let it be and yeah that's okay. I mean like different people can co-exist and that's okay. I mean, I think that's the beauty of life.

 

Dr. David Burns: Okay. Who won that one?

 

Hiral: Me.

 

Dr. David Burns: Big or small?

 

Hiral: Big.

 

Dr. David Burns: Big or huge?

 

Hiral: Huge.

 

Dr. David Burns: Huge. And now let's do a role reversal because I'll give you my serious answer and you can say Hiral, you should know everything. Or David, you should know everything.

 

Hiral: Okay. So, I should be the negative one. Negative. be the negative her.

 

Jill Levitt: Yeah. David will be positive her all and you'll be negative.

 

Dr. David Burns: Or I'll be positive David if you prefer. You can say David you should know everything or you should know everything.

 

Hiral: No, I would say David you should know everything.

 

Dr. David Burns: You know somehow when I was young and foolish I kind of was on that kind of trip thinking I was going to be a perfect therapist or a perfect researcher. And it really got in in the way of closeness. And I can remember the day I was with a patient who said, "Dr. Burns, you're not helping me." And it used to threaten me to when I heard that because I used to insist that I could help them. And I remember looking at her and saying, "You know, you're right. I haven't helped you at all, your the tests show you've been depressed every week for weeks and weeks and everything I've done hasn't been helpful to you and I just want you to know how sad and ashamed I feel because I have so much warmth and respect for you but I can only imagine how lonely and depressed you've been feeling and disappointed and I really want to hear what you have to say, it's so important.” And that was the first time I'd ever said anything like that except the fact that I'd failed. And she started sobbing. And then she said it was the best session we'd ever had. And after that, she started working really hard and turned her depression around fairly quickly. And you know what I've learned is that you know, the older I get, the more mistakes I make and that my mistakes are just a chance for humility and for learning and growing and that's not knowing everything. Man, if I knew everything, it'd be ready to die, I guess, because there would be nothing left to learn and learning and growing. And man, today I learned about this woman Hiral, who was very closed off at the beginning of the session and reminded me of the David. And what a joy it was learning how to work with her a little. She taught me a lot. And I hope this kind of growing and learning never stops.

 

Hiral: Yeah, I feel so warm now. So I think just to go back few hours before I think now I feel very connected to both of you.

 

Dr. David Burns: Yeah, beautiful. Thank you. Yeah, thank you. Well back let's see. So we've done our. Yeah, we've done on No, let's do our final feelings now.

 

Jill Levitt: Yeah. on the daily mood log or on the brief mood survey. Which one?

 

Dr. David Burns: On the daily mood log.

 

Jill Levitt: Yeah. Okay. And I'll just do the last screen share so people can see where we're looking at. But go ahead, David.

 

Dr. David Burns: Yeah. Right now, how down and unhappy are you feeling?

 

Hiral: You zero.

 

Dr. David Burns: Great. So, put a zero there if you have a way of doing it. I'm putting it on my copy here. How anxious, worried, nervous, and frightened are you feeling?

 

Hiral: Zero.

 

Dr. David Burns: Zero. How bad guilty, bad, and ashamed?

 

Hiral: Zero.

 

Dr. David Burns: Zero. How inferior, inadequate, and defective?

 

Hiral: I think 5%, but that's okay.

 

Dr. David Burns: Yeah, that's right. That's good. We don't want to let go all of that. Like pure gold. How lonely are you feeling? Zero.

 

Hiral: Zero.

 

Dr. David Burns: How embarrassed and self-conscious?

 

Hiral: Zero.

 

Dr. David Burns: Zero. How hopeless?

 

Hiral: Zero.

 

Dr. David Burns: Zero. How frustrated?

 

Hiral: Zero.

 

Dr. David Burns: How annoyed, irritated, and upset?

 

Hiral: I think five.

 

Dr. David Burns: Five. Great. Now, I have just two final questions and then I'll turn it back over to Jill. The people would see these numbers and say here's a person who in one session went from 100 to zero on eight or nine different feelings to you know to zero or on most of them and five on two of them. She's probably just saying what she thinks he wants to hear. So the first question is did you really experience that profound change in your feelings? And then secondly, what would be the one or two or three things that did it for you? Like what would be the most helpful part of the session that brought about that dramatic change?

 

Hiral: Yeah. So I think first thing was that everything was written down on a piece of paper. So it was very easy for me to identify that what is exactly going on in my head because there are this continuously self criticism is there and then I'm just putting it down on a piece of paper and then I'm going a little more deeper inside and seeing that what is it trying to say and how is it helping me and also the fact that you know when I was talking and I was doing externalization of voices there was a way of you know talking back to these negative thoughts in a positive way through these techniques called counterattack and acceptance and all. So I think that was something that really worked for me and also the positive reframing that really seeing that these feelings are these negative emotions are actually helping me to become a like helping me in some way. So yeah, I think these were the few things that really helped me. I mean because those because I was just constantly talking and thinking only negative. So there was no way out that you know I was able to move in another direction. So I think the tools helped me to you know open that locked door or the door that I was you know looking for. So something like that. Yeah.

 

Dr. David Burns: Beautiful. Well, what a joy it was not only to help you in my professional role, but to feel close to you, to get to know you, to see the flower open up, the orchids open up and blossom before our eyes here. Thank you so much for that very loving and beautiful experience. It just couldn't have been more awesome and jaw-dropping. I'm so happy for you. I'm so happy for your son and for all the people in your orbit and you're going to evolve into such a fantastic and flawed therapist.

 

Hiral: I feel so happy

 

Jill Levitt: Join the club of the flawed therapists. Openly flawed therapists. Yeah, I just wanted to comment too. I mean, of course, what a beautiful session. What an amazing opportunity to connect with you. Such a beautiful and vulnerable and flawed human as we all are. And I also have the sense that the positive reframing allowed you to really connect with your values, right? And in you know connecting with your values, that's really what then shined through in the effective externalization of voices responses, right? It just kind of kept coming back to this like this is the kind of person that I want to be. This is the kind of mother that I want to be. And it was one and this is the kind of child that I want to raise. And it was really one that would be thoughtful and flexible and you know learning and growing rather than perfect and stressed and critical. And you really came to this like kind of I need to live this way so that I can model it for my son because this is how I want him to live and seemed like your most effective responses were kind of along those lines, which I thought were super beautiful and I'm guessing kind of had their roots in the positive reframing, right? Connecting to that kind of side of yourself.

 

Hiral: Yeah, that's right.

 

Jill Levitt: Yeah. And that you could be flawed and such an unbelievably loving and caring mother, you know, and you can make mistakes and be a loving and caring mother. In fact, those two things totally go hand in hand.

 

Dr. David Burns: You look so soft and beautiful right now, Hiral.

 

Hiral: Yeah.

 

Jill Levitt: And relaxed. You look so relaxed. Yeah.

 

Hiral: Yeah, that's true.

 

Jill Levitt: You do. You look kind of in bliss mode.

 

Hiral: Yeah.

 

Jill Levitt: Yeah, David and Hiral, so kind of what we were thinking about was we can spend more time doing this for a little bit if we'd like. And then we were going to share a couple slides just with the audience about kind of if you thought this was interesting, how you could learn more. And then we were going to do Q&A with the audience. So the audience can ask questions of David and I about what they saw. They might even have a couple questions for you Hiral about your experience. So right now the audience should be sending any questions they have in the chat box to the panelists and Mike is collecting those questions. So David, should I share my slides and we'll kind of do the learn more.

 

Dr. David Burns: Yeah. Let's our slides and max our time for Q&A with our audience. And thank you all. You've been very patient and now is your chance to participate in the dialogue and share your questions and your reflections and your thoughts and so forth.

 

Jill Levitt: Yeah. And so I'll share slides. We'll kind of do a little learn more and then we'll stop sharing slides and we'll do more Q&A and again we can Hiral, if you have more thoughts that you want to share with the audience about what worked or didn't or any learning points, I think everyone would love to hear from you too. So let me do that right now. And don't forget you can just send questions right now in the chat box and Mike is going to collect those and then we'll answer them. So essentially, I'm just putting this in here and then again, we'll come back to more Q&A and sharing, but we just kind of wanted to share with you now that you've gotten a taste of the TEAM-CBT model. We'd love to also share with you ways you can learn more. We actually got a lot of questions in the chat box about, you know, this looks great, but how in the world would I do this with my patients or I'm really inspired to want to try to do this with my patients. So, we just want to share with you this opportunity. This is a brand new kind of subscription that we're offering. And over the years that I've been teaching and supervising therapists, I've heard from so many therapists that they want a place to practice and get feedback and want mentorship and a community. And so we've kind of created something that brings all of that together in one place called CBT All Access. And the CBT All Access actually I'll stay on that for one more minute is a monthly membership that includes practice and consultation groups. It includes certification and the FastTrack course which is a weekly course with home study and then practice and feedback sessions each week and special events like this one. David's toolkit is included. And so it's like a whole sort of learning ecosystem where you can learn and grow and practice. And it includes the FastTrack course, which some people who are here have actually already been a part of, but this is a kind of six-month course that has a about an hour, a week commitment of learning and practicing with us and then, home study videos that you can watch on your own, including lots of awesome interviews with David and instructional videos with me. This is just a slide that shows the many, many techniques. You got to see us do a few of these today, but we actually teach and practice all of these techniques, in the CBT All Access. And last, I'll just say it's the prices on the bottom. It's 115 a month. You can cancel any time. So, kind of a monthly subscription. And then if you're not super thrilled, you can even cancel the first month and get your money back because we definitely want to provide you with a really awesome and inspiring and helpful learning experience. So yeah, that's on there if you're interested and hope to see many of you in that. And then I'm going to invite David to share a little about the feeling great app.

 

Dr. David Burns: Well, this is something I've been developing really mentally for I'd say 40 or 50 years. I first conceptualized it in the late 1970s and finally found a group that would help me develop it. Jeremy Carmel and a number of others. But it's an app that does you know exactly what I do. We’ve trained the AI that in the latest version which we're just finalizing but there's fantastic version already. But it does what you saw us do over that two hours. But the app goes through those stages TEAM with you. And it's free for you and free for your clients currently. It'll only be available until about September because we're going to run out of funds in September and we'll have to go out of business at that point. So it will disappear in September of this year in all likelihood, but it's I think the greatest development in the history of psychiatry and psychology. And I'm just sad that, you know, we we couldn't make it work on a business level, but you can try it out and use it all you want between now and then. And if you're a therapist, it will just boost your effectiveness if you refer to your patients. Sadly, it's only in the US for now. We had hoped eventually to make it available worldwide because there's tremendous demand for it worldwide. But again, we have a very small staff and limited resources. And that means going I think to do well we'll do that if we can but our resources are pretty limited. But anyway that's the feeling great app and it's people say it's fantastic and the new version we're just finalizing now is going to be even more amazing. But it's already jaw-dropping and it's just something for you for free.

 

Jill Levitt: Awesome. And in addition, we also have some free weekly practice group. So David and I do a Tuesday evening psychotherapy on Zoom. We do a practice group and a training group. It meets on Tuesday nights from 5 to 7:00 p.m. Pacific. This is just for a therapist to learn. And you do have to make a weekly commitment, your commitment is to come regularly, but it is a free training group and we teach and practice TEAM-CBT skills. And then David has a YouTube channel that you can find on YouTube and watch tons of David's stories and videos and snippets. And that's, you know, also a wonderful free way to learn. And then David's got a podcast. Yeah, is I'm trying to think if there's anything else you wanted to say on this.

 

Dr. David Burns: No, the podcasts are free. Almost everything I'm doing is for free. And like today is for free. I was taught that the best things in life are free. So, I've tried to do as much for free as I can. And it's more or less paid off with a lot of joy. Well, let’s get on to Q&A. And also that Jill and I have a free class at Stanford that's open to therapists from all around the world. We have many from India as a matter of fact, Hiral but it's Tuesday nights and it's two hours just like the webinar today this was four hours but it's like a two hour version and you learn and you practice techniques.

 

Jill Levitt: That was what I talked about right here the weekly Tuesday group from 5 to 7.

 

Dr. David Burns: Oh yeah that’s how you join it email edwalton0000gmail.com if you're interested. Yep.

 

Jill Levitt: Okay. So, wait, I'm gonna leave Let's see. Okay. Let me I'm going to leave this on just for a moment and then I'll stop screen sharing so we can do questions and you can see us large while we're answering questions. And I do want to remind people if you're a therapist looking for CE credit, make sure that you're here till the end of the day so we can check you as having been here and then you'll get the CE survey via email if you paid for your CEs. Okay, Mike, I'm hoping you can Mike's been amazing today responding to your questions in the chat and giving you guys some prompts and some, you know, thoughts about what's going on in the session. So now Mike is going to share some questions with us.

 

Mike: Excellent. And just before I do that, thank you all so much for your comments for Hiral. I think there was three pages of love for you, Hiral. And so I'll be passing that all along to her.

 

Q&A Session