Rapid Recovery from Anxiety and Shame

In this powerful 2-hour training, CBT pioneer Dr. David Burns and Dr. Jill Levitt presents cutting-edge tools for achieving fast and lasting results in treating anxiety and shame. Witness a rare, real-time therapy session with “Melanie,” a respected mental health professional, who experienced a rapid transformation after nine years of intense self-doubt and emotional pain. Dr. Burns walks you through the TEAM-CBT framework—a structured, research-backed approach that integrates empathy, resistance-busting techniques, and highly effective cognitive and behavioral methods.

This webinar is ideal for therapists looking to enhance clinical outcomes, grow their confidence, and learn proven methods that go far beyond textbook CBT.

What You’ll Learn:
 

✅ A step-by-step guide to the TEAM-CBT framework

✅ How to use the Magic Button, Pivot Question, Double Standard Technique, and Feared Fantasy

✅ How Positive Reframing helps clients uncover strength beneath symptoms

✅ Practical insights from a live session that demonstrate rapid change is possible—even after years of suffering

✅ Earn 2 CEs (Continuing Education units)

This training is part of our ongoing mission at Feeling Good Institute to equip therapists with the most effective, evidence-based tools for meaningful change.

Jill Levitt: Okay, now I'm going to start the webinar and get us all started. Welcome everyone. We're excited to have you all with us today for our workshop, rapid recovery from anxiety and shame with CBT legend Dr. David Burns. I am super excited to be co-hosting this webinar for therapists and the general public with David Burns today. I'm going to do some introductions and also get to know who our audience is a little as we get started and then we'll get going with sharing a really beautiful story and therapy with you. So let me run this poll. Actually, it's a quick poll where we're going to ask you guys who you are so that we know how many of you are joining us as members of the general public and how many of you are joining us as therapists. I'm going to give you a minute to just click your answer to that poll and then I'll share the results.

David Burns: The results are totally unexpected and interesting.

Jill Levitt: Rather than entering in the chat box, just enter in the poll. I'll give you guys about 10 more seconds. Most of you have responded, so I will go ahead and end the poll and share the results. So 80% of you who've joined us today are therapists and 20% of you are joining us from the general public. So let me now introduce to you guys our wonderful presenter here, David Burns. I probably don't need to introduce David but as you all know, David is a world-renowned psychiatrist. He's one of the founders of cognitive behavioral therapy way back in the day with Aaron Beck. He's a CBT legend. He's a best-selling author and he's also more recently the creator of a really amazing app called the Feeling Great app that David's going to share more information with everyone about toward the end of the workshop today. I'm also going to tell you guys just a little about Feeling Good Institute as we get started. So we're global leaders in CBT treatment, training and certification. So our mission is kind of twofold. It's to train and certify therapists in TEAM-CBT and then also to help patients and our goal is to help patients get better by creating really phenomenal top-notch therapists. So Feeling Good Institute was founded by myself, Maor Katz and Angela Krumm, all of whom had trained with David many years ago back at Stamford and our mission is to alleviate suffering by really elevating the practice of therapy and really it's to take the amazing work that we learned from David and find a way to share it more widely to make therapists better and to help patients. Our goal is not only to share with therapists the tools and techniques that we learned from David but also to replicate his training style which is based on the idea that the only way to become a better therapist is to practice and get feedback.

To say a little more about that, we actually know that experience alone is not what makes therapists better. The more we practice therapy, we're not necessarily going to get better but what we need to do is learn and practice and get feedback. Experience alone does not improve therapy skills. So what I've learned from training with David is that we teach, we demonstrate and then we practice as therapists and that's the way that we can get better. So I kind of have a little teaser question here for those therapists in the audience which is I want you to ask yourself, do you want to become a better therapist? Are you willing to put time and energy into training and practicing so that you can become a better therapist? I'm guessing that the answer to this question is yes or you probably wouldn't be here today. So at the end of the session today, we'll share with you kind of a program that we've developed to help therapists become even better and that's through training and practice and we'll share with you the fast track course that we've created so that you can do that. I will share that when I first met David and started training with David which was more than 17 years ago, the only way to become TEAM-CBT certified or TEAM-CBT trained was with David at Stamford and with some of David's intensives around the country and around the world. So we're excited that we've created a kind of efficient and fast way for people to learn the amazing skills that David's taught all of us and that's what the fast track course is all about. So I will begin the main content by going over the Team framework that David's created and then I'll turn things over to David to tell you about some special work that we did with a beloved colleague, Melanie.

So you can see on the screen here the TEAM framework which TEAM-CBT stands for Testing, Empathy, Assessment of Resistance and Methods. But really, I want you to think of it as a framework for doing effective therapy that really takes the strongest predictors of successful therapy or treatment outcome and puts it into a replicable package. TEAM-CBT is effective for a whole range of things: for anxiety, depression, OCD, trauma, habits, addictions. The beauty of it is that it's a framework that you can follow regardless of what you're treating. So I want to say a little more about it which is that the T in Team stands for Testing, that's measurement. We use measures at the beginning and end of every session with every patient in order to track progress over time, in order to make sure that we're seeing the gains that we want and in order to check in with our patient and see how they're perceiving us so that we can address ruptures in the alliance. You're going to see the measurement or the testing that we use with Melanie today. The E in Team stands for Empathy and that is that we use empathy skills that we've learned from David to make sure that we're connecting with our patients, that we're addressing alliance ruptures right off the bat and that we're not just throwing powerful methods at our patients but really taking time to connect with them and to understand them. The A in Team stands for Assessment of Resistance, that is that we're going to address potential resistance, we're going to melt it away and we're going to boost motivation before coming in with the powerful methods. The M in TEAM stands for Methods and we'll be sharing with you several methods today. What I want you to take away from this slide then is that TEAM is this framework that you can learn and that you can replicate with all of your patients and to help you do that a little, you'll see there's a little TEAM icon that we've added to the slides today so you can follow along and see where we are in the TEAM framework. So now I'll let David take over and get to the fun part here.

David Burns: A number of years ago I had the chance to have some sessions recorded on video for training purposes and we had two actual television cameramen set up in our living room. I asked people in our Tuesday training group if you'd care to do a live session and we video it and if you give permission, we'd like to use it for training. A number of people volunteered and the first person on the first day was Melanie who was a beloved member of our Tuesday group for a couple of years. I had no idea what in the world would she ever need a session for because she seems like the most loving and joyous and confident and beautiful person imaginable. But it turned out that she had been struggling for more than a decade in intense shame and anxiety because she was covering up something about her past that she thought was terrible. I think all of us when we think about our own failures and shortcomings we tend to think, "Oh, this is just awful and if anyone knew this about me, they'd really judge me." That was her fear and she believed with all her heart that she was not only a failure but she was defective. As you know, when we're working with somebody, always start with a specific moment when you are upset because that's because all of your suffering will typically be encapsulated at any one five or 10 seconds when you're upset. So to understand your suffering, many, many sessions going into your childhood and so forth is usually not necessary. But if you really understand what's going on at a brief moment, you'll have all the understanding and we call that fractal psychotherapy. A fractal is a little tiny thing in nature that repeats itself, a little equation that repeats itself over and over again. That's how trees make leaves. That's how a lot of things grow. That's how forests develop by some simple thing being repeated over and over again. What Melanie said was upsetting her was she got a call from a member of her church, a woman expressing condolences over the death of her mother-in-law. After Melanie said that she said, "But I have to confess to you David, that my tears," and she began crying, "are not because of the death of my mother-in-law. You see, my mother-in-law didn't actually die, it was my ex-mother-in-law." To tell you the truth, I've had two failed marriages and I've been trying to hide it for fear that people would judge me and I can be happy maybe with my, I'm in my third marriage, it's a wonderful marriage. I've finally found my knight in shining armor and I couldn't be happier except, let's say we're out with another couple.

I forget about my failed marriages and I'm feeling good and then it hits me like lightning. Oh my gosh, what if they find out I've had two failed marriages? This was just almost unbearably shameful for her. Also, she was a beautiful woman always doing for others. She was the head of the couple's counseling, a free thing that she was doing in her church helping troubled couples. But she was telling herself, "Oh my gosh, I must be a fraud. How can I help troubled couples if I can't even make my own marriages work?" Also, what was especially sad to me is that Melanie was not only a great therapist, she was a great teacher working at here at just down the road from where I live at local community college. She often went to East Palo Alto and did a lot of outreach work for people with limited resources and she had many, many, many awards that she would get and often there would be a ceremony and the mayor would be giving her some civic award and there'd be hundreds of people in the audience. Melanie said that she hides her awards in her closet of her office and I often ask people why do you think she hides these awards and people say, "Oh, because she's depressed and she thinks she doesn't deserve them." But that's not why. She thinks she does deserve them and she's proud of them but she's terrified that a student or colleague will come into her office and if she puts all these amazing awards on her wall and they'll say, "Oh Melanie, look at all these civic awards you've received for teaching and public outreach work, that's wonderful but what are all these last names on your awards Melanie? You haven't had a bunch of marriages have you?". That's kind of like the worst fantasy and I felt so sad that Melanie has given, given, given so much and she's afraid even to show some of the benefits and awards that she's so richly deserved. So we can push on to the next slide.

As you know, one of the mandatory things and it's a blessing but frightening to therapists is that we require everyone doing TEAM therapy to measure your patients' symptoms with brief, highly accurate scales. How are you feeling at this moment? Do that at the start and end of every therapy session so you can see exactly how your patient is feeling at the start and exactly how your patient is feeling at the end and then you see how effective you were or weren't. That's the secret sauce of TEAM therapy. Most therapists do not and will not use assessment scales, wrongly and foolishly thinking that they don't need them, that they already know how their patients feel and this is a huge mistake. Because I've done research at the Stanford Hospital in the inpatient unit on how patients feel and how experts who have been interviewing them for two or three hours shortly after admission on how they feel. After it's for to make DSM diagnosis, it's called the Scid Diagnostic Interview, it's the gold standard so to speak and then after they interviewed like a hundred and over a hundred newly admitted patients then they didn't know I was going to do this but I had the patient and therapist turn their backs to each other and then fill out my brief mood survey. The patient fills it out: how are you feeling right now, how depressed are you, how suicidal are you, how anxious are you, how angry are you, things like that. The therapist fills out exactly the same scale guessing the patient's feelings because they've just been talking to the patient about their feelings for two or three hours straight. So now how is the patient feeling? It's a simple question. Also these patients rated the expert interviewing them on warmth and empathy and understanding. The experts rated themselves on the same scale guessing how they think that the patient will rate them. The shocking thing that I was able to put the data in a computer and find out the accuracy of therapists in all kinds of dimensions: how accurate are you in your understanding of depression, in your picking up if somebody is suicidal, on your understanding of anxiety, of anger, of positive feelings, and empathy, how good are you at knowing the therapeutic alliance, sensing how you're coming across to someone. The shocking results to make a long story short was that everything was less than 10% accuracy. Empathy was only 9% accurate meaning that they had almost no correct understanding of how the patient felt about them. Depression was 3%. Can you imagine spending three hours talking to someone about their depression and still not being able to know how depressed they are when they're right in front of you at that very moment? It was surprising and shocking. Suicide was 0% accuracy. What are the implications of that? You don't know how suicidal your patient is but you probably think you know but you don't. Your hunches are very unlikely to be valid. That could cost a patient their life. Anger was 0% accurate and anxiety was like 5% or something like that. The good news is if you use these instruments you will wake up from the trance you're in and begin to see reality as it is, your patients as they are and get information that you can use to fine-tune your practice. Why is Stephen Curry such a great basketball player? If you live in the Bay Area here, you know who he is. He's the greatest shooter of all time and the reason is because every time he shoots the ball, and this is true of all basketball players, you could see when it goes through the hoop and use that to adjust what you're doing. But therapists don't do that. That's why you can't improve. Someone put a question, where's the evidence that therapists don't improve? I don't know the article but maybe Jill and them can tell you what article they're citing but this is the reason why because we're not measuring things. So you're in a dream world not knowing when you're failing, not and when you're succeeding. Well these were Melanie's initial mood scores. Her depression was 50 on a 0 to 100 scale, 100 is the worst possible. Anxiety was 100. Shame was 100, the most intense anxiety and shame a human being can experience. Defectiveness 80%. Embarrassed 100%. Hopeless only 25%, that was certainly a good sign there. But frustration and anger 75 to 80%. As I say, this proof of how we can't know if I had guessed these, if anyone had guessed how she was feeling, they would, we would have all put her 5 to 10 or zero on all of these. But her scores were as high as many people on an inpatient psychiatric unit. Okay, next.

Jill Levitt: David, I was also just going to comment a couple people were asking what the scales were and I wanted to say these were actually her scores on her daily mood log which you'll see in a moment. So it's not that we administered a defectiveness scale or an embarrassment scale, people were asking, but rather these were her initial scores on her daily mood log which you'll see shortly.

David Burns: Right. Here is the daily mood log and here are those scores and the upsetting event was a call from a church member. Here's her emotions in eight different dimensions. All of them elevated and most of them extremely severe. Then what causes these feelings? Well the cognitive idea is that your thoughts trigger your feelings. That's been speculated about for the last nearly 2,000 years since Epictetus first made this claim and we are about to publish a research article where we believe we've found proof of that statistically for the first time in our app users. At any rate, Melanie was telling herself, NT is negative thoughts, "I'm a failure," and to be upset, you have to have a negative thought and believe it and her belief in that was 100%. She was telling herself, "She'll tell other people who will judge me," 100%. "I'm defective," 85%. "I can't, people will think I can't maintain relationships," she believes that 95%. "People will think that men dump me," 65%. She had many additional negative thoughts as well. One thing I love about asking patients about their negative thoughts is we all have our own unique negative thoughts. Here allows you to treat the individual in front of you rather than doing some cookbook therapy based on a DSM diagnosis and then some potentially validated treatment recipe. Although the validated treatment recipes have some value, this allows you to absolutely personalize your interventions for the thoughts that are troubling each patient you're seeing.

Jill Levitt: Sorry, I just clicked ahead. I can comment on this which is that we are kind of moving through the TEAM model. We talked about testing where we can really understand how Melanie is doing at the beginning of the session through the measures, through the daily mood log. Then next in the TEAM model we go to empathy and actually we kind of start with empathy. It's always a part of testing as well but David's developed kind of an empathy toolbox that's called the five secrets of effective communication. We won't go through all of that with you but just want to express that empathy, connection, listening before jumping in is vitally important to creating a warm and trusting therapeutic relationship. In fact, many of the methods that you'll see us do today are role-playing methods and they can even be a bit aggressive or confrontational in a way. So in order for us to be able to do those kinds of powerful methods with our patients, we really need to lead with empathy. At the same time, while empathy is enormously important and necessary, it's not sufficient for bringing about change. So empathy alone is not going to cure much of anything and powerful techniques are also needed. So we won't be showing you excerpts but suffice it to say that we spent time really listening to Melanie and understanding her and providing her with lots of warmth and support. You want me to keep going or you want to pick up here, David?

David Burns: Okay, well, I'll pick up again, you're doing great. You always do fantastic. But before we try to help Melanie or any patient, we deal with two forms of resistance. Freud spent his life trying to understand resistance and trying to find some method to reduce resistance. I developed the concept of outcome and process resistance for each of four targets: depression, anxiety, relationship problems or habits and addictions. The outcome resistance is, does the patient in this case Melanie really want the outcome she says she wants and do you really want the outcome you say you want if you're going to therapy? We asked her toward the end of the empathy, if your dream came true in this session today, was just fantastic, what would happen by the end? She wanted her anxiety and shame to disappear so she could relax and not be constantly worrying about people finding out about her and judging her. Then that, that's outcome resistance. She wants to feel happiness and joy and maybe crush these negative thoughts and reduce these negative feelings dramatically if possible. That's outcome resistance, would mean she says she wants that but might she fight us? If you're a therapist, do some of your patients fight you? Yes, but when you try to help them and you got frustrated, say, "Well, patient's asking for help with panic attacks. I'm trying to show her how to get over panic attacks and she's yes-butting me and putting up a wall and how do we bring that wall to conscious awareness and melt it away?" Then process resistance is a little different. Maybe the patient or maybe you, if you're the patient, do want a positive outcome but are you willing to participate in the process to make that happen? In Melanie's case, there are two processes she may have to do. One is to do her homework between therapy sessions, to write down her negative thoughts just on that daily mood log, identify the distortions in them and challenge them on an ongoing basis and to do other things that we ask her to do between therapy sessions to accelerate her progress. Also, since she has tremendous anxiety, the process issue there will be courage. Is she willing to use exposure and instead of hiding these, her secrets, that's the hiding that causes the shame, is she willing to open up and tell people the truth about herself and let the chips fall where they may?

Jill Levitt: The reason that we put on here, "Are you willing to do the work to get better?" Is just that we realize some of you are joining us from the general public and may be interested in, "How do I use these methods on myself?" So as we're walking through the phase with Melanie, you might be asking yourself, "Do I really want the outcome that I say I want? Why not? Why might I actually want to stay the same? Am I willing to engage in the process that I'm going to need to engage in in order to get better?" Whether that's depression or anxiety. Then we say that these methods that David's just talking about, process resistance and outcome resistance, you said testing was the secret sauce David, but we also say that agenda setting is the secret sauce, meaning it's kind of the necessary ingredient to help people to get better and that is this idea of addressing resistance. Not only are the methods in and of themselves really helpful in boosting motivation and melting away resistance, but they also are very much focused on helping patients to feel proud of their symptoms. We want to be, you'll see us, but we're going to be thinking, "How does Melanie's shame show us actually something incredibly beautiful about her and can we help Melanie turn these feelings, these negative emotions actually into sources of pride?"

David Burns: This is also one of the dimensions that my research in the last 40 or 45 years on how people change revealed that the cognitive therapy was always good but about 50% of the patients in outcome studies and in clinical settings don't respond. I discovered that the reason for therapeutic failure most of the time, even 95% or more of the time, is because there is subconscious resistance that has not been dealt with effectively. So my colleagues and I have developed about 20 new innovative techniques to bring the resistance to conscious awareness and then melt it away and that raised the recovery rate in my experience dramatically. Because once I refined this, I found my patients getting better not most of the time in 10 to 20 therapy sessions, which was great in the early days of cognitive therapy. In fact, it was a breakthrough back in 1980 when Feeling Good came out. But now when I see people or when Jill and I work together like on Melanie today, almost a good 90% of the time, we see virtually a complete elimination of symptoms in one single two-hour therapy session and then you want to do some relapse prevention after that and there may be some loose ends to attend to or there may not. But this paradoxical agenda setting is missing from many if not most schools of therapy and it's really what opens the door to dramatic, rapid recovery and we're going to share with you what that looks like now.

Jill Levitt: What are the steps for this paradoxical agenda setting and kind of how it went with Melanie? The first question that we ask people is we say, "Imagine that there was a magic button on my desk or right in front of you and if you could press that magic button and all of your negative thoughts and feelings would instantly disappear, you would right now without any effort whatsoever, you'd feel joy and self-esteem. Would you press that button?" Of course, most people are going to say, "Yes, show me the button. Where's the button?" Then our response is something along the lines of, "We don't actually have a magic button but we do have some really great tools and techniques and there's a really great chance that we will make those negative thoughts and feelings disappear. But actually, I can think that there might be some good reasons to hang on to some of your negative emotions, some reasons to continue to feel anxious or depressed or to hold on to that shame and can we talk for a few minutes about that? Can we think about that together?" That's what leads to this method that David's developed that's called positive reframing. In positive reframing, we're asking the patient to think about, and in this case Melanie, to think about what, why are her negative thoughts and feelings appropriate and what are some benefits or advantages of each of her negative thoughts and feelings and what do her negative thoughts and feelings show about her and her core values that's really positive, awesome and beautiful?. So this is kind of easy to hear but hard to understand and hard to grasp. So we're actually going to show you a few of them and then we're going to invite you to try to think through a few and do this exercise with us to see if we can uncover some of what Melanie's thoughts and feelings show about her that are beautiful and awesome and how they're actually working for her. Do you want to talk about this one, David?

David Burns: Oh sure. We're going to try to make this easy for you because initially even when seasoned therapists try to do positive reframing, they draw a blank. Because you see, we're trained, I was trained and I think most of you were trained if somebody is depressed that's due to a chemical imbalance in the brain which used to be thought, that theory has now been shown to be false, but that there's some defect in the patient's brain and that they need to be fixed. That's all in our culture. In fact, one of Melanie's negative thoughts was, "I must be defective." Instead we're saying, "Melanie, what is beautiful and awesome about your feelings of sadness and depression and how might those feelings be helpful to you?" We're going to ask those questions about all of her negative feelings. We won't go through the whole list today and all of her thoughts but it really wakens up a part of the patient's brain that's currently asleep and we could get a list of two or three or four sometimes five or more overpowering positives about every negative feeling but we'll just show you the tip of the iceberg. One thing her sadness and depression shows Melanie's tenderness about her two broken marriages. A lot of people who've had failed marriages feel bitter and blaming and angry and spiteful and revengeful but Melanie doesn't show spitefulness and a sharp edge to her soul or to her personality. She shows warmth and compassion and sometimes healthy sadness gives us a greater feeling of compassion for the suffering of others as well as ourselves. Then Melanie's up to 100% anxious, the most anxious and panicky a human being can be. Much of her life for the past 9, 10 years has been struggling with incredible anxiety. But how would that be beneficial? Well one thing is that her anxiety keeps her vigilant so for two reasons. So she won't just blurt out, "I've had two failed marriages," and then have everyone judge her, that's a self-protection or self-love piece. But also it makes her vigilant so she can make sure her third marriage is a success and she was very, very proud of her relationship now nine years with her third husband and all that she learned both from her failures as well as from her now highly successful and loving third marriage. Then shame, how could there be any good about shame? Someone on the question list said, "How does shame differ from embarrassment?" I don't actually know, they're pretty much just about synonyms. The shame means I'm afraid others are going to find out about me and judge me. I guess shame is when you're still keeping it hidden and embarrassment is when you've done something screwy in public and so others are looking at you and then you feel embarrassment. But what's great about her shame? You see Melanie's shame is a direct expression of her profound spiritual respect for other people as well as her love for the institution of marriage. You see her shame is an announcement to herself and to the world, "I love marriage and the values that go with loving families and loving relationships".

Jill Levitt: Sorry, I just clicked accidentally. Sorry about that.

David Burns: Okay, okay.

Jill Levitt: So this one David, we were going to invite the audience to do with us as an exercise. So we kind of gave you, we started to get the juices flowing I hope but now we want you to think what do Melanie's feelings of defectiveness and inadequacy show about her that's really beautiful and awesome? You can enter it in the chat box. Mike's going to read those.

David Burns: Ask yourself two questions. You say she feels defective. Well, I got to fix her. I've got to give her an antidepressant or something that's bad to feel defective and inadequate but what we're saying is what's beautiful about defectiveness and inadequacy and ask yourself first, how do those feelings help her and second and perhaps the more important, certainly equally important is what do those feelings show about Melanie and her core values as a human being that's positive, beautiful or even awesome? Of course, if you're a therapist or the general public, one thing we're hoping you'll take out of today's program is what do your feelings of inadequacy or defectiveness or panic or rage or loneliness or whatever they might be show about you that's positive and awesome, show about you and your core values as a human being and how might those feelings be helping you? So let us know what you think.

Mike Christensen: They're just flying in here David and it seems like they're right on track. She appears to be striving for excellence. She wants things to improve. She may be motivated to change. She has a high standard for herself. She wants to be more helpful, to be effective. Perhaps reflection of her own demand for human perfection, her high standards again. It shows her humility, motivates her. High standards has coming up quite a few times, humility, a willingness to grow, and it may motivate her to work harder on her current marriage.

Jill Levitt: So before I reveal the answer, you guys are all getting into it. It's this idea that rather than buying into this idea that feeling defective is terrible and feeling inadequate is terrible, we're going to kind of honor these feelings and really connect with Melanie in a collaborative way about what these feelings show about her that's beautiful and awesome. It's sort of David, you say, "What shows what's right about you rather than what's wrong with you?" So let me show you guys what we came up with which I think, I think you all hit on pretty much all of these: humility. Mike said high standards, honesty about her flaws and then maybe accountability, this idea that she's kind of holding herself accountable that she's had failed marriages and she's going to do it right this time.

David Burns: What I want to say here is this isn't a head trip, some intellectual thing. If when you see the videos of Melanie and if you knew Melanie, you know she's a manifestation of humility and kindness and warmth and that that value is expressed through defectiveness as well as her honesty and inadequacy and what a beautiful thing it is. The moment she's shame, proud of being defective, then recovery at that moment is just a stone's throw away. We need somewhat more than this positive reframing but this positive reframing opens the door to magic and typically rapid magic. We have one more exercise with a couple on this slide as well for you guys to get into it. So what does Melanie's hopelessness show about her that's beautiful and awesome or how is it helping her?. When I was creating this system, hopelessness was the second hardest one for me to figure out how could there be anything good about hopelessness. Becca says, "Hopelessness is the worst feeling, the one that leads to suicide." But now let's look at the other side. What's positive and awesome about feeling hopeless and what are some benefits of feeling hopeless?

Jill Levitt: So enter them in the chat box if you can think of benefits of hopelessness or how it shows her values.

Mike Christensen: There's a number coming in. A lot saying, she's being realistic. There's longing for meeting for meaning. It's a form of acceptance and living in the moment. Shows her honesty, there's another one. Hope is protection from disappointment.

Jill Levitt: So let's we've got a lot on here so let's do that one and then let's that's what we came up with that it protects her from disappointment but all the things that Mike is suggesting are all, they're all good. Exactly. The next one we want you guys to do, now you're going to shift from hopelessness and now do frustrated. What does her frustration show about her and her value system and how might it be helping her?

David Burns: This was the hardest one for me to figure out. In fact, I worked on it for a month and I couldn't think of anything good about frustration. One day I was sitting in a coffee shop on Castro Street in Mountain View and all these people were drinking fancy coffee and working on their laptops and I just said out loud, "Can anyone help me? I've been trying to figure out the positives in negative feelings and I can't think of anything positive about frustration. If anyone can think of anything, please just shout it out." Then someone shouted it out and I immediately saw the answer.

Mike Christensen: It sounds like you were frustrated with not being able to find it and then the answer came.

David Burns: Yeah, yeah.

Mike Christensen: People are saying that it can be, can be motivating, help you to kind of look for solutions. Shows a desire to gain knowledge, passion for change, motivation for change, search for answers.

David Burns: Yeah, what the guy shouted out was, "It shows you haven't given up on your goals."

Mike Christensen: Nice.

David Burns: I thought, "Wow, that is so cool." Because you see, my frustration with not knowing what was great about frustration kept me working on it. I hadn't given up on my goal and you're not frustrated once you've given up you see and so frustration, I said, "Yeah, that's some good." Buddha said that all the time about frustration 2500 years ago. He said, "That's good."

Jill Levitt: We have one more on this slide and one more for Mike to help us out with and that's angry or mad. What does Melanie's anger and madness show about her that's beautiful and awesome or how is it benefiting her? So work on that one now with us.

Mike Christensen: Shows passion. It can be empowering and energizing. A sense of fairness shows that she cares. Can be empowering, respect and boundaries, assertiveness.

David Burns: These are really great. One thing I try to emphasize and Jill as well is to make it specific to the person you rather than a general head trip. Melanie is mad and angry and one of the things she's afraid of is if people find out that I failed, they're going to judge me. Could that be worth being angry about? Because I was raised in a very right-wing Christian home. My father was a minister and there was a lot of judgment going on toward people who were different and it made me angry. It was painful for me once I realized, once I was old enough to realize that and a lot of people are going to judge Melanie because she's had two failed marriages and I think her sense of justice and fairness shows her willingness to stick up for herself and just makes me love Melanie even more and to feel angry with her, that this holier than now idea that some people have in and sometimes in churches that, "We're the superior people and we have the right standards and you know we don't get divorced," and that will come in a little later in her treatment. You'll see an actual video on that.

Jill Levitt: I'll just say one more thing before we move on from positive reframing that when we do this with a patient, it's actually very collaborative. So yeah, after we do that magic button and then we say, "Yeah, before you know I do have tools to help you absolutely, but there might be some good reasons for you to hang on to some of these feelings." And they even show some beautiful things about you. Then we ask them, "Can you think of any?" We sometimes the patient says, "Yeah, well my anxiety is protecting me." We say, "Great, let's write that down." We kind of go through each feeling and each thought collaboratively. So the therapist can make suggestions and see if they fit and the patient can make suggestions and together we're kind of just discovering for this patient, not generically, but for this patient, why these feelings and these thoughts are really actually showing some beautiful things and quite useful for them. So then after we do that whole kind of positive reframing, we've listed all the benefits and the beautiful qualities, then we say to the patient, "Given all these benefits, why in the world would you want to press that magic button? Why would you want to change?

David Burns: Because if you press that button, all your negative thoughts and feelings will instantly disappear with no effort, but then all these beautiful things about you are going to go right down the toilet with your negative thoughts and feelings. Is that what you want? You want all these beautiful qualities to disappear?"

Jill Levitt: Then oftentimes patients will argue for change. If we ask them, "Why would you want to change given all these benefits?" they'll oftentimes say, "You know because I'm suffering so much," like Melanie would say, "Because I just want to accept myself and be proud of my marriage because I don't want to be terrified of people seeing my new last name. I don't want to be sad when people call me to connect with me in the church." But again, this is kind of a paradoxical exercise and a paradoxical question. So then as you can imagine, people have mixed feelings. There's part of them that really, really want to change, that's why Melanie's here. She doesn't want to suffer anymore but there's part of her that realizes she doesn't want to throw all these things down the toilet as David said and get rid of all of these beautiful qualities. So that's when we come in with what we call the magic dial. So we say, "What if there was a bit of a compromise here? So instead of getting rid of your depression, your shame and guilt completely where everything needs to go to zero, what if we were to dial down your feelings to kind of just the right level that makes sense to you where you'd no longer be suffering in the way that you are but where you could hang on to some of these beautiful values and even some of the benefits?" Then we're going to go through each of the feelings on the daily mood log and ask Melanie to say, "What would be your goal? How down would you want to feel? What's kind of just the right level of anxiety? How much guilt and shame do you want to have?" That's what we put in the goal column on the daily mood log.

David Burns: And you can see that right there's the emotions and the percent before that's before we start the session and then the goal column and then we'll also do the percent after the session at the end. You can see she wanted her sadness to go from 50 to zero. She thought her anxiety could only go from 100 to 40. Patients sometimes do what I call reverse hypnosis. They try to hypnotize you into feeling as negative about themselves as they feel. When she said 40%, she said, "If my anxiety could go down to 40 and I don't believe it's possible that it could go that low because the problem is real," but she said that that would be a miracle. The lowest my shame could ever go was from 100 to 30. But she thought that it would be okay to get her inadequacy down from 95 to 10% and her embarrassment and feeling foolish and humiliated from 100 to 30. Her hopelessness and frustration and anger she wanted them all to go to zero. So now what we've done is we've made a deal with her subconscious mind. She doesn't have to resist our efforts to help her change and yes, but because she said these are the levels I'd like to bring them to if possible and so we're saying, "Okay, we've got a deal. We'll bring them down to these levels and no lower." I sometimes even say to patients, "Now sometimes the techniques are so powerful and your anxiety you could overshoot and it might go down to 30 or 20 or all the way to 10 but don't worry about that because if it if these feelings go too low, if you get too happy, we'll help you get more negative thoughts so you can push them up to the desired level before the end of the session." That usually brings some laughter to the patient and the laughter itself I think can be quite healing.

Jill Levitt: The beauty of the goal column again is that it's so individual. We're inviting the patient to recognize how much suffering their negative thoughts are causing them but we're also allowing them to recognize the benefits of them and really to kind of make a decision? Like how anxious would you want to feel, how guilty? So in a way, the magic button seems like it's this binary black and white question but actually we do that to get to kind of the beauty of the shades of gray, the beauty of the in between and again to melt away the resistance.

David Burns: One other point, the TEAM, Jill and I make it look real easy. It's actually the most challenging form of therapy in the world to learn, I'm pretty sure. I don't think anything else comes close to it and part of it is because it goes against our human nature. You see, we're operating now not as the therapist but as Melanie's subconscious mind, her resistance. We're the part of her mind that is giving her all the good reasons not to change. You see, because all your negative feelings are beautiful and at the end of risking the positives we say, "Are these, is this real?" She and every patient says, "Yes." "Are these positives powerful?" "Yes." "Are they important?" "Yes." So we're getting her to buy into how great her negative feelings are and that's a paradox because most therapists, the way I was trained and I'm sure the way you were trained was to try to be helpful. We're doing the opposite but it's an art form and it has to be done with skill and compassion and if done with skill and compassion it's extraordinarily powerful and it makes it actually impossible for patients to resist. A lot of us don't struggle with resistant patients. I can tell you that it's impossible for a patient to resist Jill or David and it's nice to know that it makes it much more relaxing to be a therapist. Resistance segment has been solved.

Jill Levitt: And this is really the same thing but just showed graphically, right, David?You can see her official scores on depression, anxiety, shame. This is all the ratings on the daily mood log and then you can see kind of what her goals were and so they varied from emotion to emotion and for good reason. So this is just a summary where we wanted to highlight for you what we just went over. So we taught you the magic button and positive reframing, that pivot question, "Given all these benefits, why would you want to change? Why would you want to lose all these beautiful things?" That's kind of where the patient argues for change and then the magic dial where we actually come to an agreement with the resistance. So that we can move forward.

David Burns: Now I have a question. If you go back to that slide down in the left hand corner, I see this little thing you promised TEAM and there's a red arrow pointing to the A. What does that mean and how are these little icons helping us with the presentation?

Jill Levitt: Glad you asked David. These icons are helping make sense of this process for everyone so that you can see that we're in the agenda setting phase here. So we started with testing and that was the arrow was at the T in Testing and then we had a slide talking about how important it is to connect and empathize and now we're in agenda setting and then when we move on to methods, you'll see the red arrow move down to methods and that way you can kind of see where we are in this overall framework. David, what I'll say is this is almost a test to who was listening because David actually mentioned the answer to this question earlier today but we're not going to be teaching you our whole process resistance sequence. Although there's to me a really mind-blowing sequence equally awesome to the positive reframing but for addressing process resistance. But the process resistance we're asking here is, let's imagine now we have Melanie saying, "Yes, I definitely want you to help me. I want to reduce these feelings. Here are my goals." Well, what is Melanie going to need to do? What is probably the hardest piece of therapy that Melanie is going to have to do that she's maybe not going to want to do in order to be cured? I can handle this Mike because I can see the chat box and it's a quick one but we have a bunch of people who were listening to you earlier David who are saying exposure and some people also are saying homework which is always true. But we oftentimes say the hardest thing for people with people with anxiety actually tend to love doing homework, they're really conscientious and great students and patients but what is she going to have to do that she's not going to want to do? Someone specifically wrote in the chat box, "Tell people about her failed marriages. Hang her awards proudly. Be courageous."

David Burns: You guys, we're just showing you a few video clips today but we also have a video clip of when I asked her this question, "What are you going to have to do to be cured?" Then she says, "Exposure." She grimaces and holds her hand over her face but then she says, "Yeah, I guess I will. I'm willing to do that." Which was a great sign and kind of a very inspiring moment too.

Jill Levitt: Some people put in the chat box things that she will need to do like homework and like self-compassion and things like that but the thing that she's not going to want to do is exposure, right? She's going to be happy to learn how to be more self-compassionate and to do homework and that's going to feel relatively easy for her but facing her fears and overcoming her shame and embarrassment is going to be the tough part.

David Burns: Telling people, "Oh, curses, I'm foiled. Do I have to do that? Please God don't make me do that." Yeah, now we're into the methods section. This is the fourth phase of the therapy session and we want to use methods to crush Melanie's negative thoughts. Now we're always highly specific, we try to avoid generalizations and crap like that that nobody was ever helped by except maybe philosophy students. But people want change at the gut level and so I said, "What negative thought do you want to work on first Melanie?" She said, "She'll tell other people who will judge me." She believed that 100% and you could even see the shock in her face when she said that thought. Now what a recovery circle is, it's a circle much like what you're looking at right now and it has all these lines coming out of it and those are this is a prison she's in and as long as she believes this she's going to feel crappy and these are techniques that can help her crush this thought. There's actually two recovery circles that go from 0 to 12 and as a group we came up with about 17 methods. Now you say, "Why would you have so many, 17 methods?" Well, we don't have 17 methods. I've developed roughly 140 techniques to crush the negative thoughts that cause depression and anxiety and relationship conflict and habits and addictions. But we don't know which one is going to work for Melanie so we want to or for you for that matter. So what we want to do is take one thought that you want to work on first and just say, "Here's 10 or 15 or 20 techniques that would help us crush this thought." That gives two messages to the patient. Number one, it's that we know it's going to be tough. We're not trivializing the, using methods to change the way you feel. After all, she's an intelligent woman and she's been in hell for 9 years and if it was easy, she would have figured it out by now. So it says, "We got to have a lot of firepower to blast this thought out of the water." But it gives a second message too and that message is, "But we have more firepower than you're ever going to need." That creates feelings of hope and confidence and excitement because most patients, I mean they've never heard of a downward arrow or examine the evidence or the shame attacking exercises or the feared fantasy technique or externalization of voices and so forth. So it's a great idea. Then we also introduce the idea to the patient that I call, "Failing as fast as I can." Since we don't know which method is going to work for you Melanie, we may have to try and fail with these techniques before we find the one that works. The faster we fail, the faster we'll get to the technique that opens up new worlds for you. Would that be okay with you Melanie? I've never had a patient disagree with it because it makes common sense but it also helps her and you because a lot of the methods won't work. What works for Mary won't help Paul or Hussein or whatever. We all have our own path to enlightenment and what we're trying to do here is we do not want to make Melanie feel slightly better, absolutely not. We want to blow this problem out of the water. We want to bring her to an experience of enlightenment, that's our secret agenda. We haven't revealed that to her yet.

Jill Levitt: The other thing I like about the recovery circle is that first of all, I like the idea that we are writing these things down, that the patient actually, this is not mystical and magical and I'm not healing my patient just by being in the room with them. I'm actually using specific tools that are going to help or techniques that are going to help them get better and that also means that whatever we know actually worked in this situation if I'm working with someone for a series of weeks, these are methods that they get to know and they think, "Oh, can we do externalization of voices again? Oh, maybe we can try the feared fantasy." They, they kind of leave therapy with a toolbox. Just like we teach therapists a toolbox, as a therapist, I'm teaching my patient kind of a toolbox and a way that they can help themselves to continue to get better even once therapy is done. So we were going to share with you all the first method that we often times use with patients is called identify the distortions and actually the kind of new spin on it is explain the distortions. David, when you first developed this method it was just identify the distortions where the patients had a long list of cognitive distortions with definitions for each of them and we would kind of identify which distortions exist in each thought. But now we have the patient not only identify the distortion but actually explain to the therapist why that distortion exists in that thought and in so doing, the patient already starts to untwist their thinking and we can kind of show you how that works. So we'll do that with one thought here. So Melanie had the thought, "She'll tell others who will judge me." So she was worried that this churchgoer would tell other people in the community about her, this being her.

David Burns: And then they'll tell others and they'll tell others and pretty soon her reputation will be ruined and her life will be ruined. This is the key belief in social anxiety.

Jill Levitt: Yes. So we would on the daily mood log, we have on the backside of the daily mood log the list of cognitive distortions and all of their definitions since we can give that to our patient and ask them to take a look and to figure out what distortions exist in that thought. Oftentimes thoughts will have many cognitive distortions. So we were going to do that as an exercise with the group today. So you have this thought Melanie has this thought, "She'll tell others who will judge me." So you can write in the chat box what distortions do you see in that thought?

David Burns: One has come up already, fortunetelling and I'll explain why that's a distortion although we would have the patient do this and that's down here the lower left, fortunetelling. She's making an arbitrary prediction, a dogmatic prediction about the future and none of us can tell the future and that that's what the distortion is. Are there other possibilities?

Jill Levitt: That's the one that many people wrote, fortunetelling and jumping to conclusions and mind reading. But we also have one who said all or nothing thinking. We might, if it were Melanie, we'd say, "Great, why is it all or nothing thinking?" This person said all or nothing thinking because she's imagining that this person will tell everyone and then everyone will judge her, like there's, it's black or it's white. No one knows and it's a secret or everyone knows and I'm destroyed.

David Burns: That it'll go from all to nothing, that it's people have on-off switches about whether they care about you. As you mentioned also mind reading, she's imagining what this woman is going to think and what other people will think. Last Friday I did this office hours which was a beautiful event. We'll probably do more of them and it just went great. People were beautiful and some of them came on screen but one person came on and was started sobbing uncontrollably and I was kind of taken aback because it wasn't a live therapy thing, it was just a question answering thing and I felt like I hadn't handled it very well and I had the thought, "Oh my, we had such a beautiful office hours and now everyone will think I'm a loser because someone came up and started sobbing uncontrollably." Then I was interested. One of my colleagues the next day said, "You know, it was such a beautiful thing and that one woman, you made you look so human and real and I felt so close to you and it just made the presentation that much stronger." So I was doing the same thing that Melanie was doing. What are some other distortions that they're seeing here Jill?

Jill Levitt: I see magnification someone said, magnification.

David Burns: Yeah, absolutely. Blowing things out of proportion. As if the whole world is depending on Melanie and how many marriages that she's had. We think we're so much more important in a way than we really are. But what's this one emotional reasoning Jill? Someone said that.

Jill Levitt: How does that feel, right? It's this idea like because I feel badly, because I feel judged that means everyone will judge me or because I feel ashamed that means everyone is going to judge me.

David Burns: Awesome. How about should statements? How someone says this is a hidden should statement. What does that mean?

Jill Levitt: I think in this one maybe the hidden should would be they're imagining like others shouldn't judge me.

David Burns: Yes, but also I should be perfect.

Jill Levitt: Right, I was thinking it could go either way. Right, like imagining hostility and angry about it. Others shouldn't judge me. Also thinking, "I should be perfect. I shouldn't have any failed marriages".

David Burns: Yes, and I shouldn't ever have anybody judge me. How can I live if one or more people are judging me?

Jill Levitt: Totally. Someone actually, I'm glad refreshingly, someone said discounting the positives. She's discounting all, there's so many positives to Melanie as a human being, as a therapist, as a community member, a churchgoer, a mother, friend and she's only focusing on this one piece.

David Burns: Mental filtering and discounting the positive. If we had time, we could do a survey. How many of you were judging Melanie? If we had time, we could do it at the end. I know my heart just went out to her. I've always loved Melanie and just felt so proud to have her as a friend and member of our training group and it's so sad that she sees herself as quite negative and she sells herself so short and then she sells the rest of us short as well thinking that we're lacking in compassion or acceptance.

Jill Levitt: Right, and then people said self-blame and as if it's her fault. I think to your point David, there's some other blame too because you're kind of imagining others as totally judgeable.

David Burns: Yeah, right.

Jill Levitt: People don't always pick up on that that actually fearing or being convinced that others would judge you is kind of a put down to the others too that you see others as judgmental and incapable of compass