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In this episode, we explore Transcranial Magnetic Stimulation (TMS) as a treatment option for Obsessive-Compulsive Disorder (OCD). We discuss the FDA-approved devices, unique protocols, and why patients need their anxiety triggered before each session. Did you know TMS for OCD targets a completely different brain region than TMS for depression?
Faculty: Simon Kung, M.D.
Learn more about our memberships here Earn 1 CME: TMS in Psychiatry: Innovations and Best Practices Exploring the Evidence of TMS for OCD
Host: Richard Seeber, M.D. -
Special Announcement #1 The Legendary Summer Intensive Starts on Thursday of this week! Featuring Drs. David Burns and Jill Levitt August 8 - 11, 2024 Click for registration / more information!
This workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend.
Special Announcement #2Here's some GREAT news! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it
Today's Podcast #408-- Does God exist?We started today’s podcast with a beautiful testimonial and a shout out for the intensive from August 8 to 11, 2024 at the South San Francisco Intensive in person or virtually if you prefer. To learn more, contact www.CBTintensive.com. Act fast because the intensive is on Thursday of this week when today’s podcast will be published.
Today, we tackle another popular and intensely debated philosophical / religious puzzle: Does God exist? People have very heated views, one way or the other. I (David) will start with a brief explanation of a Wittgenstein answer to this question, and then for the most part, we will focus instead on the question of how we all incorporate spirituality into TEAM-CBT.
Wittgenstein emphasized that philosophical problem exist when we debate about the meanings of words or terms that are vague, or poorly defined. Traditionally, we think there are three positions one could take:
Theism: You believe that God exists. Atheism: You do not believe in God. Agnosticism: You say that you do no know whether or not God exists.My own thinking, which is strongly influenced by Wittgenstein, would be that I don’t understand any of those three stances because I have no idea what you mean by your use of the word, “God.” What is it, exactly, that I’m supposed to believe in, or not believe in?
To me, the question, “Do you believe in God,” is nonsensical, so I simply do not deal with it. All of the three positions listed above are based on the idea that the word, “God,” has some kind of clear meaning that we can all agree upon. But it clearly does not.
You might define “God” as the “creator of the universe.” Well, there is certainly something magical and mysterious about the existence and creation of the universe (assuming it did begin with some kind of “big bang.”) Some questions might include “Where did all the energy come from all of a sudden?” Or “Are there many universes?”
These are valid questions, and physicists are pursuing the answers, which is very exciting and fantastic. But they are generally not invoking the concept of a “God,” although some undoubtedly would say that they do “believe in Gad.”
Regardless, I cheer them on and find every new discovery about the nature of the universe, and how the universe works, endlessly fascinating!
For today, we will ask a much simpler question of whether and how we include some kind of spiritual dimension into our work as shrinks. This is a topic that is equally exciting, and definitely meaningful.
Rhonda got us started by explain that she sees the belief in God as a matter of faith, and is not something that can be tested empirically, which is certainly true. She says she does believe in God, or some “higher power,” but does not believe in a God who “rules over things.”
She was raised in the Jewish religion, and says that many Jews believe that God exists in everyone . This sounds a little like Hinduism, which traces back at least 2500 years ago, and possibly as early as 5000 years ago. I believe that the Hindus believe that God exists in everything.
The practical impact of the belief that God exists in all of us, is that we will treat each other with love and respect, since we are all an expression of God. She also said that we can “create God among us as a community.”
Matt said that he was raised as a Christian and that when he was growing up he had heard about miracles, like Jesus raising Lazarus from the dead in the New Testament on the Gospel according to John. He said that he views our work with individuals who are severely depressed as a kind of spiritual healing, even though we are working with purely secular methods. This is especially true when we are working with individuals who appear to be paralyzed by depression, claiming they are unable even to get out of bed, people who bombard themselves with harsh criticisms, and feel hopeless and ashamed.
Matt said that self-acceptance (accepting ourselves exactly as we are) is one of the many tools we use, and that he (Matt) loves to think about the ripple effects of our work, which not only transforms the lives of individuals who awaken from their depressive trance, but this also has enormous positive effects on their friends and family as well.
He asks, “How do we achieve this?”
I (David) loved hearing from Rhonda and Matt on spirituality in TEAM, and pointed out many areas of overlap between TEAM and the Christian theology I was raised on, since my dad was a Lutheran minister. For example,
The TEAM concept that you do not, and cannot, earn genuine feelings of worthwhileness or self-esteem through achievement. In other words, your worth is not your work, but something you give yourself unconditionally. In Christianity, we are sometimes taught that you cannot get to “heaven” through your good works. Enlightenment is a gift, a decision, and not something you have to earn. We also teach that humans are not purely good, but have a mixture of positive and negative motives, and that many people suffer because of guilt and regret about past errors or sins. When we are teaching the Acceptance Paradox, we are teaching a “letting go” of the inner abuse we endure from that relentless, critical voice in our brains, labeling us and telling us that we aren’t good enough, we’re “bad,” we’re “losers,” and so forth, using powerful tools like the Externalization of Voices.In Christianity, this message is delivered in my ritualized ways, including the act of communion, confessing your sins and accepting the blood and body of Christ who “died for your sins.” This is just another way of sending the message that it is okay to accept the fact that you are flawed and fallen, and yet still worthy of God’s love—and your own love!
In the interpersonal TEAM model for troubled relationships, the entire emphasis on pinpointing your own role in a problem with a friend, colleague, loved one, or stranger, instead of casting blame on the other person and feeling angry and morally superior. My Relationship Journal is a tool designed to facilitate this process very rapidly.In Christianity there are many messages about taking out the moat in your own eye, as well as the idea that when you blame others, and cast judgment, you condemn yourself.
There is a strong emphasis on humility and accountability in TEAM-CBT. This often comes up during positive reframing; we talk about how the patient’s self-criticisms are often an expression of high standards, honesty, and humility, and that these are beautiful qualities that are real, important, and powerful.And this similar, it seems to me, to the Sermon on the Mount, where Jesus talked about “blessed are the meek, for they shall be called the Children of God.”
There are many, many additional areas of overlap, and many books have been written on this subject. During the podcast I provided examples of how the spiritual and psychological realms can meet and reinforce each other at the moment the patient recovers and discovers their own enlightenment. I am proud to have developed TEAM-CBT, and it is clearly infused with many spiritual dimensions, even though it is entirely secular.
I mentioned that I was born on a Sunday morning, and my dad said it was the only time he was unable to preach his sermon. He was too excited, especially since my parents had become reconciled to the notion that they could not have children. He called me David Dean Burns, and hoped that someday I would become D.D. Burns, D.D. DD is an honorary degree in theology, and he (and everyone) assumed that I would one day be a minister, like was. He was L.C. Burns, DD. (Lyle Charles Burns)
I went in a different direction, but have kind of returned to my original calling, though threw an unexpected route, and hope you have all enjoyed our “sermons” this morning.
I would add that I would never impose my beliefs or spiritual orientation on any patient, and only ask about the integration of their successful recovery with their own religious beliefs AFTER they have recovered, so as to add a deeper level of meaning to the work and transformation that they experienced. We only emphasized the Jewish and Christian approaches to spirituality because that was our upbringing, but the spiritual “discoveries” during TEAM treatment are actually compatible with nearly all, if not all, religions and spiritual paths.
Warmly,
Rhonda, Matt, and David
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In this episode, our host interviews Dr. David Burns about his methods for overcoming negative thoughts and promoting joy using CBT techniques. Dr. Burns discusses various techniques and introduces his new digital tool, the Feeling Great app, which tracks personal feelings to facilitate quick and effective therapy, using advanced methods to help users change their thought patterns and emotions.
Additionally, Dr. Burns emphasizes the importance of measurements in therapy for accountability and optimization, while promoting the availability of scientifically backed, drug-free treatment options for depression and anxiety, revealing his commitment to revolutionizing mental health care through his app and other resources. Listen now!
“If you look at the DSM, the diagnostic and Statistical manual, hundreds of so-called mental disorders that are described. So whatever emotion you have, it can be turned into a mental disorder. So if you're shy and most of us get anxious in public speaking or around other people, well, you don't. You're not shy. You have a mental disorder called social anxiety disorder. And that really, excuse the language, pisses me off when they do that, because you've taken a very common problem and turned it into a mental disease, and then people think they need some pill for that. And to me, that's meaningless and it's, it's wrong.” ~Dr. David Burns, Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine
To learn more -- or read the transcript -- please visit the official episode page.
Our guest, Dr. David Burns, graduated magna cum laude from Amherst College, received his M.D. from Stanford University School of Medicine, and completed his psychiatry residency at the University of Pennsylvania School of Medicine. He has served as Acting Chief of Psychiatry at the Presbyterian / University of Pennsylvania Medical Center (1988) and Visiting Scholar at the Harvard Medical School (1998), and is certified by the National Board of Psychiatry and Neurology.
Dr. Burns is currently Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, where he is involved in research and teaching. He has received numerous awards, including the A. E. Bennett Award for his research on brain chemistry, the Distinguished Contribution to Psychology through the Media Award, and the Outstanding Contributions Award from the National Association of Cognitive-Behavioral Therapists. He has been named Teacher of the Year three times from the class of graduating residents at Stanford University School of Medicine, and feels especially proud of this award.
In addition to his academic research, Dr. Burns has written a number of popular books on mood and relationship problems. His best-selling book, Feeling Good: The New Mood Therapy, has sold over 4 million copies in the United States, and many more worldwide. Feeling Good is the book most frequently “prescribed” for depressed patients by psychiatrists and psychologists in the United States and Canada. Surveys indicate that American mental health professionals rate Feeling Good as the #1 book on depression, out of a list of 1,000 self-help books.
Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the "Inside Bipolar" podcast with Dr. Nicole Washington.
Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com.
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“But rather, love your enemies and do good to them, and lend expecting nothing back; then your reward will be great and you will be children of the Most High, for he himself is kind to the ungrateful and the wicked. Be merciful, just as your Father is merciful.” Luke 6:35–36
It is certainly difficult to be “kind to the ungrateful and the wicked.” But doing so is exactly what our Lord commanded us to do. And His command is not a command in the sense of being a burden. On the contrary, it’s a command that frees us from the ingratitude and wickedness we encounter.
Oftentimes, when we encounter ingratitude from another, or any other form of wickedness, we tend to react in kind. Our fallen human nature lures us into cruelty when faced with cruelty. We criticize, condemn, attack and get angry. But Jesus is very clear that this is not how the “Most High” acts toward the wicked. And it is not how He acts toward us. In the end, the wicked who fail to repent will endure the consequences of their rejection of God’s mercy. But until that final judgment, hope of conversion must always be present. And for that reason, we must never give up on another, no matter how difficult. Kindness shown to everyone, in every circumstance, goes to the heart of the mission we have received as children of God.
Think about the person in your life who seems unworthy of your kindness and generosity. Why are they undeserving? Are they truly undeserving? The truth, according to our Lord’s teaching, is that these are not questions we should even ask ourselves. Instead, we must fully commit ourselves to loving everyone who appears to be our enemy, and do good to them and to everyone whom we encounter. Though this is difficult, it won’t be if we understand the goodness that God has shown to us.
God has shone us perfect goodness, not because He expected anything back, but simply because He has willed to love us. If we want to be children of God the Most High, then we must reciprocate the love given to us. That’s the nature of God’s love. It cannot be contained. It cannot be selfishly received without also allowing it to pour forth from our lives. When we understand this, we will understand the reason Jesus instructed us to be “kind to the ungrateful and the wicked.” It is simply because this is how God has treated us. Reflect, today, upon the unlimited love God has for you. It is beyond what you could ever comprehend.
Reflect, also, upon the great benefit there is in opening yourself to God’s perfect love, kindness, generosity and mercy. The benefit is that you are able to be filled with that which you receive. And as you receive this love of God, it necessarily overflows into the lives of everyone you encounter, the good and the wicked. Everyone must always be offered this love. Do not hesitate, for God does not hesitate with you.
Most merciful Lord, You bestow Your abundant goodness upon all people, the good and bad alike. You never cease offering Your love and mercy. May I always be counted among those who fully open themselves to Your grace, and may I always offer this same depth of love to all. Jesus, I trust in You.
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Matthias Grünewald, Public domain, via Wikimedia Commons
