448: Ask David, featuring Adam Holman

448: Ask David, featuring Adam Hollman Relationship woes--what should I do? How can animals have feelings if they can't think? How often should I fill out the Daily Mood Log? Why can't husbands express their feelings? Today we are joined by Adam Holman, LCSW. Adam has recently left his full time clinical practice in Arizona to join our Feeling Great app team here in San Francisco. I think you'll be delighted by his warmth and wisdom. Although he works with us full-time, he still practices one day per week and specializes in X depression, anxiety, and screen addiction(e.g. video game addiction and more.) He has appeared on two previous Feeling Good Podcasts, # X and # Y. We are delighted to have Adam as the honored guest on today's Ask David podcast! Here are the questions for today's Ask David. They were all written before the podcast. If you listen to the podcast, you will get much more information and perspective. The Questions Hello Dr Burns. I hope you are doing well. I participated in the webinar held on 18th of April. It was a good experience for me and I would like to thank you and your team in arranging for that.

1. Far asks: if You have a relationship problem, but also feel inadequate. Should you use the Daily Mood Log for the internal problem of inadequacy and the Relationship Journal for the actual dialogue?
2. Moritz points out that animals, who don't think in words, still have intense emotional reactions, including fear and anger. For example, when a deer spots a predator, like a cayote, it feels terror and instantly runs to get away. Doesn't this prove that terrifying events can cause feelings directly? In other words, that makes it seem like thoughts or cognitions are NOT necessary to feel emotions. What do you think?
3. Rob asks: How often do you fill out your own daily mood journals? Do you do one every day? Would you be willing to share recent examples of your own journals with podcast listeners?
4. Brittany asks: Why won't my husband share his feelings? (Or, we could ask, why can't men express their feelings?)

The Answers 1. Far asks: If you have a relationship problem, but also feel inadequate. Should you use the Daily Mood Log for the internal problem of inadequacy and the Relationship Journal for the actual dialogue? Hello Dr Burns. I hope you are doing well. I participated in the webinar held on 18th of April. It was a good experience for me, and I would like to thank you and your team for arranging it. May I ask a question? When there is a relationship problem it should be addressed by the relationship journal and interpersonal downward arrow and not by the cognitive method as far as I know. What about when there is a relationship problem together with strong feelings of depression and frustration as a result of an internal dialogue of being inadequate and defective. Should this component be addressed by the cognitive method and straightforward technique? Thanks a lot. Far Kom David's Reply This one just came in, so we'll answer it live. 2. Moritz: Are thoughts REALLY necessary to have emotional reactions to events? Hi David, first of all, thank you for the podcast, and in particular for answering my question about how you help people with schizophrenia or bipolar disorder, which came out a few weeks or months ago. I just finished listening to episode 430, where you stated that that negative thoughts can cause negative emotions (this part I'm totally on board with), but also hypothesized that probably only negative thoughts cause negative emotions. Did I understand that correctly? (If not, please ignore the rest of this email, it won't make any sense). I'm kinda confused about this claim. This is totally not my area of expertise, but I'm under the impression that fear is much older and more "primitive" than (at least conscious) thought, from an evolutionary point of view. It would seem unlikely that an old evolutionary feature in the brain would only be triggered from a newer feature. My other source of confusion comes from my own comparison with animals. It is my impression that basically all mammals show some kind of fear response, but we don't attribute thoughts to all of them, never mind full-blown self-reflective, conscious thoughts. So at least in the mammals with simpler brains, it seems likely that fear (and other negative emotions) could be triggered pretty directly without going through negative thoughts first, and it would also be quite surprising if we didn't all contain the same mechanisms, since we share most of our neural architecture with all mammals. Do you think these considerations are valid, and if yes, are they compatible with your approach? After listening to your podcast, my own mental model of negative emotions is something like this:

• stimuli can cause negative emotions directly; this happens in all mammals
• when the stimulus goes away, negative emotions also ebb and go away after a certain time, unless something keeps them alive
• in humans (and likely in at least some mammals), thoughts also can trigger emotions, and so they can disable the natural dampening of negative emotions.

This mental model might explain satisfy both the evolutionary considerations, and explain the data you've gathered from the Feeling Great app. I admit I feel a bit silly writing you this, because you spend so much more mental energy on these topics, so it seems unlikely I have anything to contribute that you and your team didn't think of. So, sorry for the long rambling, and I hope you still find something interesting in it, or maybe you can clear up some of my confusion about your model. Best regards, Moritz David's reply Thank you for your thoughtful comments. I think they are awesome, and definitely not "silly." Here's my take on it, for what it's worth, and I just speculate, too. All animals, including human animals, have perceptions. When a dear spots a cayote, the "stimulus" is a perception of a dangerous predator. This "cognition" triggers the emotion. People think cognition means sentences involving words, but my understanding is quite different. The idea is that any kind of conscious perception can trigger emotions, including sudden fear or anxiety. The perception might simply be an image, which is also a type of cognition or perception, that can suddenly trigger great fear. When I see a rock climber on TV, this "picture" or "perception" stimulates a powerful physiological fear reaction. That's because I "see" the picture as being incredibly dangerous and imagine falling. Thanks, david Might use as an ask David follow up, if that's okay! Moritz replies Ok, "simple" cognition without explicit thought can be enough to trigger emotion, got it. Feel free to use that as an Ask David if you want. Regards, Moritz David's final reply Thanks, yes, it is the perception of danger that triggers the fear. Terrific! As another example, you could argue that when the airplanes flex into the World Trade Center in New York on 9/11, everyone felt terrified, horrified, and devastated, and it was the event that caused these feelings. Doesn't this prove that thoughts, or cognitions, are not required to have powerful feelings? It would seem like you didn't have to put a thought in your mind to feel fearful when watching the horrifying images on TV. What do you think, Moritz? Well, here's my answer. It is not true that everyone had the same feelings watching that horrifying scene. We all had our own unique reactions, depending on how we were thinking about it. And of course, some people felt joy, glee, and more, and did NOT have negative feelings. That's because they thought about the event quite differently. For example, Osama Bin Lauden and his followers when watching were delighted, and like thinking, "Those Americans finally got what they deserved!" Same event—radically different emotional reactions. All of your emotions result from your thoughts. The positive and negative events of our lives do not, and cannot, affect us directly. We have to interpret the event first and give it meaning. Thanks! David

3. Rob asks: How often should you do Daily Mood Logs? Do YOU fill out your own Daily Mood Logs? Hello Rhonda and David: I hope you're both doing well. I'm a long-time listener to your podcast, and I shared an endorsement that you included in podcast episode 333 about two years ago. While listening to an episode recently, some questions occurred to me that I wanted to share with you. How often do you fill out your own daily mood journals? Do you do one every day? Would you be willing to share recent examples of your own journals with podcast listeners? I can understand how you might not want to do this and certainly respect your right to privacy, but I thought also it might be interesting for listeners to hear. I would be honored if you would share your thoughts with me when you have a moment. Rob Robinson All the replies to this excellent question will be spontaneous and live on the podcast.

4. Brittany asks: Why can't my husband express his feelings? Hi Dr. Burns, I have a question. This is something that frequently comes up in arguments with my husband. Here is an example from yesterday: Me after finding out he was upset the night before I said: "Why did you tell me everything was fine and it's all in my head if you were upset?" Husband: I shouldn't have to tell you. You should be better at reading me. I feel annoyed because when I did ask him if he was upset the night before, he denied it then put the blame on me the next day that I should be able to read his mind. That doesn't seem fair. I don't suppose I could put that in my five secrets response though as it wouldn't make the problem better. What do you think? I guess I should probably do the relationship journal. -Brittany David's reply Hi Brittany, Here's my quick assessment. Your first statement to him when he said he'd been upset sounded a bit blaming. In other words, he was trying to express his feelings openly and told you he'd actually been feeling upset. And you immediately punished him. Can you see that? In other words, you said: "Why did you tell me everything was fine and it's all in my head if you were upset?" Can you see that when he confided that he had been feeling upset, you blamed him for not telling you the night before. He might have felt scolded, put down. What do you think about that? And could that be why he has trouble expressing his feelings? Can I use this on an Ask David, with your first name or with a fake name? And yes, you can use the Relationship Journal on situations like this! For sure! Go for it! Sorry if this sounds harsh or direct. You know, I hope, that I have tremendous regard for you! David Other ideas include:

1. When we blame others, we are nearly always CAUSING the very problem we are complaining about.
2. Our anger and frustration nearly always results from "Should Statements." In other words, he "should" have expressed his feelings sooner, and better, etc. This sounds like you expect him to be some ideal husband, rather than a real husband. I sometimes also have trouble expressing my feelings, or even knowing clearly what or who I'm upset with, or why. And I always appreciate a little bit of help at figuring that out!