TEAM: a dramatically improved form of therapy

post by Jakob_J · 2021-05-31T13:33:37.016Z · LW · GW · 20 comments

Contents

    Note: The information provided below is not medical advice, and should not be treated as such. Please seek the advice of your physician with any questions you may have regarding a medical condition.
  CBT and TEAM
  A not completely fictitious example
    Benefits of telling myself that “I am a failure as a scientist”:
  Links:
  An incomplete guide to the Feeling Good podcast episodes
    Physical health
    Performance anxiety
    Existential depression
    Helping others
    Social anxiety
    Relationship troubles
None
20 comments

Note: The information provided below is not medical advice, and should not be treated as such. Please seek the advice of your physician with any questions you may have regarding a medical condition.

I believe a new form of psychotherapy has been found that is significantly more effective than more conventional therapies such as CBT. Despite this, it is unlikely to replace these in the near term. One of the many reasons for this is that the most complete source is found in a relatively obscure podcast, and it takes listening through hundreds of hour-long episodes in order to fully grasp how radically different it is from more conventional schools of therapy. However, the time investment is worth it: my own moods have improved drastically, and my life has been transformed after discovering this podcast. I frequently find that I can not only resolve most of my own mood problems at an early stage, I am also able to better empathise with others without jumping straight to “problem-solving” in a way that would be counterproductive and annoying to the other person.

The podcast is called Feeling Good, and is run by David Burns who is the author of the bestselling self-help book Feeling Good and one of the earliest practitioners of cognitive behavioural therapy (CBT). In the podcast, he introduces his new form of therapy: TEAM (also known as TEAM-CBT). TEAM is heavily influenced by CBT but actually draws from a wide range of different schools of thought (TEAM stands for Testing, Empathy, Assessment of resistance, Methods, where methods can include anything from exposure, acceptance, Gestalt therapy, et.c.).

CBT and TEAM

Building on the work of Karen Horney and Albert Ellis among others, Aaron Beck and David Burns found that depressed patients often had thoughts that were not only negative and self-critical, but also illogical; they categorised these into several “cognitive distortions”: all or nothing-thinking, overgeneralization, fortune telling, mental filter, et.c. By making patients see how factually and logically wrong their negative thoughts were, they often saw rapid recovery even in severely depressed patients. This is the foundation of CBT, which due to its effectiveness has become the most widely practiced form of psychotherapy.

Despite the success of CBT, David Burns still found that a significant minority of his patients were remarkably resistant to treatment. This led him to develop TEAM, which places a much heavier emphasis on motivation than CBT. In TEAM, the therapist takes on a different role: instead of trying to convince the patient to change his or her thoughts, the therapist tries to find reasons that the patient should not change. This is based on the insight that people may be reluctant to change if they think that their way of thinking benefits them in some way.

A not completely fictitious example

Recently, one of my papers was rejected from a journal. This made me feel discouraged, incompetent, and hopeless. My thoughts were “I am a failure as a scientist” and “I am just too lazy and incompetent to be good at anything”. 

The above thoughts certainly contain several cognitive distortions, so how could we find positive aspects of them, in order to motivate me not to change? At first, it was hard to see anything positive about these thoughts, but having done lots of TEAM homework I can now easily spot several advantages. I will list a few of them below.

Benefits of telling myself that “I am a failure as a scientist”:

By getting rid of the thought “I am a failure as a scientist”, I lose all of these benefits. My paper would still be rejected, but I would be happy about it. That doesn’t make much sense. Instead of completely changing this thought, it makes more sense to reduce the intensity of it, so that I get rid of the suffering but can keep all of the benefits. Similarly, it is also possible to "positively reframe" negative feelings such as hopelessness and feeling incompetent. Paradoxically, by consciously accepting the benefits of my negative thoughts and feelings, I am much more likely to want to change since I am no longer subconsciously resisting it. At this point, I am ready to change my negative thoughts by using methods such as the "double standard technique", where I write down what I would say to a dear friend if they were in a similar position.

This is just one of the aspects of TEAM, and I might write future posts to expand on other aspects. However, the best way to learn about it is to simply dive into the many podcast episodes, and pick ones that seem relevant to you. I have listed some of my favourites below, categorised by theme. If you would prefer to read about it, you could order the Feeling Great book which also provides a very good overview of TEAM. However, I would strongly recommend starting with the podcasts since they are completely free and contain many recordings of live therapy sessions, which really helps to show how TEAM works in practice.

Links:

https://feelinggood.com/list-of-feeling-good-podcasts/
Note: the episodes can also be found in most podcasts apps.

https://www.amazon.co.uk/Feeling-Great-Revolutionary-Treatment-Depression/dp/168373288X

https://www.amazon.com/Feeling-Great-Revolutionary-Treatment-Depression/dp/168373288X/ref=sr_1_4?dchild=1&keywords=feeling+good&qid=1622468294&sr=8-4

An incomplete guide to the Feeling Good podcast episodes

Physical health

Live Therapy with Marilyn: "What if I die without having lived a meaningful life?"

Sarah Revisited: A Hard Fall–and a Triumphant Rebound!

Escape from Physical Pain: An Interview with Dr. David Hanscom

Performance anxiety

Performance Anxiety: The Story of Rhonda, Part 1

Performance Anxiety: The Conclusion

The Achievement Addiction: Bane or Blessing? Part 1

The Achievement Addiction: Bane or Blessing? Part 2

Existential depression

Live Therapy with Dan. How Do You Treat an “Existential Depression” in the Midst of a Pandemic?

Helping others

How to HELP, and how NOT to Help!

My Husband is Leaving Me. I Think He Needs Help!

Social anxiety

Live Therapy with Michael–The Awesome Atlanta TEAM Therapy Demo!

Relationship troubles

Live Session (Lee) — Testing, Empathy (Part 1)

Live Session (Lee) — Agenda Setting (Part 2)

Live Session (Lee) — Methods, (Part 3)

Live Therapy with Sarah: Shrinks Are Human, Too!

Corona Cast 4: I Might Lose My Husband!

20 comments

Comments sorted by top scores.

comment by Kaj_Sotala · 2021-05-31T14:43:48.919Z · LW(p) · GW(p)

This sounds similar to memory reconsolidation -based therapies [LW · GW], which assume that any emotional issue that you have exists because that issue actually serves some purpose, and in fact your "problem" represents a solution for some other problem that you have had before. By acknowledging the positive purpose behind the issue, you can find a way to keep the purpose while changing the strategy.

I haven't listened to any of the episodes, though, so I'd be curious to hear whether you think that's talking about the same thing or something subtly different?

Replies from: GuySrinivasan, ChristianKl, Jakob_J
↑ comment by SarahSrinivasan (GuySrinivasan) · 2021-06-01T03:12:29.186Z · LW(p) · GW(p)

The single most important thing I got from PJ Eby was the "what's good about that?" question.

↑ comment by ChristianKl · 2021-06-01T16:40:35.929Z · LW(p) · GW(p)

I think you are focusing too much on the specific technique. With TEAM the therapist is first supposed to use a technique for (assessment of resistance) and then a technique to change (method). 

As far as I understand the technique that the OP described is one techinque that's used in TEAM for "assessement of resistance". The TEAM therapist is supposed to have a toolbox of techniques for both. While a memory based technique could be used in the TEAM framework there's no high level idea that specific techniques should be used and just first addressing resistance and then addressing change. 

Replies from: Kaj_Sotala
↑ comment by Kaj_Sotala · 2021-06-01T17:01:06.651Z · LW(p) · GW(p)

Hmm, so do you mean that TEAM does not actually assume issues to necessarily have a positive function, the idea that they might have is just one way of overcoming resistance?

Replies from: ChristianKl
↑ comment by ChristianKl · 2021-06-01T21:05:07.988Z · LW(p) · GW(p)

I take https://feelinggood.com/science-behind-t-e-a-m-therapy/ as a canonical source about what TEAM is about. 

In it David Burns writes:

Based on these studies, I radically changed the approach to treatment that I’d been using for years, and developed the Paradoxical Agenda Setting (PAS) techniques that are now at the heart of T.E.A.M. Therapy. The PAS methods are beyond the scope of this document, (see Burns, 2005, for more information), but the basic idea is to melt away the patient’s resistance prior to using any techniques to help patients with their depression, anxiety, relationship conflicts, or habits and addictions.

To facilitate this process, I developed the list of the eight most common patterns of therapeutic resistance, as along with many techniques to reverse each pattern. Certainly more research is needed, but from a clinical perspective, these PAS techniques appear to have revolutionized treatment and have produced high-speed recovery for many patients who had failed to make significant progress after years of more conventional therapy, including “Beckian” CBT.

My colleagues and I are convinced that failures of Agenda Setting represent the most common cause of therapeutic failure. We also believe that the vast majority of therapeutic failures can be quickly and dramatically reversed with the skillful and compassionate use of the PAS techniques I’ve developed.

To me this view is not about whether issues have positive function. 

David Burns also writes:

"Over the years, I’ve developed many techniques to help patients challenge and defeat the negative thoughts that trigger depression, hopelessness, and low self-esteem, as well as fears, phobias, anxiety, and feelings of panic. My treatment philosophy has always been to “fail as fast as you can,” since you can never predict what technique will work for what patient or problem."

Burns seems to me agnostic about what issues really are about and just wants the therapist to try a bunch of different techniques and measure the effects. 

TEAMs is more processed based then content based. It doesn't depend on beliefs about the true nature of mental disease.

My thoughts on Prediction-Based Medicine [? · GW]are partly a extension of the ideas of TEAMs. The way Burns proposes TEAMs to be done involves patients filling out forms before and after sessions to allow the therapist to learn when he's empathic and what results his actions have on his patients. 

Filling out the forms in paper instead of doing that digitally means that it's harder to do statistics and that it takes longer till the data that the patient filled out makes it to the therapist. If the therapist has to put down a probability on the patient having found the therapist empathic the therapist will be faster at learning when he's perceived as empathic by their patients then if the therapist just sees the numbers. The same goes for other effects of their interaction with the patient. 

My post on TOTE [? · GW]is also partly about the importance of fast feedback loops for therapists to develop treatment skills. 

Besides process the theoretical beliefs of TEAM are: Empathy is really important, alliance between therapist and patient is really important and resistance to change has to be dealt with before actually doing the problem specific change-work. 

Replies from: Kaj_Sotala, Kaj_Sotala, moritz-1
↑ comment by Kaj_Sotala · 2021-06-03T17:05:27.568Z · LW(p) · GW(p)

If the therapist has to put down a probability on the patient having found the therapist empathic the therapist will be faster at learning when he's perceived as empathic by their patients then if the therapist just sees the numbers. 

I wonder how accurate these kinds of answers are going to be. At one point my self-improvement group [LW · GW] was doing peer coaching sessions that involved giving your coach feedback at the end. I don't remember our exact questions, but questions about the coach's perceived empathy definitely sound like the kind of thing that could have been on the list.

I remember that when I'd been coached, I felt significantly averse to giving the person-who'd-just-done-their-best-to-help-me any critical feedback, especially on a trait such as empathy that people often interpret as reflecting on them as a person. I'd imagine that the status differential between a client and a therapist could easily make this worse, particularly in the case of clients who are specifically looking for help on something like poor self-esteem or excess people-pleasing. (Might not be a problem with patients who are there for being too disagreeable, though!)

↑ comment by Kaj_Sotala · 2021-06-03T16:50:15.315Z · LW(p) · GW(p)

Thanks, that's useful. I'd heard of some other reconsolidation-fans read Burns's new book and also highlight the "what's good about this" aspect of it as CBT "also coming around" to the "positive purpose" idea. So then when I thought I saw it in this post as well, I assumed that to be correct. Especially since that would have helped explain why TEAM is so effective.

Though interestingly this makes me somewhat more interested in TEAM, since it's obviously doing something different from what I already know, rather than just confirming my previous prejudices without adding new information. :-)

↑ comment by moritz (moritz-1) · 2024-04-09T16:56:37.868Z · LW(p) · GW(p)

It doesn't depend on beliefs about the true nature of mental disease.

Just a tiny correction here: CBT and TEAM both have the underlying assumption that your thoughts shape how you feel, which is an assumption about at least a part of the cause of mental diseases.

If you thought that for example depression was always just an imbalance in your neurochemistry, you'd never do a talk-based therapy and instead would focus on antidepressants.

Otherwise, I think your description of TEAM is spot-on.

↑ comment by Jakob_J · 2021-05-31T19:59:32.548Z · LW(p) · GW(p)

There are certainly similarities, but TEAM is a bit less "psychoanalytic" in the sense that it doesn't seek to unveil childhood trauma or anything like that. Instead, it focuses more on the here and now, and more on a person's positive qualities. The positive reframing step is meant to bring resistance to conscious awareness, since the patient usually do want to change their negative patterns of thought.

comment by maia · 2022-08-29T03:30:19.491Z · LW(p) · GW(p)

Hey, one year later, just wanted to say thanks for writing this post. I found the Feeling Good podcast really interesting and I've also bought and read Feeling Great, and I find myself often going back to the ideas in the book and podcast to help me with different situations. I think going through the exercises in the book helped me out a lot with medical anxiety. So, thank you for the recommendation!

comment by ChristianKl · 2021-05-31T19:53:29.620Z · LW(p) · GW(p)

The most interesting thing I found about TEAM is that David Burns makes the logical conclusion of the general finding that empathy of therapists is one of the most important factors of treatment success. 

Let patients rate the empathy of their therapist after every session and thus the therapist can work on improving their empathy (This is a combination of T and E where T is test and E is empty). 

comment by GeneSmith · 2021-06-01T07:32:32.452Z · LW(p) · GW(p)

Your not completely fictitious example is interesting.

I have these types of self-critical thoughts fairly often. Just reading your “validation” of the thought makes me feel oddly calm.

My prior for this sort of “novel therapy they works so much better than others” is that it probably doesn’t. Scott Alexander wrote a blog post about this back on the day in which he noted the effect sizes of new therapies almost always decline over time as they are studied by outside researchers rather than the inventors of the new form of therapy.

But perhaps I am wrong. Or perhaps the technique works much better for people who like that type of therapy. That’s certainly something we see evidence of in the therapy literature.

Thankfully I am not at a point in my life where I actively need therapy anymore, but if I do get back to that point I will give this a look.

Replies from: ChristianKl, Jakob_J
↑ comment by ChristianKl · 2021-06-01T16:32:27.334Z · LW(p) · GW(p)

A key feature of TEAM is that it's not just about using other therapy techniques and that most therapy techniques can be plugged into the framework in the method section. 

A huge problem of a lot of traditional therapy is that it focuses on techniques as if learning good techniques is all that's required to be a good therapist when that's not true as the research Scott references there shows. 

While the approach to TEAM uses to build skillful therapists likely isn't the only process that can work, a framework that does focus on skill development in therapists has advantages over frameworks of previous era's that are just technique focused and that treat the therapist as exchangeable. 

↑ comment by Jakob_J · 2021-06-01T07:58:49.959Z · LW(p) · GW(p)

Thanks for your comment!

Regarding your prior, yes I agree with this, and I also think the effectiveness of TEAM decreases dramatically with an unskilled therapist. All of the recorded live sessions are with David Burns, which might be an indication that it takes extreme practice to fully master it. I have only ever used it for "self-therapy", in order take the edge of some of my most self-critical thoughts as in the example. I think it works quite well for people who are looking for CBT-style therapy.

comment by hunterglenn · 2021-06-10T21:12:52.184Z · LW(p) · GW(p)

Thank you for your post, it's great to see people getting excited about TEAM therapy and you are rekindling my interest in it! I was listening to many episodes of this podcast as well, and I bought Dr. Burns's new book, Feeling Great. 

However, I've been having trouble finding a comprehensive anatomy of a standard therapy session. Have you come across anything like that, which shows step-by-step a session from beginning to end?

Replies from: Jakob_J
↑ comment by Jakob_J · 2021-06-11T10:15:52.873Z · LW(p) · GW(p)

I'm glad I managed to rekindle your interest in TEAM therapy!

Unless you have heard them already, I think the first 15-20 episodes give a pretty good overview of the structure and motivation of TEAM. The episodes with Mark, 29-35, also provide quite a good breakdown of the structure, since they stop and comment on each section before proceeding.

comment by Ilemauzar · 2021-06-02T19:01:58.434Z · LW(p) · GW(p)

Thank you, I had bought David Burn's "Feeling Good" book years ago and it was helpful at the time. Unfortunately, I seemingly lost the skills I had learned (or possibly I never truly learned them?) in my later years. I listened to a few episodes (including the Live Sessions with Lee) and I am really enjoying it. My main focus is improving my relationship, so the effective communication and focus on empathy are especially interesting to me. 

Replies from: Jakob_J
↑ comment by Jakob_J · 2021-06-02T22:51:34.856Z · LW(p) · GW(p)

Awesome, really glad that you've found the episodes helpful! I have also found that the live sessions focused on relationship issues to be some of the most enlightening ones.  

If you haven't already found them, there are several more episodes on the same theme. For example, you might be interested in listening to the ones with Mark:
Live Session (Mark) — Introduction & Testing (Part 1)

and the session with Brian:
Anger in Marriage: The Five Secrets Revisited
 

comment by hamnox · 2022-08-29T15:33:07.338Z · LW(p) · GW(p)

In TEAM, the therapist takes on a different role: instead of trying to convince the patient to change his or her thoughts, the therapist tries to find reasons that the patient should not change.

I recognize this model! The book "Immunity to Change" goes into great detail on a similar process.

Applying that specifically in a therapeutic context, to clear the path for treatment to really work, is SO BRIILLIANT!

comment by Chloe Thompson (Jalen Lyle-Holmes) · 2021-08-23T06:01:21.749Z · LW(p) · GW(p)

There's a 16 week Zoom book club coming up for Burns' book about TEAM-CBT, facilitated by a TEAM-CBT trainer, in case anyone is interested: https://www.feelinggreattherapycenter.com/book-club
(I just signed up)