Mark Noble, Ph.D. © 2022

It’s most likely that you’re having a look at this guide because you want to learn how to overcome depression, anxiety or related emotional challenges. This could be a concern for you personally, or for someone you care about. You might also be a therapist interested in improving your ability to help people in emotional need.

Another reason you might be having a look at this guide is that you’ve heard that the new therapeutic approach of TEAM CBT is exceptionally effective at helping people when their emotions are not letting them lead the life they want. It may sound too good to be true that this therapy has rapid effects, doesn’t require any medications and works for many different problems. Even though that does sound too good to be true, it wasn’t that long ago that it also sounded too good to be true that we could fly across the ocean in metal cylinders, or could see inside someone’s body without having to cut into them. One of the things that science does is to take things that seem too good to be true and makes them possible. Applying those same scientific principles is what enabled the development of TEAM CBT.

This guide was written to make it easier to learn about TEAM CBT. TEAM is an abbreviation for Testing, Empathy, Addressing Resistance and Methods, and CBT is an abbreviation for Cognitive and Behavioral Therapy. TEAM CBT was developed by Dr. David Burns, one of the leading pioneers in the development of CBT. His research over the past several decades, based on analysis of thousands of therapy sessions with clients to determine the most effective ways to enable emotional change, enabled development of the new therapy of TEAM CBT. This new approach brings together the most powerful components from many different disciplines into one therapeutic approach. TEAM CBT also includes multiple new ways to understand how your emotions work and how to change them.

This is copyrighted under Creative Commons Licenses. That basically means that the only thing you can’t do is copy them and claim they’re your work. Other than that, these guides are freely available to all. If you find them helpful, then please share them with others. If you want to translate them into another language, please go ahead and do that (and please send me a copy of the translated version). These guides first were made available in podcast 275 at feelinggood.com, https://feelinggood.com/2022/01/03/275-a-spectacular-advance-featuring-professor-mark-noble/and also can be found easily just by searching their names on your web browser.

If you decide you’d like to learn more about TEAM CBT in still more detail, one place to go is Feeling Great, the newest self-help book by Dr. Burns. This book is filled with exercises that will guide you through the steps of TEAM CBT. For many people, working with the exercises in Feeling Great will be enough to provide substantial benefit. Even if you do not have a TEAM CBT therapist available to you, Feeling Great is designed to help you improve your emotional life. In addition, the podcasts on Dr. Burn’s website (www.feelinggood.com ) provide detailed examples of every aspect of TEAM CBT. There, you can find demonstrations of the potency of TEAM CBT in sessions with people who have not been helped by years (and often decades) of other therapies for severe anxiety, depression, OCD, and multiple other problems. Because nothing else has worked for them, these are generally considered the most difficult people of all to help. Yet, it’s routine to eliminate their depression and/or anxiety in a single two-hour TEAM CBT session with Dr. Burns. Although Dr. Burns is particularly skilled in this therapy, there are now multiple TEAM CBT therapists who can routinely treat people far more effectively than with other approaches, and who can help you learn more about the skills used in this powerful new approach to treating depression and anxiety.

With best wishes for your journey to feeling great,

Mark Noble
April, 2022

The 10 steps of TEAM CBT

Step 1: Agreeing to your Action Plan

Most people with depression or anxiety spend a lot of time every day thinking about their unhappiness. Many people also often spend years in therapy, being treated with powerful medications, or both. Sometimes they make slow progress, and sometimes they don’t make any progress at all. They can spend a lot of money, and the drugs they use can have unpleasant side effects.

What if you could take 15 minutes a day out of your worrying time, a few days each week for a couple of months (and maybe less), to achieve a happier state of mind?

Would it be worth 15 minutes a day practicing some new skills so that you can make rapid progress, and to recover so much that you don’t even need a therapist anymore?

TEAM CBT requires some effort on your part because, just like learning anything else, mental health requires practicing the right skills. Just like riding a bike, learning a new language or playing a sport, you don’t learn something new without putting in some effort. The way you learn something new is to practice the new skills. TEAM CBT is designed to create the rapid emotional change you want, and the skills you’re going to practice will help make that change happen.

Trading a few minutes of your worry time every day for a few weeks in order to practice new thinking skills is part of the TEAM CBT action plan. Your therapist also may ask you to work with the book Feeling Great, which contains lots of information on TEAM therapy and helpful exercises for practicing this new way of thinking. Feeling Great costs about $20. It’s like getting a second therapist for much less than the normal cost of therapy appointments – and this is one you can work with whenever you want to improve your new thinking skills.

Let’s say you’re standing on one side of a street and it’s cold and dark and wet. You’re not happy being there. The other side of the street is sunny and warm, and that’s where you want to be.

You can’t get to the other side just by talking about how you don’t like the dark side of the road. If you would rather be over on the sunny side, then you have to decide to cross the street.

That’s why you’re here. That’s why you’re reading this. You’ve decided you want to cross the street.

Let’s learn how to do that.

Step 2: How are you feeling?

A critical part of TEAM CBT is Testing. This is an important part of what makes this approach so powerful.

TEAM CBT uses simple tests to provide information on your feelings and on your progress, beginning with the Brief Mood Survey,

(For example, at https://www.google.com/searchclient=safari&rls=en&q=david+burns+brief+mood+survey&ie=UTF- 8&oe=UTF-8)

This survey is like an emotional thermometer. It provides information needed to start a session quickly and without stress. It’s easy to use, and it takes about a minute to complete. It provides information on Depression, Suicidal thoughts, Anxiety, Anger, Relationship Satisfaction, and Positive Feelings. The Brief Mood Survey makes it easy to describe your emotions, even if you find it difficult to put them into words.

The Brief Mood Survey can be found in multiple versions by searching for “David Burns Brief Mood Survey” on the web 2 (The most recent versions include a section on positive feelings, which was not included in earlier versions of this form.) There’s a more detailed version in Chapter 1 of Feeling Great, with an explanation of how to interpret the scores in each section. There are also versions of this form in Dr. Burns’ earlier books.

The fact that TEAM CBT therapists use the Brief Mood Survey at the beginning and the end of every session also makes it clear that rapid improvement is the goal of this approach. Therapies that take months or years won’t cause much change in just a few sessions. Checking your progress at the beginning and end of every TEAM CBT session only makes sense if rapid change is possible.

Using the Brief Mood Survey al so makes it easy to find out if details of your treatment strategy need to change. For example, filling out this survey at the beginning and end of every session can reveal problems that need attention but aren’t being talked about yet.

Step 3: Empathy

The next step in TEAM CBT is Empathy. This step will accomplish four goals:

1. Acceptance: The empathy step in TEAM CBT lets you feel seen, understood and accepted for who you are. Your TEAM CBT therapist will always try to meet you where you are right now.
2. Alignment with your therapist: You’ll learn that you’re working with someone who can be counted on to be on your side.
3. Decreasing stress: If you’re feeling accepted and understood, then your stress levels will decrease naturally. Decreasing stress is a big help any time you’re trying to learn new ways of thinking.
4. Activating the nerve cells you’re going to modify: Talking about what’s troubling you will activate nerve cells in your brain that are the physical part of your feelings and thoughts. You need to activate these cells to modify them by learning new ways of thinking about your life.

By learning that you’re in a safe space where you don’t have to defend yourself, you’ll be able to share what’s troubling you. Feeling safe allows you to even share information that you haven’t shared with others. Many of us have secrets that we’re afraid to share – sometimes even with ourselves. The secrets might be about something that we did, thought or said, but just as often they’re about something that was done or said to us. For example, some people are ashamed if they get angry at someone else, or if they’re feeling jealous. At other points along the spectrum of our experiences, many people who were physically or sexually abused also can feel intense shame about what happened. They can worry that if they share such information with anyone, they might be judged, or pitied. People might have all sorts of emotions that they’ve been taught they’re not supposed to feel or express – and so they even hide them from themselves.

Talking about what’s troubling you is one of the critical steps that will help change your emotional life.

During the empathy step, your therapist will check frequently to see if they’re understanding you correctly. If there’s something you think they need to know that hasn’t come up yet, then you’re in a safe place where you can share information about anything that’s troubling you. If they’re not understanding what you’ve told them, then it’s important to correct them.

Before completing the Empathy step, your therapist may ask you to grade them on how well they’re understanding you. This is another example of the way TEAM CBT is designed to get specific information on how your therapy is progressing. If you think you’re feeling fully accepted and your therapist is understanding you well, but something is still missing, then give them a B, or even a B plus. If you think they’re not doing a good job, then give them a lower grade. Your therapist’s goal is to understand you so well that you decide that the right grade is an A. Only give this perfect grade if you feel they’ve shown full acceptance and full understanding of you.

Step 4: Work on a moment with the Daily Mood Log (DML)

After you decide your therapist understands what’s troubling you, they’ll ask if you’re ready to move on to the next step or whether you want to spend more time talking. Your therapist won’t move forward until you say that you’re ready.

Once you’re ready to move forward, it’s time to begin using the techniques that make TEAM CBT so powerful.

If you’re ready to move forward, then the next step is to take a deeper look at your emotions in just one moment of time when they were very powerful. This is another special part of TEAM CBT, and is based on the discovery that solving your problems for one moment in time can solve them for all the moments in your life. That sounds surprising but it’s true. (If you want to find out why it’s true, this information is in the Brain User’s Guide to TEAM CBT.)

The tool you’ll use to work on a single moment is called the Daily Mood Log (DML):

You can find a copy of the DML at https://feelinggood.com/wp-content/uploads/2020/08/Daily-Moodjournal- with-goal-1-a-with-Do-Not-Copy.pdf.(In Feeling Great, it’s called the Daily Mood Journal, but both names refer to the same forms.)

To start using the DML, choose a single moment to work on. It can be a time in the past, a future event that worries you, or it could be right now. Then go to the table at the beginning of the DML, circle the words that describe your emotions and write down a number between 0 and 100 to describe how intensely you feel each emotion.

Step 5: What are your negative thoughts?

Sharing your troubles can help you feel accepted and understood for a little while, but happiness requires more than that. It first requires finding out why you’re unhappy.

The central idea that explains how TEAM CBT works is the surprising discovery that your emotions come from your interpretations and predictions about what’s happening in your life. We often talk as though our emotions are explained by the events of our lives, but it turns out that what really causes our emotions is the way we think about those events.

If your thoughts are negative, then your emotions will be negative. Change your interpretations and predictions, and your emotions will automatically change to match your new thoughts. That sounds simple – but how do you do it?

TEAM CBT works by teaching you how to change the way you think about your life. That’s why your next step is to identify the negative interpretations and predictions that are the keys to understanding your emotions.

The first thing that you’ll do in this step is choose a feeling you want to work on and write down the negative thoughts associated with that feeling. You’ll also write down how much you believe thosethoughts are true. Your therapist, and Feeling Great, will explain just how to do this. Writing down each thought and how much you believe it’s true is another part of the Testing of TEAM CBT. Doing this gives you information you need in order to know when your belief in your thoughts is changing.

Step 6: Discovering awesome and beautiful things about you revealed by your negative emotions and negative thoughts.

The next step in TEAM CBT is based on another surprising discovery. It turns out that your negative feelings and thoughts reveal positive things about you. That may sound like it can’t be right, but it turns out to be true.

Discovering the positive virtues revealed by your negative feelings and thoughts is called positive reframing. Your therapist, or doing the exercises in Feeling Great, will help you learn how to do this. You’ll learn that depression and anxiety are revealing what’s right about you, not what’s wrong about you. The positive reframing step is one of the novel techniques that makes TEAM CBT more powerful than other therapies.

In addition, positive reframing gives you the information you need to melt away resistance to change. Many people with depression or anxiety find out during therapy that they have some resistance to changing their emotions. This is called therapeutic resistance. Although it doesn’t occur for everyone, when it does happen it can make recovery more difficult. And it’s confusing and frustrating, because the reason you’re seeing a therapist is that you’re not happy with the emotions you have right now. The unconscious part of your brain, however, acts as though it’s not so sure about changing these emotions. You don’t know what’s going on, but it seems like something keeps holding you back from getting to happiness. When you know in your conscious mind that you want change to happen but your unconscious mind is resisting that change, you might even start believing that you really are broken and hopeless.

Until TEAM CBT, it’s been difficult to overcome resistance to change. In fact, many therapists talk and write about resistance in ways that can actually make people feel worse. This is because therapists often believe therapeutic resistance reveals something that’s wrong with you. Instead, TEAM CBT therapists believe that the occurrence of therapeutic resistance shows that your brain is working just the way it’s supposed to, and that working with this aspect of brain function can greatly speed up therapeutic progress. This idea is discussed in detail in the Brain User’s Guide to TEAM CBT, in Feeling Great and in multiple podcasts at www.feelinggood.com.

To overcome resistance to change, you’ll use what TEAM CBT therapists call a Magic Dial to help you decrease the intensity of your negative feelings and still keep all the virtues they reveal. To use the Magic Dial, you choose the intensity of feelings that make sense to you, and write those down as your goals on the Daily Mood Log. You can set those goals at any intensity of emotions that feels right for you. Instead of believing that your emotions are something you’re stuck with, you learn that you actually can choose the intensity of your emotions.

In these steps of TEAM CBT, you’re learning how to modify specific nerve cells that are part of your negative thinking habits. Whenever you learn something new, you’re modifying your own nerve cells. As explained in the Brain User’s Guide to TEAM CBT, what you’re doing in this step is taking your “negative” nerve cells and connecting them to other “positive” nerve cells. That way, when you have a negative feeling or thought you’ll also know how to see good things about you that are also going on.

Step 7: Are your negative thoughts accurate?

Our brains are amazing, but they’re not perfect. We all have lots of flaws in our thinking. In TEAM CBT, and in Feeling Great, the thinking errors are called cognitive distortions. Other people might call them irrational thinking, or other names. What we call them isn’t important. What’s important is whether your negative thoughts are accurate and lead to helpful answers, or whether they lead you astray.

That’s why the next step in TEAM therapy is to find out if your negative thoughts are based on flawed reasoning. This is an easy skill to learn, particularly because there are only a dozen thinking errors that keep showing up in people with depression or anxiety. They include such thinking mistakes as all or nothing thinking (where we think that something can only be 100% good or 100% bad), fortune-telling (where you’re sure that something bad is going to happen even though you have no evidence this is true), mind-reading (where you believe that you know what others are thinking about you – and it’s usually bad), and nine others. All twelve thinking errors are described at the end of the Daily Mood Log.

The thinking errors of cognitive distortions occur in all of us and we’ve all experienced every one of them at one time or another - but they occur more often in depression and anxiety.

Cognitive distortions change your thinking so that you make interpretations and predictions that are not accurate. When you learn to identify and correct the distortions, then you can change your thinking and change your emotions for the better.

To find out if your negative thoughts are based on cognitive distortions, the next step is to pick a negative thought to work on and see if you can find any distorted reasoning in that thought.

Once you learn how to do this, it’s easy to move from one negative thought to the next one, and to learn how to identify cognitive distortions whenever they interfere with your happiness.

This step is another part of the testing in TEAM CBT, and it’s also another way that you’re going to modify the nerve cells that are important in your negative feelings and thoughts. You’re testing whether your negative thoughts are accurate. You’re also connecting your “negative” nerve cells to other nerve cells that identify cognitive distortions. That way, when you have a negative thought, you’ll also know how to find out whether it’s based on distorted thinking.

Step 8: The Methods of TEAM CBT enhance rapid progress, personalize your therapy, integrate all the information you’ve learned thus far, and help prevent relapses.

For many people, emotional change is already in full swing, but we’re not done yet. The goals of TEAM CBT are to enable recovery that is complete and that will last. Your TEAM therapist wants to be the last therapist you’ll ever need. The next step is important in achieving these goals.

The next step involves the use of different Methods to help bring you across the finish line of emotional change and to provide more skills to help maintain your happiness. Even if you’re already feeling pretty good, learning some of the TEAM methods is a chance to put what you’ve learned into practice so that you’re ready to respond if you hit a bump in the road later on.

TEAM CBT therapists are trained in over 100 different methods that let them adjust therapy to your individual needs. Everybody has different histories and patterns of thought, and your brain may work in a slightly different way than someone else’s brain.

This is another important aspect of TEAM CBT. If you work with a therapist who’s aligned with one particular way of working, and that approach doesn’t work for you, you’ll likely need to find a new therapist. This is much less of a concern if you’re working with someone trained in TEAM CBT, because any technique that’s useful can be integrated into the TEAM approach, and your therapy can be personalized in any way that’s helpful for you.

While you’re working with different methods, you’ll keep checking whether belief in your negative thoughts is decreasing. When you’ve crushed the negative thought that you’re working on, then you can move on to the next one. If you’re having trouble crushing a particular negative thought, don’t worry. Your TEAM CBT therapist has many methods you can try, and will find ones that work for you.

The last step in using the Daily Mood Log is to find out how much your feelings have changed. As you’ll see, if you’ve decreased belief in your negative thoughts then your negative feelings will decrease automatically. That’s because this is how the brain works. It turns out the way to change your feelings is to work on your interpretations and predictions. When they change, your emotions also will change.

Step 9: Relapse training

Another aspect of TEAM therapy that differs from other approaches is the way relapses are handled. Relapses in the treatment of depression and anxiety, with the return of the feelings that made you seek out therapy, are a frequent challenge. Symptoms can return in stressful situations, or they can return without a known cause. For most people, relapses are frightening, and can cause you to doubt yourself so much that you believe you really are defective and hopeless.

The goals of TEAM therapy are to achieve complete recovery and also to prevent relapses. To achieve recovery that lasts, TEAM therapy provides specific training to prepare you for the future. Psychotherapy is not like taking antibiotics for an infection, where the goal is to eliminate the bacteria that’s making you sick. It’s more like taking care of your bicycle or car. You don’t repair your bike or your car once with the idea that you’re done forever. The maintenance of your brain and your mental health is far more important than the maintenance of your car or bicycle, and relapse training teaches you how to do this.

Most types of psychotherapy consider relapses challenging to treat, but TEAM CBT therapists are much more positive in the way they think about relapses. Relapse training usually begins with an introduction along the lines of “I’ve got some good news, some great news and some really great news. The good news is that at some point you’re going to have a relapse. The reason this is good news is that it shows that your brain is working normally. Life has ups and downs for all of us, and no one is entitled to seven happy days a week. So, the fact that you might feel down again just shows that you’re human. The great news is that the techniques you used today will work for you every time you need them in the future. And the really great news is that now you’re able to do this on your own. These techniques are part of your new skill set. And if you need a refresher, you can do some review work with Feeling Great or check back in for a quick tune-up.”

Instead of being afraid of a relapse, people trained in the techniques of TEAM CBT welcome the chance to use their skills. It’s exciting instead of frightening, because you know you’re going to come out of it okay, and you can enjoy what you’re now able to do. You’re not helpless, because you now have powerful techniques you can use whenever you need them. The situation no longer

feels hopeless. (If you’d like more information on relapse training, there’s more in the Brain User’s Guide to TEAM CBT and in Feeling Great.)

Step 10: Evaluation: how did the session go?

How do you know what progress you’ve made? Whether improvements are going to last? How do you know what to change so that your therapy is more effective? Another of the unique features of TEAM therapy is that all these questions are addressed throughout the session and again at its end.

Every TEAM therapy session ends with filling out two forms that are very quick to use. These forms also demonstrate additional important differences between TEAM CBT and other treatments:

• The first thing to do is to fill out the Brief Mood Survey again, to find out how well the therapy session went. The information in the Brief Mood Survey helps you chart your own progress, and helps increase your awareness of your emotions

• The second form is an Evaluation of Therapy form. This is also used after every session. It just takes a couple of minutes to fill out, and it provides critical information to your therapist so they can improve their ability to be helpful to you.

When you fill out the Brief Mood Survey at the beginning and end of every session, you’ll hopefully see real evidence of change. When people fill this survey out at the end of a successful session, they’re often amazed at how much their emotions changed. The information in the Brief Mood Survey is also critical in seeing if adjustments are needed in your therapy, and identifies specific goals for any future sessions. If your scores are changing in one area but not in another, then knowing this information can help your therapist adjust the therapy precisely according to your needs.

The Evaluation of Therapy form is another unique feature of TEAM therapy. This form provides feedback to your therapist on multiple topics:

• The empathy part of the Evaluation of Therapy form is one way that you give feedback to your therapist. There is a 20-point scoring range for the evaluation of empathy during the session, and the only passing grade for your therapist is a perfect score of 20 points. This is like when you gave your therapist a grade at the end of the empathy session, but now you’re going to grade them on the entire session.

• The Evaluation of Therapy form also has sections on helpfulness of the session, satisfaction, your commitment, negative feelings and difficulties with the session.

• This form also asks what you liked least and what you liked best about the session. These questions give you the opportunity to provide even more specific feedback to your therapist.

  
  

Closing comments

I hope this Brief Introduction to TEAM CBT has been helpful to you. For more information, you can go many different resources, including A Brain User’s Guide to TEAM CBT and Exploring the Daily Mood Log. Both of these are also available for free, and both include recommendations on where to find still more information.

About the Author

Dr. Mark Noble is Professor of Genetics and Neuroscience at the University of Rochester Medical Center. He’s best known for his work as one of the pioneering figures of stem cell biology. His current laboratory is engaged in development of improved treatments for traumatic injury to the nervous system, more effective and safer treatments for various types of cancer, and discovery of new molecular pathways involved in development of the nervous system.

Following disturbing discoveries in his laboratory on the toxicity of some widely used antidepressants, Dr. Noble reached out to Dr. Burns in 2017 to understand TEAM therapy. After observing the remarkable changes that occur in high-speed therapeutic sessions, he began interacting with Dr. Burns and his colleagues to understand how TEAM therapy can produce such rapid change, even in people for whom other therapeutic approaches failed to provide benefit for years, or even decades. This work has led to new hypotheses on the neuroscience of effective psychotherapy, as well as to experiments on molecular aspects of chronic stress that feed back into Dr. Noble’s research on cellular and molecular approaches to understanding normal development and treating disease. Additional thoughts on the analysis of TEAM therapy from the perspective of brain function can be found in podcasts that are part of the free weekly series provided by Dr. Burns as part of providing training in this therapeutic approach. At Dr. Burns’ invitation, Dr. Noble also contributed a chapter on the neuroscience of TEAM therapy for Feeling Great.

Podcasts on TEAM therapy from the perspective of how the brain works are at:

https://feelinggood.com/2018/08/06/100-the-new-micro-neurosurgery-a-remarkable-interview-with-drmark- noble/ , https://feelinggood.com/2019/11/18/167-feeling-great-professor-mark-noble-on-team-cbtand- the-brain/ and https://feelinggood.com/2022/01/03/275-a-spectacular-advance-featuring-professormark- noble/ .

Podcast 275 includes links for downloading the Brain User’s Guide to TEAM CBT and Exploring the Daily Mood Log. Dr. Noble’s chapter in Feeling Great is Chapter 30.