You FEEL the Way You THINK! . . . Or Do You?
The next three podcasts feature a therapy session with Marilyn, a woman recently diagnosed with Stage 4 (terminal) non-smoker’s lung cancer. We are enormously grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will inspire you, and give you courage in facing losses, traumas and problems in your own life.
At the beginning of the therapy, Marilyn is in shock, experiencing, quite understandably, extreme levels of depression, anxiety, shame, loneliness, hopelessness, and anger. What’s the cause of her negative feelings?
According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel.
When you’re upset, you’ve probably noticed that your mind will usually be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings.
In addition, you may not be aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In fact, in my first book, Feeling Good, I listed the cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events, can be enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel.
But is this notion really true? Can’t traumatic events upset us? And can we really change the way we think and feel when the circumstances of our lives are genuinely awful? Or is this just a lot of pop psychology?
A lot of people don’t buy into the notion only your thoughts can upset you. It just seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers the negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real.
Would you agree? I know that’s what I used to think! If you’re interested, and you have not yet listened to the first Marilyn podcast, you can take the brief poll on the home page and let us know what you think!
The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating. At the end of the third podcast, you’ll have the chance to take the poll again.
In this podcast, Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session. If you’d like, you can review the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative feelings are all severe, and that her negative thoughts focus on several themes, including
- Her fears of cancer, pain, and death.
- Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, and feeling that she’s perhaps been duped by religions.
- Her feelings of incompleteness at never having had a truly loving life partner.
- Her intense self-criticisms, beating up on herself for excessive drinking during her life.
The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, where David and Matt will attempt to reduce Marilyn’s resistance and enhance her motivation using the Miracle Cure Question, the Magic Button, the Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, where David and Matt will encourage Marilyn to challenge her negative thoughts using Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and the Acceptance Paradox, followed by Relapse Prevention Training, the end of session testing, and wrap-up.
Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a spiritual person who suddenly finds herself without hope or faith, and totally lost, we have called part one, The Dark Night of the Soul, a concept from William Johnston’s classic book on religious mysticism entitled, The Inner Eye of Love.
We are hopeful these broadcasts will stimulate comments and discussions on the philosophical and spiritual messages embedded in the Marilyn session from you and our other listeners. Is it true that only our thoughts can upset us? And is the total loss of faith a necessary step on the path to enlightenment?
Live Session (Marilyn) — The Dark Night of the Soul (Part 1)
I’m 42 minutes into this, and I am so grateful to Marilyn for sharing her experiences with us. I’m sending my love and hugs Marilyn!
thanks, Rob! Can I forward your comment to Marilyn? I’m sure she’d greatly appreciate your kindness and concern! david
I admire Marilyn’s strength in sharing her story and experience to help others.
Thanks! Me too! david
I listened to the entire podcast, amazing, inspiring and I felt moved by Marilyn story. I wish her all the best. Thanks so much for your courage in sharing your story with us
Thank you! David
Marilyn’s ability to describe her terror and doubts were deeply touching and brought tears. I just saw her at the Intensive and wasn’t aware of her illness, she was so giving and helpful as she has been in the past. My love goes out to her and to those who care so deeply for her.
Thank you, Christiaan! david
I was very distressed while listening to Marilyn’s podcasts. I listened to 1,2 but I could not find #3. I found on social media the last one post 8 weeks. I was in awe of Marilyn’s courage and the humor with which you and Matt conducted the sessions, but boy was I sad, angry and depressed.
Miracle of miracles 2 days later, it was as if I was the patient and went thru the therapy. I felt calm, relaxed and full of energy.
Thank you Dr. Burns. This was an interesting experience.
Thank you too to Marilyn, Matt and Fabrice who makes listening to the podcasts an easy endeavor.
Hi Renee, Thanks for the kind comments! You can find all the podcasts on my website, http://www.feelinggood.com. Sorry you had some trouble finding one of them. David
I am blown away by this Podcast. I worked with many individuals from 2005 to 2020 as a public health specialist with the US Federal Govt, that had various stages of cancer, including some that were classified as “End Stage Terminal.” Listening to Marilyn describe her experience really touched my heart. I recommend that all my coworkers listen to this Podcast so they fully understand what these brave souls are going through. Looking at a case file is not as emotionally moving as actually listening to the client. (It breaks my heart knowing that she did not survive.)
Thanks! I have sent to Marilyn. Warmly, david
what if she chose to work first on her thought “I don’t want to have cancer?”. Would it have been worth it to analyze It’s distortions?. How would you have approached it?
This thought is not distorted, so I would start with E = Empathy and listen, using the Five Secrets. Once I’ve gotten an “A” in empathy, I’d ask if there was something they want help wtih. Best, david
It is not a distorted thought. I would empathize, let her express her fears and sadness and so forth. No one wants cancer! Healthy grief or sadness does not need treatment. But she had many distorted thoughts that she did want help with. Thanks! david
Thanks for the answer David. I have another unrelated question: how would you treat someone whose main upsetting event was “I have erectile dysfunction” or something like that?
Thank you for this question. Erectile dysfunction can have many causes, and it can be helpful to have a medical evaluation to rule out any medical causes, like diabetes, hypertension, and so forth.
Therapy can also play an important role, whether or not their are medical causes. Remember it is not the event, but our thoughts about it, that cause emotional distress. And when I treat people, I always follow the TEAM structure. I don’t chase problems with techniques or formulas.
A young man was afraid of getting nervous and not being able to get an erection with women he was dating. I asked him why it would upset him if he didn’t get an erection. What would he tell himself? His negative thought was, “This means I have a problem.” A number of cognitive techniques were helpful to him, like Identify the Distortions as well as the Double Standard Technique. For example, would he say this to a friend with a similar problem? If not, what would he say?
He said he’d tell his friend to think about it this way instead: “Maybe this means that SHE has a problem!” Although this is perhaps disrespectful, it struck him as humorous and allowed him relax a bit.
I also explained the ideas behind the Masters and Johnson sensate focus method they described in their famous book on Huma Sexual Inadequacy. The idea is to take intercourse off the table for a while, and instead to learn to pleasure one another. This removes the pressure to have sex and allows the couple to relax. This can be helpful because performance anxiety, or any strong negative emotion, can easily inhibit the sexual response. When the negative feelings are reduced, this opens the door for sexual feelings to emerge.
I suggested that he might want to modify this procedure for dating and tell the woman that he wasn’t the kind of guy that liked to hop in the sack right away and have quick sex but liked to develop a relationship first. He could tell her that if they wanted to do an overnight, and get closer, they could cuddle as long as she agreed not to have sex. He loved this idea since it took all the pressure off of him. He liked this idea, and once he set it up like this, he found that his erections came naturally. Problem solved.
But this was just the approach with one person. Everyone is different. I have treated men and women with difficulties with sex, and each story, and each human being, is unique, and requires a unique approach. For example, if the couple are close, then it can often help to work on the problem collaboratively, as described clearly in the book by Master’s and Johnson.
These are just some examples, and are not intended as a substitute for a consultation with a health professional!
Thanks David, It’s an honor for me to be able to ask you whatever questions pop into my head, since I plan on using TEAM once I graduate from grad school.
Cool. When you start your clinical training or practice, you might want to consider joining our two free weekly TEAM training groups. Best, david