Moved to Tears by Mark’s Live Therapy Podcast / How do You Treat Habits and Addictions?

Dear David,

I wanted to contact you to tell you how tremendously informative, interesting, moving and inspiring I find your work and your podcasts.

I have listened to all the podcasts—many twice. I find that on the 2nd listening, I pick more up. I get out on my bike and the miles just fly by as I listen to these!

One day my wife returned just as your wonderful episodes with Mark were concluding. As she walked in, I was weeping tears of relief as I also understood (at the same time as Mark did) that my depression and anxiety said something beautiful and awesome about me, rather than only indicating something broken and weak.

I struggled (through the tears) to tell her that these were tears of joy and relief, and not sadness.

Also, I found your book Feeling Good and the Feeling Good Handbook most helpful for my own depression and anxiety. Your wisdom about Action leading to Motivation is something I use every day personally and professionally.

I would be extremely grateful if you could help me with something that has been bothering me professionally for years. I work at the Scottish Government as a personal trainer specializing in eating for weight loss. I have used your own and other CBT based books to help people with stick to weight loss eating plans with some success. But I really get the sense that your TEAM methods might “turbo-charge” the CBT methods.

Can you detail how the paradoxical agenda setting / outcome and process resistance stage might work in eating for weight loss scenarios to help people get (and stay) motivated to stop overeating (even if it’s not a huge overconsumption, just enough to keep them overweight). How can the TEAM approach help them stick to a sensible weight loss plan?

With 35 million people (in the UK alone) in these overweight/obese categories and no signs of a slowdown, I really feel that a large-scale adoption of a “turbo-charged” approach to motivation may help turn this around.

Your very gratefully,

Greg

P.S. I look forward to watching your next live interview on Sunday which I missed this week.

Hi Greg,

Thank you for your thoughtful email and kind comments about the Feeling Good Podcasts, which I will pass along to our “patient,” Mark, and Dr. Jill Levitt, my co-therapist, and my host, Dr. Fabrice Nye. I was inspired and touched by the tears you experienced while listening to the podcast, and I’m so glad you enjoyed the live therapy with Mark!

You asked some questions about the treatment of habits and addictions, such as overeating. The Outcome Resistance issue for habits and addictions is having to give up your greatest, or only, source of pleasure and reward. The Process Resistance issue involves discipline and deprivation. That’s not a very appealing deal, because you have to give up intense and frequent instant gratification in exchange for discipline and deprivation, and this explains why treatment programs are so ineffective.

Incidentally, most treatment programs focus on trying to “help,” as opposed to focusing on why the patient really does not want to give up the habit or addiction. Without a really strong focus on motivation and resistance, nearly all treatment programs will be doomed to failure, or mediocre results at best.

And that’s what you see if you examine the controlled outcome studies that have been published. I am not aware of any really effective treatment program for any habit or addiction. Of course, every approach has advocates, and every approach works for some folks—but I’m talking about controlled outcome studies with an experimental group and a control group, in terms of short-term and long-term results. Most treatments barely outperform placebo treatment, at best.

Of course, the advocates of these approaches do not like to admit this, because they have a heavy intellectual, emotional, or financial commitment to their approach, which might be AA for alcohol misuse, or this or that commercial weight loss program that’s advertised heavily on television. Once your income, ego, or name gets invested in a particular approach, it can be very difficult, or nearly impossible, to let go and look at things objectively and admit that your favorite approach really doesn’t have much merit! Sadly, the needs of market and the needs of science often clash, and in our field, marketing usually wins.

So what do we do in TEAM-CBT? I can only give you some hints about it here, but I’ll take a stab at it and hope for the best.

Recently, several people I’ve hiked with have asked for help with their overeating. One fairly easy approach to learn is called the “Double Paradox,” and I touched on it briefly in last Sunday’s live Q and A on Facebook. You can do it on paper most effectively. First, I ask the person to list all the advantages of eating as much as you like of whatever you like whenever you like.

There are tons of advantages, including:

  • That Cinnabon (or whatever food you love) will taste SO GOOD!
  • I’m entitled to a little treat after a hard and frustrating day at work.
  • That treat will make me feel so good.
  • Eating will help me cope with negative feelings of depression loneliness, frustration, anxiety, boredom, and disappointment.
  • Eating good food is a deeply meaningful social activity with friends and family, and shows my love for others.
  • Good food tastes SO GOOD, and that’s my favorite kind of mint chocolate (or whatever.)
  • Eating is easy and rewarding.
  • Being overweight gives me an excuse to avoid dating and risking rejection.
  • Cooking and preparing wonderful food for my family is a source of great source of pleasure.
  • I’m too old to have to worry about being thin.
  • Why should I have to follow the rules of society? I have the right to be any way I want to be.
  • etc. etc.

Most individuals who are overweight should be able to come up with at least a dozen overwhelming benefits and advantages of overeating.

If the patient cannot or will not do this, then you might as well give up, because you’re already defeated by his or her denial. The fact is, overeating REALLY IS one of the great pleasures in life. You can prime the pump a little by suggesting one or two benefits of overeating, but the patient should do most of the work on this.

Then I ask the patient to list the many disadvantages of diet and exercise. For example:

  • It’s hard to diet.
  • I’ll have to struggle with cravings and temptations.
  • It’s unfair because life is already hard.
  • It’s no fun to go out and jog when it’s cold and rainy.
  • I never get a runner’s high anyway.
  • I hate exercising and I love eating!
  • It’s way more rewarding to watch TV and eat Doritos.
  • Even if I lose weight, I’ll just gain it all back later on anyway.
  • Losing weight is hopeless, so I might as well give up.
  • Other people can eat whatever they want and still be thin. Why should I have to suffer?
  • Etc etc etc.

Most individuals who are overweight should be able to come up with at least a dozen or more overwhelming disadvantages of diet and exercise.

Once we have these lists, I use another technique I’ve created called the Acid Test, which involves saying something like this:

“Gee, Jim (or Mary), given all those tremendous advantages or overeating, and the many powerful and real disadvantages of diet and exercise, it’s not at all clear to me why you’d want to change.”

Now it’s up to the patient to decide that he or she actually does not want to diet and exercise, or that he or she does want to. In most cases, your work will be done. If the patient decides he or she does not want to change, you can just “Sit with Open Hands” and ask if there’s anything he or she does want help with. This requires a therapeutic attitude of “non-attachment,” which is challenging for co-dependent therapists who are addicted to “helping.”

If the patient can convince you that he or she does want to change, in most cases he or she will run with the ball and not require any further help from you. There are tons of ways to diet, and tons of ways to exercise, and it does not make much difference what approach the patient takes if he or she is motivated. In my experience, most will know what approach they want to pursue.

Notice that this approach requires the therapist to become the voice of the patient’s conscious or subconscious resistance, and give up the role of “helper.” Some therapists can learn how to do this; most cannot, due to their own compulsive addiction to throwing “help” at patients.

I do have many more techniques, but this is getting long so let it be an introduction of sorts. Let me know if you liked this blog, and if you want more techniques to combat habits and addictions.

In addition, if you like or decide to use some of these techniques, such as the Double Paradox, the Acid Test, Sitting with Open Hands, and other approaches I have described in my podcasts, blogs, workshops, and books. I always appreciate some acknowledgement that I created them. I say this because sometimes people have taken my ideas and techniques, given them a slightly different name, and claimed them for their own. Quite a few have even started their own schools of therapy, based on one of the techniques I’ve created, without giving me any credit. I find this annoying!

I’m not criticizing you, just blowing off some steam! One of the reasons I always admired Dr. Albert Ellis is that he never did that. He always gave credit where credit was due, and had tremendous integrity. He was, arguably, a bit eccentric, but totally honest!

Thanks again, Greg!

David

 

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

3 thoughts on “Moved to Tears by Mark’s Live Therapy Podcast / How do You Treat Habits and Addictions?

  1. Dear Dr Burns,

    Thansk so much for taking the time to reply with such an detailed answer.It is very much appreciated.

    Sometimes I find that at the stage where I ask the client to think of all the advantages of, say, continuing to eating biscuits or cookies in excess of her requirements, they say “There are no advantages” or even more frustratingly ” I don’t know”. I think at this stage I should say “well, Is there anything else I can help you with?” But it is tempting to fill in blanks for them and to get frustrated at the obvious denial. What do you suggest?

    Thanks so much again,

    Greg

    • it is a collaborative effort, so you may have to prime the pump initially by giving them several suggestions. However, this is all based on the assumption you are doing TEAM in a systematic way. If you just throw various techniques at patients, you won’t have a great deal of success. david
      t

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