“I’m a failure. . . I’m not good enough. . . My life will be empty and meaningless without . . . “
Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering.
Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems.
At the time, I did not know who Daisy was, and was not aware that she was living in this area. Now, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.
The focus of the session was a problem that many young couples face–infertility. In spite of heroic, costly, and exhausting efforts to conceive using IVF (in vitro fertilization), Daisy and Zane have still not been blessed with a pregnancy. And Daisy is finding herself between a cognitive rock and a hard place. She is suffering, on the one hand, from intense feelings of failure, shame, and inadequacy because she has not yet become pregnant. But at the same time, she has mixed feelings about having children, and feels that if she can find happiness with children, she will be ostracized by society and seen as some kind of oddball.
Daisy’s scores on the Brief Mood Survey, which she completed just before the session began, indicated mild to moderate depression, severe anxiety, mild anger, and a profound loss of pleasure and satisfaction in her life–indicating an almost complete absence of any strongly positive feelings.
Daisy brought a partially complete Daily Mood Log to the session. The upsetting event she recorded at the top was “four years of infertility; three years of failed treatment. Daisy mentioned that a fifth upcoming trial with IVF was planned in a couple weeks, and that she was feeling intense anxiety. The negative feelings she circled on the Daily Mood Log, plus her intensity estimates, included:
- sad, blue, depressed, down, unhappy: 90%
- anxious, worried: 100%
- ashamed: 70%
- inferior, worthless, defective, incompetent: 100%
- lonely, alone: 70%
- hopeless, discouraged, pessimistic, despairing: 100%
- thwarted, defeated: 90%
As you can see, all of these feelings intense. These feelings did not result from the real problem, the infertility, but rather from Daisy’s Negative Thoughts about the problem, including:
- My life will be empty and meaningless without children. 90%
- People with children live happier and more fulfilling lives. 100%
- I am defective and inferior to people who can have children. 70%
- I’m missing out on the most important part of life. 100%
- If this treatment doesn’t work, my life will be a failure. 80%
- I should have done more in my career, given that I don’t have kids. 100%
- Without children, there isn’t much to look forward to. 100%
- It’s unfair that this treatment doesn’t work for us. 70%
- I’m a disappointment to my family. 80%
- If I don’t want kids, that means there is something wrong with me. 100
As you listen to the session unfolding, Dr. Burns reviews the T = Testing, followed by E = Empathy. Dr. Burns uses the Five Secrets of Effective Communication to acknowledge Daisy’s tremendous pain, without trying to save, help, or rescue her. Then he uses several Paradoxical Agenda Setting techniques to melt away any potential resistance to change, including the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. She decides she wants to dial down her negative emotions to much lower levels, without necessarily making all of them disappear completely. Then Daisy and David complete the “% Goal” column on the Daily Mood Log, indicating the ideal level for each type of feeling that she hopes to achieve by the end of the session.
- sad, blue, depressed, down, unhappy: 90% / 30%
- anxious, worried: 100% / 30%
- ashamed: 70% / 10%
- inferior, worthless, defective, incompetent: 100% / 5%
- lonely, alone: 70% / 20%
- hopeless, discouraged, pessimistic, despairing: 100% / 40%
- thwarted, defeated: 90% / 40%
As you can see, she wanted to reduce some of her feelings dramatically, such as shame, inferiority, and loneliness, and wanted to reduce other feelings moderately, including depression, anxiety, hopelessness, and feeling defeated.
At this point David and Daisy used the Downward Arrow Technique to pinpoint the underlying beliefs that were triggering this problem, starting with a new Negative Thought that popped into Daisy’s mind:
- If the IVF doesn’t work, we won’t have kids, we won’t have kids coming home for holidays and milestones–it will just be the two of us.
- Then our lives will be lacking connection.
- Then our lives won’t be meaningful.
- Then there would be no purpose in life.
As you can see, these chain of negative thoughts reveals at least two Self-Defeating Beliefs:
- A woman must have children to have a purposeful, meaningful, rewarding life.
- You must have a meaningful, purposeful life to feel happy and fulfilled.
Then David and Daisy use a variety of M = Methods to help Daisy challenge her negative thoughts, as well as these underlying beliefs, starting with the first negative thought, “My life will be empty and meaningless without children.” The Methods included Identify the Distortions, Examine the Evidence, the Paradoxical Double Standard Technique, the Externalization of Voices with role-reversals, and the Acceptance Paradox as well as the Self-Defense Paradigm.
Fabrice noticed that at one point David switched from the Paradoxical Double Standard to the Acceptance Paradox, and then went back to the Paradoxical Double Standard before switching to the Externalization of Voices for a second chem. David explains his strategy.
At the end of the session, which lasted less than two hours, Daisy was dramatically improved. If you review her completed Daily Mood Log here, you will see that she achieved or exceeded all of her emotion-reduction goals for the session. In addition, her end-of-session scores on the Brief Mood Survey indicated dramatic reductions in depression, anxiety and anger, an a huge boost in Positive Feelings. On the Evaluation of Therapy session, she gave David perfect scores on the Empathy and Helpfulness scales, and indicated what she liked least and most about the session.
What she liked the least: “It took me a while to reveal my ambivalence about having kids.”
Actually, David overlooked this as well until half way through the session, and this did make for a kind of turning point in the session. Things seem to get more immediate and real at that point.
What she liked the best: “I feel completely different–more hopeful, less anxious, and less despairing.”
Fabrice and I are deeply grateful to Daisy and Zane for allowing us to share their story with you. Although the facts of your life are likely to be very different, you may also sometimes feel down or inadequate because you, too, have not measured up to some “requirement” based on messages from society. And perhaps Daisy’s experience can inspire you to break out of your own inner prison as well, believing that you, too, are perhaps inferior, or “not good enough,” because of this or that flaw!
The next day, I received this email from Daisy:
I was planning to send you a thank you email, and you beat me to it. Thank you so much for taking the time to work with me on what has been an excruciating situation for years. Both Zane and I are extremely grateful for all the opportunities we have to spend time with you and learn from you. I actually thought it was amazing how quickly you were able to zero in on my ambivalence towards having children as well as the anger I have towards my mom and her expectations. It’s really hard for me to acknowledge either of those things, even to myself, and I thought it was so brilliant how you were able to pull those out so quickly.
There were so many “aha” moments for me last night but a couple really stand out. One was about self-compassion being the most important part of life. The other was about how it makes no sense to judge ourselves as “defective” in a global way. Those insights really hit me at a gut level last night. I’m sure I’ll be drifting out of enlightenment soon and am very grateful for your very generous offer to give me a tune-up, especially as we go through all these treatments again!
I will work on my Daily Mood Log and send it to you later this evening.
Also, many thanks to Fabrice for his insights and for making the recording possible!
I also received this wonderful email from Zane:
I also wanted to thank you for having us on the show. I really enjoyed hearing your views about what a “meaningful” life means (or doesn’t mean). It was my “aha” moment. I’ve often seen that way of thinking as a slippery slope, but only had a vague sense as to why. Hearing you describe it as a trap really made a lot of sense. Daisy and I were talking it over this morning and the thought occurred to me that meaning could often be defined as having enjoyment or interest (in one’s life or work). Therefore, looking to the world, a relationship, an experience, or a job, or [fill-in the blank] is a hidden should statement (e.g. “My life should be meaningful, and if it’s not, it’s not very good.”). Having this thought or belief kind of takes responsibility to make life fun and interesting off of oneself, and places it on external circumstances or others. Am I understanding this concept correctly?
I’m also grateful for the books and DVD you hooked me up with. And extra-large thanks to Fabrice the “Fab Man” for being the man behind the magic in orchestrating these podcasts!
Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!
At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.
David, Fabrice, Daisy, and Zane- what a gift you gave with sharing such a personal and challenging experience so many of us can relate to. Truly an awesome and inspiring example of TEAM-CBT and it’s power to heal. Love that you were able to do this and grateful that David’s work is getting the exposure it deserves.
Hi Jenny, Thanks so much for the kind and thoughtful words. I have forwarded them to Daisy, Zane, and Fabrice. david
David- I’m glad you are able to forward all of the wonderful comments to Daisy and Zane. As I listened to this closely along with seeing Daisy’s Mood Log I’m even more impressed at how fast she is able to defeat her negative thoughts and positively reframe her experience. She did beautiful work and as a “client” she would be a pleasure to work with.
Thanks, Jenny, what you say is absolutely right! When you and the patient / client are on the same page, working as a “TEAM,” magic is possible! david
Had to stop the podcast. I loved the humor you added about most of murderers on the first 48 hours having children. Very funny, and very relevant. You use humor so skillfully. Thank you so much to Daisy, Zane, and Fabrice.
Absolutely Beautifully Done….
Daisy & Zane, thank you so much for sharing a very personal experience and this session with others. David and Fabrice, thank you for your continued teaching. I am so grateful to have found this podcast! Dr. Burns, I started reading your book in my late teens and have continued to use your works throughout my career.
Thanks David and Fabrice for this awesome podcast.
Thanks to Daisy I’m really inspired to work hard and overcome my own anxiety, caused too, by society messages and SDB.
It is possible to do testing and empathy if I’m working on my own or just positive refraiming alone will be enough too melt the resistance?
I really appreciate all the work you and Fabrice put in doing this podcast, you guys are true heroes.
and thanks to Daisy and Zane for sharing such an inspiring story.
Thank you, Javier, for your kind note. I forwarded it to Daisy, Zane, and Fabrice who will also appreciate your comments. You can certainly do testing on your own, taking my depression and anxiety tests repeatedly to track progress over time. Positive Reframing can be done on your own, too, in my opinion. Of course, there is no shame in finding a good therapist, too, when folks feel stuck, but I think a lot can be done on your own, and I hope my new book will be a useful tool for folks as well. Fabrice and I do put a lot into the Feeling Good Podcasts, and of course Daisy and Zane made an enormous contribution. So your feedback is especially meaningful to all of us! David
Hi Dr. Burns!
I love the live therapy podcasts! It’s incredible to hear you work and the skill you have! I can see why you decided to bleep out the swearing; I kind of liked it personally! I really appreciated Fabrice’s explanations of the downward arrow technique and when you went back and forth between double standard and externalization of voices.
I also really appreciate Daisy putting herself out there. I’ve forwarded this to a few friends who struggle with conceiving, and I have a feeling that Daisy’s story will positively impact so many women who hear these messages about ‘what women ought to do’. I laughed out loud so many times listening to this, when you were doing the during the double standard technique. That Lisa really was a piece of work!
Keep them coming 🙂
Thank you for helping to spread the word! I deeply appreciate your kind words and have forwarded your note to Daisy, Zane, and Fabrice. All the best, david
Hi guys. Amazing podcast, David and Fabrice, you are both doing amazing work. Thank you both.
Congrats to Daisy also on her courageous story!
Two questions for you David:
1) When do you anticipate your new book will be released?
2) Would it be possible to get a copy of the positive reframing chart you used in this session?
I have found the positive reframing technique to be a great help but can find it challenging at times.
Keep up the amazing work. You are inspiring people all over the world.
From a keen follower in Ireland.
Thank you so much, John! Your kind words are deeply appreciated by all of us. You can find the PR Chart in my new book, and I am working on it actively right now. I will soon contact publishers to see who might want to publish it. Also, if you are a therapist, there are many online training groups that will speed your learning tremendously. The methods ARE complex, and training with role play practice and feedback is THE way to go! You can check at http://www.feelinggoodinstitute.com for details about online TEAM-CBT training for therapists. david
Dr. Burns & Fabrice, I just wanted to leave another comment about this particular podcast and how it helped my practice this week! (The therapist described a patient who had been feeling guilt. I deleted the details to protect the patient’s identity. David) I’ve been practicing the paradoxical agenda setting along with the other techniques you outline, but this particular podcast with Daisy and Zane really helped me seal the techniques into a more natural, organic flow.
After beginning with empathy and identifying cognitive distortions, we used the downward arrow technique to uncover the belief “I’m not there when it counts” (because she hadn’t been visiting [someone she loved] regularly during college years). The most powerful exercise was
the “Magic Button” question followed by the client identifying the pro’s of her feelings of guilt/regret and how they related to core values. We then ‘attacked’ the negative thoughts using Role Reversal. By the end of our session the belief that “I’m not there when it counts” had gone from 100% to 20%.
Again, thank you so much for these learning opportunities; this approach is amazing and I am excited to continue learning the techniques from here in Canada. Daisy and Zane are wonderful for sharing their personal experience– listening to a ‘live session’ truly helps to solidify these skills and how to use them!
Thank you so much for your kind comment. I withheld your name and the patient details out of respect for the patient, but I think people can get the essence of what you are saying. And I forwarded your comments to Daisy, Zane, and Fabrice. I am really happy to find that the live therapy is a good teaching tool. To me, it’s really powerful to see how things unfold in real time behind closed doors. Beats a lecture or chapter in a book! All the best, david
Dear Dr. Burns,
This is Sameer from India, I’m currently pursuing my Ph.D.
I’ve all of your books and been able to come out of my long struggle with depression with the help of them. But your podcasts are just things from another world! I start every morning by listening to one of the podcast as per my work requirement at the office or issue I’m facing that day.
I’m especially thrilled when listening ‘live team therapy with Daisy’ as me and my partner are facing similar sever criticism from our families for our decision to not marry or not having children. In India, married women especially face tremendous resistance when they want to continue their careers after marriage as they are pressured into giving birth. I am opposed to this idea as I believe it is a personal decision and friends, family or society may not be intruding in it.
Me and my partner have very loving relationship based on respect and personal liberty and we have been using your ‘Feeling Good Together’ to get over arguments and strength the relation. But my partner, she is facing intense hostility from her family on her decision not to marry. It had been a severely distressing issue for us for long while, but you just opened up another avenue for us to look at the situation and act accordingly.
In last two weeks we could take specific issues up with her family and using five secrets we have achieved great success in creating some bonding with them. Also Daisy’s journey to enlightenment has proved to be our journey to enlightenment as we sometimes had similar concerns over our decisions of not having kids.
Dr. Burns, the change you have brought to my life is so enormous that I feel eternally indebted to you. And as my mother puts it, you are a Sat-guru (in Sanskrit meaning enlightened saint who’s mere existence in ones life brings enlightenment to the person) in modern time.
My first passion will remain chemistry but after being introduced to and enchanted by TEAM-CBT my personal life is dedicated to understand TEAM-CBT and be amazed by applying it in day to day activities.
With Respect and Gratitude,
Thank you for your kind note! I have forwarded it to Daisy and Zane! Your words are appreciated! Best of luck with your study of chemistry. Very cool area for sure! Your journey is remarkably similar to that of Daisy and Zane! david
Hi David, I did go through the podcast, one of the questions that came across my mind is, how does one know that a thought is a good one or a bad one? or put in another way “How do I know my fortune telling thought, is really a fortune telling one”? what is the basis?
Hi Binoy, thanks! Excellent question I might address on a future Ask David podcast. However, I would need you to give me a specific example of a thought you want help with. Specifics typically lead to illumination, whereas abstract thoughts sometimes lead to endless pontification. So I hope to ear from you again! All the best, david
Thanks a lot Dr Burns for improving our lives and happiness levels. We just have to live in the moments and do our best to make our lives meaningful.
Lots of cheer
Dear Dr. Burns,
I revisit this podcast every year to remind myself to use self compassion. I love to share this podcast as well. It has such helpful techniques for challenging negative thoughts.
I don’t suppose you are able to share this information, but I am just curious to ask if you know if this couple was ever able to have children? I believe that either way, you were able to give them the tools to help them through to acceptance and a knowledge that they have a wonderful life no matter what happens, and that is the most important.
A sincere listener
Yes, thanks, KTS. Daisy became pregnant one week (roughly) after the podcast, and now is pregnant with her second child. Also, she’s made a career change and is doing phenomenally well. You will recall Zane her husband, and he’s doing really well, too!
I will forward your question, and maybe we can do a Daisy update on a podcast. Thanks! david
That’s wonderful to hear! 💛
Happy for them!
Oh, totally, that’s what I live for! Warmly, d
Thanks! And thanks to Daisy! david