086: Role-Play Techniques (Part 4) — Feared Fantasy

This is the fourth in a series of podcasts on several powerful role-playing techniques we use in TEAM-CBT. Today, we’re going to highlight the Feared Fantasy Technique.

Here, in a nutshell, is why I created this technique. In order to get over any form of anxiety, exposure is absolutely necessary. Exposure is not a complete treatment for anxiety, and is only one of 40 methods I use to treat anxiety, but it always MUST be included in the treatment package.

However, sometimes, people have fears that you cannot easily confront in reality. For example, you may have the hidden fear that others would judge you if they knew how insecure you felt inside, or if you failed at something, or if they were way more successful than you. You can’t just say to someone, “Do you think less of me because I’m actually quite insecure?” They’ll just deny it, and you’ll feel like a nut!

So I created the Feared Fantasy Technique. Essentially, you invite the patient to enter an Alice-in-Wonderland Nightmare World where their worst fear comes true, and where people not only think of you what you most dread, but they also mercilessly tell it to your face. This gives patients the chance to face the monster. In most, if not all cases, they suddenly discover, at the gut level, that the monster has no teeth.

Like the Externalization of Voices, this is a two-person technique, although I’ve sometimes done it with many people in groups. In this case, there can be numerous feared “monsters.”

In the two-person version, you and another person, who could be your therapist, go into the Alice and Wonderland Nightmare World and act out one of your worst fears, such as being rejected by an exceptionally hostile critic because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it because you discover that the monster has no teeth. Your worst fears don’t usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense. You use frequent role-reversals until the monster has been totally crushed.

I am joined in this podcast by our own beloved Dr. Fabrice Nye, and two members of my Tuesday training group at Stanford, Liz Richard, a Licensed Marriage and Family Therapist, and Dr. Rhonda Barovsky, a Forensic / Clinical Psychologist, along with Stephanie James, an LCSW psychotherapist and radio talk show host from Fort Collins, Colorado, who is visiting the group. Liz is a member of the “newbie” TEAM training group at Stanford and agreed to bring a list of her own negative thoughts that trigger her feelings of insecurity in the group. I am grateful to all of them for helping out with this podcast!

Sometimes, when I am helping a patient challenge a Negative Thought, like “I’m a bad mother” or “I’m a failure as a father,” or “my colleagues would look down on me if they knew how screwed up I actually am,” I start with a gentle technique like the Paradoxical Double Standard that we illustrated in the first podcast on role-playing techniques. It’s a gentle technique that would almost never threaten or upset a patient.

Once the patient has totally crushed the thought, I typically move up to the Externalization of Voices. This is a more challenging and powerful technique that provides a deeper level of recovery / enlightenment and allows me to model the differences between the Self-Defense Paradigm vs. the Acceptance Paradox.

Once the patient has knocked the ball out of the park with the Externalization of Voices, I often move up to the Feared Fantasy. This is the most extreme and powerful technique of all. And the moment the patient again defeats his or her most terrifying fear, the impact can be positive and extreme, and often ends in a kind of uncontrollable laughter The Buddhists call this “laughing enlightenment. It often happens the moment you suddenly realize that your worst fear was nothing more than a gigantic cosmic hoax!

You may want to read a brief description of how to use the Feared Fantasy Technique that I created several years ago for my training groups and workshops. At the end, you’ll find a comparison of the Externalization of Voices, Paradoxical Double Standard, and Feared Fantasy, along with a table contrasting the Self-Defense Paradigm with the Acceptance Paradox.

The example I am using in the write-up below is not the example in the podcast, but one I sometimes use in teaching. Often, participants are afraid to do role-playing in front of the group because of thoughts like these:

  1. I’ll probably look foolish and make a fool of myself.
  2. I’ll screw up and fail.
  3. People will judge me and think less of me.
  4. They’ll laugh at me and tell other people about what a loser I am!

It is difficult to confront these fears in reality since people generally don’t have these kinds of negative judgements toward colleagues in the group who are feeling insecure. In addition, if someone did have these kinds of thoughts they would deny having them. But in the Alice-in-Wonderland Nightmare World, people DO have these kinds of thoughts about you, and they DON’T deny them! So, it can be challenging at first to have to confront these kinds of mean-spirited perceptions, and incredibly freeing once you defeat them!

Feared Fantasy*

This is a form of Cognitive Exposure

  • Some fears are not easily confronted in reality

General instructions

Work in dyads. Decide who will play the role of therapist and who will play the role of patient

  • Use the workshop / seminar performance anxiety example

Therapist Instructions

  1. Explain that you’re going to enter an Alice-in-Wonderland Imaginary world where there are two strange rules:
  • If you think people are looking down on you, they really are.
  • Furthermore, they get right up in your face and verbalize all their negative thoughts about you. They aren’t at all nice. They try to humiliate.
  1. Ask the patient which role she or he wants to play first. Explain that you’ll do role-reversals, so the choice is not terribly important.

We’ll assume that you’ve chosen the performance anxiety example, and that you, the therapist, will start out in the role of a rejecting, judgmental audience member or friend. Your patient will play the role of himself or herself.

Now criticize your patient, saying the things that he or she would be afraid to hear, such as:

  • “Hey, I was in the audience when you did that role-play with Dr. Burns. You really looked foolish and I’ve been laughing at you ever since.”
  1. After your patient responds to each attack, ask who won the exchange. If the patient did not “win big,” do a role-reversal and see if you can come up with a more powerful response.

Tips on Defeating the Imaginary Critic

When you’re under attack, try to defeat the imaginary critic

  • You can use Self-Defense, the Acceptance Paradox, or a combination of the two

If the Self-Defense Paradigm was ineffective, try

  • The Acceptance Paradox
  • Or a combination of Acceptance and Self-Defense

If the Acceptance Paradox was ineffective, try

  • The Self-Defense Paradigm
  • Or a combination of Acceptance and Self-Defense

Comparing the Paradoxical Double Standard,
Externalization of Voices and Feared Fantasy*

Technique Patient’s Name Your Name Role-Reversals?
Paradoxical Double Standard His or her real name The name of an imaginary dear friend of the same gender as the patient. Preferably, it is not someone the patient actually knows. No
Externalization of Voices His or her real name Same name as the patient Yes
Feared Fantasy His or her real name You play the role of some judgmental or critical person the patient is afraid of. Yes

 

Comparing the Self-Defense Paradigm with the Acceptance Paradox*

Strategy

General Concept Negative Thought

Example of How to Defeat the NT

Self-Defense Paradigm You defeat the NT by arguing with it and insisting that it’s distorted and not true. A patient who suddenly relapses several weeks after recovery will often have this thought, “This shows that the therapy didn’t work and that I really am a hopeless case.” “That’s ridiculous. I had a fight with my wife last night, so it’s not surprising that I’d be feeling upset. The therapy was very effective, and this would be a good time to pull out the tools I learned and get to work.”
Acceptance
Paradox
You defeat the NT by buying into it and insisting that it is true, but you do this with a sense of humor or inner peace. During a moment of insecurity, a therapist may have the thought, “I’m not as good as I should be.” “As a matter of fact, I still have tons of flaws and a great deal to learn. Even when I’m 85 years old, there will still be tons of room for learning and improving, and that’s kind of exciting.”

The Self-Defense Paradigm is especially helpful for the types of NTs patients have during relapses, and it’s a good idea to prepare them to talk back to these thoughts when they first recover, and before they actually relapse, using the Externalization of Voices.

The Acceptance Paradox is especially helpful for the types of NTs that lead to feelings of worthless, inferiority, or a loss of self-esteem.

* Copyright © 2018 by David D. Burns, MD

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!

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Some Cool Upcoming Workshops

Coming in May!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

Coming in June! One of my best two day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

 

 

8 thoughts on “086: Role-Play Techniques (Part 4) — Feared Fantasy

  1. I enjoy your podcasts (and, I benefited much from the 1980 book, “Feeling Good”.

    On the Role Playing Podcasts, you ask the participant “Who won – and it was it Big or
    Small?” After they answer, you ask something like was it “Big or Huge” I don’t follow or understand the second part of the questioning. Isn’t it redundant?. Please explain. You and Fabrice touched on it at the end of the first Role Playing podcast, but I am still confused. Help!

    • Hi Mike, when using Externalization of Voices or Feared Fantasy, you want the patient to win “huge,” which is pretty close to enlightenment and often complete recovery. If the patient has only defeated the negative thought in a way that felt “big” but not “huge,” the patient is still believing the negative thought to some extent, and still under the hypnotic spell of the negative thought. In base ball terms, “big” would be like getting a hit, but “huge” would be more like hitting the ball out of the park, a bases loaded home run, so to speak! david

  2. Hi David, thank you for this blog post! Here’s the part of the post I have a question about:

    “I start with a gentle technique like the Paradoxical Double Standard that we illustrated in the first podcast on role-playing techniques. It’s a gentle technique that would almost never threaten or upset a patient. Once the patient has totally crushed the thought, I typically move up to the Externalization of Voices.”

    I am confused by the idea that a patient can totally crush a negative thought by using just the Paradoxical Double Standard. Is it expected that one can crush a NT with just one technique? And why move on to another technique when the problem has been solved already?

    Thank you very much,

    Julia

    • Thanks, no real need to move to another technique if you’ve totally crushed the negative thought and the patient feels euphoric! But sometimes the victory is only partial, so you can sometimes get to a deeper recovery by moving from Paradoxical Double Standard to Externalization of Voices and then to Feared Fantasy. But I have more than 100 techniques and every patient is unique and different, so these rules and formulas don’t have a whole lot of value, some value though! david

  3. Hey Dr. Burns (and others),

    I was listening to this podcast the other day and felt like I should share the thoughts I had with the feared fantasy technique in regards to the participant’s fear of the others in the Tuesday Night Group judging her because she comes in late due to working with a patients schedule. I felt it pertinent for me to share what I was thinking could be a response to such a thought or interaction.

    The fact that the participant stays at a slightly inconvenient time for herself and it interferes with The Tuesday Night Group that she is extremely excited about, proves she does take the group seriously. As a counselor/therapist the core value she holds is to treat patients. The whole purpose of going to this group is to further her skills for her patients, therefore, if she were to say no to her patients due to schedule, it would negate the training.

    Obviously this could be worded far more eloquently, but it is what it is :).

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