“Help! I’ll mumble and look nervous when I give my talk! I’m scared stiff!”
In the last two podcasts entitled “50 Methods in 50 Minutes,” David and Fabrice rapidly described 50 powerful ways to challenge and crush the negative thoughts that trigger depression, anxiety, relationship problems, and habits and addictions. Today, they describe how to select the techniques that will be most helpful for various kinds of problems, and how to individualize the treatment for each patient.
Remember that we are talking about the new TEAM-CBT. Here’s what the letters stand for:
T = Testing. We test the patient at the start and end of every therapy session to assess therapeutic progress, or the lack of progress.
E = Empathy. We use the Five Secrets of Effective Communication to provide a warm empathic connection with the patient.
A = (Paradoxical) Agenda Setting. We find out what, if anything, the patient wants help with, and bring resistance to conscious awareness. Then we will melt away the patient’s resistance using a variety of powerful “resistance busting” techniques before using any methods to try to help the patient change.
M = Methods. This is the focus of today’s podcast. We will use the Recovery Circle to select and implement the most helpful techniques, from David’s list of 50, for each patient.
The patient we will discuss is a Korean man named Daeshim who’s working for Google, and he’s been worrying for weeks about giving a presentation to a large audience at work. He explained that he does okay with small group presentations but feels totally freaked out by the idea that he would have to present to so many people.
On his Daily Mood Log, Daeshim reported many negative feelings, and rated all of them at 90 (on a scale from 0 to 100), indicating they were severe.
- Unhappy, down
- Anxious, nervous, panicky
- Defective, inferior, inadequate, incompetent
- Embarrassed, humiliated
- Hopeless, discouraged, defeated
- Angry, Upset
- Tired and exhausted from worrying
Daeshim recorded these two Negative Thoughts on his Daily Mood Log:
- People won’t understand me because my voice is soft, and English is my second language. 100%
- I’ll mumble and look nervous and use filler words like “uh” and “umm,” so my colleagues will conclude that I’m not very intelligent. 100%
Daeshim wanted to work on the second thought. I put the thought in the middle of a Recovery Circle, as you can see here. Then I selected more than 20 methods that could help Daeshim challenge the Negative Thought in the middle of the Recovery Circle. I only listed 16 of them on the Recovery Circle, but there are many additional methods that could potentially help Daeshim.
The purpose of the methods on the Recovery Circle is to help Daeshim develop a Positive Thought that he can record on his Daily Mood Log. To be effective the Positive Thought must fulfill the Necessary and Sufficient Conditions for emotional change. Do you remember what they are?
- The Necessary Condition for Emotional Change. The Positive Thought must be 100% true. Rationalizations or half truths won’t help anyone. Cognitive Therapy is based on the Biblical notion that “the truth shall make you free.”
- The Sufficient Condition for Emotional Change. The Positive Thought has to put the lie to the Negative Thought (NT). In other words, the patient’s belief in the NT must go to zero, or at least be drastically reduced. The very moment the patient stops believing the Negative Thought, the negative feelings will go down dramatically, and may even disappear entirely.
When I’m treating public speaking anxiety, I think in terms of the “Internal Solution” and the “External Solution.” The Internal Solution is changing the way you think and feel about public speaking. Once you’ve done this, your feelings of intense anxiety will be greatly reduced, along with the rest of your negative feelings.
Here’s the good news: You’ll be feeling much better. Here’s the bad news: you’ll probably still be crappy at public speaking!
But there’s hope. The External Solution involves developing better public speaking skills, and those methods will be quite different. For example, Daeshim could attend a local Toastmasters group and get all kinds of tips on how to speak in a more dynamic and effective manner.
David and Fabrice bring several of the methods to life during the podcast, just to give you a feel for how the techniques on the Recovery Circle can help the patient challenge the Negative Thought in the middle. They do not include many crucial techniques because the goal for this podcast was on how to select techniques, from the list of 50, for the Recovery Circle, and how to individualize the treatment during the M = Methods phase of the session. If you are interested in learning more about the treatment of public speaking anxiety, contact David or make comments at the bottom of these show notes and we’ll be glad to follow up for you!
Why do we have so many methods for challenging negative thoughts? There are several reasons:
- Different kinds of problems respond to different kinds of therapy techniques. The M = Methods I would use to treat depression are very different from the methods I would use to treat someone with an anxiety disorder, although there’s a little overlap. The methods for treating someone with a relationship problem, or a habit or addiction, are very different. It simply isn’t true that one size fits all!
- Two individuals with what appears to be the exact same problem, such as public speaking anxiety, panic attacks, or depression, will rarely respond to the same methods. It can be difficult, if not impossible, to predict what method will work for which person. One person might be transformed by the Feared Fantasy Technique. Another person with the same problem might respond dramatically to the Hidden Emotion Technique, or Shame Attacking Exercises, or Self-Disclosure. If you have lots of Methods on your Recovery Circle, you won’t panic when one or even many of them do not work.
- You may have to try many techniques that don’t work with a patient before you find the technique that does work. If you have lots of techniques on your Recovery Circle, you can “fail as fast as you can,” going from technique to technique until you find the one that works for each patient.
We hope you enjoyed today’s podcast. We’ve got tons of great stuff coming up, including a live session with a man asking for help with a marital problem. David and Dr. Jill Levitt worked as co-therapists, and the session was dynamic, emotional, and incredibly helpful. It will be broken down into three consecutive podcasts, with tons of live material from the actual session, along with helpful commentary and questions by our wonderful host, Dr. Fabrice Nye.
So, stay tuned!
* 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!
Attend my 2018 Summer Intensive in San Francisco!
This year, I am again offering my annual SF summer intensive in August at the South San Francisco Conference Center. This four-day intensive is almost always my most exciting and rewarding workshop of the year.
Here are the details:
David’s TEAM-CBT Summer Intensive
August 6 – 9, 2018, South San Francisco Conference Center, California
For more information, click here, or call IAHB.org at 800-258-8411
Here are just a few of the really cool things about this intensive:
- You will have the chance to practice techniques in small groups after I demonstrate each technique with a live demonstration in the front of the room.
- You will get immediate feedback and personal grooming from me and from many of my colleagues from my weekly TEAM-CBT training group at Stanford. They’ll be there to help you, and I’ll be there to help you, too!
- There will be a live demonstration on the evening of day 1. The amazing Dr. Jill Levitt will be my co-therapist. Last year’s live demonstration, and in fact all of them in recent years, have been jaw-dropping and incredibly inspirational!
- You’ll get a chance to practice TEAM-CBT in real time the evening of day 3. This will be an incredibly challenging but rewarding “solo flight.”
- You will be able to do your own personal work on the last day of the workshop using the Externalization of Voices and Acceptance Paradox. In previous workshops, at least 60% of the participants indicated they experienced jubilant enlightenment during this exercise. Their fears and insecurities suddenly vanished!
- You’ll learn how to do Relapse Prevention Training (RPT).
- You’ll learn how to improve your empathy skills.
- You’ll learn tons of powerful cognitive, behavioral, and motivational treatment techniques for depression and all of the anxiety disorders.
- You will have the abundant opportunities to schmooze with colleagues, network, and have fun.
- You will have two fabulous free luncheon banquets featuring talks by Sunny Choi, LCSW, who is using TEAM-CBT successfully with an underserved population in primary care with limited resources and language skills (“I must apologize for my success.”), and the wonderful Vandana Aspen, PhD, who will speak on “New Treatment Strategies for Eating Disorders.”)
- And much more.
If you can only attend one of my workshops this year, the South San Francisco August intensive is the one to attend!
You are assuming – without evidence – the truth of the negative thought “I am a bad public speaker.”. Or at least you haven’t shared that evidence with us in this post. Thus you focus only on the negative emotional consequences. It is at least possible that someone is a good public speaker, but discounts the positive and sees minor flaws in such stark black and white / all or nothing terms, they he devalues his true talents. Therefore, shouldn’t you at least test the truth of the negative thought: “I am not a good public speaker”?
Oh, you are so right, Malik! I don’t exactly recall the example, but the person is undoubtedly involved in All-or-Nothing Thinking, among of other distortions. This type of perfectionism is so common, and it plays a huge role in depression as well as anxiety. Thanks, and please keep the thoughtful comments coming! Good to hear from you again, Rumi! Please keep your extremely thoughtful comments coming. I am hoping, by the way, to have the chance to do a couple more podcasts or FB Live Video Broadcasts on social anxiety, which is SO common. All the best, David
David, public speaking anxiety is by FAR my biggest issue. To give context, even something as simple as going around the room and stating my name initiates the fight or flight response. I have found myself having both anticipatory anxiety and anxiety in the moment largely focused on what people will think if and when they see I’m nervous (quivering voice, pounding heart, etc.).
Is this something you have come across; a patient who dwells on the physical sensations as well as how’d they be perceived due to them in conjunction?
I can identify with many of the distortions – typically mind reading, fortune telling and all or nothing thinking.
I have all of your books and can’t seem to find the proper approach. A DML prior to or after the event (doing it after feels somewhat disingenuous)? Any other approaches or methods I should try?
Thanks David for all that you do!
Hi John, thanks, my favorite topic, I think, since I had such extreme public speaking anxiety. Did you want to send me a Daily Mood Log? d
Dear Dr. David,
Your recovery circle is amazing! It is very clear and saves therapists from getting disheartened if one method is not working. Thanks for the amazing public speaking podcast – I have spoken publicly tons of times and still get cold feet. In the spirit of sharing, I was chosen to speak to some very important guests at a university I worked in because I was deemed to be very good. On that day, the hall lights blew up, the connecting wire of my laptop short-circuited and I had to hurriedly repeat the speech all over again once the power came back on – all in front of a choicest of audience ranging from the university owners to elite heads of departments. That is one incident I will remind myself of that one instead of hiding it away! Thanks for such wonderful work you gift so generously to everyone.
Thanks so much, and great story! If okay with you, we might read your gracious note on a podcast! d