297: Yuck! Homework!
In today’s podcast, we discuss the important but dreaded topic of psychotherapy homework, and our featured guest is Alexis, whom some of you know from her fabulous work organizing beta tests for the Feeling Good App. Today, Alexis brings us a very special gift, by showing us how she “walks the walk.”!
At the beginning of the podcast, we discussed the two major reasons to do psychotherapy “homework:” First, the homework gives you the chance to practice and master the techniques you’re learning, so you can keep growing and strengthening your skills. And second, because it’s an expression of motivation; motivation alone can have powerful anti-depressive effects and lead to rapid recovery.
I also talked a research study I did with a friend and colleague who got depressed following the breakup of his relationship with the woman he’d been dating for several years. Each night he would partially fill out a Daily Mood Log, including a brief description of the upsetting even or moment. Then he would circle and rate his negative feelings on a scale of 0 (for not at all) to 100 (the worst), for how he was feeling at that very moment. Then he recorded his Negative Thoughts and indicated how strongly he believed them on a scale from (not at all) to 100 (completely).
He was telling himself that he’d never find anyone to love, that he’d never find work, and so forth.
Then he’d flip a coin to decide on one of two courses of action. If heads, he would jog for 30 minutes or so at a fairly fast clip and then re-rate his belief in each negative thought as well as the intensity of each type of negative feeling on the same scales of 0 to 100. If tails, he would work on his Daily Mood Log for 30 minutes and then rerate his belief in each negative though and the intensity of each type of negative feeling.
He did this for several weeks and I was thrilled to see that he recovered on his own from a pretty severe bought of depression without any psychotherapy or medications. However, I did give him a little coaching on how to challenge various kinds of distortions.
Once he recovered, we analyzed the data using Structural Equation Modeling. We discovered that the jogging had no effects whatsoever in reducing his belief in his negative thoughts. This finding was not consistent with the popular idea that exercise boosts brain endorphins and causes a “high.” I was not surprised, since jogging has never elevated my feelings, either, although some people do report this effect.
In contrast, on the nights that he worked with his Daily Mood Log, there were massive reductions in his belief in his negative thoughts as well as his negative feelings. This finding was consistent with the idea that psychotherapy homework is very important, whether or not you are receiving treatment from a human shrink. The study also confirmed the idea that distorted negative thoughts do, in fact, cause depression and other negative feelings like anxiety, shame, inadequacy, and hopelessness, and that a reduction in your belief negative thoughts triggers recovery.
Anecdotally, I would like to add that he maintained his positive mood and outlook following his recovery. His career flourished, and he got married. I showed him his negative thoughts years later, and he was shocked. He found it hard to believe that he was giving himself and believing such harsh and distorted messages at the time he was depressed.
I’ve often said that there is a kind of hypnotic aspect to depression, anxiety, and even anger. You tell yourself, and believe, things that are simply not true! Recovery is a little (or a lot) like snapping out of a hypnotic trance!
Here is another implication of the study of exercise vs the Daily Mood Log, as well as other studies that have confirmed the critical importance of psychotherapy homework in recovery from depression and anxiety. Because we know the importance of homework, if we are not asking our clients to do homework, then we may actually be impeding their progress rather than supporting them.
That’s why I let people know prior to the start of therapy that the prognosis for a full recovery is very positive, but homework will be required and is not optional. If they feel like they don’t want to do the homework, I don’t encourage them to work with me. This is called the Gentle Ultimatum and Sitting with Open Hands.
Oddly, enough, this approach seems to enhance patient motivation as well as patient compliance with homework between therapy sessions. The homework, in turn, speeds recovery and reduces patient drop-out.
When I’m doing research, I try to create mathematical models that reveal causal factors that affect all human beings, and not some finding that only applies to this or that school of therapy. Therefore, it would seem to follow, that doing “homework” is just as important if you are working on your own without a therapist. And it would seem like it should be important in our app, as well.
These hypotheses have been confirmed. Practice, and doing specific exercises that I’ve created, are just as important to the degree of recovery in beta testers who are using our Feeling Good App, as well as in people who are working on their own without a therapist. Today, we are joined by Alexis, who works on her own negative thoughts whenever (like the rest of us) she feels stressed out or upset.
Alexis described an example of her homework, starting with this upsetting event at the start of the pandemic:
Daily Mood Log
|Upsetting Event or Moment: Pandemic and moving back to my preferred city and leaving my mom to live alone.|
Next, Alexis recorded her negative feelings:
|Feelings||Now %||Goal %||After %|
|Anxious, worried, panicky, nervous, frightened||75|
|Frustrated, stuck, thwarted, defeated||50|
|Guilty, remorseful, bad, ashamed||100|
|Hopeless, discouraged, pessimistic, despairing||20|
|Sad, blue, depressed, down, unhappy||80|
|Inferior, worthless, inadequate, defective, incompetent||80|
|Lonely, unloved, unwanted, rejected, alone, abandoned||75|
|Angry, mad, resentful, annoyed, irritated, upset, furious||20|
|Embarrassed, foolish, humiliated, self-conscious||10|
As you can see, she felt intensely guilty, anxious, inadequate, and lonely, and had a few additional feelings that were somewhat elevated.
Then she pinpointed two negative thoughts, along with her percent belief in each one.
- I’m a bad daughter. 100%
- I should move back in with my mom. 50%
Then she identified the distortions in her thoughts, and explained why each distortion will not map onto reality. This technique is called “Explain the Distortions.”
Explain the Distortions
NT: I’m a bad daughter 100%
All-or-Nothing Thinking. I’m focusing on the idea that I can be 100% good or bad , which doesn’t make sense, since nothing in this world is completely good or bad.
Overgeneralization I’m calling myself a ”bad daughter,” as though this is label described my entire being.
Mental Filtering Instead of focusing on some of the positive things that I do. I’m focusing on the idea that I’m not doing enough.
Discounting the Positive I’m not thinking about all the loving things that I do for my mom and that I enjoy doing for her and with her.
Mind-Reading I’m telling myself that my mother thinks that I am a bad daughter, but I don’t actually have any evidence for this.
Fortune-Telling I am telling myself that I’ll never be good enough.
Emotional Reasoning: I feel like a bad daughter so I think it must be true.
Magnification and Minimization: I’m magnifying how important my conduct is to my mother (big ego).
Should Statement: I’m telling myself that I should be a better daughter and that I shouldn’t have moved back to the city where I prefer to live.
LAB: I’m labeling myself as “bad daughter.”
Self-Blame: I am blaming myself for being a “bad daughter.”
Other-Blame: I might be blaming my mother for expecting so much.
NT: I should move back in with my mom. 50%
All-or-Nothing Thinking. I’m telling myself that I’m either there 100% or not there 100%, which doesn’t really make sense. Even if I don’t live with my mom, I can still visit often and stay as long as I like.
Mental Filtering I’m focusing only on my duty to a parent and not on my commitments to myself.
Fortune-Telling I’m telling myself that something bad will happen to my mother and that she will be unable to care for herself.
Magnification and Minimization: I’m magnifying my importance (ego!!!)
Emotional Reasoning: I feel like I should live with her so it must be true.
Should Statement: I am shoulding myself.
Self-Blame: I’m blaming myself for leaving and for wanting to live on my own.
Other-Blame: I am secretly blaming my mother for making me feel this way.
You just try to challenge your negative thought with a positive thought (PT) that fulfills the Necessary and Sufficient Conditions for emotional change:
- The Necessary Condition: The PT must be 100% true, and not a rationalization.
- The Sufficient Condition: the PT must significantly or greatly reduce your belief in your Negative Thought.
Negative thought: I am a bad daughter (I should move back in with my mom.)
Write down a more positive and realistic thought:
My mom is in average health for her age and can take care of herself. She has the financial resources to maintain her lifestyle without my help.
Is this negative thought really true?
Maybe. I love my mom more than just about anyone. I do lots of things for her and with her and enjoy her company immensely.
Do I really believe it? I do.
When you use this technique, you ask yourself questions to lead yourself to the illogic of your negative thought.
NT: I am a bad daughter
Are you sometimes a good daughter? Yes
Do most adult children feel like they are a bad kid sometimes? Yes
NT: I should move back in with my mom
Should adult children live with their parents? Not if they don’t want to!
Worst, Best, Average
With this technique, you list the qualities of the opposite. Since you’re calling yourself a “bad daughter,” you can list the qualities of a “good daughter.” Then you can rate yourself in each quality, thinking of when you’re at your worst, when you’re at your best, and your average.
|Qualities of a “good daughter”||Worst||Best||Average|
|1. Calls their parents||80||100||90|
|2. Visits their parents regularly||30||100||90|
|3. Helps their parents||70||90||80|
|4. Is financially responsible for self||80||100||90|
|5. Respects their parents||0||90||80|
When you’re done, you can review your ratings. If there’s one area where you need to improve, you can put together a 3 or 4 step plan for changing. Sometimes, as in Alexis’ case, you’ll realize that you’re actually doing just fine, and no change is needed!
This technique was the icing on the cake, and Alexis decided that her thought, “I’m a bad daughter,” wasn’t actually true.
These were her feelings at the end.
|Feelings||Now %||Goal %||After %|
|Anxious, worried, panicky, nervous, frightened||75||5||10|
|Frustrated, stuck, thwarted, defeated||50||0||0|
|Guilty, remorseful, bad, ashamed||100||0||0|
|Hopeless, discouraged, pessimistic, despairing||20||0||0|
|Sad, blue, depressed, down, unhappy||80||5||0|
|Inferior, worthless, inadequate, defective, incompetent||80||0||0|
|Lonely, unloved, unwanted, rejected, alone, abandoned||75||0||0|
|Angry, mad, resentful, annoyed, irritated, upset, furious||20||0||0|
|Embarrassed, foolish, humiliated, self-conscious||10||0||0|
As you can see, Alexis put in some time and effort to challenge the negative thoughts that were triggering her unhappiness. We are indebted to Alexis for being so open and vulnerable, and for showing this how it works.
Is it worth it? That was a lot of “homework!”
That’s a decision you’ll have to make for yourself, of course. The Dalai Lama said that happiness is the purpose of life. That’s not entirely true, but there’s a lot of truth in it, for sure!
So, the question might be, what would some greater happiness be worth to you?
If you are interested in beta testing the Feeling Good App, you can sign up at www.feelinggood.com/app.
Thank you Alexis for the very special gift of your knowledge, tremendous skill, and vulnerability!
Until next time—
Rhonda and David
Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees people over Zoom and in-person. She can be reached at firstname.lastname@example.org. She is a Level 5 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.
You can reach Dr. Burns at email@example.com.
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