Ask  David

With Special Guest Expert, Dr. Matthew May

The answers to this week’s questions were written by David prior to the podcast. The live discussions will add greatly to the comments below.

1. Mary asks: How can I say no!
2. Anonymous asks about the Sufficient Conditions for Emotional Change.
3. Negar asks: How could you strengthen your spirit and increase your inner capacity to hear the pains of others and then apply ointment? . . . What should I do to have a strong spirit?
4. Giulia asks: Can CBT, or TEAM-CBT, help individuals with schizophrenia?
5. Clara asks for help with her intense public speaking anxiety.
6. Andy asks about the Queen Bee phenomenon in men, and whether it’s okay to give yourself super-positive messages.

 

1. Mary asks: How can I say no!

Dear David,

Hope you are doing very well! Absolutely love your work and TEAM.

I am writing you cause I have been quite frustrated in trying to formulate a 5 secrets response and would really need a new insight.

Recently a new flat mate was supposed to move in my flat. He texted me randomly one afternoon to say he was going to move in that evening. I accepted. A couple of hours later, it turns out he was on a train and was going to arrive with 5 hours delay, which meant he was going to arrive in the middle of the night.

Now, at this point, I wanted to use the 5 secrets to tell him that it was not possible anymore for him to come and wanted to encourage him to sleep at his friend’s places here in town. I was feeling quite upset, frustrated, angry, sad. And I guess he was feeling sad, angry, upset, frustrated, disappointed.

Here is what he said:

I’ll arrive around 2.30, I missed my connection. That’s crazy, as I already said.

Here was my attempt of response:

Shit man that sucks so much!

I guess you were not expecting to arrive so late so it must really not be nice. I’m feeling a bit uncomfortable cause it is quite late and I will be asleep by then.

I clearly didn’t do a great job in responding.

Would give myself a C probably.

He obviously was upset and annoyed and insisted to come till the point when I had to say yes.

How would you improve my response?

I find these situations, in which I need to express what I want, especially challenging.

I struggle with letting go of my ego but somehow that comes a bit more natural to me than trying to express my feelings.

Some help would be much needed!

Thanks for everything,

Julia from Italy

David’s response

“I am so sorry you missed your connection. You seem like a wonderful person, but it won’t work for me to have you move in in the middle of the night. If that doesn’t work for you. Perhaps you could stay overnight with friends or stay at a local hotel.”

If he insists, you might say:

“I understand completely that I might not be the ideal flat mate and would understand completely if change your mind about living here. In that case, we both learned something important. Apologies. I’m sorry it did not work out and I wish you the best.”

Would that work? LMK.

One thing to think about is that it is not just this specific conflict, but a pattern you might be seeing of insensitivity to the needs of others.

Best, david

 

 

2. Anonymous asks about reducing belief in negative thoughts only part way. What are the Sufficient Conditions for Emotional Change?

Dear Dr. Burns,

I hope this email finds you well.

When using various techniques to crush negative thoughts, I often manage to reduce their strength to 1 or 2 (the initial strength of the negative thoughts is around 14, while the positive thoughts I come up with only have a strength of about 13 to 16).  Once the strength of the negative thoughts drops to 1 or 2, I  feel somewhat better. But I have never been able to reduce them to 0. I noticed that in one of the chapters of Feeling Great, you mentioned that it is not always needed to reduce the strength to 0. I would like to know, in what situations is it needed to do that, and in what situations it isn’t?

Another concern I have is that the strength of my positive thoughts is only between 13 and 16, which obviously doesn’t meet the necessary conditions for emotional change, yet I do feel that my mood has improved. I’m wondering whether this could be considered an exception? Do I still have to come up with a positive thought with a strength of 100, despite the fact that the strengh of negative thoughts are  as low as 10 to15?

Best regards,

Anonymous

David’s reply

This is too abstract as I can only answer questions with specific examples. Should statements can sometimes only need to be partially reduced if the thought behind the should statement is zapped.

See this correct but equally abstract answer won’t help because you can’t “see” what’s happening without a specific example!

TEAM always and only works through specifics that are real.,

Best, david

3. Burns, I have a question. How could you strengthen your spirit and increase your inner capacity to hear the pains of others and then apply ointment? It is very hard work. What should I do to have a strong spirit? Negar

David replies

If you like, I can make this an Ask David question on a Feeling Good podcast. Essentially, I’ve never had this problem. Your thoughts cause 100% of your feelings, not the events in your life. And I have always greatly enjoyed talking to people who are hurting because I believe I have some joy and relief to offer them if they’ll do the work of therapy (psychotherapy homework between sessions. )

Best, david

4. Giulia asks: Can CBT, or TEAM-CBT, help individuals with schizophrenia?

Dear David,

Hope you are doing great and enjoying the launch of the app! Congratulations!

I’m a psychology student and this week my professor introduced the topic of schizophrenia.

He made us read an article about an individualized metacognitive behavioral program for people with schizophrenia.

This type of program specializes in changing the beliefs of patients through exercises and psycho education.

The authors of the article bring the example of a woman participating in the program, who thinks she is responsible for a fire alarm setting off. She thinks she can influence electronic devices and that computers sometimes turn off when she is in their proximity. The authors claim that, through the exercises of the metacognitive training, she was able to reduce the belief of this thought from 50% to 20%.

The same type of exercises apply to all the “distorted ways of thinking» typical of the schizophrenic patients. For example they also teach patients, who seem to have deficits in the use of the theory of mind, that interpreting somebody´s feelings only from their facial expressions is not sufficient.

I was a bit confused after reading the article.

Being a long-time podcast listener, I could not but wonder whether such thoughts of the woman in the example, could actually be changed through exercises. I was also wondering why the authors don`t mention any type of resistance on the side of the patient.

I decided to save my speculations and directly ask you, since you have worked a lot with schizophrenic patients.

Thank you so much for the amazing work you put out every day!

All the best,

Giulia from Italy

David’s reply

Hi Guila,

Thanks so much. I have treated quite a number of individuals struggling with schizophrenia, but focused only on their agendas, and that rarely or never had to do with reducing their auditory hallucinations or delusions.

Early in my CBT practice, I tried encouraging them to test their delusions, but it was not at all effective, or even welcome. The biggest error, in my opinion, in clinicians is trying to impose your own agenda on the patient. And I am ALWAYS a bit skeptical of statistics that people claim.

So, I support your doubt, that’s for sure! But my opinion only, as I’m often wrong!

Hey, can I include your excellent question in an Ask David podcast?

Best, david

 

 

5. Clara asks for help with her intense public speaking anxiety.

Hi David,

I’m really glad you replied and asked for more information about my public speaking anxiety, I didn’t expect you are going to.

I found your email in my spam folder, good that I checked before emptying it ;).

Here are 5 things that I’m afraid of before/during presentations or other form of public speaking:

1. My opinion doesn’t matter, my voice is fading, I’m not saying anything important. (My voice is indeed fading, and when I’m asked to speak louder my anxiety is raising)
2. My mind shuts down and I become a little child again when my uncle tried to teach me German and if I wouldn’t know the answer he would pull my hair, ear, yell or threaten with something, made me feel inferior. I had to hide my crying also, I would freeze and dissociate. (I used to have panic attacks in the past and dissociate even when I had to read 2 sentences out loud at school but since then I made a progress to presentations, so reading is not so scary now.)
3. Afraid of intense physical symptoms and not being able to control them, like fast heartbeats that make my chest and voice shaking and from there I dissociate, like I’m not there, I feel time and space differently and the sounds are different. Maybe I don’t want people to see that.

I know I’m not going to die, I do breathing meditations regularly and especially before presentations, sometimes I feel quite relaxed before, I know the atmosphere and people (colleagues and teachers)are chill, and when my turn comes I get intense heartbeats and is hard to breath and talk and I panic.

4. Afraid of misunderstanding things and not being able to process information in real time.

Sometimes I have to give feedback for the person before me when we have the personal project presentations in the end of a course and I struggle to process information in real time when things happen fast, like each student has 15 min presentation+ feedback included. Group presentations is about 5 min.

I try to write things down but my mind cannot process the words, they float through my head like it’s a different language. Sometimes I say ‘’sorry, there was a lot of information to follow but I liked this or that…”. People are understanding, the atmosphere is chill but I still shut down when something is expected of me in real time in a group of people. (Here comes the demanding uncle trauma.)

5. Afraid of being asked questions I’m not prepared for.

I usually read the text from my PowerPoint presentations but because I study a creative field (graphic design, UX/UI, animation…) the presentations might only include showcasing the project. If my project is a video animation or a web/app design prototype, my plan on what to say is quite short. The mind goes blank again when there is unpredictable demands expected of me.

Shortly, I’m 38 and started my healing process about 7 years ago.

I grew up in an east European country in a demanding system very judgmental and critical, with a narcissist demanding uncle until 10, with divorced parents and mom not emotional available and very immature I considered her like a smaller sister always in trouble but resistant to change. Demanding teachers where individuality did not matter. My opinion did not matter, I was just compared with others better than me.

I never felt heard, validated nor understood, I never felt a connection with the people or the country I grew up in. I was a lonely child, in a small town, not building social skills or hobby skills.

I was also depending on other people to get by or solve daily life problems, I was even too anxious to go the store alone because I was afraid to be seen and I thought people would criticize in their minds. Which happened a lot that people would judge the looks of random people walking by.

I moved to Finland 11 years ago and never looked back. I was in a toxic relationship but I found good support system and got out of it 7,5 years ago. I met different health professionals, mostly short time therapy 10-15 meetings and once 3 years where I did CBT mostly and DBT.

I am proud of myself that I put effort and work to rebuild myself, my confidence and find who am I, what I like to do. Really proud I got to the perfect university last year(first time a university student), it was my wish for very long time but I had different limitations back then and din’t know what I wanted to do.

Also I was diagnosed with fibromyalgia 4 years ago and sometimes it’s hard to identify how does it interfere with the difficulty of processing information in real time in a group, alone is okay cause I take some more time to think.

Also my brain gets overwhelmed easily when there are too many things going on at the same time (people, noises, bright lights which I am sensitive to, unergonomic chairs, desks, and the daily muscle pain I’m dealing with).

Sorry if my massage was too long, it felt good to write my stuff down and I also wanted to share my story which is about learning and progress, to see how far I can go.

I want to create myself a nice life and profession, in a country where I feel finally home.

Presentation anxiety is what I want to work on next because presentations are going to be part of my profession, and I also want to build self-confidence when I have to showcase my projects and talk about them to future clients, job interviews.

I want to learn to let the creativity out, express my opinion and not be afraid of getting positive feedback.

I had a social media account where I posted my works but I was afraid of getting followers and interacting with them, so I stopped posting. I got like 50 followers and felt good to get likes but I felt I couldn’t handle with a bigger group and also didn’t have energy to put effort in it. (I give up when things get a bit hard, it happens at school all the time.)

Please send me the unpublished chapters on public speaking if you can find them, I’m interested to read them.

Br,

Clara

David’s reply

Hi Clara,

Sure, there’s a lot to work on here, and lots of methods available, too. We will have to narrow down to focus on one specific moment you want help with, like before a presentation, or whatever. I will send you a Dailly Mood Log to fill out the event, emotions, negative thoughts, and distortions. Will attach it.

I just posted a video on public speaking anxiety on our new YouTube channel (Feeling Great) for our new app (only available so far in US.) See if you can find the video and let me know if you like it. It is short and just focuses on one aspect.

I cannot do therapy in this medium but could perhaps show you some techniques that might help. If we do that, would it be okay to publish our work in a podcast and show-notes so others might also benefit?

Your hard work, persistence, and courage are super positive signs!

I’d love to see an example of your visual work in design etc. Do you have something you could send? Just an option!

Also one of my podcasts (all are free) is on the four approaches to the treatment of anxiety. That would be a good listen. And if available, my book, When Panic Attacks would be right up your alley, so to speak.

Best, david

Matt’s Response:

Hi Clara,

I just had the pleasure of reading over your emails and wanted to thank you for being vulnerable and sharing your experience and questions. Congratulations! It seems to me that you’re already on the right track.

I have found TEAM-CBT to be extraordinarily helpful for individuals with social phobia, regardless of their ‘diagnosis’. One memorable client I worked with a long time ago had just been hospitalized due to severe psychosis, mostly paranoia.

I was extremely fortunate to train with Dr. Burns, as I’m confident this was the only reason I was able to help this person. I think most therapists fail, right out of the gate, with individuals who have paranoia. When a patient says something like, ‘the government is poisoning our water’, the average therapist will make matters worse, by their response.

Even if a therapist can empathize, this is far from curative and won’t address the underlying fears both due to unaddressed resistance, but also due to a lack of appropriate exposure techniques.

The patient has to convince the therapist (not the other way around!) that they are ready to reduce their fearfulness, addressing both their ‘outcome’ and ‘process’ resistance. The therapist can’t be reassuring, or trying to ‘help’, ‘encourage’ or ‘fix’ the patient. On the contrary, the therapist needs to be able to see the truth in the patient’s fears and acknowledge all the good reasons to remain frightened.

This approach (Empathy and Agenda Setting, in TEAM therapy) sets the stage for ‘Methods’. Because the basic problem is fearfulness, a necessary part of the treatment would be exposure, in order to disprove these fears.

The patient I’m thinking of ultimately recovered while doing social exposure (Smile and Say Hello, Self-Disclosure), but there were many other methods that were required to ‘build up’ to the exposure work. This included not-only ‘safer’ versions of exposure, including the ‘what-if’ technique, cognitive exposure, imaginal exposure and ‘feared fantasy’ techniques, but also ‘examine the evidence,’ ‘Socratic questioning,’ ‘externalization of voices,’ etc.

As David alluded to in his last email response, specificity is required for therapy to be most effective. Imagine, for example, you wanted to work on a combination of thoughts/feelings related to shame:

Upsetting Thought: ‘My feelings don’t matter’

Associated Behavior: lowering the volume of my voice/disassociating (zoning out)

I would predict that you would recover, after a little careful empathy and agenda-setting, using a few methods like these:

1. Double Standard: Would you tell a friend that their opinion doesn’t matter? Should they just shut up and go away? Would that be better? Write out that conversation with someone who is just like you. They are a dear friend, with all the same thoughts and feelings as you. How would you empathize and listen with them when they tell you that they are concerned that their opinion doesn’t matter?
2. Identify Distortions: You can refer to the list of ‘10 Cognitive Distortions on the Daily Mood Log c. David Burns, MD, to help, e.g. is this an example of ‘all-or-nothing’ thinking? Meaning, do I think that *all* of my opinions…and *only* my opinions, *absolutely never* matter, *at all, even slightly*, to *anyone*?
3. Explain the Distortions: Spell out why the upsetting thought, ‘my opinion doesn’t matter’, is distorted, e.g. ‘it’s inconceivable that *all* of my opinions would be *completely* immaterial to *everyone*, *all the time*. It’s much more likely that *some* of my opinions would matter, at least a little bit, to *some* people, *some of the time*.
4. Straightforward Technique/Externalization of Voices: try talking-back to the idea, ‘my opinions don’t matter’. Can you successfully debate with this idea? Can you accept some grain of truth in this idea? Can you greet it and brush it off, harmlessly?
5. Get Specific: What opinion of mine doesn’t matter? To whom does it not matter?
6. Hidden Emotion: Is is possible Im feeling angry, in addition to fearful? How do we feel towards people who tell us that our opinions don’t matter?
7. Socratic Technique: ”where is it written that only some people’s opinions matter?
8. Survey Technique: Ask people questions, like, if they think some people’s opinions matter more than other people’s opinions.
9. Feared Fantasy: Imagine someone who insists their opinions are the very best opinions, really great opinions, probably perfect opinions. They claim to be amazing and are also absolutely disgusted by your opinions. They say things like, ‘Your opinions are the worst’, ‘I judge your opinions and can’t believe you ever thought they mattered at all’. ‘Please be quiet and keep your opinions to yourself!’. etc. Carry out a ‘pretend conversation’, with this ‘critic from hell’.
10. 5-Secrets Training: See if you can charm the socks off this critic using the 5-Secrets! “Yeah, I was thinking the same thing, that my opinions are just opinions, and don’t really matter that much. Wow, though, you have some reallyt awesome opinions! I’d love to hear more. Did you think of those, yourself?’
11. Shame Attacking / Radical Self-Disclosure: Three times per day, go out, in public, and yell, loudly, so that at least 5 people can hear you, ‘My opinion doesn’t matter!’. You could also announce this on your social media platforms.
12. Rejection Practice: Assertively express, in public, and post, online, your opinions. Invite people to disagree and offer feedback, responding with the 5-Secrets.

Obviously this isn’t intended to and can’t substitute for therapy. However, there are many talented therapists today who can offer this approach and, in my opinion, it’s the very, very best!

Sincerely,

Matt

6. Andy asks if the strategies for challenging your automatic negative thoughts about dating are different. He’s read David’s book, Intimate Connections.

Dear Dr. Burns,

Thank you for all of your efforts in spreading your ideas around the world. I have found them to be a great help, and I’m a much happier person ever since learning and applying some of your techniques.

I was hoping you could help clear something up for me. In using your techniques to attack my negative thoughts, I would often have thoughts like “I’m a loser”, “Everyone thinks I’m boring”, or “I’m weird”. Using your techniques I would do some positive reframing and then try and replace them with more positive thoughts, which would usually be something like “I can be a bit boring sometimes, but there are people who seem to really enjoy my company so I can’t be too bad!”, or “I do have some strange interests which might put off some people, but I can’t be too bad because some people enjoy talking to me about my interests!”. I have found these methods to be really helpful in getting myself out of my negative thinking and over time I’ve found that negative thoughts like those don’t pop up so often anymore.

However, as I begin to explore dating, I’m wondering if this balanced, acceptance-based approach might benefit from some adjustment. I’ve seen that in dating contexts, more confident self-talk like “I’m an attractive person who has a lot to offer” or “I’m someone worth getting to know” might be more beneficial than my usual “I have both good and bad qualities” approach. I believe you even suggest telling ourselves such things in your book Intimate Connections.

I’d appreciate your thoughts on whether different contexts (like dating) might call for different types of positive self-talk, and if there’s value in shifting from pure self-acceptance to more assertive self-confidence in certain situations.

Thank you again for your time and everything you do.

Best regards,

Andy

David’s reply

Absolutely I agree, and it’s a great point you’re making! The strategies for dating are quite different, and self-confidence is the key, plus learning how to flirt and develop a positive interest in the other person.

People emphasize looks, and certainly stunningly gorgeous men and women are sought after, but that’s no guarantee for anything. I once treated a fellow who might have been the in competition for the ugliest man in the west coast. But lots of gorgeous women were constantly chasing him because of his extreme self-confidence!

Another dimension of attractiveness, I think, is not “needing” women to feel completely happy and worthwhile. This gives you quite a bit of power in the dating game, because you do not fear rejection.

Sex appeal is a bit like being in a hypnotic trance. You just “know:” that you’re “hot” sometimes, and that can act as a self-fulfilling prophecy.

I’d love to make this an Ask David, and can use your first name, if that’s okay, or a fake name, if that’s okay.

Best, david

Love your question, Andy!

David sends a brief follow-up

One additional point. I’ve sometimes talked about the Queen Bee phenomenon, when a woman suddenly discovers / decides that she’s highly attractive and sexy. Once in that mindset, it becomes true, and men chase them. Some colleagues have recently experienced this, and started an Intimate Connections Book Club which was a huge success.

But men can experience the same thing. In fact, in Herman Hesse’s awesome and fun novel, Steppenwolf, the hero, a cynical journalist planning to commit suicide on his 50^th birthday if something doesn’t happen to make his life meaningful, experiences a series of quasi-mystical experiences, and ends up in an “enchanted theater” or hallway with various doors you can ender. One of the doors is labelled (by my memory) “All the women in the world are yours.” When he enters that door he finds himself in a field, a meadow, and he is a kid, and a girl he had a crush on is there as well. When he was young, he was always too shy to tell that he loved her. But this time he does, and he discovers that she loves him, too!

Quite the discovery! It’s one of my favorite books, by the way.

Warmly, david

Andy replies

Dear Dr. Burns,

Thank you for your prompt response!

It looks like I was on the right track then, thank you for helping me clarify things.

I have found the advice on not needing women to be extremely helpful! Based on your advice I ended up traveling solo all across South America and had a blast!

I will try to use your exercises to shift my thinking toward a more assertive self-confidence mindset. I have some resistance to the idea, as in my home country of the UK, we tend to look down on people who are “full of themselves.” However, I just moved to the US, so perhaps I will receive a more favorable response here!

I’d be honored to have my question featured in an Ask David, feel free to use my name if you’d like! I look forward to hearing any other insights or advice you’d have for me.

I’ll be sure to check out your recommendation of Steppenwolf, too!

Thanks again and best regards,

Andy

Two questions from Aaron W. C. who is a Licensed Master Social Worker in Idaho, and said, “I look forward to the podcast.”

Warmly,.

Rhonda, Matt,  and David

Contact Information

Matt can be reached at Matthew May <matthew.may.md@gmail.com>. Or, you can check out his website, matthewmaymd.com

Dr. Rhonda Barovsky is a Level 5 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, and depression. You can reach her at:  rhonda@feelinggreattherapycenter.com.

You can reach Dr. Burns at david@feelinggood.com

 

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This is the cover of my new book, Feeling Great.

The kindle and audio versions are now available too! 

Feeling Great is ridiculously cheap right now on Amazon!