Fast, Effective Therapy for Social Anxiety

If you’d like to hear an audio of my two-hour workshop on social anxiety at the Brief Therapy Conference in Anaheim, California on December 12, 2104, you can listen to it here.

 

If you’d like to see the PowerPoint slides, click here.

Hope you like it!

David

Secrets of Self-Esteem #4: Death of the Ego

Every Sunday I lead a hike for several hours through trails near our home in Los Altos Hills. Members of my weekly psychotherapy training group at Stanford attend these hikes. Afterwards, we have a brunch, so the total experience is about four hours.

During the hikes we do personal work, since the therapists who attend struggle with all the same problems as everyone else. The idea is along the lines of the Biblical verse, “Physician, heal thyself.” If we, as therapists, have gotten in touch with our own suffering and self doubt, and transcended it, we will have far more to bring to our work with patients. On the hikes we also practice therapy techniques, and sometimes consult on difficult cases. The hikes are always great fun, and often magic occurs, with tears, laughter, learning, and growth.

After each hike, I try to send a “hiking report” to members of our training group, as well as those who hiked, summarizing a few of the highlights. On our most recent Sunday hike, we did personal work with several hikers that focused on the theme of the death of the ego. There are many different types of “ego death,” and this has to do with giving up something we want desperately, something we feel we need in order to have a happy and fulfilled life. It might be wealth, or success / great achievement, or perfection, or love, or a certain kind of career, or even something like having a child of your own.

But sometimes we cannot have that thing, for one reason or another. Then we may begin to think of ourselves as second rate, or only average, or whatever. Is it possible to let go of that “need” to be special, or to have or do something special, and still find happiness and joy in life?

If you would like to read my hiking report from Sunday’s hike, along with several responses from people in our group, please click here. After you read the report, feel free to fill out the ultra-short survey below to let me know how much you liked it. That way I’ll find out if more postings like this might be of interest to people.

There’s always a great deal for me to write about, so don’t worry if you don’t like the posting, or if you find it boring. Feel free to comment. I will survive and benefit from your feedback!

Thanks!

David Burns,  MD

Secrets of Self-Esteem, #3

Defeating All-or-Nothing Thinking

Copyright © by David D. Burns, M.D. 2014. Do not reproduce or quote without written permission.

I send out an email report to the therapists in my Tuesday night psychotherapy training group at Stanford every week after we meet. I comment on what happened and summarize the negative and positive feedback from the Supervision Rating Scale that everyone fills out at the end of the evening. I also try to make a few teaching points.

Live therapy is one of many teaching techniques we use in the training group. Several of us work together as co-therapists and we treat an actual patient while the other therapists in the group watch. We stop every fifteen or twenty minutes to make teaching points, and to get feedback from the patient and from the therapists who are watching. This allows the patient to participate in the training process as well as the therapy.

This blog is based on a recent session with a depressed young man who I’ll call Ned. Many details in the report have been heavily disguised to protect Ned’s identity. After you read my comments, you can do an ultra-fast survey to let me know if you liked it.

Click here if you’d like to read about the session with Ned.

Secrets of Self-Esteem #2

Negative Vs.Positive Distortions*

By David D. Burns, M.D.

* Copyright © 2010 by David D. Burns, M.D. Revised, 2014. Do not reproduce without permission. Do not quote or reproduce without express written permission.

In my book, Feeling Good, I listed ten cognitive distortions, or thinking errors, such as All-or-Nothing Thinking, Jumping to Conclusions, Should Statements, Emotional Reasoning, and Self-Blame. These negative distortions trigger negative feelings such as:

  • Depression
  • Feelings of worthlessness, inferiority, and low self-esteem
  • Hopelessness
  • Anxiety, shyness, and panic
  • Shame and guilty
  • Anger and frustration

The list of negative distortions has been reproduced in hundreds of magazines and books and has been helpful to many individuals suffering from mood problems. The idea is that when you’re feeling upset, you’re often involved in a mental con, but you don’t realize it. You’re telling yourself things about yourself and the world that aren’t really true. And when you change the way you think you can change the way you feel.

Most people are not aware that positive distortions can also play an important role in emotional and relationship problems, as well as habits and addictions. There are ten positive distortions that are the exact mirror images of the ten negative distortions. For example, Positive All-or-Nothing Thinking is the opposite of Negative All-or-Nothing Thinking. In both instances, you look at things in opposite, black-or-white categories, and shades of gray do not exist. In the negative version, you might think of yourself as a “loser” because your marriage broke up, or because you failed to achieve an important personal or professional goal. In the positive version, you might think of yourself as a “winner” because of some positive event or personal success.

Positive distortions can be as destructive as negative distortions. When left unchecked, they can trigger mania (abnormal mood elevations), habits and addictions such as gambling and alcohol and drug abuse, and relationship problems, as well as feelings of rage, violence, and even war. For example, Hitler’s messages to the German people involved a skillful blend of positive and negative distortions. He tried to sell the German people on the idea that they were a superior race with the right or duty to exterminate Jews, mental patients, gypsies and others who were labeled as “bad” or “inferior.” Unlike the negative distortions, the positive distortions typically lead to intoxicating mood elevations so you may not be motivated to challenge them or to change the way you’re thinking.

Here are brief definitions, along with some examples, of the ten positive and negative distortions.

Checklist of Negative and Positive Distortions*

Distortion

Negative Distortion Example

Positive Distortion Example

1. All-or-Nothing Thinking. You think about yourself or the world in black-or-white, all-or-nothing categories. Shades of gray do not exist. When you fail, you may tell yourself that you’re a complete failure. When you succeed, you may tell yourself that you’re a winner and feel superior.
2. Overgeneralization. You think about a negative event as a never-ending pattern of defeat or a positive event as a never-ending pattern of success. When you’re rejected by someone you care about, you may tell yourself that you’re an unlovable loser who will be alone and miserable forever. When you overcome an episode of depression or self-doubt, and you’re suddenly feeling happy again, you may tell yourself that all your problems are solved and that you’ll always feel happy.
3. Mental Filter. You think exclusively about your shortcomings and ignore your positive qualities and accomplishments. Or, you dwell on the positives and overlook the negatives. A TV talk show host told me that he typically received hundreds of enthusiastic emails from fans every day, but there was nearly always one critical email from a disgruntled viewer. He explained that he’d obsess for hours about the negative email and completely overlook the hundreds of glowing ones. As a result, he constantly struggled with feelings of anxiety and low self-esteem in spite of his tremendous ratings and popularity. You may fantasize about how good that desert will taste, and ignore the negatives, like gaining weight and feeling guilty or bloated afterwards. Or, you may tell yourself how great you’ll feel if you have a drink, and ignore the fact you nearly always drink too much and end up with a hangover.
4. Discounting the Facts. You tell yourself that negative or positive facts don’t count, so as to maintain a universally negative or positive self-image. Discounting the Positive: When someone genuinely compliments you, you may tell yourself they’re only saying that to make you feel good. Discounting the Negative: When you’re trying to diet and feeling tempted by something tasty, you may tell yourself, “I’ll only have one little bite.” But you’ve probably given yourself this message on hundreds of occasions, and it has never once been accurate!During an argument, you may get defensive and insist that the other person is “wrong.” Then the conflict escalates.
5. Jumping to Conclusions. You jump to conclusions that aren’t warranted by the facts. There are two common forms that are called Mind-Reading and Fortune-Telling.
Mind-Reading, you make assumptions about how other people are thinking and feeling. If you’re feeling shy at a party, you may tell yourself that other people don’t have to struggle with shyness or that they’d look down on you if they knew you were shy. You tell yourself that a relationship is going really. well when the other person is actually feeling annoyed or unhappy with you.
Fortune-Telling, you make dogmatic negative or positive predictions about the future. When you’re depressed, you may tell yourself that you’ll never recover. When you’re feeling anxious, you may tell yourself that something terrible is about to happen—“When I give my talk, my mind will go blank. I’ll look like an idiot.” You tell yourself, “I’ll just have one drink” or “one bite,” when, in fact, you never stop at just one drink or bite.
6. Magnification and Minimization. You blow things out of proportion or shrink their importance inappropriately. This is also called the “binocular trick” because it’s like looking through the ends of a pair of binoculars, so things either look much bigger, or much smaller, than they are in reality. When you’re procrastinating, you may think about everything that you’ve been putting off and tell yourself how overwhelming all those tasks will be. (Magnification) You may also tell yourself that you’re efforts today wouldn’t amount to anything anyway, so you might as well put it off. (Minimization) When you’re trying to diet and you’re feeling tempted, you may tell yourself: “This ice cream will taste so good!” (Magnification). Will it really be that good? Will it be worth the way you’ll feel about yourself after you give in to the urge to binge?
7. Emotional Reasoning. You reason from how you feel. In point of fact, your feelings result from your thoughts, and not from what’s actually happening. If your thoughts are distorted, your feelings will be as misleading as the grotesque images you see in curved fun-house mirrors. When you procrastinate, you may tell yourself, “I’ll clean my desk (or start my diet) when I’m more in the mood. I just don’t feel like it right now.” Of course, the feeling never comes! When you’re depressed, you may tell yourself, “I feel like a loser, so I must really be one.” Or “I feel hopeless, so I must be hopeless.” When you’re gambling, you may say, “I feel lucky! I just know I’m about to hit the jackpot.”This distortion also triggers romantic intoxication. When you meet someone attractive, you may feel so happy and excited that you think that he or she must be wonderful—the man (or woman) of your dreams.
8. Should Statements. You make yourself (or others) miserable with “shoulds,” “musts” or”ought to’s.” Hidden Shoulds are sometimes implied by negative thoughts.
Self-Directed Shoulds cause feelings of guilt, shame, depression, and worthlessness. You tell yourself that you shouldn’t have screwed up and made such a stupid mistake. When you’re feeling tempted, you may tell yourself, “I’ve had a hard day. I deserve a drink (or a nice dish of ice cream).”
Other-Directed Shoulds trigger feelings of anger and relationship problems. You may tell yourself, “That fellow shouldn’t cut in front of me in traffic like that. I’ll show him that he can’t get away with it!” You may tell yourself that your values are the best values and that other people should think and feel the same way.
World-Directed Shoulds cause feelings of frustration and entitlement. “The train shouldn’t be late when I’m in such a hurry!” You may tell yourself that the world should be the way you expect it to be.
9. Labeling. You label yourself or others instead. Labeling is actually an extreme form of overgeneralization, because you see your entire self or essence as defective and globally bad, or superior. You may label yourself or someone you’re not getting along with as “a loser” or “a jerk.” A physician slipped up on her diet and gave in to the temptation to eat a donut Then she told herself that she was “a fat pig with no will power.” This thought was so upsetting that she ate six more donuts. When you do well, you may think of yourself as special or as “a winner.” Motivational speakers, politicians, and athletic coaches often use this strategy to motivate people. But in reality, there’s no such thing as a “winner” or a “loser.” We’re all human beings, and no one can win or lose all the time.
10. Blame. You find fault with yourself (Self-Blame) or others (Other Blame). Self-blame. If you’re depressed, you may beat up on yourself constantly and mercilessly, blaming yourself for every error and shortcoming instead of using your energy to find creative solutions to your problems. Other-blame. During an argument, you may tell yourself that the other person is to blame for the conflict. Then you feel like an innocent victim and overlook your own role in the problem.

Although it is a matter of controversy, I believe that it is possible to feel joyous and enlightened without positive distortions. I’m also convinced that healthy negative emotions (such as sadness or healthy fear) can be distinguished from unhealthy negative emotions (such as clinical depression or a panic attack) by the presence or absence of negative distortions in the thoughts that trigger the feelings.

In the third chapter of Feeling Good I described an experience during my medical school when I was on call for the inpatient surgical service one evening at the Stanford Hospital. One of our patients was an elderly man with a kidney tumor. We operated and successfully removed his kidney, and the prognosis seemed positive. Unfortunately, he suddenly developed an aggressive metastasis to his liver and was placed on the critical list. The metastasis was not treatable.

His elderly wife stayed by his bed night and day, and wouldn’t leave the hospital. At times, she would just let her head slump next to him on the bed and fall asleep. She often stroked his head and said, “You’re still my man and I have always loved you.”

One night he began to slip into a coma, so the family was notified. Nearly a dozen of them soon arrived in his room, including his children and grandchildren. One of his sons asked if I could remove the catheter from his penis, because it had been uncomfortable for him. I was pretty unsure of myself, and didn’t even know how to remove a catheter, so I checked at the nursing station, but they said it was okay and explained how to do it. I asked if this meant that he was dying, and they said he was.

I went back to the room, pulled the curtain around the bed, and removed the catheter from his penis. Then I opened the curtain again. His son looked at me and asked, “Does that mean he’s going to die tonight?”

I had grown attached to him because he was a very kind man who had reminded me of my grandfather. Tears were rolling down my cheeks as I said, “He’s slipping into a coma, but he can still hear you, so it’s time to say goodbye. I loved him, too.” They all gathered around his bed to comfort him. I went to the room where the residents did their charting work and began to sob. He died within an hour.

To my way of thinking, the experience of profound sadness and loss, without distortions, is not depression, but rather a celebration of life. Sadness reflects our capacity for love. Healthy negative and positive emotions don’t need treatment, but are part of the richness of the human experience.

Sometimes healthy negative emotions (such as grief) are complicated by negative distortions, so healthy and unhealthy feelings coexist. In this case, you can use the “Mood Journal” to pinpoint and challenge your distorted negative thoughts. In Feeling Good I also described a severely depressed, suicidal physician whose brother had committed suicide. She was telling herself: 1. His depression was my fault because our parents loved me more when we were growing up. 2. I should have known he was suicidal the night he killed himself. 3. Because I failed him, I too, deserve to die.

These thoughts contained many distortions, such as Self-Blame, Should Statements, and Emotional Reasoning, as well as Mind-Reading and Fortune-Telling, since she expected herself to know how he was thinking and feeling the night he took his life. Fortunately, we were able to find a way to challenge and defeat those thoughts during her seventh therapy session. Her depression and suicidal urges vanished, and she was finally able to grieve his loss. Paradoxically, the intense depression, shame, and guilt she was feeling had prevented her from grieving his loss in a healthy way.

Secrets of Self-Esteem, Part 1

* ©2013 by David D. Burns, MD

Do not copy, publish or reproduce without the written permission of Dr. Burns.

I’m going to start out with a few postings on the popular subject of how to boost your self-esteem and overcome feelings of worthlessness, inferiority, or inadequacy. These feelings are among the most important symptoms of depression, and most people fall into black holes from time to time when you begin to feel that you’re not as good as you should be.

Therapists are not immune from these feelings, either. In fact, when I give workshops for mental health professionals around the US and Canada, it seems that the vast majority of the therapists who attend have struggled with feelings of depression and anxiety. Cartoons often focus on the theme of therapists who are nuttier than their patients. There’s a lot of truth in that. Many people pursue a career as a psychotherapist primarily because of their own suffering, in the hopes of finding personal healing along the way. And there’s certainly no shame in that. In fact, therapists who have experience profound personal healing have much more to offer their patients than simply tools and techniques. They can say, “I know how painful your suffering is, because I’ve been there myself. And I also know how to show you the way out of the woods, so you can regain joy and self-esteem again.”

To get the ball rolling, I’m providing some information from a short interview I did on this topic for a Toronto newspaper recently. I pointed out that when you’re experiencing low self-esteem, the culprit is always your thoughts. You are giving yourself negative messages, like

  • “I should be better than I am,” or
  • “I shouldn’t have made that mistake,” or
  • “I’m inferior–there’s really nothing special about me.”

You may even tell yourself that you’re defective.

Although you probably believe these painful thoughts with all your heart, they are, in fact, distorted and illogical. You’re telling yourself things that aren’t really true. Depression is the world’s oldest con. You’re probably involved in All-or-Nothing Thinking, Mental Filtering, Discounting the Positive, Emotional Reasoning, Should Statements, and Self-Blame, to name just a few of the “cognitive distortions” that trigger depression and anxiety.

Here’s the good news–when you change the way you THINK you can change the way you FEEL. To find out how, check out one of my books, such as Feeling Good: The New Mood Therapy or The Feeling Good Handbook. Numerous research studies have revealed that roughly two thirds of the people who read one of these books and do the exercises experience substantial, and even dramatic, improvements in mood and outlook within four weeks, even without antidepressants or therapy. These studies included individuals who were moderately to severely depressed.

What was equally startling was that the effects seemed to stick–long-term follow-up studies revealed that patients felt even better at their three-year follow-up evaluation.  So although these books are not panaceas that will cure all depression, they can certainly help. And it’s also good news that we now have powerful, fast-acting, drug-free treatments for depression and all of the anxiety disorders as well.

Most of us fall into black holes of self-doubt from time to time. Recovery from those feelings is one of the greatest feelings a human being can experience. I’d love to show you how to have this experience, too.

For more on overcoming depression and low self-esteem, stay tuned.