042: Shame-Attacking Exercises

042: Shame-Attacking Exercises

Picture 9Making a Fool of Yourself — On Purpose!

In this podcast, David and Fabrice discuss a mind-blowing technique developed by the late Dr. Albert Ellis to help individuals struggling with shyness. It’s called Shame-Attacking Exercises. Essentially, you do something bizarre in public to overcome your fear of making a fool of yourself; and you will probably discover that the world doesn’t come to end. When used skillfully, this method can be incredibly liberating.

However, there are several ethical considerations. First, before therapists can ask their patients to do Shame Attacking Exercises, therapists have to do Shame-Attacking Exercises themselves! David explains his first, terrifying Shame-Attacking Exercise in a Chinese restaurant in New York after giving a talk at a workshop sponsored by Dr. Ellis.

In addition, therapists have to be careful in the way they use Shame Attacking Exercises, and who they use them with. You have to have an excellent therapeutic alliance with your patient, and the patient has to trust you. In addition, the exercises have to be in an appropriate location—for example, it would be disrespectful to do them in a hospital. And you have to be careful that the Shame Attacking Exercises is not aggressive or frightening to other people.

He also describes how Shame-Attacking Exercises helped a man and a woman he treated who were both afraid to flirt with people they were attracted to, and in both cases, he had to push fairly hard since the patients put up stiff resistance to the idea.

TEAM-CBT includes many powerful techniques, and while they have the potential to bring about rapid and often fantastic change, they also have the potential to hurt if not used skillfully and appropriately. Any listeners who are interested in using these techniques should first consult with a mental health professional to make sure the techniques are appropriate and likely to be helpful to you.

All that being said, you will (we hope) LOVE this podcast!

In upcoming podcasts, David and Fabrice will address questions on OCD (Obsessive-Compulsive Disorder) submitted by several listeners. Is OCD an organic illness? Are drugs necessary in the treatment? What’s the prognosis? David will describe powerful, drug-free treatment methods based on the four models he uses to treat all anxiety disorders: the Motivational, Cognitive, Exposure, and Hidden Emotion Models.

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Do We Have a “Self?” / Truth vs. Happiness

Do We Have a “Self?” / Truth vs. Happiness

IMG_1226Hi Dr. Burns,

Being as you love my questions here is another. It is a heavy philosophical one but don’t feel the need to give a long answer. The question is: Should we believe what is true or what makes us happy?

Albert Ellis, in his book “the Myth of Self Esteem,” actually mentions you. I know you’d want to kill the guy if he were still alive for destroying the basis of many of your books, but don’t you feel honored that grumpy old Al mentioned you? He writes a few hundred pages but all he seems to be saying is that you can’t prove whether you are worthwhile or not so you’d might as well believe that you are.

My new coach seems to think that truth is relative and all that kind of stuff. She thinks that you should believe what is best for you and don’t worry about whether it’s true. Even Dr. Ali Binazir says something like the usefulness of a belief is more important that its truth (can’t find exact quote).

What do you think? Should I believe what makes me happy and forget about logic or keep on thinking (and maybe be not as happy)?

Richard

Hi Richard,

Great questions, thanks!

First, with regard to Dr. Ellis, I was a huge fan of his, and we saw eye to eye on a great many topics. I admired his ruthless integrity and regard for the truth. He did not steal ideas from others, as so many in our field do, and call them his own, but always gave credit where credit was due. So I was a huge fan and always honored when he mentioned me!

of course, he was a wild man, no doubt about it, and all those who saw him in person during his workshops will know what I mean. Every third word that came out of his mouth was the F-word. But he had tremendous numbers of fans and followers. In fact, i think many people liked him because he was so delightfully outrageous and honest!

As you know, Dr. Ellis created Rational Emotion Therapy (RET), which later morphed into Cognitive Behavioral Therapy (CBT). He is considered the “grandfather of CBT.” Beck is often thought of as the “father of CBT.” I might be the son of CBT! Who knows? So many talented therapists and researchers have contributed to the new approaches in psychotherapy that began about four or five decades ago.

I agree with Ellis that you cannot measure your worthwhileness as a human being, so you might as well give up this fruitless and often painful endeavor. but I don’t even need to assume that I am worthwhile. I am too busy enjoying life to waste time on that idea!

I have a beautiful new kitty, Miss Misty. she doesn’t care whether or not I am worthwhile, either! But she loves to play and cuddle. That’s enough for me.

You can measure the worthwhileness of specific things, like this post. For example, you might give it an A, a B, a C, or below, depending on how much you like it and learn from it. But you cannot measure the “worthwhileness” of your “self.” In fact, there is no “self.” We can focus on improving in specific areas, however. For example, if you exercise regularly your conditioning will improve. But your “self” won’t improve!

One of the best students I ever had was Matt May, MD, who now teaches with me at Stanford and has a booming clinical practice. He is a totally fabulous clinician, dear friend and esteemed colleague. When he was a resident, I would supervise him three hours a week, going over clinical cases and personal issues as well, which is typical of what happens in psychiatric training.

One day we were driving back to my house from a pizza place where we’d been eating and discussing his cases, and going over some personal stuff. We stopped at a stop sign, and he looked at me in very meaningful way and said, “Dr. Burns, I want you to know that I’m working so hard every day to become a better person!”

I said, “Matt, I hope you get over that pretty soon!”

He immediately broke into laughter and “got it.” That was the moment of his enlightenment. Enlightenment often comes with laughter, as you realize your suffering has been the result of a kind of cosmic joke. This is a Buddhist notion going back 2500 years, but it is also embedded in most religions.

Thie idea that we have no “self” is mystical but practical and potentially liberating. Buddha got the ball rolling when he talked about the “Great Death,” or the death of the ego. I lost my “self,” along with my “self-esteem” years ago, when I was jogging home from the train station in Bryn Mawr Pennsylvania after work. And what a relief to get rid of them. They kind of fell off, and then I started jogging faster without having to carry them any longer.

Sadly, my “self” (and my pride) have a way of coming back to life from time to time, so then I have to get rid of them again! That sucks!

If you understand this, it is likely crystal clear and super obvious, perhaps. But if you don’t understand it, it is likely sounding like so much mumbo-jumbo!

You asked if we should believe what is true, or what makes us happy? This is a vague question, so I don’t know what you are referring to. Usually I try to avoid general questions without specific examples. Perhaps you could make your question a bit more specific? For example, what belief in particular are you referring to?

If you go to Las Vegas you may want to believe that if you put your life savings on a number on the roulette wheel, you will earn a tremendous amount of money. But the likelihood is small, so even though the notion is enticing, you probably won’t want to do that.

In therapy, I use both truth and motivation in working with someone who is depressed, anxious or angry. Both are powerful and potentially healing technologies for folks. Obviously, we tend to believe things that appear to be true. But we also tend to believe what we WANT to believe. Motivation also plays a basic and powerful role in how we think and what we do.

Cult leaders motivate followers by telling them absurd things that could not possibly be true. For example, the Heaven’s Gate San Diego cult leader told his followers that if they committed suicide they would be reincarnated on the Hale–Bopp comet that was passing close to the earth. So they all killed themselves! The cult followers WANT to believe what they are being told, so they buy into it. Hitler used the same method to motivate people, telling them they were the superior race. People want to feel superior, and want to scapegoat and blame others for their problems.

From a philosophy of science perspective, some statements or theories can be proven to be false. For example, you can easily test the claim that if you drop your pen, it will float up to the ceiling. Drop it and you will see that this theory is false.

But sometimes we make value judgments, or stipulations, that cannot be proven one way or the others. For example, take the statement, “All men (or all humans) are created equal.” This is a value system we endorse, but it cannot be proven one way or the other. Our moral and legal laws are like this.

Take the belief, “I should always try to be perfect.” This cannot be proven to be true or false, it is just a value you might, or might not, endorse. There are many advantages to this belief, as well as many disadvantages. I deal with this belief all the time in therapy, as it seems to trigger feelings of depression, inferiority, anxiety, and defectiveness, to name just a few. But at the same time, the belief may motivate and make you feel like something wonderful is going to happen when you achieve your goal.

So, sometimes considerations about truth will dominate our thinking and our decisions, and sometimes considerations about advantages and disadvantages (motivational issues) will tend to dominate our thinking, and sometimes considerations of truth as well as motivation both play a role in how we think, feel, and behave.

This is all a bit too theoretical for me, although still interesting. I am a psychiatrist, but my main treatment tool is psychotherapy. The type of psychotherapy I do always focuses on something specific and real, for example, a specific moment when someone is upset and wants to feel better or behave more effectively. General discussions have been much less effective as treatment tools in my experience.

But still fun to talk about! So thanks, Richard!

David

David’s Ted Talk

Hi Web visitors,

I was thrilled to get this unexpected and wonderful email today:

Hi Dr. Burns,

I just published this post on The Huffington Post entitled The Best Ted Talk I’ve Ever Seen, on your Tedx Talk in Reno. It was amazing. To view my post, CLICK HERE.

James E Porter

I am very appreciative, James! Thanks so much!

David