027: Scared Stiff — The Hidden Emotion Model (Part 5)

027: Scared Stiff — The Hidden Emotion Model (Part 5)

Fabrice launches this Podcast by asking David to remind us about the differences between healthy fear and unhealthy, neurotic anxiety, or an anxiety “disorder” like a phobia, or OCD, and so forth. David explains that negative thoughts, and not events, trigger all our emotions, healthy or unhealthy. However, healthy fear results from negative thoughts that are valid and undistorted, and does not need treatment. For example, if you are walking around Chicago in an area dominated by gangs, you may have the thought, “I could get shot. I better be careful because it’s dangerous here!” Your fear is healthy and can keep you vigilant and alive in a genuinely dangerous situation.

In contrast, neurotic, unhealthy anxiety results from thoughts that contain the same ten cognitive distortions that cause depression, such as All-or-Nothing Thinking, Jumping to Conclusions (e.g. Mind-Reading and Fortune-Telling), Emotional Reasoning, Magnification, Should Statements, and more.

David explains that the Hidden Emotion Model is radically different from CBT, exposure therapy, and most other current treatments for anxiety. The theory behind Hidden Emotion Technique is that “niceness” is the cause of (almost) all anxiety in the United States at this time. In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed to want.

David brings this powerful treatment technique to life with a vignette involving Terry, the woman with ten years of terrifying panic attacks described in previous podcast. When David asked about her very first panic attack, ten years earlier some amazing and illuminating information emerged.

David gives tips on how therapists can use the Hidden Emotion Model,

  1. The hidden emotion or conflict is buried in the present, and not in the past.
  2. It is something very ordinary, such as not liking your job, or your major in college, or a conflict with a friend, family member or colleague.
  3. The anxiety is nearly always a symbolic expression of the feeling or problem the patient is not bringing to conscious awareness. David gives listeners an exercise to see if they can pinpoint the symbolic meaning of Terry’s panic attacks.

Fabrice asks the important question—what do you do when the anxious patient insists that there aren’t any hidden feelings? David explains that most anxious individuals will say that, and describes how to bring the hidden feeling or problem to conscious awareness.

He emphasizes the three things he really likes about the Hidden Emotion Model:

  1. It explains the timing of anxiety attacks, so it has tremendous explanatory power. Freud said that anxiety is the mysterious emotion, that comes out of the blue, and strikes like lightning, without rhyme or reason. David disagrees, and emphasizes that anxiety rarely or never comes from out of the blue.
  2. The Hidden Emotion Model can have powerful and rapid healing effects for patients with every type of anxiety, as well as individuals struggling with hypochondriasis and those who go to medical doctors with complaints of pain, fatigue, or dizziness that does not appear to have a valid medical cause.
  3. The Hidden Emotion Model teaches us that the ultimate cause of most anxiety is the fear of the self, of our emotions and how we genuinely feel as human beings.
  4. The Hidden Emotion Model teaches us that recovery from anxiety does not involve recovery from some “defect” or “mental disorder,” but rather the discovery of what it is like to be human being, with all of our feelings, and that it is okay to have an express those feelings.

Finally, David explains that while this technique traces to the teachings of Freud, Freud might turn over in his grave and find it superficial or silly, since David simply tells anxious patients that they are suppressing or repressing something that’s bothering them, and insists they bring it to conscious awareness right away. David accepts this criticism, but also adds that the Hidden Emotion Technique works and frequently triggers complete recovery with patients who are only partially helped by the skillful use of cognitive techniques and exposure techniques.

However, the “niceness” phenomenon only seems to affect about 75% of anxious patients; sometimes, a phobia is just a phobia, with no hidden feeling or conflict. Those individuals will not be helped by this technique. Fortunately, we have dozens of other powerful techniques that will be curative!

Why Do We Act in Such an Illogical Way?

Why Do We Act in Such an Illogical Way?

Dear Dr. Burns,

My name is Sonja and I am a student of psychology in Mainz, Germany. Ironically, I got my first depressive episode in the middle of my studies. After reading “Feeling Good,” I just had the strong wish to let you know how awesome and amazing your book is!

It seems to me that it is not written only for people with depression or other mental illnesses, but it has a huge potential to enrich all kinds of human interactions. The methods you describe for fighting against the symptoms of depression seem so totally logical and comprehensible that I wonder why most people act in such an illogical way, even if they are more or less healthy.

I was never before so exited by a book and just wanted you to know that your work is appreciated :). I just wanted to tell someone, but didn’t expect that all of the people around me would understand my excitement.

With kind regards,

Sonja

Dr. David’s Response

Thank you Sonja! Your kind words are greatly appreciated. I agree with you that it is kind of a mystery why we human beings do this to ourselves—why do we beat up on ourselves so relentlessly with negative messages that are so distorted and unfair? Even though we don’t yet know the causes of depression and anxiety, it is great to have powerful, practical tools to help people break out of bad moods. And when a patient or reader has been helped, I feel the joy, too! Best of luck in your ongoing studies and career.

Please keep in touch! And if you ever visit the San Francisco Bay Area, please visit my training group that meets at Stanford Tuesday evenings. And thank you for giving permission to publish your wonderful note on my new website!

David Burns, MD

Fitness and Self-Esteem

Hi website visitors,I recently received a lovely email and some cool questions from a journalist working for the website, POPSUGAR, (http://www.popsugar.com/), a wellness website which claims more than a billion visitors per year. Wow! That’s a lot! She asked for some help on the topic of self-esteem and body image.Here’s her note:

Hi! Dr. Burns,

Thanks so much for getting back to me; I honestly didn’t know if you’d see my message!

I have some questions for you, and would of course link my interview to Feeling Good, and mention your resources. I have to tell you — your book changed my life, and the lives of many people I’ve talked to who have also struggled with depression and anxiety. I got it for my dad last Father’s Day and he loved it, too.

My idea for our story is centered around the idea that many women deal with a lot of negative self-talk, whether it’s about their physical appearance, fitness journey, abilities, etc. I brought up your 10 categories of distorted thoughts in our staff meeting and how your book teaches someone to identify those and replace those thoughts with ones that are rooted in positivity and reality — we all thought this will be a wonderful trick to teach our readers as well.

Would love to include a quote or two from you in the intro about identifying these thoughts, and how to correct them. In fact, if you could answer these four questions it would be a great help:

  1. How do distorted thoughts affect body image?
  2. Do you think distorted thoughts can be a roadblock in someone’s wellness/fitness journey? How so?
  3. What’s a small piece of advice you could suggest to a woman struggling with poor self-esteem/body-image issues?

And less important, but if you have time:

  1. Do you believe that fitness and healthy eating plays a strong role in having a healthier mindset and more positive / realistic thoughts?

Thank you again for your help on this story, I’m so honored to work with you! Have a great night,

Dominique

To read David’s response, CLICK HERE!

Or, if you prefer to read Dominique’s columns based on her email exchanges with David, here they are:

Dr. Burns,

I just realized I never sent you the finished piece! It did so well and my colleagues LOVED it! Here’s the link (CLICK HERE).

http://www.popsugar.com/fitness/How-Stop-Negative-Thoughts-43019339

I also referenced you and that post we worked on together in my latest piece about food shaming. CLICK HERE

http://www.popsugar.com/fitness/How-Stop-Food-Shaming-43176079

Let’s definitely work on something again soon — our readers love any mental health topics, and are starting to be more open about anxiety. Excited to do more together soon!

Should Statements: Is there a moral / ethical dimension?

Hi Website visitors,

I got an interesting email from a brilliant colleague, Rabbi Joel Zeff, who joined one of the Sunday hikes a year or so ago. He asked about the ethical implications of one of the ten cognitive distortions: Should Statements. This is a cool topic, and I hope you enjoy the exchange! Feel free to comment, too, as usual!

David

Dear Dr. Burns,

You might remember me from one of the Sunday morning walks. (I am the rabbi being trained by Leigh Harrington.) I am most pleased to report that I completed the TEAM-CBT Level One training in November. Leigh was absolutely marvelous and I look forward to continuing my training with this powerful approach towards healing.

Meanwhile I have returned to Israel and am completing my dissertation for the doctorate in pastoral counseling from the San Francisco Theological Seminary (Presbyterian), an affiliate of the Graduate Theological Union in Berkeley. I recently posted the following inquiry, for my dissertation work, on the TEAM listserv and wonder if you would consider addressing it (many thanks!):

Dear Friends,

I am currently working on a doctoral dissertation in pastoral counseling. I am creating a source book for Jewish pastoral counseling which presents examples of cognitive re-framing found in the Jewish mystical thinking of Rabbi Abraham Isaac Kook, the Chief Rabbi of Israel during the “Pre-State” period of the British Mandate (died in 1935).

My point of reference is the wonderful TEAM training I received from Dr. Leigh Harrington (thank you so much Leigh!). As part of my writing, I want to address the interface of ethics and cognitive distortions. One gets the impression that cognitive distortions are not defined by ethical considerations. The primary criteria seems to me whether or not the cognition is firmly rooted in reality and to what extent it is helpful in living a relatively happy and productive life.

Do ethical considerations play a role in defining a “distortion” and/or impact on the course of therapy?

This question was particularly accentuated with regards to “Should Statements.” Ethics would posit that people “should,” for ethical reasons, behave in certain ways. Why should we not expect certain standards of conduct, on ethical grounds? I can understand why we might work on not becoming overly emotionally reactive, but that is not the same as saying “why should he/she behave otherwise?”.

I would very much appreciate your thoughts on this, as well, any references to writing on this particular issue that I could incorporate into the dissertation.

If you are able to address the issue, might I have permission to quote you referenced as “in private correspondence?”

Many thanks,

Joel Zeff,

Hi Rabbi Joel,

Good to hear from you! I still have vivid memories of the Sunday hike you joined not long ago!

In my writings (books, blogs, etc.) and teachings (workshops, podcasts) and therapy work, I have always emphasized that there are three valid uses of the word, “should”—the legal should, the laws of the universe should, and the moral / ethical should.

  • Legal should: You should not drive at 100 miles per hour because you’ll get a ticket.
  • Laws of universe should: If I drop this pen, it should fall to the floor due to the law of gravity.
  • Moral / ethical should: “Thou shalt not kill,” which is straight from the Ten Commandments.

Other uses of the word, “should,” are generally not valid, and they can be painful, too. When you say something like this–“I should be a better teacher (or therapist, or Dad, etc.),” or “I shouldn’t be so screwed up,” or “I shouldn’t have made that investment,” or “I shouldn’t be so shy,”—these are not valid uses of the word, should.

Let’s say you have a fear of bridges, like a psychologist I once treated. She told herself that she “shouldn’t” have this fear, and therefore was “screwed up,” and “shouldn’t be screwed i[.” Is this a valid use of “should?”

Well, it is not illegal to be “screwed up,” or to have a fear of bridges. Also, having a fear of bridges does not violate any of the laws of the universe. Nor is it immoral or unethical to have a fear of bridges. For example, you don’t see , “Thou shalt not fear bridges,” listed in the Ten Commandments, or in any of the holy texts from any religion.

If you look up the word, “should” in one of those huge dictionaries, you will see that it’s origin traces back to the Anglo-Saxon word, “scolde.” So, essentially, you are scolding yourself for having some flaw or shortcoming when you use the word, “should.”

You can combat these painful types of self-criticisms in many ways, but one of the easiest is the Semantic Method—you simply substitute gentler language, such as “I would like to be a better teacher” (or therapist, or Dad, or whatever). Then you can focus on the specifics of what you are doing in your teaching, for example, that’s effective, or ineffective, and make a plan for improvement, if needed.

But in a clinical situation, other methods will almost always be needed, especially Paradoxical Agenda Setting techniques, along with empathy and all the rest of the TEAM-CBT treatment techniques. There are numerous techniques that can be used to combat these dysfunctional uses of “Should Statements.” For example, you can say, “It would be great if I could get over my fear of bridges,” and then you can use a variety of techniques to overcome your fear of bridges, if that is your goal. But that is radically different from beating up on yourself.

Should Statements will generally double your trouble. First, you have some flaw, and second, you are filled with self-hatred because you are telling yourself that you “should not” have that flaw. Then you may feel ashamed and defective, or inferior, or even hopeless.

Shoulds directed toward others cause anger, but are equally irrational. Other directed “shoulds” are usually combined with other-directed blame, and are sometimes difficult to combat. That’s because anger and blame usually make people feel morally superior to others—for example, the blame may be directed at certain religious, political, or ethnic groups, and you may enjoy feeling morally superior to the group or the person you are angry with.

The late Albert Ellis, PhD, humorously called this “shoulding on yourself” (or others.) He also called it the “shouldy” approach to life. He tried to show the “shoulding” patient why these statements are irrational, using the technique called Examine the Evidence. He often said things like, “Where is it written that you shouldn’t have this or that problem?” Or “where is it written that your spouse should be different from the way s/he is?” He often made these statements with considerable force and charisma. Those who remember seeing him when he was still alive will know exactly what I mean!

Some people could see his point, and bought it, while others simply could not “see” it, and got turned off by Ellis. That’s why I’ve developed motivational approaches, like Paradoxical Agenda Setting, that therapists can used before trying to modify the patient’s negative thoughts. You can use techniques like Paradoxical Cost-Benefit Analysis and Sitting with Open Hands, for example. This protects the therapist from having to “sell” something to a reluctant “customer,” and greatly boosts therapeutic effectiveness..

There is no conflict I have ever detected between any form of spirituality, religion, or ethics and good, effective therapy. In my experience, individuals who have resolved and recovered from depression, anxiety, relationship problems, or habits and addictions frequently become more spiritual, and have a deeper understanding of spiritual / mystical / theological / philosophical concepts at the moment of recovery, although that probably sounds vague and maybe goofy. That would have to be the topic of another conversation.

I wrote an article on Should Statements that I might publish on my website at some point.

Albert Ellis was one of the first individuals who taught about the problems with Should Statements, back in the 1950s. He pointed out the three valid uses of shoulds that I listed above. The idea that there are valid uses of shoulds, including Moral Shoulds, is an old and well established concept that is embedded in all of the cognitive therapies.

The feminist psychiatrist, Karen Horney, wrote about the “Tyranny of the Shoulds” in the 1950s as well. My mother was struggling with some depression then, and found the books of Karen Horney to be helpful. I was just a kid at the time. I’m still a kid, but more of an old kid now!

Good luck with your dissertation. I’m sure it will be thought provoking, and interesting to many people!

Hope you can come on a hike again one day!

David