Building Self-Esteem and Overcoming Toxic Shame–as well as feelings of depression, anxiety, inferiority, hopelessness, and anger!
Let’s face it–nearly all of us fall into the black hole of depression, anxiety, shame, and self-doubt at times. Then it’s time to ask yourself what you’re telling yourself, write down your negative thoughts, identify the distortions in them, and substitute thoughts that are more positive and realistic. Sound too easy? The results can be mind-blowing!
David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT.
David hopes to make the actual video of this dramatic therapy session available soon right here at http://www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.)
While listening, you can download pdfs about each of seven steps to help you break out of bad moods and boost your self-esteem:
Step 1. Identify the Upsetting Event
If you click on Melanie’s Daily Mood Log you will see that the Upsetting Event was something seemingly innocuous.
Step 2. Rate Your Negative Feelings
If you click on Melanie’s Daily Mood Log again, you will see how she circled her feelings and rate each type of a feeling on a scale from 0% to 100%. You will see that her negative feelings were actually incredibly intense.
Cognitive therapists, going all the way back to the Greek Stoic philosopher, Epictetus nearly 2,000 years ago, say that we are upset, not by things, or events, but by our thoughts about them. If you click on Melanie’s Daily Mood Log with Negative Thoughts yet again, you will see what she was telling herself about the phone call from the member of her church.
Step 4. Positive Reframing
This is one of the many powerful new features of TEAM-CBT. Before trying to change the way you think and feel, focus on your negative thoughts and feelings one at a time and ask yourself two questions:
What are some benefits, or advantages, of this negative thought or feelings?
What does this negative thought or feeling show about me and my core values that’s positive and awesome?
Briefly stop the recording and review Melanie’s Daily Mood Log. Then see how many positives you can list. For example, what does Melanie’s shame show about her that is awesome and positive? And what are some really beautiful things about her sadness and depression? What are some potential benefits of her anxiety?
Step 5. Identify the Distortions
After the Paradoxical Agenda Setting (in this case, Positive Reframing), I asked Melanie what Negative Thought she wanted to work on first. She selected the second negative thought, “She’ll tell other people who will judge me.” See how many distortions you can find in this thought, using the list of ten distortions on her Daily Mood Log.
When you’re done, you can see how Melanie identified the distortions in this thought, using abbreviations, in the Distortion column of her Daily Mood Log. However, on the podcast, David identified one additional distortion he had overlooked during the live session with Melanie. Can you figure out which one it is?
Step 6. Challenge the Negative Thought
There are more 50 techniques that you can use to challenge a Negative Thought. After listing roughly 17 promising methods during the session, Melanie decided that she wanted to start out with a gentle method called the Paradoxical Double Standard Technique. If you click on Melanie’s Daily Mood Log again, you can see the Positive Thoughts Melanie came up with to challenge the Negative Thought, “She’ll tell other people who will judge me.” You will also see how strongly she believed them. Remember that the Necessary Condition for Emotional Change is that the Positive Thoughts all have to be 100% true. Rationalizations and half-truths will rarely, if ever, give anyone genuine relief or mood elevation.
Now the question is this: Did the Positive Thoughts reduce Melanie’s belief in the Negative Thought? Remember the Sufficient Condition for emotional change: the Positive Thoughts must drastically reduce the belief in the Negative Thoughts. That’s the whole goal, in fact, of cognitive therapy. Remember, when you change the way you THINK you can change the way you FEEL!
If you click on Melanie’s Daily Mood Log again, you’ll see that her belief in the Negative Thought was, in fact reduced. Sometimes, you will want to reduce your belief in a Negative Thought all the way to zero. But in this case, 35% was sufficient, since some people may, in fact, judge Melanie, although most people probably will not.
Step 7. Outcome: Re-rate Your Negative Feelings
Once you’ve clobbered one negative thoughts, it’s generally much easier to knock the rest of your Negative Thoughts out of the park. This was the case with Melanie. If you review her final Daily Mood Log, you can see how she challenged the rest of her Negative Thoughts and the incredible impact this had on her feelings.
Next week we will have something very special and very precious for you–
Podcast 079: What’s the Secret of a “Meaningful” Life? Live Therapy with Daisy
This will be a dramatic and inspiring podcast that Fabrice and I feel very grateful to be able to share with you. The podcast will be based on an actual therapy session with a young woman who is struggling with depression, anxiety, and self-doubt because of fertility issues, due to strong. societal messages that women shouldhave children and should want children. This will be a unique opportunity to go behind closed doors to see TEAM-CBT live and real with someone like yourself who is struggling with intense negative thoughts and feelings.
The live therapy sessions we have published previously–with Mark, who felt like a failure as a father, and with Marilyn, who was confronted by a sudden and totally unexpected horrific diagnosis of Stage 4 lung cancer–received tremendously positive feedback from all of you. Now we are proud to present yet another live therapy session next week! So mark your calendars!
March 22 and 23, 2018 Rapid Recovery from Trauma,(David D. Burns, MD)J&K Seminars, Lancaster, Pa 15 CE credits, includes live evening demonstration on the evening of day 1. You can join in person or online from wherever you live!
Additional Resources for the General Public (all available at Amazon.com, as well as other booksellers)
Feeling Good: The New Mood Therapy
The Feeling Good Handbook
Feeling Good Together
When Panic Attacks
General public and mental health professionals might enjoy the recent article about David in Stanford Magazine authored by Robert Strauss entitled “Mind Over Misery.”
Additional Resources for Mental Health Professionals
David’s Tuesday evening TEAM-CBT meets at the Behavioral Sciences Building, 401 Quarry Road, Room 2209 from 5:00 to 7:30 PM, and is free. It is open to all SF Bay Area mental health professionals as well as graduate students in any mental health field, including but not limited to Stanford graduate students. There are teachers include:
Podcast 34: Live Therapy Session with Mark: “I’ve been a failure.”
M = Methods (cont’d)
In the last podcast, David and Jill helped Mark challenge one of his negative thoughts, “There must be a defect in my brain that prevents me from developing a loving relationship with my son,” using Identify the distortions and the Paradoxical Double Standard Technique. In this podcast, they continue encouraging mark to challenge his negative thoughts using additional techniques, including the Externalization of Voices, which is arguably the most powerful Cognitive Therapy technique ever created. The goal of the Externalization of Voices is to create genuine and lasting change at the gut level.
Although it is one of the first cognitive Therapy techniques Dr. Burns created, it is rarely used by cognitive therapists in the United States, perhaps because it is so edgy, or perhaps because it is sophisticated and requires a high degree of therapist skill. The Externalization of Voices is often paired with another technique Dr. Burns created called the Acceptance Paradox. The goal of the Acceptance Paradox is a profound and lasting change in the patient’s core beliefs and values, and it sometimes triggers spiritual enlightenment, although it is an entirely secular method.
Jill and David also use the Semantic Method and Re-attribution in this segment, and end with a brief illustration of how Mark might interact differently with his son using the Five Secrets of Effective Communication. David and Jill emphasize that this is the “External Solution,” and that up to this point in the session they’ve been working on the “Internal Solution.”
In the next podcast, Jill and David will return to T = Testing to find out how Mark feels at the end of the session, and how he rates Jill and David for Empathy, Helpfulness, and other measures of the therapeutic relationship. At the end of the session, Dr. Burns asks Mark if the change was real, or simply something fake for the purpose of the podcast. At that point, something stunning happens, which turned out to be the highlight of the entire session. So stay tuned!
And thank you, so much, for your ongoing support of our efforts! We all greatly appreciate your many kind and encouraging comments and emails on our podcasts. That motivates us to work really hard (and joyously) to bring more of this kind of teaching to you!
One quick note. I do not answer messages from Facebook, as I am getting far more than I could ever attend to. Which is great, but sad for me since I don’t want people to feel ignored. The best way to contact me is to make comments at the end end of my blogs, as I often respond to those, or simply to contact me through my website, feelinggood.com.
Podcast 33: Live Therapy Session with Mark: “I’ve been a failure.”
M = Methods, part 1
So far, the therapy with Mark had focused on
T = Testing: David and Jill review Mark’s feelings at the start of the session
E = Empathy: David and Jill listen and provide empathy as Mark describes his feelings of shame and discouragement because of his failure to develop a loving relationship with his oldest son.
A = (Paradoxical) Agenda Setting: David and Jill find out what, if anything, Mark hopes to get out of this session, which appears to be complete relief from his negative thoughts and feelings. Then the bring his subconscious resistance to change to conscious awareness, and melt it away using the Magic Dial, Positive Reframing, the Acid Test, and the Magic Dial.
In this session, David and Jill began using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%.
Do you know what the necessary and sufficient conditions are for feeling emotionally upset? The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought. And if you review his Daily Mood Log from the last session, you’ll see that Mark does have a high degree of belief in all his negative thoughts. When you’re feeling depressed, anxious, inadequate, or hopeless, I suspect that your mind is also flooded with negative thoughts that seem entirely true to you.
Do you know the necessary and sufficient conditions for emotional change?
The necessary condition is that you can challenge the negative thought with a positive thought that is 100% true. Rationalizations and half-truths will never help anyone, at least not in my experience. But having a valid positive thought is not sufficient for emotional change. For example, Mark could tell himself that he’s a very high powered physician in a world-famous medical center, and that thought would be 100% true. But that thought won’t help Mark because he’ll still believe there’s something defective in his brain that prevents him from having a loving relationship with his son.
The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic.
But how can we challenge Mark’s belief in the NT. Remember, he is incredibly intelligent, and he’s been hooked on this NT for decades. So we can’t just tell him to cheer up, or encourage him to think more positively, or reassure him that his brain is A-Okay. Not only will those simplistic approaches fail, they would likely annoy him because they sound patronizing and might convey the message that’s he’s an idiot for believing something so ridiculous.
Instead, as a TEAM-CBT therapist, I think of 15, 20 or even more powerful and innovative techniques that I can use to gently guide the patient to his or her own discovery that the negative thought is simply not true. That’s what we do during the M = Methods portion of a TEAM-CBT session.
You will listen as David and Jill generate Next, Jill and David generate a Recovery Circle, selecting 16 techniques they could use to help Mark challenge the Negative Thought in the middle of the Recovery Circle. To see the Recovery Circle, CLICK HERE. David and Fabrice discuss the rationale for the Recovery Circle–you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy.
One of the first methods we use is so basic that it is programmed right into the Recovery Circle, and it’s called Identify the Distortions. Fairly early in today’s recording, Jill and David will ask Mark to identify the distortions in his Negative Thought (NT), “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” At that point, Fabrice will ask you to pause the recording and see how many distortions you can identify in the thought. You can write them down on a piece of paper, or simply print the linked PDF and identify them with check marks on the list of 10 cognitive distortions from my book, Feeling Good: The New Mood Therapy. CLICK HERE FOR TEN COGNITIVE DISTORTIONS
After Mark identifies the distortions in his Negative Thought, Jill and David encourage him to challenge it, using a variety of techniques on the Recovery Circle, starting with the Paradoxical Double Standard Technique. This is a gentle technique that is often effective for people who are compassionate. Because this technique seems to be helping, they ask Mark to record his positive thought in the Daily Mood Log, and to indicate how strongly he believes it. Then you will see that Mark’s belief in the Negative Thought is reduced to zero if you CLICK HERE.
In the next podcast, David and Jill will continue with the Methods portion of the session using additional techniques on the Recovery Circle. This will be a unique opportunity to hear many of these techniques in real time with a real person, as opposed to simply reading about them in a book. So–stay tuned to our Feeling Good Podcasts–and thank you so much for your enthusiastic support!
Part 4—A = Paradoxical Agenda Setting (PAS, cont’d
As the session continues, Jill and David encourage Mark to develop his list of positives. Mark draws a blank at first. This is very common among patients and therapists alike. Most of us have not been trained to think about depression, anxiety, shame, defectiveness, hopelessness and anger as being good or positive. In fact, we think of them as symptoms of “mental disorders,” according to the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association.) So we think of them as bad, something to get rid of, something needing treatment.
But after David and Jill prime the pump, Mark is surprised that they quickly come up with a list of 16 positives that are real and powerful. At this point, they ask Mark why in the world he’d want to press the Magic Button and have all of his symptoms suddenly disappear–given all these positives. This is called the Acid Test and it’s also paradoxical. David and Jill have now become the resistant part of Mark’s subconscious mind–the part that clings to these symptoms. And when the therapists become the voice of the resistance, the patient will nearly always become the voice that argues for change.
The paradox is resolved with the Magic Dial. Toward the end of this podcast, you will want to review Mark’s Daily Mood Log, with the Goal column filled out on the table of negative emotions.
David points out that there is no single tool or technique that triggers recovery in patients. Instead, each component of T E A M contributes in radically different ways to the substantial or even dramatic improvement the therapists are hoping to bring about it today’s session.
In the next Podcast, David and Jill will begin the M = Methods portion of the session.
After reviewing Mark’s scores on the Brief Mood Survey, the Empathy phase of the session unfolds. During this phase of the session, David and Jill will not try to help, rescue, or save Mark. They will simply try to see the world through his eyes and provide some warmth and compassion.
Mark explains that he had two goals in life when he was a young man. He hoped to have a large, loving family; and wanted to become a skillful and compassionate physician. Although he has achieved the second goal, he has felt sad and guilty for decades because of his failure to develop a loving relationship with his oldest son from a previous marriage.
While Mark tells his story, David and Jill encourage him to record his negative thoughts and feelings on a form called the Daily Mood Log, and to rate how strong each feeling is, on a scale from 0% (not at all) to 100% (the most extreme).
As you can see, Mark has many different kinds of negative feelings ranging in severity from 30% (moderate) to 80% (severe).
If you’ve been listening to the Feeling Good Podcasts, you know that negative feelings do not result from what’s actually happening in our lives, but rather from our negative thoughts about what’s happening. David and Jill encourage Mark to record his negative thoughts on the Daily Mood Log as well, and to indicate how strongly he believes each one on a scale from 0% (not at all) to 100% (completely).
You can also see that Mark is telling himself that he’s been a failure as a father, that his brain is defective, and that he is not doing a good job for David and Jill. These thoughts all involve self-blame. You’ll notice that he also has two other-blaming thoughts. This is not unusual. When you’re not getting along with someone, you may spend part of your time telling yourself that the problem is all your fault, and part of your time telling yourself that it’s someone else’s fault. As a result, your negative feelings may shift back and forth from guilt and shame to anger and resentment.
Most therapists would not interrupt and ask their patients to record their negative thoughts and feelings while they are venting. However, this information will prove to be incredibly valuable later in the session.
Jill and David ask Mark how they’re doing on empathy. If Mark gives them a high rating, they will go on to the next phase of the session, called Paradoxical Agenda Setting. That’s where they will find out what, if anything, Mark wants help with, and see if he has any conscious, or subconscious, resistance to change.