Enjoy David’s Fabulous Canadian Summer Intensive!*

Enjoy David’s Fabulous Canadian Summer Intensive!*

Coming in July! My annual Canadian summer intensive!

“Advanced Cognitive Therapy for
Depression and Anxiety Disorders”

Whistler, BC, Canada
July 3 – 6, 2018

This brief video will explain why you should attend!

For workshop description / registration details, click–Jack Hirose & Associates Inc.
Phone: 604.924.0296, Toll-free: 1.800.456.5424

You’ll LOVE this workshop and you’ll learn TONS of helpful techniques to treat depression, anxiety disorders, and habits and addictions.

You’ll have your evenings free to enjoy the beautiful Whistler countryside, and I will likely offer optional evening hikes as well, with opportunities for personal work and consultation.

You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

Mike Christensen and several others will be joining me at Whistler to help out with supervision of the small group exercises. Mike and I will also be doing a live therapy demonstration with an audience volunteer on the morning of day 2. Mike is a tremendous teacher and therapist, and a highly esteemed friend and colleague.

I hope you can join us in Whistler!

087: Role-Play Techniques (Part 5) — The Devil’s Advocate Technique

087: Role-Play Techniques (Part 5) — The Devil’s Advocate Technique

In today’s podcast, we will illustrate the Devil’s Advocate Technique, another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as:

  • Drug or alcohol abuse
  • Overeating / binge eating
  • Shopping addiction
  • Internet addiction
  • And procrastination, which is our problem for today.

David and Fabrice are joined by Sara Shane, a member of David’s Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.

Sara explains that she has a small clinical practice in the central valley of California working with children but would like to expand her practice to include teenagers and adults, so she can use the exciting TEAM-CBT skills she’s been learning in the Tuesday group over the past year. In addition, Sara is bilingual, so this would open up the possibility that many Spanish speaking individuals could have the opportunity for treatment with TEAM-CBT.

But to do that, Sara would have to start marketing her practice, but she’s been procrastinating. She never seems to get around to it, and always places the wants and needs of others in her family above her own.

David asks her what it is she’d have to do. She says she wants to put together a brochure describing her work so she could send it to people on her mailing list who might send her some referrals. David ask her to list the first few steps of her task, limiting what she would have to do to just to get started, something requiring only about 5 minutes.

Here are the first steps, and time required for each:

  1. Sit down at the computer and turn it on. (30 seconds)
  2. Open a blank document in MS Word. (30 seconds)
  3. Jot down a few names for my practice, even if they aren’t especially good (since they can be revised later). (4 to 5 minutes)
  4. Add my contact information. (1 minute).

So, the total time required would be six minutes or so. David asks if she’d be will to do it tomorrow morning from 9 AM to 9:06 AM. She said she’d actually like to start tonight, but it is already 9 PM and she still has a two-hour drive home. So she agrees to do it first thing in the morning instead. She also agrees to send an email to Fabrice and David and the Tuesday group at 9:06 with one of two messages: “Mission Accomplished” or “I stubbornly refused.”

Now we’re ready for the Devil’s Advocate Technique. David and Fabrice will play the role of the Devil who tempts Sara to procrastinate, using the actual thoughts Sara has when she’s procrastinating. They include:

  1. I’ll do it later.
  2. There’s always tomorrow.
  3. I don’t have any appointments tomorrow, so I can start to work on the marketing materials then.
  4. I have to take Mom to her doctor’s appointment now, so I can work on the marketing materials later.
  5. Right now, I just need some rest and relaxation, some time for myself.

David begins and tells Sara, “Oh, you can do it later. There’s no reason for you to have to do it now!”

Sara’s response is decent, but not super-strong. You’ll hear on the audio that it’s a bit half-hearted, and not overwhelmingly convincing. And if she can’t crush the tempting thought during the session, she definitely won’t be able to resist it when she’s home alone.

Instead of giving Sara some tips on how to improve it—which David says the therapist should never do when working with someone with a habit or addiction—David suggests that maybe the problem of procrastination perhaps isn’t something Sara wants to work on right now.

This is called Sitting with Open Hands, and it’s far more powerful than trying to “help.” Trying to help a patient who’s struggling with a habit or addiction will usually just make the problem more intense.

Fabrice points out that people don’t need to be “taught” how to say “no” to some tempting thought. They just have to make a decision!

When David sits with Open Hands, Sara gets agitated and insists she really does want to defeat her procrastination. That’s the most common reaction to “Sitting with Open Hands.”

Then David asks if she’d like to try again. David verbalizes the first tempting thought again, and Sara immediately hits it out of the park in a convincing way.

David and Fabrice take turns as the “Devil,” verbalizing all Sara’s tempting thoughts. One by one, Sara destroys them. She leaves the session on a glow, quite excited about the new direction for her practice.

David and Fabrice emphasize that the Devil’s Advocate Technique is not a method you would just throw at someone with a habit or addiction. Instead, you would work with the person systematically, going through the T E A M model, one step at a time, just as you would with any patient. The Devil’s Advocate Technique is simply one of the M = Methods in TEAM. And it probably won’t be effective if you haven’t done skillful paradoxical agenda setting first, to find out if the patient really is motivated to give up his or her addiction.

Did it work? Was this little mini-session effective? That’s always the question, isn’t it?

Well, here’s the answer! Fabrice and I received this email from Sara this morning:

Hi Dr. Burns and Fabrice,

Thank you so much for the opportunity to volunteer last night for the podcast. What an awesome experience! I am so inspired and motivated that it was hard to stop creating my business postcard to email you that I had accomplished my mission!!!

This is really funny but truly AMAZING!!! I have done beyond what I agreed to do, and this just makes me feel so HAPPY!!!

THANK YOU, THANK YOU SO MUCH!!!

I’M LOVING THIS!

Sara Shane

Way to go Sara! Fabrice and I are so proud of you, and looking forward to the exciting expansion of your practice!

* Copyright © 2018 by David D. Burns, MD

Some Cool Upcoming Workshops

Coming in May!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

Coming in June! One of my best two day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

 

 

Amazing Follow-Up from the David and Jill FB Show on Defeating Habits and Addictions (April 15, 2018 show)

Amazing Follow-Up from the David and Jill FB Show on Defeating Habits and Addictions (April 15, 2018 show)

David and Jill Show is back! Treating Habits and Addictions, Part 2

Hi all!

Here is a mind-blowing email I just got from a fan who watched the David and Jill Show (with special guest Mike Christensen) two days ago. I’m sure you’re going to LOVE it!

On the show, we illustrated several powerful TEAM-CBT methods for defeating habits and addictions (especially overeating):

  • Double Paradox
  • Addiction / Habit Log
  • Devil’s Advocate Technique
  • and more.

Next Sunday, April 22, 2018, we will probably discuss the Four “Great Deaths” of the Ego on the David and Jill Show at 3 PM. The Buddha was the first, I believe, to talk about the death of the “self” as the key to enlightenment, but now we have not one, but four separate “great deaths.” We will discuss them from a psychological as well as a spiritual perspective.

And now, here’s is the really cool email I just received from an individual I’ll call “X.”

Respected and Dear Dr. Burns,

Your Facebook live show this Sunday (Apr 15th) was just brilliant! I thought it’ll be a good idea to share my own experience with you regarding my problem with overeating. Please let me know if I’ve made any errors while applying Paradoxical Agenda Setting or Devil’s Advocate Technique. I am getting great results and able to follow a diet plan for last two weeks since I did this. Below is my records of 1. Paradoxical Agenda Setting & 2. Devil’s Advocate. 

Paradoxical Agenda Setting for understanding the benefits of my overeating: 

  • I feel great about my life when I eat whatever I want & that I am in control of my finances. 
  • When I order expensive food in classy restaurant, I feel like I’m a financially superior person, 
  • I don’t need to deal with my anxiety & negative thoughts, instead I can order a lot of delicious food. 
  • I can brag about all the things I’ve eaten & efforts I’ve taken to obtain many fine delicacies.
  • I take pride in my fastidious, obsessive admiration of cuisines & demand respect from people around me while eating or cooking anything. 
  • I love to go to expensive restaurants, flaunting mismatch cloths to pretend I’m some well -heeled, eccentric, powerful member of society with great connections & influence.

 With these advantages in my mind I tried the Devil’s Advocate Technique. Here’s my dialogue with the imaginary tempter, the “Devil.” 

Devil (D): Isn’t this a great morning? Let’s begin with a lovely breakfast from ‘German Bakery’ or Starbucks, tell me where do you want to go? 

Me: Yes, this is a truly great morning. I just love it! I’m feeling really fresh & energetic. It is best to start with finishing off the draft of the paper. I don’t think having a breakfast will be        very helpful now. 

D: Oh!!! How can you work on empty stomach? Let’s got to some classy place & have a breakfast shaming even businessmen. 

Me: I know very well that fasting helps me work better with amazing concentration & deep insight. So it is great to have empty stomach; & since when have I started bothering so much about what other think of me? 

D: No, you will get anxious while dealing with difficulties in course of writing the paper. You need to eat something. A sweet, soft, juicy pastry or cheesy, creamy, rich sandwich will help you relax & get in proper mood. Let’s have some mac & cheese with that amazing Mango baked cheese cake! 

Me: Surely, it does makes me relaxed after having the delicacies you mentioned. But this has unfortunate side effect too, as it makes me feel bloated, tired and sleepy. Also the only proven way to deal with anxiety is to understand and record distorted negative thoughts; then countering them with truth based positive thoughts. This whole process itself is very enlightening and sometimes downright enjoyable! 

D: Stop rambling like a stupid. You are what you eat & if you eat nothing, you are nothing – you can’t afford to eat delicious, expensive food & that’s why you pretend you need to diet. It’s just way to fool everyone including yourself, you are actually hiding your poverty & sub-standard quality of life. 

Me: I do find it difficult to agree with “you are what you eat” statement, can you elaborate on it a bit so I can understand it better? For example, if I eat chicken, then do I become chicken? 

D: This just proves it that you are an idiot, sub-standard person, not worthy of living in this society. Your level of stupidity is unprecedented on this planet. For God’s sake just eat something now or you will kill yourself by starving., you stupid fool!!! 

Me: I totally agree with you about my stupidity & I may add to that, I’m sometimes rather stubborn too and that has caused some disasters in past. But I do like to test things thoroughly before I give up on them. And as you said I’m stupid so I may continue ‘stupidly’ believing that following this diet is helping me till I get results contrary to the belief. 

D: It will be too late by then & you’ll permanently damage your brain & kidneys. I have to force you to eat something, now!  

Me: It is better to take chance with this one and according to my doctor this is not remotely as dangerous as you say it is. Hare-brained me can’t understand everything through logical arguments like you do; so I need to take some real experience. What do you think? 

D: I give up! go kill yourself! You alone will be responsible for your misery. 

Me: Oh, not today, but thanks a ton for the suggestion, and for your concern! 

Listening to your Sunday broadcast I felt compelled to try this technique, which has been very helpful! Apologies for a bit long email, I hope you would get time to read it.  

Once again thank you very much for writing the great books and making all the resource available to everyone. I believe I will get a chance to meet you in person someday.

Sincerely,

X

Some Cool Upcoming Workshops

Coming in May! This one is SOLD OUT in person but we still have PLENTY OF SPACE TO JOIN ONLINE!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are no spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, including the fantastic Mike Christensen.

Coming in June! One of my best two day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

David and Jill Show (live FB Broadcast) with Mike Christensen, Returns Today April 15, 2018 at 3 PM (PT)!

David and Jill Show (live FB Broadcast) with Mike Christensen, Returns Today April 15, 2018 at 3 PM (PT)!

David and Jill Show is back! Treating Habits and Addictions, Part 2

Hi all!

Last week, my guest was Stephen Pfleiderer, founder of SF Intervention, and we discussed treatment of individuals with hard-care addictions. Today, along with Dr. Jill Levitt and Mike Christensen, we will discuss practical tools for individuals fighting less severe habits and addictions such as

  • overeating
  • excessive drinking
  • procrastination
  • shopping addictions
  • drugs
  • and more.

We will illustrate several powerful TEAM-CBT methods such as the

  • Double Paradox
  • Addiction / Habit Log
  • Devil’s Advocate Technique
  • and more.

 

Some Cool Upcoming Workshops

Coming in May!

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

There are only a few spots left for the live workshop in Palo Alto, but we still have room for you to join us for the online version. We will have helpers to guide the small group exercises for those online, as well as those who attend in person.

Coming in June! One of my best two day workshops ever!

“Scared Stiff: Fast, Effective Treatment for Anxiety Disorders”
a two-day workshop Sponsored by Jack Hirose & Associates
June 4 -5, 2018 Calgary, Canada
June 6 – 7, 2018 Winnipeg, Canada
Mike Christensen and several others will be joining me at both locations to help out with supervision of the small group exercises. You’ll LOVE this workshop and you’ll learn TONS of powerful techniques to treat every type of anxiety. You’ll learn how to heal your clients and your own feelings of insecurity and self-doubt as well!

I greatly appreciate your support, and hope you will continue to spread the word about TEAM-CBT and www.feelinggood.com. i am trying hard to reach as many people as possible with my free programming and blogs designed to help individuals struggling with depression, anxiety, relationship conflicts, and habits and addictions, as well as the therapists who treat them!

David

072: Secrets of Weight Loss — Making Good on Your New Year’s Resolutions!

072: Secrets of Weight Loss — Making Good on Your New Year’s Resolutions!

Why you DON’T really want to lose weight!

In today’s podcast, David and Fabrice address two terrific questions submitted by listeners:

  • Greg: What’s the difference between Outcome and Process Resistance for dieting and weight loss?
  • Gary: How do you deal with motivation and resistance when dealing with habits and addictions, such as overeating, in TEAM-CBT?

David explains that in his workshops, he often asks his audiences, “how many of you would like to lose some weight?” And he asks you that same question now.

In his workshops, 65% of the hands go up. Did your hand go up too?

Then he say, “all of you who raised your hands just made a mistake! You definitely do NOT want to lose weight. You probably DO want to be thin and attractive, and in great physical condition, but you DON’T want to lose weight. Do you know why? There are only two things that you can do to lose weight–diet and exercise. And they both suck!”

David describes two new, powerful techniques he has created for resolving this dilemma–the Double Paradox and Devil’s Advocate Technique. David and Fabrice bring these techniques to life for you. If you are interested in losing weight, make sure you do the two exercises on paper while listening to this podcast. In fact, take a moment, but the podcast on pause, and get a piece of paper and a pen or pencil right now.

Here’s how they work:

  • Double Paradox: First, you draw a line down the middle of a blank sheet of paper, from top to bottom. Label the left-hand column “Advantages” (or ADV) and the right-hand column “Disadvantages” (or DIS). Now, in the left-hand column, list all the Advantages of eating as much as want of whatever you want, whenever you want.  As you will see when listening, there are many! Then, in the right-hand column, list all the disadvantages of diet and exercise. As you will see, there are also many!

David asks, “given all of the tremendous benefits of eating as much as you want whenever you want, and all the overwhelming disadvantages and hassles of dieting and exercising, why in the world would you want to change?”

He explains why this paradoxical strategy can be so powerful and helpful. In essence, the therapist becomes the voice of the patient’s subconscious resistance instead of trying to “help” or persuade the patient to change.

Research and clinical experience confirms that trying to “help” people lose weight is usually doomed to failure. In fact, if you review the world literature on the treatment of habits and addictions, you will discover that practically ALL diets and weight loss programs have limited success AT BEST.

  • Devil’s Advocate: This is a powerful and fun role-playing technique. First, you list all the positive thoughts that tempt you to give in when you are tempted and craving your favorite food–such as pasta, chocolate, ice cream, donuts, or whatever your weakness is. Then you ask a friend or therapist to play the role of the tempting devil who will try to tempt and seduce you into giving in.Your job is to fight back and defeat the devil. You can record the interactions on your cell phone. if you defeat the devil, you can listen to the recording whenever you are tempted!

David also describes a third, time-honored technique that can be important in dieting (or in overcoming any negative habit or addiction):

  • Stimulus Control: Instead of constantly struggling with temptations, you simply avoid them.

David and Fabrice discuss paradoxical vs. straightforward treatment strategies for habits and addictions, and also raise the question of whether there is some “superior” type of diet or exercise, or whether most, if not all, of the action is in the motivation.

David and Fabrice also discuss strategies for maintenance of weight loss once you have achieved your initial goal.

David and Fabrice love your questions so keep them coming!

Fabrice and I hope you enjoy our Podcasts, and also hope you can leave some positive comments for us and some five star ratings if you like what we’re doing!

Subscribe

At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.

 

Role Model? Or Possibility Model?

Role Model? Or Possibility Model?

In my Tuesday evening psychotherapy training seminar at Stanford, we train therapists in TEAM-CBT, and one of the teaching methods involves personal work for the therapists, kind of on the idea of “Physician, heal thyself.” (Luke 4:23) We work on mood problems, like depression and anxiety, relationship problems, and habits and addictions. One of our favorite members, Paulita, just made a brief video describing the work she did recently on her addiction to a certain kind of candy, and graciously allowed me to publish it here! I think you’ll enjoy it!

In her email giving me permission, Paulita wrote,

I would like to be a “Possibility” Model (not Role Model) – because I am an example of the possibility that even old dogs can learn new tricks!

Here’s the way I would put it–are you old enough yet to learn some new tricks? Paulita just turned 80 and is one of our liveliest and most beloved members. She is a local marriage and family therapist, and was originally from the Philippines.

Paulita made the video to help promote a workshop at the Feeling Good Insititute tomorrow (May 21st, 2017) on overcoming habits and addictions using TEAM-CBT. They may have a few spots left, so feel free to check them out if you’d like to attend!

By the way, my Tuesday psychotherapy training group is free of charge to northern California metal health professionals, so contact me if you’d like to visit or learn more about the work we do!

The goofy picture of me at the top (at least for some of you who read this on social media) was taken after our hike on sunday, in a place where you can order exotic Chinese drinks like Mango Lychee Green Tea Teazer (which I had). More on that later! It was a fantastic hike with a special guest.

David

 

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

 

 

Can You Treat an Addiction to Romantic Fantasies?

Can You Treat an Addiction to Romantic Fantasies?

Hi Dr. Burns,

I have really enjoyed your podcasts – they make Mondays the best day of the week!

I am just a lay person but I’m very fascinated with how differently all of our minds operate. One thing you have talked about is treating addiction, and the resistance to treatment. I’m curious if you have ever seen a case where the addict is fixated on a fantasy, an idea in their mind that they perceive to be special somehow, but would be ordinary to any other onlooker. Specifically the example I had in mind was a romantic fantasy.

This type of addiction becomes devastating when the addict becomes aware of the reality and how different it is from their fantasy. Is there any way to cure a person who is addicted to a romantic fantasy? I think there are some who refer to this as “limerence” but I don’t think this is a widely accepted terminology.

Susan

Hi Susan,

Thank you. I’m so glad you enjoy the Feeling Good Podcasts, and I hope more and more people will sign up for them. Your support really encourages Fabrice and me!

Yes, I’ve treated many individuals who were addicted to some romantic fantasy, or some other thought or fantasy they were hooked on. You are right to call this an addiction, because the fantasy can provide a kind of mental high.

I cannot do therapy in this medium, but I can give you a general example of how I might proceed to work with someone with this problem. Keep in mind that your specific details will be different, so much of this will not apply to you.

The first thing I’d do, after empathizing for a period of time, so my patient felt completely understood and accepted, would be to help him or her list all the really great things about the fantasy. It is exciting, it provides distraction from other problems that may be causing anxiety, and it lets you hang on to the person you are fantasizing about, without having to let him or her go. It also shows that you have high ideals for your romantic life, care a great deal about others, and value loving relationships. Your fantasies are also a kind of fabulous compliment to the person you are fantasizing about. And, the fantasy may protect you from the problems of dating real people, who can seem pretty darn flawed and annoying in comparison with our fantasies about our ideal partner, who looks fantastic and fulfills our every dream. In addition, you can avoid the whole reality of dating, which can be massively time-consuming, energy draining, anxiety-provoking, and frustrating.

Then I would say, given all these benefits, why in the world would you want to give that up?

Now the ball would be in your court to try to persuade me to work with you, and to try to convince me that you really do want to change. If you cannot convince me, then I would “Sit with Open Hands,” letting you know that it is totally okay with me if you keep fantasizing. As long as you enjoy it, and it doesn’t cause problems, there is really no good reason to change.

But if you did want to change, there are a host of powerful methods we could use, such as Self-Monitoring (tracking each time you have the fantasy, using a wrist counter, like golfers wear on their wrists to keep track of their score), the Devil’s Advocate Technique, scheduled Fantasy Breaks, and more. We could also work on improving your dating skills and relationships with people you are interested in, with Smile and Hello Practice, Flirting Training, Rejection Training, the Dave Letterman Technique, Shame Attacking Exercises, Self-Disclosure, and more.

A business graduate student came to me for help because he’d broken up with his girlfriend, who was now dating another fellow in his class. And he kept having fantasies of the two of them having sex together. This disturbed him greatly, and made it hard to pay attention in class, but he couldn’t shake the fantasies from his mind. He also started driving past her apartment over and over, to see if the other fellow’s car was parked outside.

After trying several techniques that did not help, I suggested he wear a golf score counter, and count how many times each day he had these distracting sexual fantasies of his ex-girlfriend making love to her new boyfriend. I told him that all he had to do was just click his wrist clicker, and then just let the fantasy go and carry on with what he was doing.

At the end of the day, I told him to record the total on his calendar and reset the counter to zero for the next day. I told him to keep it up for four weeks, since the fantasies often diminish in the third week.

For the first three weeks, he averaged more than 90 fantasies per day. Then the numbers started falling, and by half way through the fourth week, they disappeared entirely, along with his depression.

Any one technique like that might, or might not, help. That’s why I developed dozens and dozens of techniques to help individuals who are feeling unhappy, or who are addicted to people or substances that are making their lives miserable.

One woman kept having romantic fantasies after her boyfriend broke up with her. She kept thinking about how wonderful he was and remembering some incredibly loving moment. After spending some time deciding whether she was really motivated to let go of the memories—since that would mean having to grieve his loss and admit he was gone—we tried a number of techniques. The one that helped was Image Substitution. Each time she had some wonderful memory of him, she would switch to some disturbing memory of him—and there were many! That did the trick nicely!

Thanks, Susan for your excellent question. I think many people can identify with thinking we “need” some person or something to feel happy and fulfilled. I could write much more on this topic, but this is already long.

You might also want to read my recent post on “Is Love an Adult Human Need?”

David

Can You Treat Habits and Addictions Without a Support Group?

Can You Treat Habits and Addictions Without a Support Group?

Dear Dr. Burns,

Do you believe that addictions can be healed without a support group? And if so, why is there no book by Dr. Burns specifically on addiction recovery?

Ploni

Dr. David’s Response

Hi Ploni,

Thanks for your question. I have a new workshop on addictions and habits for next year, so I have been thinking about this topic. Also, some of my students and colleagues in my weekly training group at Stanford treat habits and addictions, including eating disorders, drug and alcohol abuse, and so forth. So we spend quite a bit of time developing new treatment techniques.

I think that support groups, like AA or Smart Recovery, can be helpful for many people with addictions, and support groups like Recovery International (formerly Recovery, Inc) can be helpful to people with mood or relationship problems. However, some people can conquer habits and addictions without a support group. Partly, it depends on the severity of the problem and the motivation of the individual.

Many people believe that people overeat or use drugs or alcohol to self-medicate their own depression, loneliness, or low self-esteem. While this may be partially true in some cases, I believe that habits and addictions are primarily motivational problems, and not emotional problems. My recent research on approximately 160 patients admitted to the Stanford Hospital’s psychiatric inpatient unit did not seem to support the notion that depression and anxiety trigger addictions. In fact, individuals who were depressed actually tended to binge less, on average, than individuals who were not depressed. I have not published this finding, as the main focus of the research was different–but the negative correlation between overeating and depression was consistent with conventional psychiatric thinking that a loss of appetite can be a symptom of depression and low self-esteem.

In addition, I could not validate the idea that depression and low self-esteem have a causal effect on alcohol or drug abuse, either. But a brief assessment test I developed called the “Urges to Use Scale” was massively correlated with drug and alcohol use. This seems to indicate that positive, seductive temptations are the driving force behind most, if not all, addictions.

In other words, my findings suggested that people drink or overeat or use drugs primarily because it feels darn good to overeat or get high.  So why do we overeat? I believe that we overeat because of the abundance of good food in our society, and because eating is immediately reinforcing. Of course, alcohol and drugs are also widely available in our culture, and TV ads provide powerful temptations to drink.

While distortions are involved in addictions, they are mainly positive distortions, such as “Oh, that beer would taste SO GOOD!” Or “I deserve some dark chocolate right now. I’ve had such a hard day.” I have created a list of ten positive distortions that correspond to the ten negative distortions in my books, such as Feeling Good. They positive distortions are mirror images of the negative distortions, and I will post them soon on my website.

Of course, negative distortions also play a role in addictions, along with positive distortions. After giving in to the temptation to drink or overeat, we may scold ourselves with negative distortions: “I SHOULDN’T have eaten that chocolate. I’m just a fat pig. I’ll NEVER lose weight!” These thoughts can trigger feelings of shame and hopelessness, which can trigger more addictive behavior, such as overeating or compulsive drinking.

Unlike negative distortions, positive distortions create immediate positive consequences if you give in to them. That’s why habits and addictions can be challenging to treat, and why motivational techniques are of tremendous importance. Traditional cognitive therapy techniques can be helpful for the negative distortions, but new and different kinds of techniques are needed to combat the positive distortions, such as Paradoxical Agenda Setting, the Decision-Making Form, and the Devil’s Advocate Technique, to name just a few. Of course, Empathy and respect for the patient are also extremely important.

All the best,

David D. Burns, M.D.