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.