086: Role-Play Techniques (Part 4) — Feared Fantasy

086: Role-Play Techniques (Part 4) — Feared Fantasy

This is the fourth in a series of podcasts on several powerful role-playing techniques we use in TEAM-CBT. Today, we’re going to highlight the Feared Fantasy Technique.

Here, in a nutshell, is why I created this technique. In order to get over any form of anxiety, exposure is absolutely necessary. Exposure is not a complete treatment for anxiety, and is only one of 40 methods I use to treat anxiety, but it always MUST be included in the treatment package.

However, sometimes, people have fears that you cannot easily confront in reality. For example, you may have the hidden fear that others would judge you if they knew how insecure you felt inside, or if you failed at something, or if they were way more successful than you. You can’t just say to someone, “Do you think less of me because I’m actually quite insecure?” They’ll just deny it, and you’ll feel like a nut!

So I created the Feared Fantasy Technique. Essentially, you invite the patient to enter an Alice-in-Wonderland Nightmare World where their worst fear comes true, and where people not only think of you what you most dread, but they also mercilessly tell it to your face. This gives patients the chance to face the monster. In most, if not all cases, they suddenly discover, at the gut level, that the monster has no teeth.

Like the Externalization of Voices, this is a two-person technique, although I’ve sometimes done it with many people in groups. In this case, there can be numerous feared “monsters.”

In the two-person version, you and another person, who could be your therapist, go into the Alice and Wonderland Nightmare World and act out one of your worst fears, such as being rejected by an exceptionally hostile critic because you aren’t smart enough or good enough. When you face your worst fear, you often gain liberation from it because you discover that the monster has no teeth. Your worst fears don’t usually turn out to be real monsters, but figments of your imagination that you can defeat with a little logic, compassion, and common sense. You use frequent role-reversals until the monster has been totally crushed.

I am joined in this podcast by our own beloved Dr. Fabrice Nye, and two members of my Tuesday training group at Stanford, Liz Richard, a Licensed Marriage and Family Therapist, and Dr. Rhonda Barovsky, a Forensic / Clinical Psychologist, along with Stephanie James, an LCSW psychotherapist and radio talk show host from Fort Collins, Colorado, who is visiting the group. Liz is a member of the “newbie” TEAM training group at Stanford and agreed to bring a list of her own negative thoughts that trigger her feelings of insecurity in the group. I am grateful to all of them for helping out with this podcast!

Sometimes, when I am helping a patient challenge a Negative Thought, like “I’m a bad mother” or “I’m a failure as a father,” or “my colleagues would look down on me if they knew how screwed up I actually am,” I start with a gentle technique like the Paradoxical Double Standard that we illustrated in the first podcast on role-playing techniques. It’s a gentle technique that would almost never threaten or upset a patient.

Once the patient has totally crushed the thought, I typically move up to the Externalization of Voices. This is a more challenging and powerful technique that provides a deeper level of recovery / enlightenment and allows me to model the differences between the Self-Defense Paradigm vs. the Acceptance Paradox.

Once the patient has knocked the ball out of the park with the Externalization of Voices, I often move up to the Feared Fantasy. This is the most extreme and powerful technique of all. And the moment the patient again defeats his or her most terrifying fear, the impact can be positive and extreme, and often ends in a kind of uncontrollable laughter The Buddhists call this “laughing enlightenment. It often happens the moment you suddenly realize that your worst fear was nothing more than a gigantic cosmic hoax!

You may want to read a brief description of how to use the Feared Fantasy Technique that I created several years ago for my training groups and workshops. At the end, you’ll find a comparison of the Externalization of Voices, Paradoxical Double Standard, and Feared Fantasy, along with a table contrasting the Self-Defense Paradigm with the Acceptance Paradox.

The example I am using in the write-up below is not the example in the podcast, but one I sometimes use in teaching. Often, participants are afraid to do role-playing in front of the group because of thoughts like these:

  1. I’ll probably look foolish and make a fool of myself.
  2. I’ll screw up and fail.
  3. People will judge me and think less of me.
  4. They’ll laugh at me and tell other people about what a loser I am!

It is difficult to confront these fears in reality since people generally don’t have these kinds of negative judgements toward colleagues in the group who are feeling insecure. In addition, if someone did have these kinds of thoughts they would deny having them. But in the Alice-in-Wonderland Nightmare World, people DO have these kinds of thoughts about you, and they DON’T deny them! So, it can be challenging at first to have to confront these kinds of mean-spirited perceptions, and incredibly freeing once you defeat them!

Feared Fantasy*

This is a form of Cognitive Exposure

  • Some fears are not easily confronted in reality

General instructions

Work in dyads. Decide who will play the role of therapist and who will play the role of patient

  • Use the workshop / seminar performance anxiety example

Therapist Instructions

  1. Explain that you’re going to enter an Alice-in-Wonderland Imaginary world where there are two strange rules:
  • If you think people are looking down on you, they really are.
  • Furthermore, they get right up in your face and verbalize all their negative thoughts about you. They aren’t at all nice. They try to humiliate.
  1. Ask the patient which role she or he wants to play first. Explain that you’ll do role-reversals, so the choice is not terribly important.

We’ll assume that you’ve chosen the performance anxiety example, and that you, the therapist, will start out in the role of a rejecting, judgmental audience member or friend. Your patient will play the role of himself or herself.

Now criticize your patient, saying the things that he or she would be afraid to hear, such as:

  • “Hey, I was in the audience when you did that role-play with Dr. Burns. You really looked foolish and I’ve been laughing at you ever since.”
  1. After your patient responds to each attack, ask who won the exchange. If the patient did not “win big,” do a role-reversal and see if you can come up with a more powerful response.

Tips on Defeating the Imaginary Critic

When you’re under attack, try to defeat the imaginary critic

  • You can use Self-Defense, the Acceptance Paradox, or a combination of the two

If the Self-Defense Paradigm was ineffective, try

  • The Acceptance Paradox
  • Or a combination of Acceptance and Self-Defense

If the Acceptance Paradox was ineffective, try

  • The Self-Defense Paradigm
  • Or a combination of Acceptance and Self-Defense

Comparing the Paradoxical Double Standard,
Externalization of Voices and Feared Fantasy*

Technique Patient’s Name Your Name Role-Reversals?
Paradoxical Double Standard His or her real name The name of an imaginary dear friend of the same gender as the patient. Preferably, it is not someone the patient actually knows. No
Externalization of Voices His or her real name Same name as the patient Yes
Feared Fantasy His or her real name You play the role of some judgmental or critical person the patient is afraid of. Yes

 

Comparing the Self-Defense Paradigm with the Acceptance Paradox*

Strategy

General Concept Negative Thought

Example of How to Defeat the NT

Self-Defense Paradigm You defeat the NT by arguing with it and insisting that it’s distorted and not true. A patient who suddenly relapses several weeks after recovery will often have this thought, “This shows that the therapy didn’t work and that I really am a hopeless case.” “That’s ridiculous. I had a fight with my wife last night, so it’s not surprising that I’d be feeling upset. The therapy was very effective, and this would be a good time to pull out the tools I learned and get to work.”
Acceptance
Paradox
You defeat the NT by buying into it and insisting that it is true, but you do this with a sense of humor or inner peace. During a moment of insecurity, a therapist may have the thought, “I’m not as good as I should be.” “As a matter of fact, I still have tons of flaws and a great deal to learn. Even when I’m 85 years old, there will still be tons of room for learning and improving, and that’s kind of exciting.”

The Self-Defense Paradigm is especially helpful for the types of NTs patients have during relapses, and it’s a good idea to prepare them to talk back to these thoughts when they first recover, and before they actually relapse, using the Externalization of Voices.

The Acceptance Paradox is especially helpful for the types of NTs that lead to feelings of worthless, inferiority, or a loss of self-esteem.

* Copyright © 2018 by David D. Burns, MD

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

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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

 

 

084: Role-Play Techniques (Part 2) — Paradoxical Double-Standard Technique

084: Role-Play Techniques (Part 2) — Paradoxical Double-Standard Technique

The is the second podcast on TEAM-CBT role-playing techniques and features the Paradoxical Double Standard Technique. David describes watching Dr. Maxy Maultsby do a demonstration of the Double Standard Technique when he was a psychiatric resident in the 1970s at the University of Pennsylvania medical school. He was quite surprised when the patient, who was severely depressed and suicidal following a break-up with her boyfriend, improved dramatically within an hour. David modified the technique in several ways, and tonight will present what is probably the most powerful way to use this technique.

The technique is based on the idea that most of us operate on a double-standard. When we are upset about some failure, mistake, or inadequacy, we tend to beat up on ourselves mercilessly. But if we were talking to a dear friend with the exact same problem, we’d be far more compassionate and realistic. Once you make the patient aware of this double-standard, you ask if he or she would be willing to talk to himself or herself in the same way he or she would talk to a dear friend.

But the unique feature of the way David does it, is that you, the therapist, “become” a dear friend of the patient, kind of like a long-list identical twin who is actually virtually identical to the patient, but a different person. Then the therapist (playing the role of the friend) describe the problem the patient is struggling as if it is your own problem.

Then you ask the patient what he or she thinks. Typically, the patient will respond with great compassion. Then you, the therapist, cross examine the patient, to make sure what the patient is saying is the absolute, 100% truth. Finally, you ask the patient to record this in the Positive Thoughts column on his or her Daily Mood Log.

While no technique will work for everyone, this one works for many patients if:

  1. You’ve done excellent Empathy first.
  2. You’ve done skillful Paradoxical Agenda Setting to melt away the patient’s Outcome Resistance.
  3. The patient is reasonably compassionate and actually does have a double standard. On rare occasions, you may have a patient who hates himself or herself, who also hates other people. For these patients, the technique will not be effective.

The special guest tonight is Eleanor Scott, a community therapist who is a student in David’s Tuesday group at Stanford, and who has bravely volunteered to help demonstrate teaching techniques once again. (Eleanor was also feature in an Empathy role-play a couple weeks ago.)

Eleanor has brought a partially completed Daily Mood Log to the group, and the Upsetting Event is simply being in the Tuesday group and feeling insecure while trying to learn TEAM-CBT. These feelings are a fairly common, almost universal, among the therapists who attend David’s training groups. Initially, nearly all of them feel intense anxiety, along with a myriad of other negative feelings, such as shame and inadequacy, due to the belief that they are not “good enough,” along with the fear that others in the training group will notice their ineptitude and judge them!

Eleanor’s Negative Thoughts included:

  • I should be learning more quickly.
  • The other students will notice that I don’t know what I’m doing!
  • I’m never going to get this.
  • I don’t know what I’m doing.
  • I sound like an idiot/stupid.
  • I suck!

David explains how the Paradoxical Double-Standard Technique works, and demonstrates it with Eleanor. Eleanor finds a powerful inner voice and quickly blasts all of her Negative Thoughts out of the water.

David cross-examines Eleanor to find out if this amazingly rapid and dramatic change in her Negative Thoughts and feelings was real, or if she was just being “nice” to try to produce a good role-play for David!

Fabrice raps up the podcast with his (as usual) great interview with David and Eleanor, bringing out many of the teaching points during the session.

Follow-up: The day after the recording, Eleanor sent this fantastic email to our training group, and she gave me permission to share it with all of you.

Hi Tuesday groupers,

I wanted to share a success that I had with everyone, especially my ‘newbie’ group.  I received a low grade on an evaluation of a therapy session by a client last week, and I started the session today by discussing this with the client.  I used the Five Secrets of Effective Communication to acknowledge that she wasn’t heard (Disarming Technique) and shared how I felt about the session (“I Feel” Statement). I also asked about what I had missed (Inquiry). Throughout her account, I used Thought and Feeling Empathy.

The connection that was created from this was incredible.  I was able to truly see this client and hear her story and see the amazing grace with which she lives her life (Stroking).

I also think that I was able to truly be present and vulnerable with my client had a lot to do with the amazing work I experienced being a volunteer on the podcast last night.  I can’t thank you enough David… I am STILL feeling good and I’m riding this good feeling as far as it takes me!

If you get a chance… volunteer for the podcasts… it’s such an incredible opportunity for growth!

Thanks,

Eleanor

David’s response: Wow! Way to go, Eleanor! Awesome!

Next week: More of David’s Role-Playing Techniques!

Coming VERY Soon! Advanced, High-Speed TEAM-CBT for the Treatment of Depression and Anxiety 

We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.

  • 6 CE Credits
  • The cost is $135
  • You can join in person or online from wherever you live!

You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!

In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!

You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.

Jill and I hope you can join us!

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and 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.

 

 

083: Role-Play Techniques (Part 1) — Externalization of Voices / Acceptance Paradox

083: Role-Play Techniques (Part 1) — Externalization of Voices / Acceptance Paradox

This is the first several podcasts on the Role-Playing Techniques David has created. They include:

  • Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
  • Paradoxical Double Standard Technique
  • Feared Fantasy
  • Devil’s Advocate
  • Forced Empathy
  • Man from Mars
  • And more

David’s explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique–while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT.

Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and “Sarah,” one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.

Sarah has brought a partially complete Daily Mood Log to the session. The Upsetting Event was that Sarah has decided to move to Austin, Texas in two weeks. She has many moderately strong negative feelings about the move, including sadness (30), anxiety and nervousness (75), inadequacy (60), loneliness (75), self-consciousness, and discouragement (70). She also felt stuck and defeated (70). The numbers in parentheses indicate how strong each type of feeling was on a scale from 0 (not at all) to 100 (extremely.)

Her Negative Thoughts include:

  • “All of my friends are ahead of me in life (careers and relationships).”
  • “I should be further along in my career and I should be 100% certain this is the best career for me in the long term.
  • “For the most part, I haven’t helped most of my clients very much.”
  • “My anxiety over the past year indicates that I’m in the wrong profession.”
  • “I’ll never get back in the great shape, physically and emotionally, that I was in three years ago.”
  • “Moving to California set my life back by a year.”
  • “I won’t be able to make new friends in Austin.”
  • “I will be lonely and without friends.”
  • “I won’t be able to cope with stress.”
  • “My therapy skills aren’t good enough,”

and more.  Her belief in many of her Negative thoughts is quite high, in the range of 70% to 100%. However, her belief in one of them, “Moving to California set my life back by a year,” was only 20%.

Although David did not intend this to be a live therapy session, but rather a practice session to demonstrate how the Externalization of Voices works, David does some brief paradoxical Agenda Setting first, since Sarah’s example is real, and not made up. David uses several techniques to melt away Sarah’s Outcome Resistance, including:

  • The Invitation
  • The Miracle Cure Question
  • The Magic Button
  • Positive Reframing

During the Positive Reframing, David asks Sarah two things about her negative thoughts and feelings:

  1. What does each negative thought or feeling reveal about you and your core values that is positive and awesome?
  2. What are some advantages, or benefits, of each negative thought or feeling?

They come up with a list of ten positives, including these: “My negative thoughts and feelings show that

  1. I’m realistic and honest.
  2. I’m thoughtful.
  3. I’m committed to self-care, since I want to have good mental and physical health.
  4. I’m motivated to grow and improve my therapy skills.
  5. I have compassion for my clients and want to give them the best care that I can.
  6. I’m honest about my shortcomings.
  7. I’m humble.
  8. I have high standards.
  9. I want to connect with others.
  10. I’m committed to my career.

They conclude the Paradoxical Agenda Setting with the Magic Dial. Sarah decides to lower her negative feelings f to much lower levels, in the range of 5% to 15%.

Then, David asks Sarah which Negative Thought she wants to work on first. She chose the thought about never being able to get back into top physical and mental shape again. They identify the many cognitive distortions in the thought, such as All-or-Nothing Thinking, Overgeneralization, Mental Filter, Discounting the Positive, Fortune-Telling, Magnification and Minimization, Emotional Reasoning, Should Statements, and self-Blame.

Then David explains how the Externalization of Voices works, and they launch into the technique. David starts out as the “Negative Sarah,” and attacks her with the Negative Thought she wanted to attack first, using the second-person, “You.” Sarah responds in the role of the “Positive Sarah,” using the first-person, “I.”

Sarah fairly quickly knocks the ball out of the park, and easily crushes the Negative Thought David has attacked her with. Then David attacks Sarah with the rest of her Negative Thoughts, one at a time, doing occasional role-reversals to illustrate different ways to attack the thought. They continue doing role-reversals until Sarah described her victory over each Negative Thought as “huge.”

This only takes a few minutes. Then Sarah re-rates her negative feelings on the Daily Mood Log, and nearly all have been reduced to zero. David cross-examines Sarah to find out if this amazingly rapid and dramatic change was real, or if she was just being “nice” to try to produce a good role-play for David!

Fabrice raps up the podcast with his (as usual) great interview with David and Sarah, bringing out many of the teaching points during the session. He emphasizes that you can actually use many of David’s 50 Methods when doing Externalization of Voices, and points out the power of “Let’s Be Specific” that David demonstrated during the role-playing.

Next week: The Paradoxical Double Standard Technique!

Coming Soon! Advanced, High-Speed TEAM-CBT for the Treatment of Depression and Anxiety 

We warmly invite you to attend this fabulous, one-day workshop by Drs. David Burns and Jill Levitt on Sunday, May 20th, 2018. Click on the link above for registration and more information.

  • 6 CE Credits
  • The cost is $135
  • You can join in person or online from wherever you live!

You will enjoy learning from David and Jill, working together to bring powerful, healing techniques to life in a clear, step-by-step way. Their teaching style as a team is entertaining, funny, lucid, and inspiring. This is a day you will remember fondly!

In the afternoon, you will have the chance to do some personal healing so you can overcome your own feelings of insecurity and self-doubt. David and Jill promise to bring at least 60% of the audience into a state of spiritual and psychological enlightenment, WITHOUT years of meditation. That’s not a bad deal at all!

You will LOVE this workshop. Seating for those who attend live in Palo Alto will be strictly limited, and seats are filling up fast, so move rapidly if you are interested.

Jill and I hope you can join us!

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and 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.

 

 

082: Neil Sattin Interview — Change your Thoughts, Change Your Life!

082: Neil Sattin Interview — Change your Thoughts, Change Your Life!

In this podcast, David and Fabrice feature David’s recent interview on the topic of “Change your Thoughts, Change Your Life!” The interview was first published on Neil Sattin’s highly regarded Relationship Alive Podcast. Although some of the material may be familiar, there’s much that’s new, and you will enjoy the chemistry between Neil and David as they discuss each of the ten cognitive distortions and raise many challenging questions, such as:

  • Is it really true that only our thoughts–and NOT external events–can change the way we feel?
  • If someone has the belief, “I’m unlovable,” isn’t that type of thought immutable? How could you possibly change or modify a thought that may be rooted in traumatic experiences and so deeply embedded in a patient’s psyche?
  • Should we try to change other people’s cognitive distortions, or just our own?
  • How can we challenge each of the ten cognitive distortions?

And much more!

David’s first interview with Neil received more than 25,000 downloads in the first month, and this riveting interview promises to be every bit as popular. If you want to download a transcript of this exciting interview, you can do so at www.neilsattin.com/feelinggood2.

Coming Soon!

Next week we will begin an exciting series on the powerful role-playing techniques in TEAM-CBT, including

  1. Externalization of Voices (with Acceptance Paradox and Self-Defense Paradigm)
  2. Paradoxical Double Standard Technique
  3. Devil’s Advocate
  4. Forced Empathy
  5. Man from Mars
  6. And more

These episode will feature students and teachers in David’s Tuesday training group at Stanford, so you will get a taste of what an actual Tuesday group is like and see, first hand, how these methods work. They are unique to TEAM-CBT, and most have been created by Dr. Burns. We will also devote one episode to live Shame-Attacking Exercises, featuring the master of Shame Attacking, Dr. Joseph Towery, and we will all be out on the street doing Shame Attacking ourselves.

These episodes will be designed for therapists as well as your patients, and of course also for the general public.

Also Coming Soon!

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!

You will LOVE this workshop because you will learn and practice techniques you can use in your clinical practice, but you will also have the chance to do your own personal work! And you will also have the unique opportunity to experience the tag-team teaching of David and Jill working together!

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and 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.

 

 

What’s the Meaning and Purpose of My Life?

What’s the Meaning and Purpose of My Life?

Is love a human need? How about achievement? How do we achieve “self-actualization?” What about Maslow’s hierarchy of “needs?”

Hi visitors, here’s a cool email question about the meaning and purpose of life that I got from a highly esteemed fan.

Hi David,

Looking at the comments thread on your home page, I had a question based on some comments from others. Is it important to know the purpose of your life in order to feel self-contented and happy?

I could not come out with an appropriate answer for myself. Is there really a way to find out what the purpose of your life is, or does it really matter? And even if it does matter, what do we do if we find out our purpose? Maybe that’s not practical in today’s materialistic world.

I read an article on Abraham Maslow’s hierarchy of needs pyramid. From the bottom to the top of the pyramid, he lists

  • physiological needs
  • security needs
  • belongingness and love needs
  • self-esteem needs through accomplishments
  • and finally, self-actualization.

Here’s my question: Can humans be really happy without any or even many of these missing needs?

Practically, I see it as difficult. But, by cognitive theory it seems to be possible at least to the level of not disturbing ourselves for the missing needs.

To make it short my question, in essence, is this: What can be the true drivers of happiness in today’s times while at least one or more needs is challenged in this need hierarchy, especially love and relationship needs along with the realization of our full potential.

Thanks,

Rajesh

 

Hi Rajesh,

Thanks for another cool question! I can only ramble a bit and give you my take on it.

I recall reading about Maslow’s “needs” theory in college, in a class on so-called “third force psychology.” The writers in that movement focused, if I recall correctly, on achieving peak experiences, as opposed to becoming less depressed or anxious. At the time, I like the class and found it inspirational.

However, my thinking as a cognitive therapist, and now as a TEAM-CBT therapist, has evolved a great deal from my thinking during my college days. I have discovered that some of these “needs” are not really “needs,” but wants, although this is, of course, extremely controversial.

Individuals who I have treated who thought of love and achievement as “needs” have been very depressed, and sometimes even suicidal. If you read my book, Feeling Good, you’ll find sections on the so-called “Love Addiction” as well as the “Achievement Addiction.”

One potential problem is that if you tell yourself that you “need” love or achievement to feel happy and fulfilled, you may set yourself up for intense anxiety and depression when you are rejected, or when you fail. In addition, it is not really true that adult humans need love or a certain level of achievement to feel happy and fulfilled. Of course, to some people, what I am saying right now will seem like the darkest type of heresy!

In the chapter in Feeling Good on the “Love Addiction,” you can read about a woman who was dumped by her husband, so he could have an affair with his secretary. She was devastated and told herself, “I need John’s love to feel happy and fulfilled.” This thought triggered intense depression and hopelessness.

I encouraged her to do an experiment to test this belief, using the Pleasure Predicting Sheet. She discovered, much to her surprise, that simply being by herself, and treating herself in a loving way triggered high levels of satisfaction. In contrast, a lunch with her husband turned out to be one of the most miserable experiences of her life.

This gave her morale a tremendous boost, because she realized she did not actually “need” her husband’s love. Being around him was clearly NOT a source of happiness or “self-actualization.” She began dating and soon fell in love with a fellow who was far more suitable for her. And of course, the moment she no longer “needed” her husband, he begged for her to return. Instead, she filed for divorce.

This happens almost every time. When you “need” things, they tend to be elusive; when you no longer “need” the universe, the universe will come to you.

Her husband called and said he was enraged with me, because he’d referred his wife to me and had asked me to take care of her in case she became suicidal. I told him, “I did, I did!”

So, to answer your questions from my, admittedly controversial, perspective, there is no one “meaning” or “purpose” in life. Instead, there are an infinite number of meanings and purposes that present themselves in the experiences we have at every moment of every day. For example, right now I am answering your question, and enjoying this dialogue. That’s enough “meaning” and “purpose” for me for the moment. When I finish this blog, I will find some other activity, or purpose.

And as far as “self-actualization” goes, that just sounds to me like another perfectionistic trap. Right now, I’m too busy having fun to care about “self-actualization.” I think life, and the many rewards of life, can be found in the here-and-now, in our moment-by-moment reality, and not so much in the clouds of abstraction.

As a psychiatrist, I don’t usually approach these things from an overly general or philosophical perspective. Instead, I ask my patients to pinpoint one specific moment when they were feeling anxious or depressed on the Daily Mood Log. Then I ask them to rate their negative feelings and record the negative thoughts that triggered those feelings. Then we can identify the many cognitive distortions in those thoughts.

At that point, I bring the patient’s resistance to conscious awareness and melt it away, using Paradoxical Agenda Setting Techniques, like the Invitation Step, the Miracle Cure Question, the Magic Button, Positive Reframing, and the Magic Dial. At that point, we use several methods to challenge and crush the negative thoughts. This usually leads to a rapid and fairly complete elimination of the negative thoughts and feelings, and often ushers in fairly intense feelings of joy.

That’s just a brief overview, of course. If the patient has Self-Defeating Beliefs that get in the way, such as the belief that he or she “needs” love, approval, achievement, or perfection in order to be “worthwhile,” then we sometimes modify those beliefs as a part of Relapse Prevention Training.

Achievement can be very rewarding—but it does not make you more “worthwhile” and is no guarantee for happiness. Same goes for love, approval, perfection, fame, status, or wealth. There’s certainly nothing wrong with love or approval, but it does not make you more “worthwhile.”

One last point is this: physiological needs are true needs. We do need food, air, and water to survive. Without them we die. So the basis of Maslow’s pyramid is valid. But most of the rest of his pyramid consists of wants, not needs. My take on it! Some will probably insist I’m a quack!

You might think of security as a “need.” For example, if you were in a dangerous situation, such as a war zone where bullets were flying, and you had no protection, you could die.

But Maslow includes financial security, health and well-being as “needs.” Well, if you listen to the podcasts featuring live work with Marilyn, you will discover that she experienced “self-actualization” after a diagnosis of stage 4 lung cancer. But if Dr. Matthew May (my co-therapist) and I had taken the path of believing that she could not feel happy and worthwhile without good health, this “need” approach might have doomed her to ongoing severe depression and anxiety.

And I’ve treated many people with intense anxiety and depression who feared going bankrupt. Five of them actually DID have to declare bankruptcy while I was treating them. And you want to know the really odd thing? The day they went bankrupt, every single one of them recovered! Their feelings of depression and anxiety were not caused by their lack of financial security, but rather from their distorted negative thoughts, thinking (wrongly) that they’d be worthless and unlovable if their business failed. That’s why their negative feelings disappeared–they discovered that their fears were baseless.

By the way, people elevate all kinds of things to the level of needs. For example, someone wrote to me earlier in the week, quite irate, because he did not believe that thoughts create emotions. He said the facts of your life create your feelings.

My goodness! I don’t think he’s read any of my books or listened to the live therapy with Marilyn! I’ve really addressed the idea that our feelings result entirely from out thoughts, and not external events, so many times! But many people still don’t “get it!” And some don’t want to get it!

He gave the example that if your IQ is only average, or even below average, you cannot be happy, since you might want to study physics, but you’re not smart enough to do that!

This actually happened to me in college. I thought it would be super cool to major in physics, but the kids in my class who were majoring in physics—Phil Allen, Farzam Arbab, and Joe Stiglitz—had IQs far above mine, and it simply was not a smart option for me. So, I majored in philosophy instead, which was a lot easier for me. And I’ve loved the road I’ve traveled!

Think about this: Half of the people in the world have IQs below 100—that’s the half-way point, by definition. Half of us have IQs above 100, and half have IQs below 100.

Does this mean that half of the people in the world are doomed to depression? That sounds totally nutty and simply doesn’t accord with the facts! But when you tell yourself that you “need” this or that to feel happy, you turn yourself into a victim.

The fellow who wrote to me was pretty indignant and seemed intent on proving how “wrong” I was! As I’ve said, these issues are sensitive and highly charged for many people, and controversial, to be sure.

That’s why I don’t evangelize too much. I treat people who are suffering, people who are motivated to change. If someone wants to view love or achievements as “needs,” and if this belief system is working for him or her, then that’s totally fine by me.

One last point, just to be safe. I mentioned that love is not an adult human need. When Aaron Beck first made that claim in one of the weekly seminars I was attending as post-doctoral fellow in psychiatry at the U. Penn. Medical School in Philadelphia, I practically fell off my chair and had the thought: “He must be some kind of sociopath to believe such a horrible thing!” But over time, I discovered he was right, and that insight saved the lives of quite a few rejected, lonely and suicidal people I have treated over the years.

When I say that love and achievement are not “needs,” people get annoyed with me as well. Some skeptics remind me about infants with the “failure to thrive” syndrome—they don’t develop properly without love, without being touched, that sort of thing. I think that line of research is valid. For infants, love and nurturing do seem to be human needs. For adults, I think it is more productive to think of them as “wants.”

A Cool Upcoming Workshop for you!

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

 

 

081: Ask David: What’s the Best Smoking Cessation Treatment? Is there a Dark Side to Human Nature?

081: Ask David: What’s the Best Smoking Cessation Treatment? Is there a Dark Side to Human Nature?

“Do I always have to face my fears? Aren’t some fears healthy?”

In this podcast, David and Fabrice answer five challenging questions submitted by listeners:

  1. Galina asks whether we always have to face our fears? Isn’t it okay to be anxious sometimes?
  2. Courtney asks how to find the supplemental written materials, tests, and diagrams if you have purchased the eBook or audio-book copy of Feeling Good: The New Mood Therapy.
  3. Carlos asks about the best treatment for smoking cessation. During the discussion, Fabrice asks if Paradoxical Agenda Setting is important for therapists using hypnotherapy.
  4. Avi asks whether humans have a dark side, with dark negative motives that sometimes compete with positive, loving motives. And if so, how do therapists help patients deal with their own negative motives?
  5. Ben asks what to do if you’re very anxious but simply can’t pinpoint your negative thoughts.

Coming Soon!

In a couple weeks we will begin an exciting series on the powerful role-playing techniques in TEAM-CBT, including

  1. Externalization of Voices with Acceptance Paradox and Self-Defense Paradigm
  2. Paradoxical Double Standard Technique
  3. Devil’s Advocate
  4. Forced Empathy
  5. Man from Mars
  6. And more

These episode will feature students and teachers in David’s Tuesday training group at Stanford, so you will get a taste of what an actual Tuesday group is like and see, first hand, how these methods work. They are unique to TEAM-CBT, and most have been created by Dr. Burns. We will also devote one episode to live Shame-Attacking Exercises, featuring the master of Shame Attacking, Dr. Joseph Towery, and we will all be out on the street doing Shame Attacking ourselves.

These episodes will be designed for therapists as well as your patients, and of course also for the general public.

Also Coming Soon!

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!

You will LOVE this workshop because you will learn and practice techniques you can use in your clinical practice, but you will also have the chance to do your own personal work! And you will also have the unique opportunity to experience the tag-team teaching of David and Jill working together!

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

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080: Ask David: Where Do Negative Thoughts Come From?

080: Ask David: Where Do Negative Thoughts Come From?

“I’m a loser. . . I’m a failure. . . Where do my negative thoughts come from? “

In this podcast, David and Fabrice answer several fascinating questions submitted by listeners:

  1. Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
  2. Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
  3. Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?

Two Cool Upcoming Workshops for you!

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! 

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!

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

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079: What’s the Secret of a “Meaningful” Life? Live Therapy with Daisy

079: What’s the Secret of a “Meaningful” Life? Live Therapy with Daisy

“I’m a failure. . . I’m not good enough. . . My life will be empty and meaningless without . . . “

Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering.

Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems.

At the time, I did not know who Daisy was, and was not aware that she was living in this area. Now, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.

The focus of the session was a problem that many young couples face–infertility. In spite of heroic, costly, and exhausting efforts to conceive using IVF (in vitro fertilization), Daisy and Zane have still not been blessed with a pregnancy. And Daisy is finding herself between a cognitive rock and a hard place. She is suffering, on the one hand, from intense feelings of failure, shame, and inadequacy because she has not yet become pregnant. But at the same time, she has mixed feelings about having children, and feels that if she can find happiness with children, she will be ostracized by society and seen as some kind of oddball.

Daisy’s scores on the Brief Mood Survey, which she completed just before the session began, indicated mild to moderate depression, severe anxiety, mild anger, and a profound loss of pleasure and satisfaction in her life–indicating an almost complete absence of any strongly positive feelings.

Daisy brought a partially complete Daily Mood Log to the session. The upsetting event she recorded at the top was “four years of infertility; three years of failed treatment. Daisy mentioned that a fifth upcoming trial with IVF was planned in a couple weeks, and that she was feeling intense anxiety. The negative feelings she circled on the Daily Mood Log, plus her intensity estimates, included:

  1. sad, blue, depressed, down, unhappy: 90%
  2. anxious, worried: 100%
  3. ashamed: 70%
  4. inferior, worthless, defective, incompetent: 100%
  5. lonely, alone: 70%
  6. hopeless, discouraged, pessimistic, despairing: 100%
  7. thwarted, defeated: 90%

As you can see, all of these feelings intense. These feelings did not result from the real problem, the infertility, but rather from Daisy’s Negative Thoughts about the problem, including:

  1. My life will be empty and meaningless without children. 90%
  2. People with children live happier and more fulfilling lives. 100%
  3. I am defective and inferior to people who can have children. 70%
  4. I’m missing out on the most important part of life. 100%
  5. If this treatment doesn’t work, my life will be a failure. 80%
  6. I should have done more in my career, given that I don’t have kids. 100%
  7. Without children, there isn’t much to look forward to. 100%
  8. It’s unfair that this treatment doesn’t work for us. 70%
  9. I’m a disappointment to my family. 80%
  10. If I don’t want kids, that means there is something wrong with me. 100

As you listen to the session unfolding, Dr. Burns reviews the T = Testing, followed by E = Empathy. Dr. Burns uses the Five Secrets of Effective Communication to acknowledge Daisy’s tremendous pain, without trying to save, help, or rescue her. Then he uses several Paradoxical Agenda Setting techniques to melt away any potential resistance to change, including the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. She decides she wants to dial down her negative emotions to much lower levels, without necessarily making all of them disappear completely. Then Daisy and David complete the “% Goal” column on the Daily Mood Log, indicating the ideal level for each type of feeling that she hopes to achieve by the end of the session.

  1. sad, blue, depressed, down, unhappy: 90% / 30%
  2. anxious, worried: 100% / 30%
  3. ashamed: 70% / 10%
  4. inferior, worthless, defective, incompetent: 100% / 5%
  5. lonely, alone: 70% / 20%
  6. hopeless, discouraged, pessimistic, despairing: 100% / 40%
  7. thwarted, defeated: 90% / 40%

As you can see, she wanted to reduce some of her feelings dramatically, such as shame, inferiority, and loneliness, and wanted to reduce other feelings moderately, including depression, anxiety, hopelessness, and feeling defeated.

At this point David and Daisy used the Downward Arrow Technique to pinpoint the underlying beliefs that were triggering this problem, starting with a new Negative Thought that popped into Daisy’s mind:

  • If the IVF doesn’t work, we won’t have kids, we won’t have kids coming home for holidays and milestones–it will just be the two of us.
  • Then our lives will be lacking connection.
  • Then our lives won’t be meaningful.
  • Then there would be no purpose in life.

As you can see, these chain of negative thoughts reveals at least two Self-Defeating Beliefs:

  1. A woman must have children to have a purposeful, meaningful, rewarding life.
  2. You must have a meaningful, purposeful life to feel happy and fulfilled.

Then David and Daisy use a variety of M = Methods to help Daisy challenge her negative thoughts, as well as these underlying beliefs, starting with the first negative thought, “My life will be empty and meaningless without children.” The Methods included Identify the Distortions, Examine the Evidence, the Paradoxical Double Standard Technique, the Externalization of Voices with role-reversals, and the Acceptance Paradox as well as the Self-Defense Paradigm.

Fabrice noticed that at one point David switched from the Paradoxical Double Standard to the Acceptance Paradox, and then went back to the Paradoxical Double Standard before switching to the Externalization of Voices for a second chem. David explains his strategy.

At the end of the session, which lasted less than two hours, Daisy was dramatically improved. If you review her completed Daily Mood Log here, you will see that she achieved or exceeded all of her emotion-reduction goals for the session. In addition, her end-of-session scores on the Brief Mood Survey indicated dramatic reductions in depression, anxiety and anger, an a huge boost in Positive Feelings. On the Evaluation of Therapy session, she gave David perfect scores on the Empathy and Helpfulness scales, and indicated what she liked least and most about the session.

What she liked the least: “It took me a while to reveal my ambivalence about having kids.”

Actually, David overlooked this as well until half way through the session, and this did make for a kind of turning point in the session. Things seem to get more immediate and real at that point.

What she liked the best: “I feel completely different–more hopeful, less anxious, and less despairing.”

Fabrice and I are deeply grateful to Daisy and Zane for allowing us to share their story with you. Although the facts of your life are likely to be very different, you may also sometimes feel down or inadequate because you, too, have not measured up to some “requirement” based on messages from society. And perhaps Daisy’s experience can inspire you to break out of your own inner prison as well, believing that you, too, are perhaps inferior, or “not good enough,” because of this or that flaw!

Daisy Follow-Up

The next day, I received this email from Daisy:

Hi David,

I was planning to send you a thank you email, and you beat me to it. Thank you so much for taking the time to work with me on what has been an excruciating situation for years. Both Zane and I are extremely grateful for all the opportunities we have to spend time with you and learn from you. I actually thought it was amazing how quickly you were able to zero in on my ambivalence towards having children as well as the anger I have towards my mom and her expectations. It’s really hard for me to acknowledge either of those things, even to myself, and I thought it was so brilliant how you were able to pull those out so quickly.

There were so many “aha” moments for me last night but a couple really stand out. One was about self-compassion being the most important part of life. The other was about how it makes no sense to judge ourselves as “defective” in a global way. Those insights really hit me at a gut level last night. I’m sure I’ll be drifting out of enlightenment soon and am very grateful for your very generous offer to give me a tune-up, especially as we go through all these treatments again!

I will work on my Daily Mood Log and send it to you later this evening.

Also, many thanks to Fabrice for his insights and for making the recording possible!

Best,

Daisy

Zane Follow-Up

I also received this wonderful email from Zane:

Hi David,

I also wanted to thank you for having us on the show. I really enjoyed hearing your views about what a “meaningful” life means (or doesn’t mean). It was my “aha” moment. I’ve often seen that way of thinking as a slippery slope, but only had a vague sense as to why. Hearing you describe it as a trap really made a lot of sense. Daisy and I were talking it over this morning and the thought occurred to me that meaning could often be defined as having enjoyment or interest (in one’s life or work). Therefore, looking to the world, a relationship, an experience, or a job, or [fill-in the blank] is a hidden should statement (e.g. “My life should be meaningful, and if it’s not, it’s not very good.”). Having this thought or belief kind of takes responsibility to make life fun and interesting off of oneself, and places it on external circumstances or others. Am I understanding this concept correctly?

I’m also grateful for the books and DVD you hooked me up with. And extra-large thanks to Fabrice the “Fab Man” for being the man behind the magic in orchestrating these podcasts!

Zane

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

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061:  Ask David! What Causes Depression and Anxiety?

061: Ask David! What Causes Depression and Anxiety?

Podcast 61, David and Fabrice answer your questions

In today’s podcast, David and Fabrice address a number of excellent questions submitted by listeners:

  1. Are the scales on your Brief Mood Survey reliable and valid?
  2. How can I identify my Negative Thoughts when I’m upset but I can’t figure out what I’m thinking and telling myself?
  3. I have social anxiety and don’t want to get out of bed. I’d rather just lie in bed and watch Game of Thrones. Help me! What should I do?
  4. I saw an article in the paper that claimed that bacteria in the gut cause anxiety. Is this true? If not, what does cause depression and anxiety?
  5. Could your tools, like the Cost-Benefit Analysis, help with problems that aren’t necessarily emotional problems? Like what career to pursue, or what college to go to?
  6. What should you do if you feel great at the end of a therapy session, and then become severely upset again during the week?
  7. How does Dr. Burns deal with resistance from colleagues when he is trying to teach these new TEAM-CBT techniques? Does he run into much resistance? How does he feel about the resistance?

David and Fabrice love your questions so keep them coming!

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