053: Ask David — “I don’t feel like doing it!” Quick Cure for Procrastinators

053: Ask David — “I don’t feel like doing it!” Quick Cure for Procrastinators

Quick Cure for Procrastinators

In this podcast, David and Fabrice answer a question from a listener named Benjamin on the topic of procrastination. He wrote:

“The live therapy with Marilyn was very interesting – like other listeners, I was impressed by her character and strength.

“Towards the end of this most recent podcast, you were musing on what topics to cover in future podcasts. I would love to hear about how you treat people suffering from chronic laziness (“Do Nothingism”). In particular, there seems to be a strong potential of a Catch-22 with Process Resistance: The patient cannot find the motivation to do anything, yet they have to carry out the process (do the homework) to improve.

“Even worse, in “Feeling Good”, you categorize “Do Nothingism” into around 10 different categories, and suggest a different approach for each one. What should a lazy person do, who identifies with multiple categories, but is already starting to feel overwhelmed at the prospect of doing one of those activities, let alone five of them?

“I would love to hear David’s thoughts on this!”

David and Fabrice begin by thanking Benjamin, and David emphasizes how helpful and inspiring it is to receive specific questions like this, which makes it easy to create a (hopefully) informative and interesting podcast.

David says that his thinking about the treatment of procrastination has changed greatly since he wrote Feeling Good. One big change is that he no longer tries to “help” individuals who procrastinate, since this will cause them to continue to procrastinate, and the failure will now be the failure of the therapist, who’s “helping” wasn’t good enough.

Instead, David outlines a multi-step approach, based on someone who has ten years of unfiled papers that have piled up in his office, so that by now 15 feet of desk space is completely covered by piles of papers roughly one foot high. Fabrice plays the role of the resistant patient, and David plays the role of the therapist.

The steps include:

Paradoxical Agenda Setting: David asks, “The procrastination seems to be working for you. Why would you want to change? Let’s make a list of all the benefits of procrastination, and all the reasons NOT to change.” David emphasizes that the patient has to convince the therapist that this is something he really does want to change. It’s NOT the therapist’s role to help or to convince the patient to change!

Miracle Cure Question: What kind of help would you like in today’s session? Most patients say they need help with motivation. David declines to offer this, explaining that it isn’t on the therapeutic menu today—only the “Blue Plate Special!” The patient must agree to begin working on the filing in spite of having no motivation.

David also explains the underlying concept behind this strategy: most procrastinators are waiting for motivation, but that never works. You’ll be waiting forever, because you’re NEVER going to feel like doing all that filing! You aren’t entitled to motivation!

Productive individuals know that action comes first, and motivation comes second.

Specificity: What time would you like my help in overcoming your procrastination? The patient’s requests for help yesterday or tomorrow are declined by the therapist, so they settle on 6 PM today.

Little Steps for Big Feats: Let’s list the first five things you would need to do tonight at 6 PM, making sure that every step can be completed in 15 to 30 seconds. They list these steps:

  1. Walk into my office
  2. Choose one pile to start working on
  3. Pick up the top piece of paper on the pile
  4. Put it into a blank manila file folder
  5. Label the file folder

Let’s Be Specific: David asks if Fabrice needs help with Step 1? Step 2? Etc. Fabrice finally admits he can do these five steps.

Five Minute Rule: David asks if Fabrice will agree to do these five steps between 6 PM and 6:05 PM, and if he will agree to work on his filing for ONLY those five minutes. At the end of the five minutes he has completed 100% of the assignment. The rationale is that if Fabrice tries to do it all, he’ll get so overwhelmed that he won’t do anything. But if he agrees to ONLY five minutes, that will be do-able. And if he surprises himself, and gets motivated to do more, he can, be he only gets credit for the first five minutes.

Problem – Solution List: David asks Fabrice to put a line down the middle of a piece of paper, from top to bottom, and list all the problems that will get in the way at 6 PM, and then to list convincing solutions to each problem in the right-hand column. Fabrice lists two problems: 1. I won’t feel like it. And 2. Traffic might be heavy, so I might not get home by 6 PM.

“I Stubbornly Refused” Technique: David asks Fabrice to agree to an unusual phone call at 6:05 PM!

TIC – TOC Technique: David plays the role of Fabrice’s “Task-Interfering Cognitions” (TICS) that will tempt him to procrastinate, and asks Fabrice to play the role of the “Task-Oriented Cognitions” (TOCS) he can use to combat the TOCs. The TICS include the familiar ones such as:

  1. Five minutes won’t help, the job is overwhelming.
  2. Even if I get started, I’ll just relapse, so there will never be a permanent solution.
  3. It’s not such a big problem, I don’t need to do my filing now.
  4. I can watch Game of Thrones on TV instead. That will be more fun.
  5. It will be too anxiety provoking to get started.
  6. It’s too late to get started anyway.
  7. Tomorrow will be a better day.

David confesses the problem is one that he actually had, and describes how he solved it, using this exact approach!

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 forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

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050: Live Therapy with Marilyn, Part 2, Is Depression a “Mental Disorder?”

050: Live Therapy with Marilyn, Part 2, Is Depression a “Mental Disorder?”

The Hidden Side of Depression, Anxiety, Defectiveness, Hopelessness and Rage

We nearly always think about negative feelings, such as  severe depression or anxiety, as problems that an expert must try to fix, using drugs and / or psychotherapy. And there are a multitude of theories about why humans become depressed, including, but not limited to:

  • Reality. We think we get depressed because reality sucks. We believe our mood slumps result from the negative circumstances in our lives, such as being alone following a rejection, experiencing the loss of a loved one, not having enough money, education or resources, social prejudice, or (as in Marilyn’s case) facing some catastrophic circumstance, such as severe illness.
  • Upbringing. We think we get depressed because of insufficient love and nurturing in childhood, or because of traumatic childhood experiences.
  • Biological factors. We believe that feelings of depression and anxiety result from problems with our genes, or diets, or because of a chemical imbalance in our brains.

Certainly, there can be some truth in all of these theories. Reality does kick us all in the stomach from time to time, and the pain we feel is understandable. My wife and I lost her father to Parkinson’s Disease a few years ago. We loved him tremendously, and his loss was extremely painful for everyone in our family.

Most of us have experienced less than ideal circumstances when growing up as well, and many have been victimized by horrific experiences, such as child abuse or bullying. And clearly, some psychiatric illnesses, such as schizophrenia, do result from some kind of biological abnormality in the brain.

But the problem with all of these theories is that they put us at the mercy of forces that are largely beyond our control—since we often cannot do much to change reality, rewrite our childhoods, or modify our brains short of taking this or that medication. And, in addition, these theories all suggest that negative feelings like depression and anxiety show that there is something wrong with us.

In this podcast, Matt and David take a radically different approach, and argue that Marilyn’s intense feelings of depression and anxiety are not “mental disorders” that reflect some defect in Marilyn, but rather the expression of what is most beautiful and awesome about her. They also argue that there are large numbers of advantages, or benefits, of feeling the way she does. They use several Paradoxical Agenda Setting Techniques, including the Invitation, the Miracle Cure Question, the Magic Dial, Positive Reframing, and the Magic Dial. The results are stunning and unexpected.

At the end of this segment, David and Matt argue that it might be desirable for Marilyn to continue to feel some of her negative feelings, and ask her how depressed she would like to feel at the end of the session, using the “% Goal” column on her Daily Mood Log. She also indicates how anxious, ashamed, defective, alone, hopeless, frustrated, and angry she would like to feel.

The third and final podcast next week will include the M = Methods phase of the session along with the end-of-session T = Testing and wrap-up, including Relapse Prevention Training.

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Feeling Good Podcast Request: More Live Recorded Trauma Treatment, Please

Feeling Good Podcast Request: More Live Recorded Trauma Treatment, Please

 

Hi Dr. Burns,

A request for a future podcast, if I may:  The session you did with “Mark” and his son, “Oliver,” was awesome!!!  I’ve listened to it several times.  That paradoxical agenda setting technique is just genius (because it’s so genuine)!  And I’ve been using it with depressed/low self-worth friends and clients with amazing results!  Any chance you could do a session like that with someone struggling with severe trauma?  I would love to see how you adapt your TEAM approach to working with trauma clients.

By the way, I wanted you to know you are welcome to use my full name on your website, if that would be helpful to you.  I’m honored to be quoted!

V. Ritchie Pruehs, LMFT
Employee & Student Assistance Program
LOMA LINDA UNIVERSITY HEALTH/Shared Services

 

Feeling Good Podcast - Fabrice

Hi V,

Thought you might enjoy this photo from my podcast host, Fabrice Nye, Ph.D. We took the photo last Saturday morning during a recorded therapy session with Marilyn.

Thanks for another wonderful email. The upcoming live therapy with Marilyn will show you how I work with someone experiencing severe trauma, in this case, a recent diagnosis of terminal cancer. Also, I’ve been doing trauma workshops around the US for the past three years, always with a live demonstration on the evening of day 1 with a volunteer from the audience who has experienced trauma. I will be doing more trauma workshops in the fall, and I think one will be in Southern California again. I’ll be updating my workshop page soon to include the new dates and locations, but I’m pretty sure it will be in Woodland Hills, CA, November 9 and 10. Perhaps you can come to it!

In addition, I hope to have many trauma examples in the new book I am writing, some with links to the actual recorded sessions. You can also see how I treat trauma if you click here. The session you will link to is with a woman who experienced three decades of rape and domestic violence. I have always found that trauma cases are the easiest to treat, which I think may be the opposite of the way most people think about it. It is a great honor to be able to provide rapid and profound relief to individuals who have been suffering so severely and for such a long period of time.

I have treated approximately 40 patients who have experienced severe traumas in the past several years, including rapes, beatings, horrific accidents, severe medical problems, childhood abuse, family tragedies involving injuries or deaths of children, psychological exploitation, and more. Almost every individual I’ve worked with has experienced a complete, or near-complete, elimination of symptoms in just one two-hour session using the new TEAM-CBT techniques.

The rapid changes are due, in large part, to new techniques I have developed to reduce or eliminate what has been called therapeutic “resistance.” I’m glad you are seeing some of the same amazing results in your work! It is SO EXCITING to have these new tools available.

I believe that TEAM represents a significant breakthrough in treatment, but it requires considerable commitment to learn it since it is not a gimmick or formula, but a systematic and highly individualized approach to treatment of all patients, and not just those struggling with the aftermath of a traumatic experience. And in my teaching, I have learned, sadly, that it can be difficult, sometimes, to pry therapists loose from their current orientations, even though their outcomes might fall far short of what one might hope.

So stay tuned and stay in the loop! Fabrice and I really appreciate your thoughtfulness and interest!

All the best,

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 forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

037: Ask David — “My negative thoughts aren’t distorted!”

037: Ask David — “My negative thoughts aren’t distorted!”

Podcast 37: Ask David

“My problems are real! The world really IS screwed up! And that’s not a distortion. So what can I do about my severe depression and anxiety?”

IMG_1764David and Fabrice discuss two questions submitted by Feeling Good Podcast listeners.

#1. Shari writes:

“I read your book Feeling Good and now I am reading your book When Panic Attacks–thanks to April’s podcast with you. I still struggle but recently our current political situation and environmental research about our negative impact on earth—has triggered severe anxiety and depression again. The problem is that I don’t think my thoughts are distorted—it certainly seems logical to assume that life on earth is threatened. So I am not sure how to do this. How can I make progress with my mental and emotional health while being aware of situations around the world? Any advice or thoughts would be deeply appreciated.”

This is a wonderful note, and I’m sure that huge numbers of people feel the same way, in varying degrees. So how can we attend to our own emotional well-being in the face of genuine adversity?

Dr. Burns discusses this from the perspective of Paradoxical Agenda Setting, which is the key component of TEAM-CBT, and emphasizes the most common therapeutic error of all—jumping in to try to help, without seeing all the really GOOD reasons for the patient NOT to change. From this perspective, Shari’s question becomes the most important question in all of psychiatry and psychotherapy—how do we help patients who may not want to change?

#2. After listening to the A = Agenda Setting portion of the live therapy with Mark, Paul submitted this question:

“Hi David,

Thanks to you, Fabrice and Jill for this episode – as with the previous episodes with Mark, this has really helped in bringing the TEAM approach to life. As I have been using your books in the past few years to self-treat feelings of anxiety and depression, I was very keen to hear how the new agenda setting step works.

I am wondering what your thoughts are on how effectively the “A” step can be carried out by a patient on his/her own (i.e. without someone else verbalizing the reasons not to change / playing the part of the patient’s sub-conscious)? Do you have any tips? I think I heard Mark say something to the effect that, on his own, he wouldn’t have thought of all the positives that you came up with in the session.

Thanks again for sharing these great tools and techniques – looking forward to the “M” step soon.

Paul”

This was another terrific question on a topic of great importance. David explains that it is actually easier for patients to learn to use Positive Reframing and the other Paradoxical Agenda Setting techniques than for therapists to learn them. Because of his excitement over this prospect, David has just begun a new book which will show depressed and anxious individuals exactly how to do this on their own in a step-by-step manner. He is optimistic that the new TEAM-CBT techniques, in book form, may be even more helpful to patients than his first book, Feeling Good: The New Mood Therapy. Research studies indicate that 65% of patients with moderate to severe depression improve substantially within four weeks of receiving a copy of Feeling Good, even without any other treatment. Dr. Burns is hopeful that his new book will provide the answers for the 35% who were not helped by Feeling Good.

So the answer is yes, I think many individuals WILL be able to do the “A” step on their own, and I am hopeful the positive impact will be great!

If you would be interested in David’s new book, please indicate this in the Survey attached to this podcast.

David and Fabrice have exciting plans for upcoming podcasts. They will be addressing these two questions in one or two podcasts:

  1. Is it possible to measure our “worthwhileness” or “worthlessness” as human beings?
  2. Do we even have a “self”?

These two questions have been discussed by experts for thousands of years, going all the way back to the Buddha, and most recently by the incredible Austrian philosopher, Ludwig Wittgenstein. And although the answers are tremendously simple, people can’t seem to “get it.” The issues are not simply philosophical, but eminently practical, since most depression and anxiety result from the perception that one is “worthless,” or “inferior,” or simply “not good enough.”

In addition, David and Fabrice are hoping to create a second live therapy session broken into smaller podcast chunks, but featuring David and a totally awesome former student and now highly esteemed colleague, Matthew May, MD. For the past ten years, David has been telling workshop audiences that Matt is one of the finest therapists in the world. So this is an event you won’t want to miss!

Click here to listen to Fabrice being interviewed on Dr. Carmen Roman’s podcast.

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032: Live Session (Mark) — Agenda Setting Phase (Part 4)

032: Live Session (Mark) — Agenda Setting Phase (Part 4)

Part 4—A = Paradoxical Agenda Setting (PAS, cont’d

As the session continues, Jill and David encourage Mark to develop his list of positives. Mark draws a blank at first. This is very common among patients and therapists alike. Most of us have not been trained to think about depression, anxiety, shame, defectiveness, hopelessness and anger as being good or positive. In fact, we think of them as symptoms of “mental disorders,” according to the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association.) So we think of them as bad, something to get rid of, something needing treatment.

IMG_1860But after David and Jill prime the pump, Mark is surprised that they quickly come up with a list of 16 positives that are real and powerful. At this point, they ask Mark why in the world he’d want to press the Magic Button and have all of his symptoms suddenly disappear–given all these positives. This is called the Acid Test and it’s also paradoxical. David and Jill have now become the resistant part of Mark’s subconscious mind–the part that clings to these symptoms. And when the therapists become the voice of the resistance, the patient will nearly always become the voice that argues for change.

The paradox is resolved with the Magic Dial. Toward the end of this podcast, you will want to review Mark’s Daily Mood Log, with the Goal column filled out on the table of negative emotions.

David points out that there is no single tool or technique that triggers recovery in patients. Instead, each component of T E A M contributes in radically different ways to the substantial or even dramatic improvement the therapists are hoping to bring about it today’s session.

In the next Podcast, David and Jill will begin the M = Methods portion of the session.

031: Live Session (Mark) — Agenda Setting Phase (Part 3)

031: Live Session (Mark) — Agenda Setting Phase (Part 3)

Part 3—A = Paradoxical Agenda Setting (PAS), Initial Segment

IMG_6023    115-1504_img

In the early days of my career, I (Dr. Burns) would have assumed that Mark definitely wanted to change–after all, he’d been in a lot of pain for a long time, and he came to the session because he wanted help. So, following the empathy phase of the session, I would have jumped in with a variety of cognitive therapy techniques to help Mark challenge his Negative Thoughts, such as “I’ve been a failure as a father,” or “my brain is defective.” Although this might have been effective, there’s a good chance that it might not have worked. That’s because Mark might have “yes-butted” me or insisted that he really was a failure and that I just wasn’t “getting it.”

In fact, the attempt to help the patient without first dealing with the patient’s resistance is the cause of nearly all therapeutic failure. But most therapists make this mistake over and over–and don’t realize that their well-intentioned efforts to help actually trigger and reinforce the patient’s resistance.

Instead, TEAM Therapists use a number of Paradoxical Agenda Setting (PAS) techniques designed to bring the patient’s subconscious resistance to conscious awareness. Then we melt the resistance away before attempting to change the way the patient is thinking and feeling. I (DB) have developed 15 or 20 PAS techniques, and Jill and I  used several of them in our session with Mark:

  • The Invitation Step
  • The Miracle Cure Question
  • The Magic Button
  • Positive Reframing
  • The Acid Test
  • The Magic Dial

When Jill and I use Positive Reframing, we are hoping that Mark will make an unexpected discovery–that his negative thoughts and feelings, such as his sadness, shame, discouragement, and inadequacy actually reflect his core values and show what a positive, awesome human being he is. In other words, he will discover that his core values are actually the source of his symptoms as well as his resistance to change.

This approach represents a radical departure from the way many psychiatrists and psychologists think about psychiatric symptoms as well as resistance.  When I was a psychiatric resident, I (DB) was trained to think about resistance as something negative. For example, we may tell ourselves that resistant patients cling to their feelings of depression and worthlessness because they want attention, because they want to feel sorry for themselves, because they fear change, or because they are afraid will lose their identity if they recover. While there’s some truth in these formulations, they may not be helpful because they tend to cast the patient in a negative light, as if their symptoms and their resistance to change were somehow bad, or childish, or based on some kind of chemical imbalance in their brains. As you will see, the TEAM-CBT approach approaches resistance is radically different manner.

We will give you the chance to pause the podcast briefly and try your own hand at Positive Reframing before you hear it live during the session. Specifically, we will ask you to review Mark’s Daily Mood Log, and ask yourself these two questions about each of his negative thoughts and feelings:

  • What does this negative thought or feeling show about Mark that is beautiful, positive, and awesome?
  • What are some benefits, or advantages, of this negative thought or feeling? Are there some ways that this thought or feeling is helping Mark?

As you so this, make a list of as many Positives as you can on a piece of paper. See what you can come up with.

I want to warn you that it may be difficult to come up with your list of Positives at first. If so, this is good, because when you hear the next podcast, you’ll have many “ah ha!” moments and it will all become quite obvious to you. Then you will have a new and deeper understanding of resistance–an understanding that can help you greatly if you are a therapist or if you are struggling with your own feelings of depression and anxiety.

Jill gives a great overview of why the paradoxical approach is necessary during the Paradoxical Agenda Setting phase of the session.

To learn more about Paradoxical Agenda Setting, you can read David’s featured article in the March / April 2017 issue of Psychotherapy Networker entitled “When Helping Doesn’t Help.” You will see how he helped a woman struggling with intense depression, anxiety and rage due to decades of horrific domestic rape and violence.

 

025: Ask David — How do you handle a patient you don’t like (or who bores you)?

In this Podcast, David answers two intriguing questions posed by listeners, and one question posed by his host and colleague Dr. Fabrice Nye.

  1. How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide.
  2. How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely.
  3. How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.