Defeat Perfectionism on Today’s David and Jill Show!

Defeat Perfectionism on Today’s David and Jill Show!

Special 90-minute show!

Watch FB Live TODAY, November 11th, 2018,
at 3 PM (PT) with David and Jill!

Join Dr. Jill Levitt and me as we return for our Facebook Live Show today on The Perfectionist’s Script for Self-Defeat! Perfectionism is one of the most common problems we see in clinical practice, and you may struggle with your own perfectionism as well.

Do any of these thoughts sound familiar?

  • I shouldn’t have screwed up!
  • I’m a failure.
  • I should be better than I am.
  • I’m unlovable.
  • I’m more screwed up than my patients!
  • At my age, I should have it more together.
  • I’m a bad mother (or father, or therapist, etc.)
  • My presentation was only okay. Darn it! I should have hit it out of the park!
  • I’m just average. There’s nothing really special about me.
  • If people found out about how anxious and insecure I am, they’d judge or reject me.
  • If you can’t do something perfectly, there’s no point in doing it at all.
  • Your worthwhileness as a human being depends on your productivity, intelligence, and achievements.
  • All my parents care about is my grades. They don’t really love me for who I am.

Perfectionism can triggers clinical depression and feelings of inferiority and loneliness as well as social anxiety, performance anxiety (e.g. writer’s block), OCD (compulsive checking, cleaning arranging, etc.), eating disorders, and the addiction to work.

Is perfectionism necessarily a bad thing? Maybe it’s a good thing! Where would we be without Thomas Edison, for example? Tune in Sunday and find out!

The show will be chock full of real and inspiring cases as well as helpful treatment techniques. This David and Jill Show will be geared toward therapists and the general public alike, including teenagers and adults.

Here’s an approximate and imperfect outline of today’s show

  1. What is perfectionism? How does neurotic perfectionism differ from the healthy pursuit of excellence?
    1. The woman who scrubbed her bedroom floor until it had to be replaced.
  2. What’s perceived perfectionism?
  3. The Self-Defeating Beliefs (e.g. “Self-Esteem Equations”) that trigger perfectionism:
    1. I must be perfect in order to be happy.
    2. If I’m not perfect then I can’t be happy.
    3. People won’t love me if I’m damaged or flawed, or if I screw up.
  4. How is the concept of perfection promoted in our culture?
    1. In the media
    2. In our child rearing practices
    3. In sports
    4. Motivational speakers at sales conferences
      1. You must be number ONE!
    5. In our societal values
      1. Calvinist work ethic: You ARE what you DO.
    6. What are the cognitive distortions trigger perfectionism?
      1. All-or-Nothing Thinking
        1. My workshop with Aaron Beck at ACBT
      2. Mental Filter / Discounting the Positive
        1. The Cincinnati talk show host
      3. Mind-Reading
      4. Magnification
      5. Should Statements
    7. Personal examples
      1. David’s early therapy career
      2. Jill’s examples
    8. Tools to overcome perfectionism
      1. Specificity / Daily Mood Log
        1. Need a nice example
      2. Magic Dial / Positive Reframing
        1. What does your perfectionism show about you that’s positive and awesome? What are some benefits of your perfectionism?
        2. Would a Cost-Benefit Analysis be useful also. Some overlap with Positive Reframing.
      3. The Semantic Technique
      4. The Experimental Technique
        1. The attorney who was afraid to lose a case in court.
      5. The Pleasure / Perfectionism Balance Sheet
        1. The physician who thought he had to perfect.
      6. Externalization of Voices / Acceptance Paradox
        1. Can use some of the bulleted thoughts listed above that are common among therapists as well as their patients
      7. Feared Fantasy
      8. Dare to be average!
        1. David’s writer’s block when trying to revise Feeling Good

This is one show you WON’T WANT TO MISS!

We hope you can join us live. However, the show will be recorded, as usual, so you can tune in anytime on my Public FB page! Usually the show is an hour, but we’ll do a special, extended, 90-minute show for this cool topic!

Dr. Levitt is Director of Clinical Training at the Feeling Good institute in Mt. View, California. She is a co-director of my weekly psychotherapy training group at Stanford, and is absolutely superb. When we work together, the chemistry can be pure magic (most of the time, but not always!) The photo below was at taken at our recent Sunday workshop on Advanced TEAM-CBT techniques.

Jill and david 2

David

Here in some exciting upcoming workshops for you–

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI
To register, or for more information, call: 800-844-8260

* * *

December, 2018

Brief Therapy Conference, December 6 – 9, Burlingame, California

Sponsored by the Milton Erikson Foundation

I will be giving a Keynote Address on

Overcoming Therapeutic Resistance

on Sunday, December 9, 2018, from  2:30 – 3:30 PM

plus a two-hour workshop on Friday, December 7, 2018 from 10:45 AM – 12:45, with Dr. Jill Levitt on

Healing Yourself: A Live Demonstration of TEAM-CBT

plus two other presentations at this fantastic event.

Hiking Report / Photos

Hiking Report / Photos

Hi everybody,

I have not shared any of Maryam Hamidi’s fabulous photos from our Sunday hikes recently, so decided to post some for you today. We had eight brave hikers, and some really amazing things happened as we were doing personal work and case consultation along the way.

We were pleased that Dr. Mark Noble from the University of Rochester was able to join us once again. Some of you may have heard him on our Podcast #100 on “TEAM-CBT and the Brain.” He is currently working on a book on that title, and has generously volunteered to contribute preview chapter in my upcoming book.

I hope you enjoy these beautiful pics!

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IMG_6125

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Here in some exciting upcoming workshops for you–

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI
To register, or for more information, call: 800-844-8260

* * *

December, 2018

Brief Therapy Conference, December 6 – 9, Burlingame, California

Sponsored by the Milton Erikson Foundation

I will be giving a Keynote Address on

Overcoming Therapeutic Resistance

on Sunday, December 9, 2018, from  2:30 – 3:30 PM

plus a two-hour workshop on Friday, December 7, 2018 from 10:45 AM – 12:45, with Dr. Jill Levitt on

Healing Yourself: A Live Demonstration of TEAM-CBT

plus two other presentations at this fantastic event.

Overcome Perfectionism on the David and Jill Show, Nov 11, 2018!

Overcome Perfectionism on the David and Jill Show, Nov 11, 2018!

Special 90-minute show!

Watch FB Live on Sunday, November 11th, 2018,
at 3 PM (PT) fr with David and Jill!

Join Dr. Jill Levitt and me as we return for our next Facebook Live Show! We will focus on perfectionism, a problem that probably plagues you and your patients as well. In fact, perfectionism is one of the most common problems we see in clinical practice, and most of us struggle with our own perfectionism as well. Perfectionism is a major cause of depression as well as social anxiety, crippling performance anxiety, and more.

Here’s the rough preview of our show.

Do you or your patients reach for the stars and end up grasping air? Perfectionism is one of the most common problems we see in clinical practice, and most mental health professionals at times struggle with their own perfectionism as well.

Do any of these thoughts sound familiar?

  • I shouldn’t have screwed up!
  • I’m a failure.
  • I should be better than I am.
  • I’m unlovable.
  • I’m more screwed up than my patients!
  • At my age, I should have it more together.
  • I’m a bad mother (or father, or therapist, etc.)
  • My presentation was only okay. Darn it! I should have hit it out of the park!
  • I’m just average. There’s nothing really special about me.
  • If people found out about how anxious and insecure I am, they’d judge or reject me.
  • If you can’t do something perfectly, there’s no point in doing it at all.
  • Your worthwhileness as a human being depends on your productivity, intelligence, and achievements.
  • All my parents care about is my grades. They don’t really love me for who I am.

Perfectionism triggers clinical depression and feelings of inferiority as well as many anxiety disorders, such as social anxiety, performance anxiety (e.g. writer’s block), OCD (compulsive checking, cleaning arranging, etc.), and more.

Perfectionism has also been implicated in eating disorders such as anorexia nervosa, although the causal relationships are not entirely clear, plays a role in the addiction to work, and is often associated with loneliness.

But is perfectionism necessarily a bad thing? What’s the difference between neurotic perfectionism and the healthy pursuit of excellence? Tune in Sunday and find out!

The show will be chock full of real and inspiring cases as well as helpful treatment techniques. This David and Jill Show will be geared toward therapists and the general public alike, including teenagers and adults.

Outline of the Show

  1. What is perfectionism? How does neurotic perfectionism differ from the healthy pursuit of excellence?
    1. The woman who scrubbed her bedroom floor until it had to be replaced.
  2. What’s perceived perfectionism?
  3. The Self-Defeating Beliefs (e.g. “Self-Esteem Equations”) that trigger perfectionism:
    1. I must be perfect in order to be happy.
    2. If I’m not perfect then I can’t be happy.
    3. People won’t love me if I’m damaged or flawed, or if I screw up.
  4. How is the concept of perfection promoted in our culture?
    1. In the media
    2. In our child rearing practices
    3. In sports
    4. Motivational speakers at sales conferences
      1. You must be number ONE!
    5. In our societal values
      1. Calvinist work ethic: You ARE what you DO.
    6. What are the cognitive distortions trigger perfectionism?
      1. All-or-Nothing Thinking
        1. My workshop with Aaron Beck at ACBT
      2. Mental Filter / Discounting the Positive
        1. The Cincinnati talk show host
      3. Mind-Reading
      4. Magnification
      5. Should Statements
    7. Personal examples
      1. David’s early therapy career
      2. Jill’s examples
    8. Tools to overcome perfectionism
      1. Specificity / Daily Mood Log
        1. Need a nice example
      2. Magic Dial / Positive Reframing
        1. What does your perfectionism show about you that’s positive and awesome? What are some benefits of your perfectionism?
        2. Would a Cost-Benefit Analysis be useful also. Some overlap with Positive Reframing.
      3. The Semantic Technique
      4. The Experimental Technique
        1. The attorney who was afraid to lose a case in court.
      5. The Pleasure / Perfectionism Balance Sheet
        1. The physician who thought he had to perfect.
      6. Externalization of Voices / Acceptance Paradox
        1. Can use some of the bulleted thoughts listed above that are common among therapists as well as their patients
      7. Feared Fantasy
      8. Dare to be average!
        1. David’s writer’s block when trying to revise Feeling Good

This is one show you WON’T WANT TO MISS!

The David and Jill show is usually on the first Sunday in every month, but this month it will be on the second Sunday (November 11, not November 4). We hope you can join us live. However, the show will be recorded, as usual, so you can tune in anytime on my Public FB page! usually the show is an hour, but we’ll do a special, extended, 90-minute show for this cool topic!

Dr. Levitt is Director of Clinical Training at the Feeling Good institute in Mt. View, California. She is a co-director of my weekly psychotherapy training group at Stanford, and is absolutely superb. When we work together, the chemistry can be pure magic (most of the time, but not always!) The photo below was at taken at our recent Sunday workshop on Advanced TEAM-CBT techniques.

Jill and david 2

Here in some exciting upcoming workshops for you–

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI
To register, or for more information, call: 800-844-8260

* * *

December, 2018

Brief Therapy Conference, December 6 – 9, Burlingame, California

Sponsored by the Milton Erikson Foundation

I will be giving a Keynote Address on

Overcoming Therapeutic Resistance

on Sunday, December 9, 2018, from  2:30 – 3:30 PM

plus a two-hour workshop on Friday, December 7, 2018 from 10:45 AM – 12:45, with Dr. Jill Levitt on

Healing Yourself: A Live Demonstration of TEAM-CBT

plus two other presentations at this fantastic event.

113: Ask David: How Can I Overcome My Perfectionism?

113: Ask David: How Can I Overcome My Perfectionism?

Hi everybody! In today’s podcast we answer five challenging questions submitted by fans and listeners such as you!

1. Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What’s the best degree? Should you go to school to become a psychologist,  clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning!

2. Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies.

3.  Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called “somatic” symptoms of depression, like insomnia or changes in appetite.

For example, some “experts” would argue that the following are all symptoms of clinical depression:

  • insomnia or the opposite—sleeping too much;
  • increased appetite or the opposite–decreased appetite;
  • loss of interest in sex, or the opposite, sex addiction;
  • loss of interest in work, or the opposite, being a workaholic.

How can opposite symptoms be symptoms of depression? Does this make sense? Are these really the symptoms of depression, or simply non-specific symptoms? What are the five key symptoms of real depression?

4. Kevin is a therapist with a simple question: How do I get over my desire to help?

5. Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn’t making any progress in the therapy.

Thanks for listening to our Feeling Good Podcasts. Please tell your friends about us or forward this to them so our numbers can continue to grow. We are now in the range of 60,000 downloads per month, thanks to all of you! Fabrice and I greatly appreciate your support!

David and Fabrice

Subscribe

Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy. You can reach him at fabrice@life.net. You can reach Dr. Burns at David@feelinggood.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

* * *

A Cool Upcoming Workshop for YOU!

Two great locations: SF and Portland

plus Live Streaming from Portland
so you can attend from anywhere in the world.

TREAT ANXIETY FAST–

Powerful, Fast-Acting, Drug-Free Techniques 
to Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018: San Francisco, CA
(in person only)

and

December 3 and 4, 2018: Portland, Oregon
(in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed teachers!

Sponsored by PESI

To register, or for more information, call: 800-844-8260

The Perfectionist’s Script for Self-Defeat–On the David and Jill Show, Nov 11, 2018!

The Perfectionist’s Script for Self-Defeat–On the David and Jill Show, Nov 11, 2018!

Watch FB Live on Sunday, November 11th, 2018,
at 3 PM (PT) for a full hour with David and Jill!

Join Dr. Jill Levitt and me as we return for our next Facebook Live Show! We will focus on perfectionism, a problem that probably plagues you and your patients as well. In fact, perfectionism is one of the most common problems we see in clinical practice, and most of us struggle with our own perfectionism as well. Perfectionism is a major cause of depression as well as many of the  anxiety disorders, such as social anxiety and crippling performance anxiety.

Do any of these thoughts sound familiar:

  • I shouldn’t have screwed up!
  • I’m a failure.
  • I should be better than I am.
  • I’m unlovable.
  • I’m more screwed up than my patients!
  • At my age, I should have it more together.
  • I’m a bad mother (or father, or therapist, etc.)
  • My presentation was only okay. Darn it! I should have hit it out of the park!
  • I’m just average. There’s nothing really special about me.
  • If people found out about how anxious and insecure I am, they’d judge or reject me.
  • If you can’t do something perfectly, there’s no point in doing it at all.
  • Your worthwhileness as a human being depends on your productivity, intelligence, and achievements.
  • All my parents care about is my grades. They don’t really love me for who I am.

What’s the difference between neurotic perfectionism and the healthy pursuit of excellence? What are the cognitive distortions that cause perfectionism? What does your perfectionism show about you that’s positive and awesome? What are some of the benefits of perfectionism? What’s the difference between Perfectionism and Perceived Perfectionism? How can you overcome perfectionism? What does “Dare to be Average” mean? That sounds awful!

Tune in Sunday and find out! The show will be chock full of real and inspiring cases and treatment techniques. This David and Jill Show will be geared toward therapists and the general public alike, including teenagers and adults.

This is one show you WON’T WANT TO MISS!

David’s cover feature on perfectionism in Psychology Today Magazine in 1980 was the most popular article in the history of that magazine. Perfectionism still plagues tens of millions of Americans, and countless more world wide. Is there a solution, or escape, from this trap? Do we even WANT a solution?

The David and Jill show is usually on the first Sunday in every month, but this month it will be on the second Sunday (November 11, not November 4). We hope you can join us live. However, the show will be recorded, as usual, so you can tune in anytime on my Public FB page!

Dr. Levitt is Director of Clinical Training at the Feeling Good institute in Mt. View, California. She is a co-director of my weekly psychotherapy training group at Stanford, and is absolutely superb. When we work together, the chemistry can be pure magic (most of the time, but not always!) The photo below was at taken at our recent Sunday workshop on Advanced TEAM-CBT techniques.

Jill and david 2

Here in some exciting upcoming workshops for you–

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI
To register, or for more information, call: 800-844-8260

* * *

December, 2018

Brief Therapy Conference, December 6 – 9, Burlingame, California

Sponsored by the Milton Erikson Foundation

I will be giving a Keynote Address on

Overcoming Therapeutic Resistance

on Sunday, December 9, 2018, from  2:30 – 3:30 PM

plus a two-hour workshop on Friday, December 7, 2018 from 10:45 AM – 12:45, with Dr. Jill Levitt on

Healing Yourself: A Live Demonstration of TEAM-CBT

plus two other presentations at this fantastic event.

099: Nicole Bell’s Incredible Interview with Dr. David Burns

099: Nicole Bell’s Incredible Interview with Dr. David Burns

Behind His Brilliance: Critical Thinking

Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about

  • David’s path into the mental health field
  • the difficulties and rejections David faced getting his first book, Feeling Good, published
  • David’s advice to listeners interested in therapy
  • how he approaches perfectionism, depression, and anxiety with patients
  • the joys of a life free from the need to be special—
  • and much more!

Click here if you’d like to learn more about Nicole and hear more of her fantastic interviews! Lisa’s show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa’s most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.

Uncovering Self-Defeating Beliefs (SDBs)–For Therapists (and Interested Patients) Only!

Uncovering Self-Defeating Beliefs (SDBs)–For Therapists (and Interested Patients) Only!

oThis is a technical memo for therapists who use a technique I developed years ago called the Individual Downward Arrow Technique. The goal of this technique is to uncover each patient’s (client’s) Self-Defeating Beliefs (SDBs), such as Perfectionism, Perceived Perfectionism, or the Brushfire Fallacy. I developed this memo for my Tuesday evening TEAM-CBT group at Stanford following a session practicing this technique earlier in the week.

Why would a therapist want to uncover SDBs? Cognitive Therapists work with (at least) two types of cognitions that can cause emotional distress. First, Negative Thoughts happen in the here and now and only cause emotional distress at specific moments in time. Let’s say you have public speaking anxiety, and you’re about to walk up to the podium. You are probably telling yourself things like this: “I’ll blow it. My mind will go blank. I’ll make a total fool of myself. People will laugh at me and judge me.” These kinds of Negative Thoughts happen in there here-and-now, when you are feeling anxious or depressed. The Negative Thoughts are usually not present when you are feeling happy and confident.

The SDBs represent a second category of cognition. These belief systems represent some of our core values, and they are always there in the background, whether or not we are upset. So, for example, you may have a belief called Perceived Perfectionism, thinking that people will not accept, respect or love you if you screw up or appear vulnerable. Or you may have the Approval Addiction, thinking you need everyone’s approval to feel happy and fulfilled. Or you may have the Achievement Addiction, basing your self-esteem on your intelligence or accomplishments. There are a great many kinds of SDBs.

The cognitive theory of emotional distress works like this: the combination of a Self-Defeating Belief (such as the Achievement Addiction) plus a negative event (such as screwing up or doing poorly when you give a talk) triggers emotional distress. That’s when you are flooded with negative thoughts and feelings, such as “Gosh, my talk was kind of a dud. People seemed bored. I’m a loser,” etc.

So the SDBs appear to explain the timing and reason for episodes of depression and anxiety.  And if we can pinpoint and change the patient’s (client’s) SDBs, we can not only help the patient to feel better in the here-and-now, but we may also help to prevent painful mood crashes in the future.

In this memo, I discuss the finer points of how to use the Individual Downward Arrow Technique to pinpoint each patient’s Self-Defeating Beliefs. If you are interested, I could address how to change SDBs in a future blog or in an upcoming Feeling Good Podcast.

I will be curious to find out if this type of information is of interest to my readers, so please let me know what you think! If the information that follows is too technical, no problem! I just want to get a feel for what people like and want so I can serve you in the best possible way. Thanks!

David

Tips for Therapists When Using the Individual Downward Arrow Technique

By David Burns, MD*

I would like to thank Daniele Levy, PhD for conceptual and editing help!

What is the Individual Downward Arrow Technique? This technique will help you pinpoint the Individual Self-Defeating Beliefs (SDBs) that make the patient vulnerable to depression and anxiety. For example, the patient may base his or her self-esteem on accomplishments, the so-called “Achievement Addiction,” or may struggle because of Perfectionism, Perceived Perfectionism, Entitlement, or the Approval or Love Addiction. You can find a list of “23 Common Self-Defeating Beliefs” in the Therapist’s Toolkit or my Feeling Good Handbook. The Individual SDBs are often “self-esteem equations,” of the form, “To be a worthwhile human being I need substance X.” Substance X could be great achievement, wealth, love, perfection, approval, or always pleasing others, for example.

To use this technique, draw a downward arrow under a Negative Thought on a Daily Mood Log and ask your patient, “Why would it be upsetting to you if this thought were true? What would it mean to you?” This will trigger a new Negative Thought. Tell the patient to write it down under the arrow and repeat the process several times. The NTs you and your patient generate will lead to the underlying beliefs at the core of his or her suffering.

There are three additional Uncovering Techniques. The Interpersonal Downward Arrow Technique helps you pinpoint the beliefs and attitudes that trigger conflicts and difficulties in the patient’s personal relationships. The What-If Technique helps you pinpoint a core feared fantasy that trigger’s the patient’s anxiety. And the Hidden Emotion Technique helps you bring suppressed hidden problems and conflicts to the patient’s conscious awareness.

Here are some important tips to keep in mind when using the Individual Downward Arrow technique:

SET UP

  1. Always start with a Negative Thought (NT) from a Daily Mood Log when doing the Downward Arrow Technique. Don’t do the Downward Arrow Technique for some problem the patient has, or based on some emotion the patient has.
  2. Both patient and therapist must be writing during the Downward Arrow Technique. Usually, I use a blank sheet of paper, because the DML gets too filled up with the chain of NTs. But keep in mind that your blank sheet of paper is really an extension of the NT column on the DML.
  3. Remember to be compassionate when doing the Downward Arrow, and not overly harsh or intellectual. For example, if the patient says, “That would mean I was a total failure,” you can say, “Of course, that would be pretty painful for almost anyone to feel like you were a total failure, but I’m wondering what it would mean to you? Why might that be upsetting you?”
  4. If the patient becomes tearful, perhaps recalling a painful childhood memory during the Downward Arrow process, put your techniques on the shelf and empathize, encouraging your patient to vent and open up. These moments can be quite important to the patient.

WORDING OF NTs

  1. Convert rhetorical questions into statements. “Why am I so screwed up?” can become “I’m screwed up,” or “I shouldn’t be so screwed up.”
  2. When doing a Downward Arrow from a “Should Statement,” such as “I shouldn’t have left my husband,” you can say, “Let’s assume it’s true that you shouldn’t have left your husband, but you did. What does that mean to you? Why is that upsetting to you?”
  3. Never put emotion words or descriptions of upsetting events in the NTs column when doing the Downward Arrow. Instead, ask for the NT that is associated with the emotion or event. For example, if the patient says, “Then I’d feel ashamed,” you can say, “What is the NT that would make you feel ashamed? What would you be telling yourself?”
  4. If the patient comes up with a wish or a positive thought when you’re doing the Downward Arrow Technique, you can convert it to an NT. For example, let’s say a patient has this thought about dropping out of school: “I’ll be letting my parents down. I’ll be a disappointment to them.” Then you ask, “If this were true, what would it mean to you? Why would it be upsetting to you?” The patient might say, “Well, I really want my parents to be proud of me.” You can easily convert it by saying, “So let’s assume you really want your parents to be proud of you, but they’re actually disappointed in you for dropping out of school. What would that mean to you? Why would that be upsetting to you?”

PROBING

  1. If the patient says, “I don’t know,” use Multiple Choice Empathy. For example, the patient may have the NT, “Then I’d be all alone forever,” when you are doing the Downward Arrow Technique, but when you ask, “And what would that meant to you, and why would that be upsetting to you,” he or she might say, “I don’t know.” Using Multiple Choice Empathy, you might say, “Of course, probably no one would want to be alone forever, but it could mean different things to different people. Some people might think that if they’re alone, they can’t survive, or if they’re alone, it means they’re unlovable and worthless, and others might think it’s impossible to feel happy and fulfilled when you’re alone. Do any of those possibilities ring true for you?”
  2. You can also use the “Man (or Woman) from Mars” approach if the patient says, “I don’t know why that would be upsetting for me.” Let’s say the patient comes up with this thought during the Downward Arrow Technique: “That would mean I failed,” but can’t explain why failure would be upsetting or bad. You can say, “Let’s assume I’m a man (or woman) from Mars, and I don’t know how things work here on the surface of the earth. So I might ask you to explain why failure is considered a negative thing here on the earth. What happens to people who fail at something?” This will usually make it easier for the patient to continue the Downward Arrow Chain.
  3. Using Bracketing when the patient cycles back and forth between two NTs. For example, the patient might say, “Then I’d be a failure,” followed by “Then no one would love me,” followed by “Then I’d be a failure,” etc. You can bracket them in this way: “And suppose you were a failure, and no one loved you. What would that mean to you? Why would that be upsetting to you?”

GOAL CONSIDERATIONS

  1. The purpose of the Downward Arrow Techniques is uncovering the patient’s SDBs, not change. You can change SDBs, but change is not the goal when you are doing an Uncovering Technique. If you think about an NT on a Daily Mood Log, most of the time we are doing horizontal arrow techniques. In other words, we want to move from the NT column on the left to the Positive Thought (PT) column on the right, and this involves trying to challenge and crush the NT so that emotional change will suddenly happen. In contrast, when you use a downward arrow technique, you are drilling down deeper into the patient’s psyche to uncover the beliefs that give rise to the negative thoughts and feelings. You are moving to a deeper level.
  2. Sometimes, a patient will begin to recognize the absurdity of the NTs when doing the Downward Arrow, and will begin to come up with convincing and effective Positive Thoughts (PTs). This is okay, and you can encourage the patient to write the PTs in the PT column on the Daily Mood Log.
  3. The Self-Defeating Beliefs are the logic behind the negative thoughts on the Downward Arrow Chain, since the thoughts do not logically follow from one another. For example, a psychologist’s favorite patient unexpectedly committed suicide, and one of his NTs was: “I should have seen this coming. I should have known he was suicidal.” His next thought on the downward chain was, “This means I’m a failure and a fraud.” Notice that the second thought does not follow logically from the first thought, but the SDB that links them is Perfectionism. His third thought was, “My colleagues will judge me and reject me.” Again, this does not follow logically, and the SDB that links them is Perceived Perfectionism—namely, the belief that others will not accept, love, or respect him if he is vulnerable, or human, or makes a mistake.

* Copyright © 2017 by David D. Burns, MD

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 resources for mental health professionals as well as patients!

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Thanks! David

 

017: Ask David — Dare to be “average”—The perfectionist’s script for self-defeat

In this podcast, David answers a challenging question posed by a listener:

Dear Dr. David:

In your Feeling Good Handbook, you suggest that the reader just allows himself or herself to be an ordinary person instead of trying to be perfect. Contrary to your opinion in the book, you’re an outstanding therapist in reality. You’ve studied in one of the world’s top colleges, you’re well-educated with a doctor degree, and successful in your career and life. How can I believe your claim? I’m quite confused!

Sincerely, XXX

David first distinguishes perfectionism from the healthy pursuit of excellence, and then describes a painful incident when he was a Stanford medical student. One afternoon, he attended an afternoon Gestalt encounter group at the home of a friend and mentor in Palo Alto. During the group he was ripped to shreds by the other participants. At the end of the group, the other participants seemed elated, but he felt intensely humiliated, ashamed, and discouraged. This led to an unexpected interaction with his mentor that helped to change his life.

David also discusses his clinical work years later with a depressed and anxious professional who had never experienced even one minute of happiness in spite of a life of fabulous success and achievements.

At the end, David and Fabrice promise a future podcast on this topic: “Self-Esteem: What is it? How do I get it? How can I get rid of it once I’ve got it?”