049: Live Therapy with Marilyn, Part 1, The Dark Night of the Soul

049: Live Therapy with Marilyn, Part 1, The Dark Night of the Soul

You FEEL the Way You THINK! . . . Or Do You?

The next three podcasts feature a therapy session with Marilyn, a woman recently diagnosed with Stage 4 (terminal) non-smoker’s lung cancer. We are enormously grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will inspire you, and give you courage in facing losses, traumas and problems in your own life.

At the beginning of the therapy, Marilyn is in shock, experiencing, quite understandably, extreme levels of depression, anxiety, shame, loneliness, hopelessness, and anger. What’s the cause of her negative feelings?

According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel.

When you’re upset, you’ve probably noticed that your mind will usually be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings.

In addition, you may not be aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In fact, in my first book, Feeling Good, I listed the cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events, can be enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel.

But is this notion really true? Can’t traumatic events upset us? And can we really change the way we think and feel when the circumstances of our lives are genuinely awful? Or is this just a lot of pop psychology?

A lot of people don’t buy into the notion only your thoughts can upset you. It just seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers the negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real.

Would you agree? I know that’s what I used to think! If you’re interested, and you have not yet listened to the first Marilyn podcast, you can take the brief poll on the home page and let us know what you think!

The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating. At the end of the third podcast, you’ll have the chance to take the poll again.

In this podcast, Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session. If you’d like, you can review the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative feelings are all severe, and that her negative thoughts focus on several themes, including

  • Her fears of cancer, pain, and death.
  • Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, and feeling that she’s perhaps been duped by religions.
  • Her feelings of incompleteness at never having had a truly loving life partner.
  • Her intense self-criticisms, beating up on herself for excessive drinking during her life.

The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, where David and Matt will attempt to reduce Marilyn’s resistance and enhance her motivation using the Miracle Cure Question, the Magic Button, the Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, where David and Matt will encourage Marilyn to challenge her negative thoughts using Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and the Acceptance Paradox, followed by Relapse Prevention Training, the end of session testing, and wrap-up.

Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a spiritual person who suddenly finds herself without hope or faith, and totally lost, we have called part one, The Dark Night of the Soul, a concept from William Johnston’s classic book on religious mysticism entitled, The Inner Eye of Love.

We are hopeful these broadcasts will stimulate comments and discussions on the philosophical and spiritual messages embedded in the Marilyn session from you and our other listeners. Is it true that only our thoughts can upset us? And is the total loss of faith a necessary step on the path to enlightenment?

Live Session (Marilyn) — The Dark Night of the Soul (Part 1)

 

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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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