Self-Acceptance, People who Resist, Secrets of Dynamic Job Interviews, Five Secrets with your Boss, Do Cognitive Distortions Cause Transgenderism?

Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!

Questions for the this Ask David Podcast

1. Rizwan suggests a new method for self-acceptance.
2. Anonymous asks how to convince someone that depression is NOT due to a chemical imbalance in the brain. My father does not believe that you can change the way you FEEL by changing the way you THINK!
3. Marc asks about tips for job interviews, as well as how to respond during periodic performance reviews at work.
4. Brian asks if transgenderism could be the result of distorted thoughts.

1. Rizwan asks

I have a question about the Acceptance Paradox that came to my mind during our Tuesday training group on 19 Dec, 23.

As homework, will it be useful to ask clients to make a list of things which they have already accepted in life and made peace with?

At the next stage, in the session, would it be useful if the therapist asks them, "why did you accept and make peace with those things?

“Can you use the same criteria to accept other things in your lives which you are not accepting now?"

Sincerely, Rizwan

 David’s take

Yes, you can certainly try that and let us know how it works out? I do lots of spontaneous and “new” things in almost every therapy session. Some things work out, and others do not. That way, I learn from my clinical work.

One thing to be aware of is that your proposed approach might overlap with “helping,” when a paradoxical approach might have more “punch” / impact, After all, the Acceptance Paradox is arguably more of a decision, than a skill.

But try, even with yourself if you like, and let us know what you discover. TEAM constantly evolves, and you can be an important part of that process!

Best, david

2. Anonymous asks how to convince someone that depression is not due to a chemical imbalance in the brain and that you can change the way you FEEL by changing the way you THINK?

Hi David

I love listening to your podcasts. And now I am seeing differences in my life but not my father who has been depressed for around 40 years. He is on medicines and has an extreme belief that it's on the basis of chemical imbalance. He is a pharmacist by profession, and loves to learn about how chemical changes mood swings.

I am not able to convince him to read your books. He just take sleeping pills every single and sleeps all day. He is learning something about neuroplasticity which is actually the case that happens in cbt.

But he think it's some kind of thought changing therapy which cannot change the chemical in our brain. Please help David. I would love you to answer this.

Regards,

Anonymous

David’s Response

Hi, I once gave the keynote address at a research conference at the Harvard Medical School. When the department chairman introduced me, he something like, “Dr. David Burns is going to show us how you can change brain chemistry with CBT, and without drugs!” It was pretty cool!

That’s one dimension. And we could add more evidence and research findings to support our side of the argument.

But on another level, we see the underlying issue of trying to convince someone who is taking an adversarial position and content with their own thinking and beliefs, and determined to argue no matter what evidence you present.

In my experience, spending time trying to convince them is almost always a losing cause. All you do is engage in a frustrating philosophical debate, at least that’s my thinking!

The podcasts on the theme of “How to Help and How NOT to Help” might be useful, in case you are looking for help with your relationship with your father. Your love and concern for him is huge and very touching!

Okay to use in an Ask David? I will not use your first name!

Best, david

3. Marc asks for tips on job interviewing.

Hi David, I hope you are keeping well.

I am wondering if you have any tips / strategies/resources that you recommend for an upcoming job interview?

Also, you once told a story of someone who worked in the tech industry that you counselled, and you recommended some questions for him to ask in periodic performance reviews. Does this ring a bell at all? I've had trouble remembering/locating this Podcast.

Stay well,

Marc

David replies

Hi Marc, Yes, we can discuss the secrets of successful job interview  on a podcast. I have LOTS of tips, actually, and we can perhaps do a podcast on this.

We could also focus on how to respond to your supervisor during performance reviews, and I DO have an amazing story about that as well; it was the fellow who had been fired six times in two years.

Thanks for reminding me. I might have given him the name of Rameesh, but not sure!

Best, David

 4. Brian asks: Could transgenderism result from distorted thoughts?

Hi David,

Happy New Year, and thank you for your amazing Monday podcasts.

I just started listening to yours today about transgenderism. Could transgenderism be the result of distorted thoughts?

I know it's a very sensitive subject like anti-depressants.

Thanks,

Brian

David’s Reply

Hi Brian,

Thanks for the question. Copying Robin, as she’s the expert.

But to my way of thinking, the answer is no. I believe, though I’m no expert, that gender identity as well as sexual preferences are primarily biological in origin, although there are obviously strong cultural influences and biases.

For example, ice cream preferences are kind of inherent to people, and mysterious, and cannot be changed by changing our thinking! I love blueberry pie, and many others don’t care for it. Just a preference!

Saying that gender results from distorted thoughts might also be hurtful, as if our identities might be somehow “wrong” or “defective.”

Might use as an Ask David question if you and Robin have no objection.

Best, david

Thanks for listening today!

Featured Photo is Dr. Amy Huberman The Amy Story, Part 2: The Joys of Doing the Laundry!

Amy and her exuberant son, Sasha, and wife, Alena

Last week you heard Part 1 of the Amy session, which included T = Testing, E = Empathy, and A = Assessment of Resistance. Today, you will hear Part 2 of Amy's exciting journey from perfectionism to JOY.

M = Methods

We used a variety of Methods to help Amy challenge her negative thoughts, starting with the first, “I’m failing my patients.” We started with Identify and Explain the Distortions, then went to the Double Standard Technique, and ended up with the Externalization of Voices.

As a reminder, you can see Amy's  Daily Mood Log at the start of her session here..

As an exercise, see how many distortions, or thinking errors, you can find in her first Negative Thought, “I’m failing my patients,“ using the list of cognitive distortions on the bottom of her Daily Mood Log. You’ll find the list of the ten cognitive distortions if you click here.  After you’ve identified each distortion, see if you can explain two things about it:

1. Why is this distortion in Amy’s thought unrealistic and misleading?
2. Why might it be incredibly unfair and hurtful?

You’ll find my list of the distortions in this thought at the end of the show notes. But don’t look until you’ve made your list!

These techniques we used were effective , as you’ll hear on the podcast, especially the Externalization of Voices. You’ll hear us doing role-reversals with Amy, and the method that “won the day” was the CAT, or Counter-Attack Technique, combined with the Acceptance Paradox. The Acceptance Paradox involves finding truth in a negative thought with a sense of peace or even humor. The CAT involves confronting the hostile voice in your head and tell it to go fly a kite, or other gentle but firm message

You’ll enjoy seeing some striking changes in Amy, as her tears and feelings of intense self-doubt are suddenly transformed into joy and laughter.

Those changes created strong feelings of joy for Jill and me as well. We both have incredibly fondness and admiration for Amy, and feel great joy as well when she feels joy.

Here are Amy’s final scores at the end of the session.

Emotions % Now % Goal % After Sad, blue, depressed, down, unhappy 80 25 0 Anxious, worried, panicky, nervous, frightened 80 20 0 Guilty, remorseful, bad, ashamed 90 5 0 Worthless, inadequate, defective, incompetent 100 15 5 Lonely, unloved, unwanted, rejected, alone       Embarrassed, foolish, humiliated, self-conscious       Hopeless, discouraged, pessimistic, despairing 90 5 0 Frustrated, stuck, thwarted, defeated 80 5 5 Angry, mad, resentful, annoyed, irritated, upset, furious       Other      

 

The Joyous Dr. Amy!

Sudden and dramatic change is pretty trippy, but it isn’t much good if it doesn’t last. And it won’t! Negative thoughts and feelings will always return, because no one can be happy all the time. That’s why some relapse prevention training and ongoing practice and refinement of what you’ve learned can be vitally important.

In our follow-up session with Amy one week later she said she’d felt way better during the week, but did, in fact, have some relapses and had to challenge her negative thoughts again. She’d been helped a lot by the idea that it was okay to fail, to seek consultation, and learn, and that failing with patients gave us endless opportunities to learn and grow as therapists. And it was also okay not to have to listen so intently to the attempts of the negative self to put her down.

In fact, our misery almost never results from our failures, but from telling ourselves that we “shouldn’t” ever fail, and from punishing ourselves mercilessly when we do.

One of her most exciting statements in our follow-up session was that she discovered that even something as humble as putting the dirty clothes into the washing machine could be a joyous experience without that negative voice in her brain constantly hollering at her that she wasn’t good enough!

Teaching points

1. It was hard, at first, for Amy to “see” how distorted and unfair her negative thoughts were. She is an extremely intelligent, accomplished, and beloved colleague, and yet most of us cannot “see” or really “grasp” that we can be pretty mean to when we’re feeling down and anxious.

I have often said that feeling anxious and depressed is a lot like being in a deep hypnotic trance, telling yourself and believing things that just aren’t true. For example, Amy is doing beautiful work with the great majority of her patients, and is doing the exact same thing with the patients who are responding beautifully as she is with the two who are stuck. So, when she tells herself she’s a failure, she’s clearly involved in All-or-Nothing Thinking. In other words, she’s thinking that if she’s not perfect, she’s a complete failure and a fraud.

She also seems to have many Hidden Shoulds (e.g. I SHOULD be able to help every single patient quickly) and Mental Filtering (focusing only on the negatives) and Discounting the Positive (ignoring the positives, as if they didn’t count.)

1. The techniques that were the most helpful for Amy were

• Positive Reframing: that’s where we pointed out the positive aspects of Amy’s Negative Thoughts and feelings.
• The Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT.
• Be Specific: Amy was Labeling herself as a “fraud” and a “failure,” and she was Overgeneralizing from two patients to her entire self and career. Jill emphasized Be Specific. In other words, focus on and accept what’s real. What’s real is that Amy has been valiantly struggling to help two patients who are stuck. She can just accept that, and get some consultation and guidance from a colleague, which would probably help her get unstuck.

So, instead of labelling yourself as “a failure” and “a fraud,” which are just mean, vague words, you can tell yourself that you have a specific problem—in Amy’s case, getting stuck with two very anxious patients. Then you can focus on getting some help in solving that specific problem—for example, by seeking consultation from a colleague.

Jill said that’s what she does when she gets stuck. I used to do that every week, especially when I was first learning cognitive therapy. Getting stuck, then, can simply be an opportunity for growth and learning cool new tools.

If we never got stuck, we’d never learn anything new!

1. The very moment Amy stopped believing her negative thoughts, her feelings instantly and dramatically changed. That change happened suddenly, over the course of about 30 seconds, and you can SEE it in her face and hear it in her voice. But it won’t last forever!
2. Jill pointed out that the belief at the root of Amy’s problem was Perfectionism, and the idea that “I should know exactly what to do with all of my patients.” That may be a pleasant fantasy, and it might even motivate us to work hard and achieve, but it’s also a recipe for misery!

Follow-up

Rapid recovery is great, but will it stick? You will hear excerpts from our brief follow-up session one week later for Relapse Prevention Training. The idea is that none of us can feel happy forever, and negative thoughts will creep back into our minds sooner or later.

However, you can anticipate this and prepare for it by challenging your negative thoughts with the same techniques that helped you the first time you improved. That’s because the details will usually be different every time you’re upset, but the pattern of self-critical negative thoughts will usually be the same.

And this DID happen to Amy, just as it will happen to you. But this was an opportunity for her to deepen her understanding of perfectionism and to refine and enhance her ability to respond to her negative thoughts.

During the weeks following the recording of this podcast, Amy found that she experienced some resistance to using the counterattack technique. She began to feel like she was relating to her perfectionism as an enemy and attacking it—and in doing so, was discounting all the good in it, including the values that came shining through during the Positive Reframing. She found that a better fit for her, instead of the counterattack, was to disarm her perfectionistic thoughts by seeing the truth in them. In fact, you could view this as yet another form of acceptance. When she did this, the perfectionistic voice in her head naturally backed down and gave her the space to do what matters to her unencumbered by self-criticism.

I thought it was cool when she described experiencing waves of joy while doing the laundry—an activity that had always felt like a chore to her before, when it was accompanied by thoughts like “I should have finished this laundry days ago.”   She discovered that without beating up on herself, something as humble as doing the laundry could be incredibly rewarding!

After our follow-up meeting, I got a lovely email from Amy about the joys of giving up the need for perfection, and sent this follow-up reply to Amy:

Thank you, Amy, you are the BEST!

I did a four-day intensive in San Antonio years ago with a small group of about 25 therapists. As you know, I always BS and say “As the Buddha so often said . . . “ followed by something goofy or quasi-mystical or whatever, and most people seem to kind of like that and see it as fun or humorous or whatever.

Well, I was doing that at the workshop, and at one of the breaks a woman approached me and said she was interested in my Buddhist remarks because she had been raised as a Buddhist in an Asian country where Buddhism is prominent. I panicked and thought I’d been found out and exposed as a fraud.

She went on to say that their family gave up Buddhism, however, and she was sad. I asked why they gave up Buddhism, and she explained that her mother suffered from severe depression, and the Buddhists taught that’s because you think you “need” things, and if you’re a good Buddhist you won’t think that way and you won’t ever suffer. Since she suffered, she felt like a failure as a Buddhist, so the family gave up Buddhism.

I told her that she might not be aware that there are actually two schools of Buddhism. There’s low-level Buddhism and high-level Buddhism. In low-level Buddhism, you’re not allowed to want or need anything, and you’re not allowed to suffer. That’s sounds like that was the school of Buddhism your family was raised in.

But there’s another type of high-level Buddhism. In high level Buddhism you’re allowed to suffer and struggle, and screw up, and fail, and all sorts of stuff.

She got animated and said, “I didn’t know that. Thank you so much. You’ve restored my faith in Buddhism, and I can’t wait to tell my mother!”

Aside from my being elderly and half-demented, I hope that makes some sense in light of our work together with Jill!

So, if you need any translation or explanation, Amy, I’m inviting you to join the high-level Buddhist therapist group where you’re allowed to screw up with some of your patients, or even many!

Warmly, david

Subsequent Follow-Up

I forgot to tell you what happened to Amy’s two “stuck patients.” Well, she got some consultation about why these patients might be stuck, which is nearly always an Agenda Setting problem—the therapist is working harder than the patient due to the need to “help,” and this plays into the patient’s ambivalence.

This struck a chord, and Amy was very excited to see her patients again, and both suddenly got “unstuck,” although in somewhat different ways. And that is why I call it the Acceptance Paradox. The moment YOU change, and accept yourself, your world will also change!

Or, to put it differently. We often see the world as “different” or as “other,” thinking we are separated. The Buddhists see the world as “one,” and that is certainly true in therapy as well.

Answers to the Quiz Question

David’s list of Distortions in Amy’s Negative Thought:

“I’m failing my patients.”

1.     All-or-Nothing Thinking. This is not realistic because Amy is not stuck with all of her patients. And even though she's still far short of her hopes for these two patients, they may feel they are getting lots of TLC and support from Amy. 2.     Overgeneralization. This is misleading because she’s overgeneralizing from her two failures to her “self,” and labeling herself as “a fraud and a failure.” She also overgeneralizing to the future, thinking things will never change or improve so she should get a new career. 3.     Mental Filtering. She only focusing on the two patients who are stuck. 4.     Discounting the Positive. She’s overlooking the fact that she’s going excellent work with a great many people, and has tremendous integrity, skill, and commitment to her patients. 5.     Magnification and Minimization. She’s kind of blowing things out of proportion, although it’s always good to focus on patients who aren’t yes improving. 6.     Emotional Reasoning, She FEELS like a failure so thinks she IS a failure. 7.     Hidden Should Statement. She thinks she SHOULD be perfect! 8.     Labeling. Same as Overgeneralization. See above. 9.     Self-Blame. She’s blaming herself instead of loving herself and focusing on getting she help she needs and deserves!

Thanks for listening today!

Rhonda, Amy, and David

Featured Photo is Dr. Amy Huberman The Amy Story Part 1: True Confessions of a “Fraud” and a “Failure” Part 2: The Joys of Doing the Laundry

Amy and her exuberant son, Sasha, and husband, Poppy

Today’s podcast, and next week’s podcast, include a single, two-hour session with Amy Huberman, MD. Amy is a psychiatrist in private practice in Baltimore, MD. She also serves on the volunteer faculty at the Johns Hopkins University School of Medicine.

Amy specializes in brief, intensive psychotherapy to help people overcome struggles with anxiety, OCD, and trauma, but today comes to us to get some help with her own anxiety. Often doing our own work can be a vitally important part of our training and growth as mental health professionals.

Amy has been upset because she is stuck with two of her patients, and she’s telling herself that she’s a “fraud” and a “failure.” Although her life is undoubtedly very different from yours, the root cause of her problem might be very similar to the source of your unhappiness, especially if you sometimes get down in the dumps and tell yourself that you’re just not good enough.

My co-therapist for this session is Jill Levitt, Ph.D. co-founder and Director of Clinical Training at the Feeling Good Institute in Mt. View California. Jill also serves on the Adjunct Faculty at the Stanford Medical School and is co-leader of my weekly TEAM Therapy training group at Stanford, Tuesdays from 5-7:00 pm pst.  If you are interested in joining David and Jill's Tuesday group, please contact Ed Walton, [email protected].

That group is now virtual and therapists from the Bay Area and around the world are welcome to attend. It is free of charge. Rhonda Barovsky also runs a free weekly training group with Richard Lam, on Wednesdays, from 9-11:00 am pst, which is also free of charge. If you are interested in joining the Wednesday group, please contact Ana Teresa Silva, [email protected].  Because the groups are virtual, they are open to therapists from around the world.

Amy has been a member of our Tuesday training group, and is a highly skilled, certified TEAM therapist. Like nearly all the mental health professionals who come for training every Tuesday, Amy has incredibly high standards and is sometimes harshly self-critical when she feels she is not living up to them.

At the same time, those high standards can be strongly motivating, and this can create strong feelings of ambivalence when it’s time to change.

Sound familiar? If you’re struggling with perfectionism, you might want to check out these two podcasts!

Part 1. The True Confessions of a “Fraud” and a “Failure”

Amy opened by saying she was anxious and telling herself:

I’m about to reveal my weaknesses and my inner self—This is something I’ve never done before in such a public setting. . . I also have to confess that I’m struggling with social anxiety right now. I’m afraid that my patients might see this and think, “I don’t want to work with her! I want to work with a competent psychiatrist.”

I Included that because I am hoping you will appreciate Amy’s incredible courage and gift of sharing her true inner self today!

Amy described the problem that’s been bothering her for several weeks. Although she specializes in the short-term treatment of anxiety, she has been struggling with two patients with OCD symptoms who have been stuck and not making significant progress for a long time.

This has triggered feelings of shame and intense anxiety which have invaded Amy’s every moment when she’s NOT seeing patients, and has even prevented her from getting restful sleep at night. She keeps ruminating and beating up on herself.

You can see Amy's  Daily Mood Log Amy here.. As you can see, she was feeling intensely sad, panicky and ashamed, and rated these three feelings as 80% on a scale from 0 (not at all) to 100 (the most severe). She was also feeling worthless and defective which she rated at 100%, as well as hopeless (90%) and stuck (80%).

As you know, feelings do not result from the events in our lives (in Amy’s case, the fact that two of her patients were stuck), but rather from her thoughts, or interpretations, of those events. You can see on her Daily Mood Log that she was being intensely self-critical, telling herself that she was failing her patients, that she should refund their money, that she was not competent to practice psychotherapy and should find a new career, that she “should” know how to get them unstuck, and more, and finally that she was a fraud and a failure.

Her belief in all of these thoughts was super high, ranging from 80% to 100%. And if you’ve ever felt down or inadequate, I’m sure you recognize the same types of thoughts in your own thinking, telling yourself that you’re a failure, or not good enough, and so forth.

During the session, Jill and David went through the TEAM acronym:

T = Testing

We measured her negative feelings at the start of the session so we could measure them again at the end to see how we did.

E = Empathy

We listened and supported Amy without trying to “help” or “save” her. The goal was to understand her thoughts and feelings accurately, while providing a sense of compassion, warmth, and acceptance.

This phase of the two-hour session lasted about 30 minutes, and Amy told us how she constantly ruminated about those two patients, asking herself “What am I doing wrong, what am I missing, what should I be doing differently?” She described these thoughts as a relentless “broken record in my brain.”

She confessed that her deepest fear was, “What if they kill themselves and I was responsible for their deaths?” She said this fear was almost unbearable!”

I pointed out that was also my deepest fear when I was in private practice—I was never upset by treating large numbers of severely depressed patients in back-to-back sessions, and it always made me happy, since I felt I had something to offer. But if I said something that hurt someone’s feelings, I found that pain almost unbearable until I saw the patient again the next week, and could talk things over and get back on a positive track.

Jill pointed out that Amy’s ruminations showed that she was a highly responsible psychiatrist who cared deeply about her patients! And while that is certainly a positive thing, the intensity of her fears had invaded every minute of her life, making her life miserable, even when she was with her family.

Amy said her fears have intensified since 2020, when she transitioned away from a traditional psychiatric practice involving long-term weekly psychotherapy and med-management, to focusing on short-term intensive psychotherapy using the TEAM model.

Then we asked her to grade us at the end, thinking about three categories of Empathy:

1. Did we understand how she was thinking?
2. Did we understand how she was feeling?
3. Did she feel cared about and accepted?

She gave us an A, which triggered our move to the next phase of our work with Amy.

A = Assessment of Resistance

In this phase of the session, we pinpointed Amy’s goals for our session and  melted away her potential resistance to her stated goal of learning to give up that self-critical voice in her brain. We asked her to imagine we had a Magic Button, and if she pushed it, all of her negative thoughts and feelings would instantly disappear, with no effort on her part, and she’d feel jubilant and happy.

She said she wasn’t so sure she’d do that. Most patients say YES, but Amy is familiar with the TEAM approach and knows that negative thoughts and feelings often result from some of our positive qualities.

Our strategy at this phase of the session was paradoxical: Instead of trying to help, save, or rescue Amy, and instead of trying to persuade her to change, we took the role of her subconscious resistance to change. With her help, we listed some of the many positives in her negative thoughts and feelings by asking these two questions.

1. What does this negative thought or feeling show about you and your core values that’s positive and awesome?
2. How might this this negative thought or feeling be helping you and your patients?

Here are just a few of the positives we found in her negative thoughts and feelings:

The Positives in Amy’s Negative Feelings

Feeling What this Shows Inadequacy Keeps me from being overconfident   Keeps me humble, so I’m open to what I may be missing   Shows I care about constant growth and learning   Shows I’m listening   Shows I care about my patients Anxiety Motivates me to think about things from other perspectives   Motivates me to work hard   Keeps me honest   Shows that I have high standards   My high standards have motivated me to learn a lot.

You can do the same kind of Positive Reframing with all Amy’s negative thoughts and feelings, as well as your own. The list of positives would be long and impressive!

After listing these positives, we asked Amy these three questions:

1. Are these positives real?
2. Are they important?
3. Are they powerful?

How would YOU answer these questions if you were Amy?

She gave a strong yes to all three questions.

At the end we pointed out that it might not be such a great idea to push the Magic Button to eliminate the negative voice in her brain, because then all these positives would also disappear.

Instead, she decided to use the Magic Dial to reduce her negative feelings to some lower level where she could keep all the positives but suffer much less. Here you can see her goals for how she wanted to feel at the end of her session.

 

Emotions % Now % Goal % After Sad, blue, depressed, down, unhappy 80 25   Anxious, worried, panicky, nervous, frightened 80 20   Guilty, remorseful, bad, ashamed 90 5   Worthless, inadequate, defective, incompetent 100 15   Lonely, unloved, unwanted, rejected, alone       Embarrassed, foolish, humiliated, self-conscious       Hopeless, discouraged, pessimistic, despairing 90 5   Frustrated, stuck, thwarted, defeated 80 5   Angry, mad, resentful, annoyed, irritated, upset, furious       Other      

 

As you can see, she decided to aim for fairly large reductions in all six of her negative feelings.

These goals are not guarantees she will be able to reduce her feelings. In addition, the goals are not rigid, since she may be able to reduce them even further once she begins to challenge her negative thoughts.

Our real aim at this phase of our work was to reduce her feelings of shame and failure so she could see that her “symptoms” were NOT the expression of what was WRONG with her, but the expression of what was RIGHT with her. Paradoxically, this often reduces the resistance to change and vastly enhances the possibility of rapid and dramatic change during the final, M = Methods portion of the session that you’ll hear next week, along with some follow-up information.

The important thing we’ve hopefully accomplished is reducing Amy’s resistance so she can learn how to challenge and defeat the relentless and hostile voice in her brain that constantly puts her down whenever she fails to live up to her extremely high, and arguably perfectionistic, standards.

End of Part 1 Thanks for listening today. Be sure to tune in to the exciting conclusion of the work with Amy next week!

Rhonda, Amy, Jill, and David

Why Do We Resist Accepting Ourselves Other People, and the World? The Five Most Common Reasons!

Rhonda and David are joined in today’s podcast by Dr. Matt May, a super popular and loved guest on our show, to discuss the resistance findings in David's recent survey on acceptance and resistance. The following is a summary of some of the statistical findings, but the actual podcast dialogue was wide ranging and tremendously engaging, and won't require a lot of statistical smarts!

We also discussed the vitally important difference between healthy and unhealthy acceptance.

• Healthy acceptance is accompanied by feelings of joy, lightness, and liberation. Unhealth acceptance is accompanied by feelings of unhappiness and despair.
• Unhealthy acceptance is characterized by Should Statements and self-punishment for your failures and shortcomings.
• Healthy acceptance is an expression of self-love.

The group brought the five most common reasons to life with engaging stories.

Why should you accept yourself? We are not saying that you "should," and it's really a decision. However, the statistical models the I (David) developed indicated that healthy acceptance can trigger a 49% reduction in negative feelings and a 39% boost in positive feelings, which is tremendous.

Matt told an inspiring story about two strategy for training the dolphins at SeaWorld. One strategy involved trying to shape the behavior of the dolphins with little shocks, in much the same way that some people train horses. Sadly, the dolphins went to the bottom of the pool and appeared depressed, not moving much. It was a complete failure.

Then they tried a radically different strategy--they gave a new group of dolphins fish to reward them for doing the things the trainers wanted them to do. This strategy was tremendously successful.

So, the question is whether you want to shape your own life with frequent shoulds and self-criticisms, which can have the effect of electric shocks every time you fail or screw up or fall short of your goals, or whether you want to shape your life with love and rewards. Some of us have discovered that acceptance is way more fun and vastly more effective!

Quick Bottom Line

The typical survey respondent endorsed 1/3 of the 12 Resistance Scale items, and seemed to believed that Acceptance would be foolish and lead to a life of misery and mediocrity. The actual causal impact of the Non-Acceptance and Resistance scales on positive and negative feelings was massive and appeared to be in the exact opposite direction.

Findings

The respondents in the Resistance survey endorsed an average of 33.8%. (+/- 0.1%) of the items, ranging from 0 to all 12. The most commonly endorsed was, “Acceptance is easy for rich and famous, but hard if you’re struggling just to pay the bills.” 47% (+/- 2%) endorsed this item.

The least endorsed was, “If I beat up on myself, people will love me more,” although 25% (+/- 1%) of the people endorsed this item, so it was fairly popular. The high scores on the resistance scale items is also pretty consistent with my experiences over the years—the people in the study, and the people I’ve worked with, have expressed MANY reasons to beat up on themselves.

You can see the list of the 12 Resistance Scale items below. I have bolded the five most often endorsed. As you can see, many people surveyed believed that acceptance is fine for people who are rich and famous, but terribly painful and foolish for people who struggle with real problems. Many respondents were convinced that acceptance leads to pain, robs you of motivation and does not make sense in a the world that’s falling apart.

1. If I accept my flaws and shortcomings, I'll end up with a second-rate life.
2. If I accept my flaws and shortcomings, I’ll lose all my motivation to learn
3. If I beat up on myself and work my ass off, people will love and admire me.
4. It would be tremendously painful to accept my flaws and shortcomings. That would be like giving up and having to live with a heavy load of inadequacies.
5. Life has many real disappointments and losses. I don't want to feel happy and chipper by “accepting” all those negatives when the world is falling apart all around me. That just doesn’t make sense!
6. I haven’t achieved many of my goals in life. I think it would be kind of pathetic to suddenly accept myself and feel enormous joy that I haven’t really earned or deserved.
7. I’ve often fallen short, and I’ve made a lot of mistakes in my life. Are you saying that I should be happy about that? Hell NO!
8. I am never going to accept myself as just another average or below-average person. That would be awful!
9. If I accept my flaws, failures, and shortcomings, I’ll just be like everyone else. I won’t be special, and I won’t have the chance to become special.
10. If I admit that I often fail and screw up, people will think less of me.
11. If I’ve done things that have hurt others or if I’ve violated my moral values, then I deserve to suffer.
12. Acceptance is fine and easy for people who’ve enjoyed tremendous success, but it’s really hard if you’re struggling to pay the bills, or if you feel like you haven’t succeeded at much.

What did the analyses show about the impact of resistance and non-acceptance on how we feel?

• The Resistance scale had powerful direct causal effects on the Non-Acceptance scale and accounted for a whopping 46% of the variance is the Non-Acceptance scale. In other words, the more intense your resistance, the more you will fight against accepting your flaws.
• The causal effects of the Acceptance and Resistance scales on negative and positive feelings were massive. They can reduce positive feelings by as much as -48% and increase negative feelings by as much as +47%. Or, to put it differently, the statistical models predict that healthy self-acceptance will not lead to misery and isolation, but can dramatically reduce unhappiness and boost feelings of joy and self-esteem.
• The total effects of Singleness and Income on positive and negative feelings were relatively small, by comparison. In addition, about half of the causal effects of Singleness and Income are indirect and mediated by their causal effects on the Resistance and Non-Acceptance scales.
• The direct effects of Singleness on the positive and negative feelings scales were -4% (positive feelings) and +6% (negative feelings).
• The maximum direct effects of income on negative feelings were +4% (positive feelings) and -9% on negative feelings). To experience this boost if you’re in the lowest income bracket ($200,,000.)
• Almost all of the 12 items were more strongly endorsed by younger individuals. Three items—Ri, R8 and R9—were more strongly endorsed by men at the p

Accept this Sh__? Hell No!

Rhonda and David  are joined in today’s podcast by two dear friends, Dr. Matt May, a popular regular on our show, and Matt Pierce, a co-founder of the soon-to-be-released Feeling Great App

Brief bio sketch of Matt Pierce goes here, should you wish to include it in the show notes. Matt,. A pic would also be great, but not required. People get tired of the same pics each week, so a fresh face to illustrate this episode would be cool!

You’ve probably heard about acceptance. It’s a popular buzzword in the mental health space these days. In fact, some experts claim that it’s THE key to happiness and enlightenment.

It’s NOT, but it can be incredibly helpful.

I wanted to learn more about Acceptance and put some numbers on it’s effectiveness, or lack of effectiveness, so I recently sent an invitation to the 45,000 people on my mailing lists to complete a new survey on acceptance and resistance. More than 1,000 quickly responded, which was great. I hoped the data could provide some answers questions like these:

• What is acceptance?
• How interested are we in accepting themselves, other people, and the world?
• Many people, and perhaps most of us, strenuously resist acceptance. Why?
• What are the things that we have the most trouble accepting about ourselves and others?
• Is all the hype about acceptance justified? Does it actually have meaningful effects on how we feel?
• Can money buy happiness? And if so, how much, exactly, does it cost?
• Why are single people more depressed and unhappy than people with partners? And if so, is it because of the lack of a loving partner? Or was there some other reason?

Thanks for listening, David, Rhonda and Matt

Do we have a "Self"? Or "Personality"? What's the best way to combat Should Statements?  Is TEAM effective without a therapist?  What's the Difference between Positive Reframing and Positive Thoughts? 

Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!

Questions for today’s Ask David Podcast:

1. Stefan asks if we have a “self” or a “personality.”
2. Slash wants to know how to combat a “Should Statement.”
3. Magellan asks about the effectiveness of TEAM without the guidance of a therapist.
4. Werner asks about the differences between Positive Reframing and the Positive Thoughts you record on the Daily Mood Log.

 

1. Stefan asks if we have a “self” or a “personality.” What is the so-called “Great Death” of the “self,” referred to in Buddhism?

Hi David,

I really love your work, both the books and the podcast you’ve created. Lots of great tools there. I think your down-to-earth approach is effective and great in de-mythologizing mental health care.

Still, one thing has been bugging me about your approach: the fact that you quite casually seem to discount the existence of the self. As a theologian I understand this position. In discounting the self as a construct, you’ll open the way to less resistance and more acceptance. I studied both Christianity and some Buddhism, and in that tradition the self is essentially something to let go of as an illusion. I think you called this the death of the ego, and it’s common in many mystical currents both within and without the major religious traditions.

However, by embracing this tradition in a therapeutic setting, I think there’s a great risk to gloss over long-held implicit beliefs or patterns in the construction of a personality that might hold people back from reaching their full potential. More specifically, I’m talking about schemas or Lifetraps (in the terminology of Jeffrey E. Young and Janet S. Klosko). I know Aaron Beck supports their work to address these “chronic self-defeating personality patterns” that are usually considered the be part of the self. What’s your take on their work?

Kind regards, Stefan

David’s reply

Hi Stefan,

Personality, like "self" is not a "thing," but just the observations that different people have different behavioral patterns. So, some are more outgoing, for example, while others are more introverted and shy and insecure.

The only meaning of "self" is the context in which the word appears. So, "behave yourself" simply means that you are misbehaving and need to stop!

Can you come to the Sunday hike is a question. It does not need the add on, "and do you plan to bring you 'self.'"

The only meaning of any word is the context, and many uses in the English language, or any language. Nouns do not always refer to "things." Words are just sounds that come out of our mouths.

I don't go into this much because few people "get it."

Thanks so much, Stefan.

Warmly, david

PS The above is my take on Wittgenstein's Philosophical investigations, published after he died in 1950. .

Second PS I had a random and fairly weak thought, but here it is. When doing my daily “slogging” a while back, I was going through a pleasant and familiar path and noticing how beautiful everything was, and had the thought, “This land is so valuable and expensive, and I’m SO GLAD I don’t have to own it. It would involve a nightmare of paper work, taxes and all kinds of worries. But I can just enjoy it without any of those burdens of ownership.

Then I thought of the “self,” and what a heavy burden it is to “have one,” and worry about whether or not it is “good enough,” or “inferior,” and so forth. Selves tend to be a bit overweight, and heavy to carry around. And how much more fun, beautiful, and rewarding life is without having to have a “self” to worry about.

Rhonda found this helpful after a time feeling confused about the "self," and Matt added this: "Right, and if we own the 'land' one day, and it changes, the next moment, is it the same 'land'?  Do we still own it?"

Matt’s "Self" Thoughts

Wittgenstein is one of my favorite philosophers due to the elegance of his solution to philosophical problems, which is to recognize that they are not, in fact, ‘problems’.  Instead of trying to answer the question, ‘is there a self’, ‘do I have a self’, he would point out that these questions are meaningless and can’t be answered.

One way to bring these questions into a form that could be useful and answerable, is to define the terms.  What is the ‘self’, and what can it do?  How would I know, if I had a ‘self’?  If the definition was in the form of a testable hypothesis, we’d be a step closer to arriving at a meaningful answer.

In some cases, this answer is incredibly meaningful, in terms of our mental state and relationships.  Let’s try on a few possible definitions of ‘self’ and consider some experiments that could be done to test whether these hold water.

‘Self’:  (from Meriam Webster):  one’s essential being, which separates them from others.  (I don’t find this definition useful, because now I just have to define what is an ‘essential being’?  What are we talking about?

‘Self’:  The subject of our experience; the thing that is thinking our thoughts, and feeling our feelings.  (This is also problematic for many reasons.  First, it’s based on an unproven assumption that experience requires an experiencer.  Descartes believed this but Nietsche retorted that this logic was highly flawed as it smuggles the ‘self’ into the equation without any justification.  Further, there are many ‘nondualistic’ philosophies that challenge the ‘separateness’ of ‘self’ and experience.  Meaning, the presence of thought doesn’t mean anything other than the presence of thought.  We ought to be skeptical of introducing additional complexity into the situation according to the principle of ‘Occam’s Razor’, that the simplest hypothesis that explains all the observations is more likely to be correct).

‘Self’:  The ‘CEO’ of your mind, the aspec of yourself that is directing your body, attention and decision-making.  (This is problematic in many of the same ways as the above definition.  It’s also the most readily falsifiable definition.  We can experiment with our ability to control our decision-making in a variety of ways, one of which is to see if you can ‘choose’, with your ‘self’ not to understand the words on this page.  Or to sit quietly and not think.  If our ‘self’ can’t use its ‘free will’ to control the brain’s activities in such simple ways, why would we imagine that we have a self, controlling our brain, at all?

In fact, most of us believe in a ‘self’, which, if we attempt to define it carefully, it can be proven NOT to exist.  However, this is an unacceptable conclusion for many people, even though it results in a form of enlightenment.  This form of enlightenement is slightly different from ‘self acceptance’.  It’s more like ‘waking up from a dream of a self’ than ‘acceping a flawed self’.

All that said, yes, it’s often incredibly useful to inspect our assumptions about our ‘self’, in terms of our ‘roles’ and ‘rules’ in our relationships.  David offers the ‘Interpersonal Downward Arrow’ to do this in a single session.  There, we might discover we are stuck in a belief system that is counterproductive, like, ‘we must be perfect’, ‘we should never have conflict’, etc.  There are countless ways people think about their ‘self’ which can be productive or a ‘trap’.  Obviously, if we had no sense of our identity, purpose, role, etc., it would be hard to know what to do with our ‘selves' on a day-to-day basis!

 

2. Slash asks how she can combat her “Should Statement.”

Hi David

I did some exercises and found I a believe that I should play guitar effortlessly or else I should enjoy the process of learning. My disadvantages are greater in CBA. Now what thought should I replace with so that I could have the advantages too.

Slash

David’s reply

Thanks, Slash!

It is a should statement.

Essentially, your “should” doesn’t make sense since there is no rule that says you should, must, or ought to enjoy something you don’t enjoy right now, so you are just putting pressure on yourself unnecessarily.

I once had a patient who had previously been treated briefly by Dr. Albert Ellis when he was in New York. He was on vacation, and was feeling depressed and telling himself that he SHOULDN’T be unhappy since he was on vacation. He thought he SHOULD be enjoying himself.

He said that the thing that helped the most was when Dr. Ellis said, “Where the F__K is it written that you are obligated to enjoy being on vacation?” (Ellis used that word a lot!)

He said he immediately gave himself permission to feel miserable on vacation, and instantly felt better! This is an example of what I call the Acceptance Paradox. When he accepted his unhappiness, instead of struggling in shame to make it go away, it disappeared.

I have a similar story. I used to have a keen interest in collecting coins from around the world, and when I was an intern at Highland Hospital in Oakland, I used to enjoy going to the local coin stores to see if I could find some interesting foreign coin to purchase for a few dollars. This was always exciting, but one day I was in the S & D Coin store just a few miles from our apartment, realized I was totally bored and had lost my interest in collecting foreign coins.

I told the friendly dealer, and he said, “Oh, don’t worry about it. Just do something else in your free time for a few weeks and your interest in collecting will probably come back.”

So, I did that, and that’s just what happened. Essentially, he was also giving me “permission” to feel the way I was feeling, and not the way I thought I “should” feel! And when I accepted my negative feelings, they ran their course and disappeared.

That worked for me, but there are a lot of methods in TEAM, and you sometimes have to try quite a few before you find the one that works for you, since we’re all different.

The “go to” method for Should Statements is called the Semantic Technique. Using this method, you could tell yourself, “Right now I seem to have lost interest in music. It would be great if it comes back again, and probably will. But it’s natural not to feel excited about music all the time.”

Notice that I used “it would be great if” in place of the “Shoulds.”

As an aside, we just completed a new class for the Feeling Great App entitled “Your PhD in Shoulds.” You might want to check it out.

There’s also a lesson on perfectionism at the end of the class.

Best, david

Cost-Benefit Analysis

If I make mistakes, then I am not talented enough to play guitar.(associating my self worth with talent of playing guitar.) Advantages of Believing This Disadvantages of Believing This 1.It will push me to work harder. 1.There is lot of internal pressure. 2.It will motivate me to try different things until I find any solution. 2.It makes me depressed. 3.It can help me to be perfect/achive skills like my idol guitarist. 3.It ruins my currently playing technique I want to master. 4.People will admire me. 4.It makes me stuck at particular point from where I am not able to move forward. 5.It shows that I am one cut above others. 5.It hinders my progress with respect to guitar playing skills. 6.People who think I am not enough I can prove it to them. 6.It makes me frustrated irritated. 7.It can help me to be confident. 7.Endless cycle which I feel I am stuck in the moment and cant get out of it.   8.The quest to achieve will take forever which will make me hopeless and which further decreases my tolerance to make mistakes/which will further make me vigilant to see my mistakes as fault which cannot be corrected.   9.My moral goes down.

 

3. Magellan asks: Can you do TEAM-CBT without a shrink?

Dear David,

Could you tell us about studies of the effectiveness of any written TEAM or other therapy materials offered without therapist guidance (for example when people are on a waitlist to see a therapist)?

I think I heard of one done with Feeling Good. I wonder if one may be done with Feeling Great.

Thanks,

Magellan

David’s response: We have impressive results with our app, which I can describe. It is completely automated without therapist guidance. It is kind of like my first book, Feeling Good, on steroids!

I also have precise data on waiting list controls. The waiting list do not improve until they start the Feeling Great App and then they experience rapid and dramatic changes with a couple days.

There's no doubt about the effectiveness of the app. Also, there's extensive research proving the effectiveness' o my first book, Feeling Good. There's no question about the effectiveness of these self-help tools. I have many questions about the effectiveness of human shrinks, however!

 

4. From Werner Spitzfaden: Positive Reframing vs Positive Thoughts

I periodically come across clients who get confused by the concept of the Positive Reframing vs Positive Thoughts on the DML.

The question they pose is if the Positive Reframe is similar to the Positive Thoughts on the DML?

After some explanation I focus on Positive Reframing as a way of seeing that even the most difficult and painful thoughts and feelings reveal something powerful and awesome about us and then ask if that's true about them. This focuses on Outcome Resistance.

The positive thoughts on the DML focus on defeating their negative thinking with 2 conditions needing to be present: their new positive thought needs to be believable and it has to drastically reduce the distress resulting from your negative thought.

This focuses on the early stages of Methods coming after looking at Distortions followed by the Straight Forward Technique. I would love to hear David's take on this.

David’s Response

Yes, Werner, you are right! The goal of Positive Reframing is not to “Cheerlead” or to persuade the patient that their negative thoughts are not correct, but rather to help them see why they may fight to hang on to their negative thoughts and feelings, because they are beneficial and helpful in many ways.

This is the latest list of questions you can ask when doing PR with a negative thought. Most will also apply to a negative feeling.

1. 1. What is the truth in this negative thought? (This is essentially the Disarming Technique applied to your own self-criticism)
   2. Why might this negative thought or feeling be healthy and appropriate, given my circumstances.
   3. Why might this negative thought or feeling be helpful to me?
   4. What does it show about me and my core values that’s positive and awesome?
   5. What might be some negative consequences of giving up this negative thought or feeling?

You were spot on about Positive Thoughts. To be helpful, they must fulfill two conditions.

1. 1. They must be 100% true. Half-truths and rationalizations are rarely or never helpful/
   2. They must drastically reduce your belief in the distorted negative thought.

Hey, Werner, we miss you like crazy in the Tuesday group and in our (now small and humble) Sunday hikes. Hope you’re doing well.

Can You Treat ADHD with TEAM? Does Humor Play a Role in Therapy? What's the Difference between Rejection Practice and Shame-Attacking Exercises? Featuring Dr. Matthew May

Note: Not all of the information covered here is in the podcast, and much of what we discuss in the podcast is not covered here.

Questions for the next two Ask David Podcasts:

1. Rich asks how you treat ADHD in TEAM.
2. Hwa-Chi Qiu Alvarez asks about the use of humor in therapy.
3. Rima asks about the differences between Rejection Practice and Shame-Attacking Exercises.

 

1. Rich asks: How do you treat ADHD?

From Richard: How about a podcast concerning ADHD? I feel that applying TEAM would work. No? I mean “disorders” arise from distortions…so what does a distraction “disorder” arise from?

Thanks for all you do David,

Rich

David’s reply:

Hi Rich,

I don’t treat “disorders,” I treat individuals at specific moments when they’re struggling and wanting help! Hope that helps.

As an aside, if you or a friend, colleague, or patient have ADHD and you can describe a specific moment when that person was struggling, I would love to hear about it! Then you’ll see how TEAM works it’s magic by focusing on individuals, and not “problems” or “disorders,” etc.

TEAM is a “fractal psychotherapy.” I will explain!

Warmly, david

Matt’s Take: Thanks for the question, Rich! I love what David is saying, about treating the individual, not the diagnosis.

There are a lot of things that can interfere with focus and attention, such as. medical problems, sleep difficulties, toxin exposure, substance misuse, and relationship problems. In addition, depression and anxiety can interfere with concentration and contribute to ADHD symptoms.

Below, I’ve listed many of the distracting thoughts that my clients have had. Along with a list of some good things about being Distracted.

Hope you enjoy!

Matt’s A – Z List of Distracting Thoughts:

1. I don’t feel like doing this
2. This is boring and no fun
3. I never get to do what I want
4. It’s not fair
5. I’ll do it later
6. There’s plenty of time
7. Best not to rush things
8. I might be missing out on something interesting or important
9. I’ll check my phone one more time, real quick, and then get right back to work
10. This time will be different. Seriously. I mean it.
11. Actually, I’m feeling too tired to concentrate
12. I’ll just take a quick, 5-minute nap
13. I’ll get to work when I feel more rested and motivated
14. I’ve had a hard day and deserve a little break and some fun
15. Tomorrow’s going to be really hard, so I need to rest up
16. I just *can’t* concentrate, at all
17. There’s something seriously wrong with me
18. I lack willpower / I have no ambition
19. I shouldn’t have to do this
20. There’s no point doing this
21. I’ll never be able to do this
22. I need to be doing important, interesting things
23. It would be really exciting and fun to … x, y, z, instead
24. I need to tidy up a bit before starting this big project
25. I don’t know where to get started / don’t want to mess up
26. I’ll be too distracted if I don’t take care of this one thing, first

 

Matt’s A – Z List of GOOD Reasons to be Distracted

1. I can be spontaneous, have fun and be present, in-the-moment
2. I won’t miss out on something interesting and important
3. I won’t waste my life doing boring stuff that leads nowhere
4. I’ll focus on what makes me happy
5. I won’t let other people control me or make my decisions for me
6. I like to feel powerful and in-charge; I call the shots
7. This is my time, nobody controls me
8. It’s calming to know that I’m in-control
9. I want to treat myself with respect
10. I want to be free, not shackled
11. It’s important to take breaks
12. I want to maintain a good work-life balance
13. It’s fun and exciting to be a bit of a ‘rebel’
14. I’m my own unique person, doing things my way
15. I just want to ‘go with the flow’, it’s easier
16. I want to be safe, protected me from failure. I can’t really fail if I don’t give it my all
17. I can get instant relief from the pressure anxiety when I outsource this task to ‘future me’
18. I deserve to do what I want, when I want to; I’m sticking up for me
19. I can reject others’ advice and feel superior
20. I don’t know where to start
21. I can have more time to plan
22. I’ll be less likely to mess up if I consider my approach carefully
23. I don’t want to do an average job, this needs to be amazing
24. I can prepare, talk, plan and complain; that’s more interesting and fun than doing
25. I don’t have to face how dull and boring some parts of life can be
26. I can daydream about a better life

On the live podcast, Matt and Rhonda gave examples of individuals diagnosed with “ADHD” who all needed completely different and highly individualized treatment, which is what TEAM is all about.

Matt described treating a boy with ADHD who would get anxious in class when he was called on to read out loud. He was afraid he’d get nervous and make mistakes, and the other students would judge him.

The technique that helped him was the Feared Fantasy.

Matt also described a fellow with ADHD who had trouble keeping appointments and getting places on time. He was helped by the technique I have called “Little Steps for Big Feats,” and the treatment was similar to the methods we used to treat procrastination.

Rhonda described someone with ADHD who felt anxious in social situations, and he was helped with the same types of techniques we would used to help anyone with social anxiety.

The bottom line: treat the person, not the so-called “disorder”!

 

1. Hwa-Chi Qiu Alvarez suggests: An episode focused on humor and its uses/impacts could be interesting, I didn't find any. What are some strategies for when humor backfires? How did you learn to appropriately use humor with patients?

David’s reply will include:

1. First, time I “discovered” humor when teaching the psychiatric residents with Aaron Beck.
2. How I think about my own use of humor: I just kind of blurt out things that are outrageous.
3. Buddhists have concept of “Laughing Enlightenment,” which occurred during the Terri jumping jacks video.
4. What laughing creates is the experience of not taking ourselves so
5. The time I laughed with a patient during the entire session.
6. When NOT to use humor, and what to do when it backfires.

During the live podcast, Matt, Rhonda and David talked about why and how humor can be helpful—in therapy, in teaching, during podcasts, and in life in general.

David talked about how he “discovered” humor when teaching a group of psychiatric residents at the University of Pennsylvania, and how he used a humorous Feared Fantasy to help a depressed FBI agent who was demoralized because he didn’t have a sense of humor. This was a problem because the men at work of joked around the water or coffee pot during breaks. When David modeled how to accept the fact that he had no sense of humor during the Feared Fantasy, it struck his funny bone, and he laughed so hard he fell out of his chair.

This was a paradox, since the very moment he accepted the fact, without shame, that he had no sense of humor, he suddenly discovered his awesome sense of humor! I, David, call that the Acceptance Paradox.

David also described how humor helped a woman who had struggled for ten years with terrifying panic attacks and extreme depression.

David also warned about the pitfalls of using humor with angry or severely depressed individuals who feel intense grief or extreme worthlessness and hopelessness.

Matt’s Take

I’ve noticed that if you’re ‘supposed’ to laugh, you won’t. But, if you’re not supposed to laugh, you probably won’t be able to stop laughing. Maybe that’s why, when we tried to talk about it, on the podcast, it was really dry and unfunny? Normally I’m hilarious.

1. Rima asks: I believe rejection practice is a fine art and I’m just trying to understand the specifics a little more, and how it differs from Shame Attacking Exercises.

David talks about some of his male patients doing rejection practice by asking as many women out as possible and collecting no’s from them. The way David explains it, it seems standard practice for the patients to self disclose to the women that they are doing the rejection practice and are collecting no’s. My question is, if you disclose this information, would that be considered a safety behaviour and maybe less powerful exposure than not disclosing what you are doing?

I’ll give you a personal example that hopefully will clarify more. I have been doing my own rejection practice to experience how it feels for myself. One of the things I set myself was to ask someone to sing a duet with me. I found that a little daunting so to make it easier for myself, I disclosed to a woman that I am doing shame attacking/rejection practice and thus would she help me and sing with me. I felt I was using a safety behaviour and protecting myself from certain judgements from her. Therefore, I’m wondering if the patient disclosing what they are doing would be as helpful exposure as not disclosing.

David Comment

You are confusing Rejection Practice with Shame Attacking Exercises. They are actually very different.

You can do Rejection Practice with or without telling the person what you are doing.

Shame Attacking is just done without giving away what or why you’re doing it. For example, if you want to sing in public, you can just do that. Or you can approach a person or couple and offer to sing for them, and then when done hold out your hand as if asking for a tip.

There are certain general guidelines for Shame Attacking that we can mention, as they are very important.

You can also do with as a duet with someone you know, so you are doing Shame Attacking together. But in this case, you are definitely not confusing it with Rejection Practice.

During the live podcast, Matt discussed the pros and cons of two different styles of Rejection Practice, and David and Rhonda and Matt sharpened the contrast between Shame-Attacking Exercises and Rejection Practice, which are actually quite different, although there is clear some overlap.

Rhonda described a Shame-Attacking Exercise that David persuaded her to do after a Sunday hike, in a Chinese restaurant when everyone was ordering dim sum. Rhonda went to a nearby table and asked the people who were seated if she could taste their food!

This was almost impossibly anxiety provoking, but to Rhonda’s surprise, they let her tase one of their dim sum and she said it tasted great. They asked if she wanted more! It was a great exercise in overcoming social anxiety.

Matt described one of his outrageous Shame-Attacking Exercises in a grocery store, lying on his back making angels in the snow in the produce section, talking loudly about what an awesome grocery store it was.

He said that he was surprised and relieved to discover that no one seemed interested in what he was doing. He said that one of our illusions is that people are incredibly interested in us, whereas in reality, most people are mainly interested in themselves!

Quite a useful discovery.

Matt’s Take

Hi Rima, thanks for this nuanced question, I can tell you’ve been paying close attention!

As a little background, the fear of getting rejected can cause a lot of suffering and deprivation, both emotionally and in the form of loneliness, relationship problems and career development. Overcoming this fear can improve one’s social life, relationships and career. However, there’s a ‘necessary’ part of overcoming any fear, which people don’t want to do. It is to lower our defenses and face the fear directly. This is the only way to prove that we are, in fact, ‘safe’, for example, when we are rejected.

Rejection Collection (getting rejected frequently and regularly, and counting these as ‘wins’) is a powerful social exposure method that has helped many people, including myself, overcome the fear of getting rejected.  Huge thanks to David for helping me overcome my resistance to trying this (extremely challenging) exercise. Doing so has helped me overcome my fear and has radically improved many aspects of my life.

Exposure may not work, however, for a variety of reasons. A common one is motivational. For example, we may not want to feel ok, if we’re getting rejected. We might prefer to feel upset, perhaps as a motivator to improve.

Surprisingly, there are many good reasons to base some portion of our worth on the approval of others: Wanting to live up to their expectations, wanting to be open to feedback, wanting to avoid conflict, wanting to be maximally motivated to work hard, in our relationships, to be mature and responsible.

TEAM therapy stresses the importance of raising these motivational elements to the surface for discussion, in an admiring way, before deciding whether to change anything about a person.

If someone can still convince me that they want to overcome the fear of rejection and are willing to do the hard work, rejection collection is extremely effective and powerful. It’s good to know that one’s nerves won’t be the thing that gets in the way of developing a wonderful social life.

Rejection collection can still fail, however, for other reasons. For example, it’s common to focus too narrowly on only one method. There are many, many methods that can help, and may be necessary, to overcome a fear of rejection. Just in the category of ‘Social Exposure’ there are quite a few:

TEAM Therapy Social Exposure Methods:

• ‘Smile and Say Hello’ practice
• ‘Talk Show Host’ technique
• ‘Self-Disclosure’
• ‘Flirting Training’
• ‘Survey Technique’
• ‘Shame attacking’
• ‘Rejection Collection’
• ‘Rejection Feared Fantasy’

You’re correct, too, Rima, about the problem of ‘safety behaviors’. Even if ‘rejection collection’ were the method that could lead to a cure, it still might fail if we are, in some way, ‘protecting’ ourselves, during the rejection collection exercise. The most common form of ‘safety behavior’ I’ve seen, when doing ‘rejection collection’, is to rush the process. Then, we can tell ourselves, ‘well, if I’d really tried and put in the time and all my effort, I wouldn’t have gotten rejected’. This defeats the most liberating experience of, ‘I got thoroughly rejected, despite my best effort, and it’s totally fine’.

You asked, is it would be a ‘safety behavior’. if you said this to a stranger: “Please reject me, to help me get over my fear of rejection.’,

I would not necessarily label it as a safety behavior, unless it was the only thing that was said. I would consider this to be ‘Self Disclosure’ (talking about oneself in a vulnerable way) combined with rejection collection. If this were the only thing you said to someone, then I’d agree that it’s a ‘safety behavior’, as there’s a rushed element to it, as opposed to a ‘best effort, still failed, it’s fine’ experience.

The liberation of a ‘real’ rejection is a glorious thing and is, in my experience, most often achieved by combining multiple of the above techniques, starting with, ‘smile and say hello’, ‘talk show host technique’, ‘flirting’, self-disclosure, survey technique and only then asking for a rejection. Practicing this for a bit using the ‘Rejection Feared Fantasy’ (a role-play/practice exercise with one’s therapist) is often great preparation for the real-life experience.

We thank Rhonda for recording for us today, when she is just starting to recover from COVID, and the day before a trip to visit her son, daughter in law, and two wonderful grandchildren.

We love you Rhonda, and wish you the best for a wonderful month!

Thanks for listening today, and thanks for submitting your excellent questions.

Stay tuned for more answers to your questions next week, including these:

1. Magellan asks about the effectiveness of TEAM without the guidance of a therapist.
2. Werner asks about the differences between Positive Reframing and the Positive Thoughts you record on the Daily Mood Log.
3. Anonymous asks several questions about the Feeling Great App.

Matt, Rhonda, and David

Transgender Issues Featuring Dr. Robin Mathy

Emily Dickinson, from Amherst, Massachusetts, was one of the greatest American 19th century poets, and after hearing one of our Amherst professors explain her life and work, I fell in love with her incredible poetry. When she attended Mt. Holyoke College as a freshman, she was obligated to sign up as a “Christian,” a “Non-Christian with hope,” or a “Non-Christian without hope.”

She was the only student who had ever signed up as a “Non-Christian without hope,” and she was given one semester to change her registration category. When she refused, she was asked to leave, and spent the rest of her life living in Amherst, baking cookies for children and writing her fabulous poems, which were sometimes included in her cookie packages.

Her poetry was all about loss, which was much the story of her life. However, she was not self-pitying, which is part of what makes her poetry so sad and magical.

Emily Dickinson always dreamed of visiting the west, but never got the chance to travel much beyond the outskirts of Amherst.

She once wrote,

To make a prairie,

It takes one clover,

and a bee.

One clover and a bee.

And reverie.

The reverie alone will do, if bees are few.

Tears come to my eyes every time I think about that poem! When I was a student at Amherst, we used to visit her grave, and I once actually knocked on the door of the house where she once lived. I explained I was a huge fan and actually got the chance to look around. I actually found a poem scribbled on a scrap of paper on a window ledge.

Today we interview Dr. Robin Mathy, who describes herself as “A human who hopes.” Robin is a well-published expert on LGBTQ issues, with a specialization in transgender research and political activism based on science to debunk hateful myths about sexuality.

She is also a new member of our Tuesday training group at Stanford!

In addition to studying to become a TEAM therapist, Robin is a Doctor of Social Work student at Tulane University.  She is a researcher and activist who has published four books and more than 50 peer-reviewed articles or book chapters.  She is a beloved member of David and Jill’s Tuesday TEAM CBT group.

Rhonda kicked off today’s podcast by reading two very moving endorsements from people who heard part 1 of the live work with Jessica, “Living with Regrets,” which we had published just prior to our interview with Robin.

Then Rhonda kicked off our dialogue with Robin by asking if there are any special treatment considerations when you are working with trans individuals.

Robin said that there really aren’t—TEAM-CBT is already highly personalized and individualized, so we let the patient set the agenda. Robin emphasized the importance, of course, of being warm, affirming, and supportive.

In addition, do not assume that the patient is there because of gender identity issues, or automatically refer them to a support group on that topic, because the patient’s issue may be radically different, and that would amount to stereotyping your patient.

I asked Robin for a simplified introduction to LGBTQ, including what these terms actually mean. That’s because I have to admit I never had any good sexual diversity training during my medical school or psychiatry residency, and I suspect that some of our podcast fans, perhaps many, would also appreciate a little enlightenment based on science.

Robin pointed out that transgender has to do with identity issues: what is your sense of self? Do you see yourself  more as a woman or a man? And sometimes, this will be quite different from the gender you were assigned at birth.

So, for example, you may be assigned as a boy at birth, but your sense of who you are may be a girl, when you are young, and a woman as you develop during puberty. In this case, you would be a trans-gender woman. To be respectful, you should refer to a transgender woman as she or her. And, of course, if you were assigned as a girl at birth, but your sense of who you are is a boy/man, you would be a transgender man, referred to as he / him.

Some transgender people are nonbinary, meaning they do not want to be referred to as either a man or a woman, and they do not want to be referred to with either binary pronoun. To be respectful and sensitive, you should always ask someone what pronouns they prefer.

In contrast, the terms, LGBQ, do not refer to gender identity, but rather to sexual attraction. So, a lesbian is a woman who is sexually or romantically attracted to women, and a gay man is attracted to men, and so forth.

The term, “cis,” refers to your gender that was assigned at birth. According to the National Center for Transgender Equality,

When a person begins to live according to their gender identity, rather than the gender they were thought to be when they were born, this time period is called gender transition. Deciding to transition can take a lot of reflection. . . . Possible steps in a gender transition may or may not include changing your clothing, appearance, name, or the pronoun people use to refer to you (like “she,” “he,” or “they”).

But it can be a bit more complex. Robin says:

A lot of people like me do not actually identify as transgender. I was assigned as a male at birth, but I have always felt like a girl / woman. I think of myself as gender-diverse, not as transgender. . .

I remember taking a bath with my sister when we were young, and I realized that I had something that didn’t belong on me. . . .

My parents raised me as a boy, but I was always effeminate. As I developed as a teenager, my transition was from being “me” to being “fully me” and completely embracing my identity as a woman. This was freeing to me.

We are taught to believe that there are two types of chromosomes that determine our gender: XX for female and XY for male. But this is misleading because there is actually a broad range of chromosomal makeups (sex), sexual attractions as well as gender identities, and gender identity and sexual attraction can be completely independent. For example, someone can be a transgender woman, and be attracted to either men or women or both.

Robin pointed out that some transgender women can look like glamorous women, and two transgender women have actually won national beauty contests. "It is cruel," Robin suggests," to insist that transgender women must use men’s bathrooms, just because they have the XY chromosome set."

She pointed out that gender identity usually develops by age 7, but in trans individuals the incongruity between their gender identity and sex assigned at birth crystallizes at around age 10 or 11, during puberty. Although many transgender people recall being gender nonconforming and/or identifying as another gender in early childhood, we now know this is not always the case.

We discussed the pain of discrimination trans individuals face, and Robin described her own suicide attempt in her early twenties, in part because her male sexual organs and secondary sex characteristics like facial hair “disgusted me.”  Fortunately, she was assigned a very understanding gay psychiatrist in the hospital, and he said that she could start transitional hormone therapy right away if she was interested, and this was a great help.

She said that she was a candidate for the Olympic wrestling team, and it was clear that she did not appear feminine to others because of her muscles, and she experienced a great deal of ridicule and rejection when began to transition. This negative bias included some medical professionals she consulted for help. Eventually she was able to obtain gender-affirming surgery. She said she came out as gender-diverse in March 2023 to be an advocate because 24 states in just the past three years have banned gender-affirming medical care for minors.

Robin also clarified the meaning of the term, queer, which used to be a pejorative term. Now it is embraced by the LGBTQ community as a term referring to all sexual and gender minorities.

Toward the end of our interview, Robin emphasized the importance of hope, and said she had a “glimmer” of hope, even in her darkest hours.

To learn more about Robin’s pioneering work, or if you are interested in the science and research regarding transgender issues, Robin warmly invites you to visit her YouTube channel, (27) Robin Mathy - YouTube. She says, “Please feel free to disseminate the information” and wants you to know that “I love comments (positive and negative).” So give her some feedback if you’re so inclined!

Thanks for listening today!

Robin, Rhonda and David

Overcoming Loneliness Part 2-- A Master Class on the Feared Fantasy Technique Featuring Dr. Orly Marmur

This is the second of a two-part series on loneliness, featuring the courageous personal work of Dr. Orly Marmur with Drs. David Burns and Jill Levitt as co-therapists.

After Orly shared her story, we worked on helping her learn to use the Five Secrets, especially the Disarming Technique and Inquiry, to develop closer relationships with others. Jill described the philosophy of this approach as learning to be ”interested” in others—encouraging them to talk about themselves—rather than trying to be “interesting" or "impressive," which is usually a losing battle.

We also worked with the Feared Fantasy technique to help Orly deal with her fear of rejection. Essentially, we explained that we would enter an Alice-in-Wonderland Nightmare World where there were two weird rules:.

1. If you think people are judging you or looking down on you, they really are!
2. In this Nightmare World, people are not polite but get right in your face and tell you all the negative thoughts they’re having about you.

We asked Orly to describe the worst criticisms she thought her friends might have about her. Here’s the list:

1. We’re not really interested in you.
2. You don’t really say or create anything interesting.
3. You are by yourself. We have families.
4. You’re not funny enough.
5. You’re not fun enough.
6. You’re too intellectual.
7. You’re too political.
8. You’re a liability.

Orly bravely took the role of herself to kick things off, and Jill and David played the role of the “friends from hell,” and verbalized these criticisms to Orly.

At first Orly struggled to respond effectively to the critical statements. She got stuck defending herself at times, and forgot to express interest in the critic and the specific criticisms.

David and Jill modeled more effective responses, using the Five Secrets of Effective Communication, including

• The Disarming Technique (finding truth in the criticisms),
• Inquiry (ask for more information with a spirit of curiosity)
• Thought and Feeling Empathy (acknowledging how the critic was thinking and feeling)
• “I Feel” Statements (sharing feelings like sadness, shame, and loneliness in an open, respectful way)
• and Stroking (expressing positive regard for the critic, even in the heat of battle).

Orly did a fantastic job, as you’ll hear on the podcast, and we did some role reversals to refine certain responses.

The goal of the Feared Fantasy is not so much to prepare for rejection in the real world, since very few people would ever say these things in such a harsh and open way. The Feared Fantasy “Monster” actually exists primarily in your own mind. But since most of us never think about the thing we fear, we don’t realize or discover that the monster has no teeth.

That is to say that by engaging with your greatest interpersonal fears, you discover that if someone were to attack you with over the top vague criticisms, you would survive, and it would reveal something terrible about the other person, not about you!

The Feared Fantasy Technique brings this to life in a dramatic, emotional, and vivid way.

At the end of the session there was a dramatic reduction in all of Orly's scores on the Emotions Table of her Dailly Mood log. Her

• Unhappiness dropped from 40 to 0
• Anxiety dropped from 100 to 5
• Shame went from 85 to 0
• Worthlessness dropped from 95 to 0
• Loneliness fell from 100 to 10
• Self-consciousness fell from 8 to 5
• Hopelessness fell from 100 to 5
• Stuck and defeated fell from 100 to 0
• Resentment fell from 90 to 0
• Disappointed in myself fell from 100 to 0

As you can see, there was a dramatic reduction in all of her scores.

We asked Orly what the most important healing elements during the session were. What techniques were that were most helpful.

Orly said that the empathy from Jill and David was really  important as she felt heard and accepted. The Feared Fantasy Technique also made a huge difference, as it taught her what she wanted, which was to feel intense feelings without doing anything about them. Orly felt that this is the continuation of earlier work that made her realize that she struggles with Emotophobia (which means “the fear of feeling your emotions), and she wanted to increase her capacity to simply feel.

Rhonda, Jill, and David want to give a shout out and virtual hug to Orly for a most fantastic session and learning opportunity for all of us.

Teaching Points

Here are a few teaching points for therapists as well as the general public.

1. The secret of meaningful relationships is to be interested in others instead of trying to be “interesting” or impressive. You do not need to add more accomplishments to the list in order to feel close and loved by others.
2. The Disarming and Inquiry Techniques (which are parts of the Five Secrets of Effective Communication) are extremely important in calming troubled relationships, if used skillfully, because they open the door for the other person to be heard and validated, and hopefully interested in healing and repairing the relationship.
3. When you use the Feared Fantasy Technique, you discover that the rejecting “monster” you feared has no teeth, and you may also discover that you are the one who created it. In other words, the “monster” you’ve feared was always just the projection of your own self-criticisms!
4. The Feared Fantasy is an intense method that can be helpful when the patient feels “trapped” or intensely afraid of rejection. However, it requires a strong foundation of trust between the therapist and the patient, especially when you respond to the “monster’s” criticisms with acceptance and vulnerability.
5. The more “over the top” the criticism is in the feared fantasy, usually, the more successful the method is, because you discover two things: 1) that the extremely harsh criticisms reveal something negative about the critic, rather than about you, and 2) specific criticisms (e.g., “you haven’t read enough books”) are very easy to agree with and disarm and do not have to hurt your ego!
6. Rhonda pointed out that during the early empathy phase of the session, Jill and David did “very basic, simple empathy” without any attempt to cheerlead or “help.” Very few therapists can do this, and most therapists don’t even realize that their empathy / listening skills are poor.
7. The use of David’s empathy scale at the end of every session with every patient can be extremely eye-opening for therapists who are brave, because you will see how your patient really sees you and rates your empathy skills.
8. Effective therapy is highly individualized and rarely or never formulaic. Orly started out by asked for help with symptoms of PTSD that started the day of the horrendous slaughter of many Israeli citizens by the invading Hamas fighters. But the session evolved into something entirely personal involving Orly’s relationships with herself and with other people.
9. In the end, Orly worked on accepting herself, connecting with others, and reducing her own perfectionism and perceived perfectionism, a therapeutic agenda that emerged as David and Jill empathized and collaborated with Orly. This led to Orly feeling less lonely, isolated, and numb, and more able to feel her feelings!

Follow-up (many weeks later)

Orly reported that she has felt “calm and quiet” since her session. She has definitely attempted to use the Disarming and Inquiry Techniques in several relationship situations, but said that the most important change has been her feelings of “inner calm and peace of mind.”

She said that she is no longer so invested in doing for others or attempting to show people that she is there for them. She simply lets things unfold naturally and is now able to let go and accept it when things she hoped for don’t happen.

This may be related to reducing her underlying beliefs around perfectionism and perceived perfectionism that were targeted in the feared fantasy work that she did during the session. Instead of thinking that she has to be impressive in order to be loved, she has learned to accept herself, which is arguably the greatest change a human can make!

For those who might be looking for a bottom line, I (David) might summarize Orly’s subtle but remarkable change as a boost in acceptance of self and the world—a result that is easy to explain, but difficult for most people to comprehend, and even harder implement in our own lives.

A big thanks to you, Orly, for teaching all of us through your own courageous personal work as the New Year unfolds and hopefully offers more world peace and increased love and connection.

Thanks for listening!

Warmly,

Rhonda, Jill, Orly, and David

 

Overcoming Loneliness Part 1-- How to Develop Loving Relationships Featuring Dr. Orly Marmur

This is the first of a two-part series on loneliness, featuring the courageous personal work of Dr. Orly Marmur with Drs. David Burns and Jill Levitt as co-therapists.

Orly is a clinical psychologist from Southern California and member of our Tuesday TEAM-CBT training group at Stanford. She loves to hike, and recently went on a 25 mile solo hike from the North to the South Rim of the Grand Canyon, an arduous hike that she planned for a long time  She happened to be hiking on October 7, 2023, the day of the Hamas invasion of Israel.

The hike was a huge victory for Orly, but when she arrived at the top of the South Rim, her cell phone was instantly bombarded with news and emails about the Hamas invasion and brutal murder, beheading, and rape of many innocent Israeli citizens.

For the next several days, Orly’s mind was flooded with flashbacks of her life, growing up in Israel when the country was still young, and living through four wars. Her father and brothers were in one war together, and her brother was wounded, but survived and recovered.

Orly felt guilt and shame because she was not there to help. She said that she wanted to go to Israel to help her brother with his farm, but was conflicted because she did not want to abandon her clinical practice in Southern California.

She explained:

I grew up with the people who started the State of Israel. Those were idealistic, heroic times. My grandmother left Europe when she was 17 and settled in Israel. The focus was on building. We learned to be heroic.

A few days later, in the Tuesday group, David noticed that I was feeling down and lonely unable to focus and “checked out.” I had  a hard time feeling my feelings. I had shut down.

I began being flooded with memories of sexual molestation at my grandparents’ house when I was a girl in Israel. I remember standing next to a tree, and feeling like I was “different” from the other kids,

I started feeling sad and guilty about losing so many relationships over the years. I’ve alienated so many people, and now I want to accept responsibility for that.

When my daughter was 1 year old, I became friends  with other parents at the day care center. We became like an extended family as our kids grew up, getting together on Fridays for dinner, celebrating holidays together and being there for each other.

However, during the pandemic, I began to feel rejected by them. And sometimes there were individual rejections. We had often camped out together over the years, but all of a sudden, I was not invited. I was the only single person. The rest of the group are couples. Over the years, I was told a few times that, at times, my presence makes things difficult.

Since then, I’ve been invited to some but not other functions of our group. I haven’t felt like people are interested in me, or like me.

I also want to feel my feelings and develop a sense of empathy for others and greater pride in myself—after all, I DID survive.

I became very politically active with others interested in supporting Israel after the October 7th invasion. I was hoping to feel close to people, but it didn’t work because I still felt alone. I had hoped they’d be impressed with my political activism, but it didn’t help.

My problem was not the war, but me.

I’m hoping today you can help me to feel my feelings again! I realize that I tend to jump to action rather than feel my feelings. I think that it has to do with my upbringing and the circumstances and culture that I came from. Next week you will hear the exciting conclusion to the work with Orly, and a follow-up several weeks later.

Orly's Daily Mood Log. End of Part 1

Thanks for listening today!

Rhonda, Jill, Orly, and David