287: Ask David, Featuring Matt May, MD: Acceptance. Irritating Questions. And More!

287: Ask David, Featuring Matt May, MD: Acceptance. Irritating Questions. And More! Today, Rhonda, Matt and David answer several challenging questions submitted by fans like you. William asks: How would the TEAM-CBT model look with an addiction or a habit like procrastination? Robin asks: What’s the difference between a habit and an addiction? Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Matt asks: What’s the full list of questions that David finds irritating? Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox? Phil asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?! Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1: William asks: “How would the T.E.A.M. model look with addiction and procrastination?” I have a question about your recent podcast on weight loss with Dr. Angela Krumm. She is doing a great job … but did not need any help from others. About the T = Testing part of TEAM, you could say that Angela had lost her kilo’s. But I am not recognizing the testing in the form of a depression / anxiety test or something alike. With the E = Empathy part, it is even more strange. Where is the Empathy section? How would the T.E.A.M. model look with addiction and procrastination? Anyway, I assume you can’t expect that addiction and procrastination issues will be solved in a single therapy session? I realize that Dr. Burns empathized in the podcast, but then the ‘work’ already was done. Thanks a lot, William David’s reply Thanks, William, for your thoughtful questions. I will probably make this an Ask David, but here's the short answer. Yes, empathy must always come first. As you point out, Angela was simply discussing the methods she used for weight loss. This was not a live therapy session. And yes, in therapy sessions I always start with T = Testing, but often add the Temptations Scale as well. And yes, procrastination can usually be cured in a single (two-hour for me) session, and sometimes addictions too, but severe addictions might need ongoing support, as with AA for example. Rhonda and I did a free two-hour workshop on Habits and Addictions on January 26th, 2022, sponsored by PESI. To view it, you can click on the link and download the entire video. Then you can watch it locally on your devise. On the bottom of my homepage on www.feelinggood.com, you’ll find an offer for two free unpublished chapters on habits and addictions. D 2: Robin asks: What’s the difference between a habit and an addiction? No email, just the question. David’s reply You could check with a dictionary. I think Shakespeare said that a rose by any other name is still a rose! Technically, an addiction is associated with physiologic dependence and withdrawal symptoms during discontinuation. But once again, if “yearning” is a withdrawal symptoms, then habits, too, could be seen as addictions of sorts. You might also think of habits and addictions as two points on a continuum, with addictions being on the more severe side of the bell-shaped normal distribution curve. But all these definitions are, to some extent, arbitrary. Does “alcoholism” exist? Or just people who are drinking excessively? 3: Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Dr. Burns, I am a huge fan of your books and podcast, and I enjoyed your talk today on Habits and Addictions as well as your “Feeling Great” bonus chapter on the same. I struggle with a habit of internet surfing (news, social media, etc.) when I’m avoiding boring or unpleasant tasks at work. Do you feel that motivational and cognitive techniques are sufficient for addressing this habit when it often feels like my actions operate below the level of consciousness? For example, I often start surfing the internet before I even consciously realize what I’m doing! Additionally, I’ve found stimulus control to be difficult for this habit given that I work on the computer all day. Any advice on addressing this particular habit, or similar ones, would be much appreciated. Thank you for all of your work helping people! Edwin David’s reply Check out the free chapter(s) offer at bottom of my homepage. Read, do then exercises, then you can ask your question. Also, it depends on how far “below consciousness” your habit is. If it is only a couple inches below, you should be fine! D 4: Matt asks: What is the full list of questions that David finds irritating? David’s reply Good question. Most of the time, I really appreciate the comments and questions from our many fans around the world, but there are, in fact, some questions that I find irritating. This may not be the “full list,” but these are some questions that could use, perhaps, a bit of fine tuning! Some people ask vague, “help me” questions, and like “I’ve always struggled with anxiety. What should I do?” There are two problems with this question. First, I spent most of my life answering this question with inexpensive paperback books, free podcasts, free anxiety and depression classes on my website, and more. So, I don’t want to have to repeat all of that for this or any person who writes to me. Perhaps you can tell me which resources you’ve already tried, and where you’re stuck, specifically. Sometimes, I list the resources, like the “Search” function on every page of my website, www.feelinggood.com, or the list of books there, or the list of podcasts, with links, or the free classes, and more. In addition, those of you who are familiar with my work understand that I never try to help anyone on a “general” level. I can only help you at a specific moment in time. When was it? Where you when you felt anxious, or whatever? What was going on? What were you thinking and feeling at the moment? Record it on a Daily Mood Log, and highlight the Negative Thought you can’t successfully challenge. What are the distortions in that thought? Then I can give you all kinds of help! Perhaps in a future Ask David I can list some more types of problematic questions. Thanks! But while we’re at it, here’s another. Sometimes, people will ask a question that was answered 40 years ago, and ever since, as if they’ve come up with something new. In addition, if they ask questions with a kind of “gotcha” arrogance, I sometimes feel annoyed. Here’s an example. People sometimes say, “Oh, I can see that my negative thought is irrational, but it still upsets me. That shows that cognitive therapy doesn’t actually work!” Here’s what I’m thinking when I hear that: “Aren’t you special! My goodness, no one ever thought of that before!” In fact, you may be able to identify some of the distortions in your negative thought, but you DON’T see that it’s “irrational.” You STILL BELIEVE IT! I’ll say it again. Let’s say you’re trying to challenge a Negative Thought on your Daily Mood Log, like, “I’m a failure” or “I’m defective,” and you believe that thought 100%. Obviously, you’ll feel pretty bad. There are two requirements for an effective Positive thought: It must be 100% true. It must drastically reduce your belief in the Negative Thought, perhaps all the way to 0%. The very moment you stop believing the Negative Thought, your feelings will instantly change. This is not “easy,” like so many people seem to think. That’s why I’ve developed more than 100 methods for challenging distorted thoughts. You won’t need them all, and perhaps you’ll only need a few, but it’s great to have so much firepower available to relieve people of the suffering they experience from feelings of depression, panic, guilt, shame, inadequacy, loneliness, hopelessness, anger, and more. I have wondered if it would be helpful to have a place on my website where I could give the instructions for asking really good Ask David questions. Then I could require people to read it prior to submitting questions. 5: Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox? I have a question about one moment in time, the actual moment of recovery. I'd like to better understand what's happening, in that moment, and why some folks, especially those with hopelessness and a strong desire to 'be better' get stuck at the brink, during 'externalization of resistance', for example, and respond in ways like, 'I'd love to accept myself, I just don't know how' and 'it's too hard to accept myself.' I have felt frustrated with clients when they say this and find it challenging to disarm. I feel tempted to disagree and argue that it's far 'harder' to criticize ourselves than to simply *not* do that. I will think, 'it's hard to put down the whip? It's hard to lower the bar? wouldn't it be harder to continue to carry the whip and keep the bar raised?'. I can see how disagreeing and arguing, here, risk empathy and agenda-setting errors. I suspect my resistance has to do with not wanting to collude with the patient's hopelessness/avoidance. I then wonder, perhaps getting hypnotized, whether there is some real difficulty, other than resistance, that I'm not understanding. I am entering these conversations with a set of assumptions, which may be incorrect, regarding what is happening in the moment of recovery: My assumptions are that the cognitive and motivational models are correct and that self-criticism, and the desire to criticize oneself (high-standards) are what result in low self-esteem and feelings of worthlessness. Hence, to make the transition from depressed to recovered, the process would start with approving of our depressed self. Putting this another way, we can't recover, before we recover ... so in the actual moment of recovery, we will be accepting our self-critical, depressed 'self', flaws-and-all, including the 'flaw' of being self-critical. Positive Reframing and successfully 'talking back' to our resistance catalyzes this change and allows us to use methods like, 'Acceptance Paradox' successfully, leading to elimination of worthless feelings, in that moment. Anything either of you would disagree with, there? If so, when a patient says, 'I want to accept myself, I just don't know how' or 'it's just too hard to accept myself', especially coupled with, 'I don't have resistance, I just can't do it', what is the best response? Thanks, Matt David’s reply The word “acceptance” has no set meaning, so I would want to start by asking the patient what they think “acceptance” is—what is it that they think they can’t or don’t want to do? Also, what time of day did you want to accept yourself, and what were you doing at that moment. What were you thinking and feeling, and who were you interacting with? What did they say and what did you say next? Interpersonal acceptance means accepting your role in a conflict, using the Relationship Journal, instead of blaming the other person. I am thinking of making a list on the various “types” of acceptance, and what methods we can use to enable each type. Acceptance might be different for depression vs anxiety vs a relationship problem vs habits and addictions, and recovery from each is associated with one of the four Great Deaths of the “self.” For example, emotional acceptance has to do with seeing the positives in all of your negative emotions, fairly easily accomplished via Positive Reframing. Specific Acceptance has to do with moving from Overgeneralizations and Labels (e.g. “I’m a failure”) to the specific: what, exactly, did I fail at? Then you can accept that specific failure and make a plan for change if you want. Then you can have Existential Acceptance, where you accept that you are a “failure” or a “worthless human being” on a general level, and this can be accomplished with Let’s Define Terms as well a sense of humor. You can also do two CBAs on the Adv and DiSalvo of Self-Acceptance vs Self-Condemnation. You can also use the Double Standard / Paradoxical Double Standard. What would you recommend to someone else with self-critical or self-condemning thoughts? And what does their Double Standard say about them that’s positive and awesome? Just some rambling thoughts! Another solution has to do with recognizing the nonsensical nature of the notion of the “self.: Fabrice says the magic mushroom therapy helps with this, as you finally “see” that the idea of the “self” is just a kind of illusion. I’m just babbling. This can be a vexing problem for sure. The buddha had little luck on it 2500 years ago, as his followers couldn’t “get it” either. Let’s add this to our Q and A list? Finally, role reversal in Ext of Voices can often help, and also “seeing” someone else discover self-acceptance in a group setting can help, too. I learned it from my cat Obie. Neither of us weas “special,” but we sure had fun hanging out! The six months I spent taking 20 hrs a week of table tennis lessons helped too. I improved but remained sucky compared to the pros, but it was tremendous fun trying! Does any of this make sense or help? David 6: Philoma asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?! David’s reply For me, I get excited about what I'm doing. Also, when I do my "slogging" (= slow jogging), which I hate, I have learned just to try to go about 20 feet at a time, like seeing if I can make it to that tree. This helps a lot. Also, I am very lucky to be doing mainly things I totally love and find exciting. That helps enormously. Finally, I am surrounded by people who are very positive and supportive, which makes things non-burdensome. Conflict can be fatiguing! Good relationships can be energizing. And oh, I forgot the main key to energy. One big cup of coffee in the morning! Warmly, david Phil’s reply to David: Words of wisdom, for sure! Happy slogging and all the best for a great 2022! Thanks for listening and reading today! Rhonda, Matt, and David

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