Exploring Therapeutic Techniques Through Live Engagement

Live work with Joshua-- The Secret of Self-Esteem

I was recently a guest on the “Philosophical Weightlifting” podcast with host Joshua Gibson (link). At the end of the interview, he asked if I could give an example of some of the techniques in TEAM-CBT, so I decided to jump right into a live demonstration, in real time, which we are publishing on today’s podcast. I am very grateful to Joshua and hope you enjoy the session as much as we did!

The session covers a number of topics that just about everyone can relate to, including a couple extremely common Self-Defeating Beliefs:

1. The Achievement Addiction
2. The Love Addiction
3. The Inadequacy Schema (“I’m not good enough.”)

It also covers some familiar territory, including the question, “Am I good enough?” It also provides an answer to the questions: “What is the secret of self-esteem,” and “what is the secret of sex appeal?”

To kick things off, Joshua shares an upsetting event along with some of his negative thoughts and feelings. The upsetting event was feeling attracted to a young woman who waited on him in a restaurant, and then going to his car and wishing he’d asked for her personal information for a date. Then he courageously went back and did just that, but got shot down.

Paired with this experience, his overwhelming thoughts and how strongly he believes each one are:

1. I won’t be successful. 85%
2. I won’t get to live the life I want to live. 70%
3. I won’t find love. 90%
4. I’m not attractive. 100%

This is a list of Joshua’s negative feelings, and how strong each one was at the start of the session:

Feeling % Now % Goal % End Anxious 95%     Sad 90%     Guilty 85%     Inadequate 90%     Lonely 90%     Embarrassed 90%     Hopeless 85%     Frustrated 70%     Angry (with self) 75%    

Two things stand out when you examine this list. First, Joshua is an attractive, friendly, and personable young man hosting a popular podcast. If we didn’t have these estimates of his feelings, you would have NO WAY of knowing how he felt inside.

These feelings are all very severe. So many people we greet in our daily lives are similar—looking terrific on the outside, but dying of loneliness and unhappiness within.

Second, he is experiencing nine different types of similarly elevated negative feelings, and not just one negative feeling. This confirms statistical modeling I’ve done with data from the Feeling Great App. There appears to be an unknown “Common Cause” in the human psyche that activates numerous feelings simultaneously.

This is like the “dark matter” of the human psyche. We can prove its existence, but don’t yet know precisely what it is! However, our goal today will be to see if we can help Joshua change the way he’s feeling, regardless of what’s causing his pain.

Positive Reframing Tool

Feeling Positives Frustration It has motivated me to work hard   It shows I have not given up Anxiety Keeps me from putting myself at risk   It has inspired me to face my fears and grow Sadness Shows how much I care about others   Helps me understand others who are suffering, like my mom   Shows I have high standards and high expectations Guilt Shows that I want to live up to my expectations   Shows that I have a strong moral compass Inadequacy Shows I’m honest about my flaws and eager to improve   Show I’m humble   Makes me approachable Loneliness Has helped my develop independence and autonomy   Has motivated me to reach out to close community and to create my own Embarrassment Makes me behave in socially desirable ways Hopelessness This serves as a driving force   Shows that I’m a critical and realistic thinker   Protects me from disappointment Anger (at self) Shows that I have high expectations for myself and hold myself to a nigh standard

You can see Joshua’s goals for each negative feeling after we used the Magic Dial. The whole idea was to lower his negative feelings, not all the way to zero, since that would also wipe out all these positives, but lower them enough so that he would suffer less and still preserve all the many positives we listed, and more.

Feelings Table with Goal column filled in

Feeling % Now % Goal % End Anxious 95% 20%   Sad 90% 10-15%   Guilty 85-90% 15%   Inadequate 90% 10%   Lonely 90% 20%   Embarrassed 90% 10-15%   Hopeless 85% 20%   Frustrated 70% 20%   Angry (with self) 75% 5%  

As you can see, he decided to lower all of his negative feelings if possible. Now, we’re ready for the M = Methods of TEAM-CBT. Joshua said he wanted to work on, “I’m not attractive” first. I asked Joshua how and why he came to this conclusion, since he is clearly a large and attractive guy.

He confessed he had severe acne when he was an adolescent, and now has scarring that makes him look “disfigured”.

Although he probably does have some scars, I asked Joshua if he thought this thought might contain some cognitive distortions. He immediately mentioned All-or-Nothing Thinking (AON). I asked Joshua to “Explain this Distortion.” Specifically, I wanted him to imagine that I was a fourth grade student, and to explain to me in simple terms WHY this thought is an example of AON, why the AON in this case is unrealistic and misleading, and why it is also unfair.

He did a great job, and this reduced his belief in the thought to 50%. As an exercise, can you think of some additional distortions in this thought? Briefly stop this recording so you can write them down on a piece of paper, and then you can look at the answers at the end of the show notes.

“Explain the Distortions” was an excellent first step, but it was not enough, so we went on to the Paradoxical Double Standard Technique. I played the role of a long lost identical twin or best friend who was just like Joshua. I explained that I thought I was not attractive, and asked him what he thought.

He did a tremendous job, and argued that this was not really valid, and I asked if he was being honest or just trying to cheer me up. He said he was being completely honest.

Then we switched into high gear, using a much more aggressive technique, the Externalization of Voices, including Self-Defense, the Acceptance Paradox, and the Counter-Attack Technique, with perhaps a couple additional techniques thrown in. He got some strong momentum and blew all four negative thoughts out of the water.

We were out of time, but did take the time to rate how he felt at the end, which you can see below.

Feelings Table at the End of Session

Feeling % Now % Goal % End Anxious 95% 20% 0% Sad 90% 10-15% 0% Guilty 85-90% 15% 0% Inadequate 90% 10% 0% Lonely 90% 20% 0% Embarrassed 90% 10-15% 0% Hopeless 85% 20% 0% Frustrated 70% 20% 0% Angry (with self) 75% 5% 0%

Answer to the quiz question above:

The thought, “I’m not attractive contained many distortions in addition to AON, including:

OG = Overgeneralization

MF = Mental Filtering

DP = Discounting the Positive

MR = Mind-Reading

Mag/Min = Magnification and Minimization

ER = Emotional Reasoning

LAB = Labeling

SH = Hidden Should Statement

SB = Self-Blame

I was extremely grateful and honored to be a guest on Joshua’s wonderful podcast, Philosophical Weightlifting, and invited him to join our Tuesday psychotherapy training class at Stanford because of his work in coaching.

If you are a mental health professional, including a therapist or coach, contact me and let me know! The classes are two hours weekly and free of charge, although some course materials are required.

Thank you so much, Joshua, for sharing your “inner self” with me and all of your and our podcast fans!

And thank you, all of you, for listening or watching today!

Rhonda, Joshua and David

The following is an awesome email I received from Jason Meno right after he listened to the Joshua session.

Hey there!

I just finished listening to the last hour segment of David's "Philosophical Weightlifting" podcast episode with Joshua Gibson (it starts at about 1:13:52). It was fun to see a 45-minute TEAM session in action.

I thought the Externalization of Voices (EoV) that was done here that seemed to work really well, really fast. It also highlighted a lot of complex dynamics that I see David use a lot. Here's my analysis of what went down and what I think we can learn from it:

Joshua's attack: Joshua's negative thought was "I'm not attractive", but when it came time for him to attack, he said, "You know Joshua, you are disfigured and because of that you're unlovable and that's an unavoidable thing you're going to have to deal with."

This attack is a lot more powerful than just the thought "You're not attractive." It digs into hurtful labels, hopelessness, and frustration. When you are in the position of roleplaying as the negative voice, there's often new and subtle dimensions that come out of it. Right now we are making it easy for the user to attack the AI by just printing out their negative thoughts, but I think letting the attack be more dynamic would be a lot better.

David uses Be Specific: "Can you tell me in what way I'm disfigured?"

I REALLY like Be Specific. It sets things up very well. I'd love to do this as part of the EoV formula.

Joshua answers: "Yes, so you had acne growing up and now you have scars as a result and that makes you look different from everyone else."

David uses Paradoxical Acceptance / Humorous Magnification: "Well, thank you, wise guru. I'm enlightened now and see that I'm some kind of ugly monster who's going to scare all the women in the United States. But what you're saying is a lot of horseshit, and you know it."

David's sarcastic tone belittles the negative voice's criticism, which also lightens up the absurd magnification that follows. He then quickly rejects the absurd and flows into healthy acceptance following this.

David uses Straightforward Acceptance: "But it's true I'm not perfect, and I did have acne, and I do have scars, and there there's plenty of Hollywood movie stars who have some kind of fantastic looks."

There's something very powerful about going from the absurd magnification into this healthy acceptance. It's kind of like framing the horrifying absurd with the moderately painful truth makes the truth a lot easier to accept.

David uses Defense: "I have a lot about me that's attractive that I can be proud of, including my love, my humility. I've built a tremendous body that 99% of men would be the envy of, and 100% of women would love to touch and fondle."

The self-compassion and focusing on specific strengths and pride in accomplishments seems to a very effective defense. There's also a little magnification and humor going on here too that works well. This is a lot stronger than a lot of defenses I see where people just say the thought is being distorted or unfair.

David sets up the Counter-Attack Technique: "But there is one thing that's very, very unattractive about me that you didn't mention."

Joshua asks: "What's that?"

David uses the CAT: "That's that effing crappy voice in my head belittling me and constantly putting me down. And when I'm not listening to you, I'm feeling pretty damn happy. So, to quote the Buddha and Jesus alike, shut the f up."

One of the things that seems to make the CAT really effective is when you can take the negative voice's criticism and throw it right back at the negative voice itself. In this case, the negative voice is the real unattractive quality.

Awesome work David, and I'd love try out this EoV framework in the app.

Best,

Jason

Roughly one week after the session with Joshua, Rhonda and David interviewed him for his reflections on the session and an update on how he's doing now.

He said:

I've reflected a lot on this, and what has changed for me. There were many things that impacted me, but positive reframing was a game-changer. For example, if I get anxious, I welcome the feeling, and tell myself, "This anxiety will help me with this project."

I was getting a tattoo, and it hurt, so I told myself, "I'm glad it hurts. This pain protects my body."

And, of course, people with leprosy lose the ability to feel pain, and the consequences are disastrous and tragic. He continued,

I have become more accepting, and talk openly about my appearance. I've had the courage to face that fear. The theme of my life has been, "I'm not good enough." But now I remind myself that I've done all kinds of cool stuff. For example, I coached several people into the top five in the United States in power lifting. I'm way less self-critical now. I visited, and loved, the Tuesday group at Stanford. I didn't judge myself but just jumped in and did what I could do!

We concluded the session with some Relapse Prevention Training, using Externalization of Voices to challenging his previous negative thoughts, including the thoughts he will have when he relapses. such as

• I'm not good enough.
• I'm a hopeless case.
• The therapy didn't work on me because I'm different.
• I'm a hopeless case.

We used Externalization of Voices with role-reversals, and Joshua won "huge!" His final response was, "There's pain and joy in life. I'll feel joy and love!"

Thank you for listening today. We hope you enjoy the intensely personal work with Joshua. Let us know what you think, and if it touched you if you've ever felt like you weren't "good enough!"

Warmly,

Joshua, Rhonda, and David