412: Ask David: Give-Get Imbalance; Best Anxiety Treatment; Externalization of Voices; and more

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What's a Give-Get Imbalance? What's the Best Treatment for Anxiety and Dysthymia? Can you do Externalization of Voices on Your Own?

The show notes for today's podcast were largely written prior to the show. Tune in to the podcast to hear the discussion of these questions by Rhonda, Matt, and David.

And keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks!

1. Suzanna asks: What's a "Give-Get" imbalance? And how can you get over it?
2. Martin asks: What's the best treatment for anxiety and dysthymia?
3. Eoghan (pronounced Owen) asks: Can you do Externalization of Voices on your own?

1. Suzanna asks: What's a "Give-Get" imbalance? And how can you get over it?

Description of Suzanna's problem.

Suzanna is a woman with a grown daughter with severe brain damage due to a severe brain infection (viral encephalitis) when she was an infant. Suzanna was constantly giving of herself and catering to her daughter. She explains that her daughter can be very demanding and throws tantrums to get her way, and kind of controls the entire home in this way.

She can only talk a little and has the vocabulary of about a two-and-a-half-year-old. She can mostly express the things she wants or doesn`t want on a very basic level. She mostly understands what I want from her, but mostly does not want to do what I ask her to do. She can be very stubborn. And I cannot reason with her because she has her own logic and, in her eyes, only her logic is valid. Maybe all a little bit like a two-and-a-half-year-old.

Suzanna struggles with negative feelings including guilt, anxiety and depression, because she is constantly giving, giving, giving and feeling exhausted and resentful. And she tells herself, "I should be a better mum." Can you spot any distortions in this thought?

Put your ideas in the text box, or jot them down on a piece of paper, and then I'll share my thinking with you!

What are the distortions in the thought, "I should be a better mum"?

There are many distortions in this thought, including All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Magnification and Minimization, Emotional Reasoning, Self-Directed Should Statements, and Self-Blame. There may be one or two more, too!

The first step in change nearly always includes dealing with motivation and resistance. Suzanna decided to do a Cost-Benefit Analysis, as you can see below, and a revision of her Self-Defeating Belief, as you can see below.

Another helpful step might include "No Practice," which simply means saying "no" so you don't constantly get trapped by "giving," as well as "giving in."

A third critically important strategy involves the mom and dad making the decision to work together as a loving team in the management of a troubled child, rather than fighting and arguing with each other, as we've discussed on previous podcasts. However, in many, or possibly most cases, the parents are not willing to do this. They are more concerned about being "right" and so they continue to do battle with each other, as well as the child who needs a more loving structure.

David

Cost-Benefit Analysis Self-Defeating Belief: I should be a better mum to my daughter

Advantages of this belief
(How does believing this help me?)

Disadvantages of this belief
(How does believing this hurt me?)

This thought motivates me to:

• Put myself out.
• Push myself to give what I have.
• Find ways to advance her development. Find ways to involve her in everyday life.
• Invest myself into her and her life as much as I can, physically, emotionally and time wise.
• Try to find ways that my daughter can have a fulfilling life.
• Try hard to connect to her, her pain, her needs, her sadness and her frustration.
• Try to make her life as easy as possible.
• Try my hardest to see her world through her eyes and gain deeper understanding of how she feels.
• Try to understand what is upsetting her when she throws a tantrum.
• Stay healthy and fit to have energy for her.
• Try to make her life rewarding and meaningful.
• Fulfill my duty as a mum to my daughter who needs my support.
• I can feel good about myself.
• I satisfy other people's expectations of me.
• Protects me from criticisms from my husband

• I am a prisoner to my daughter.
• No matter how hard I try I don`t seem to make a meaningful difference to her life and to her development.
• I am a "Siamese Twin" to her. I cannot move or do anything if she doesn`t want to.
• I reason with my emotions instead of thinking rational at times.
• I let my daughter get away with "murder".
• I find excuses for her behaviour.
• I find excuses for her why she cannot behave differently.
• I beat up on myself when I feel I failed her.
• I take all responsibilities away from My daughter and make them my own.
• I blame myself when I cannot motivate her to do something.
• I blame myself when she is bored and unhappy.
• I feel guilty doing my own things.
• I feel guilty when I do not involve her in my activities.
• I feel guilty when I expect her to do entertain herself for a while.
• I cannot live my own life.
• I cannot be myself at times.
• She rules my life, and she lives my life.
• I feel trapped and frustrated.
• I feel I need to constantly entertain her.
• I feel responsible for her happiness.
• I feel responsible when My daughter is sad and frustrated.
• I feel exhausted and overwhelmed at times.
• I feel unhappy and unfulfilled.

Advantages: 20 Disadvantages: 80

Semantic Method: Re write your personal value

I want to be a mum to My daughter and help her along and invest myself into her. But I also want to treat myself the way I treat her. She has a "right" to live a happy and fulfilling life, but so do I. Our needs and desires are equally important and deserve the same attention and care. I can only continue to look after My daughter well if I look after myself too and take myself and my needs and desires as seriously as I do hers. There needs to be a give-get balance so that both of us can be healthy and happy and stay healthy and happy. I want to help her to slowly take new steps into independence and support her lovingly along the way.

2. What's the best treatment for anxiety and dysthymia?

Hello Dr. Burns,

What method of treatment would you suggest for GAD and dysthymia? 3rd wave CBT, ACT? What is best based on science?

Can you recommend some books please?

thank you

Martin

David's Reply

My books are listed on my website, FeelingGood.com. They all describe my approach, which is a bit like CBT on steroids. But every patient is treated individually and uniquely, following a structured and systematic approach that facilitates rapid and dramatic change.

I don't recommend "methods of treatment" or "schools of therapy" based on so-called "diagnoses," but treat the individual with TEAM. Every session with every patient is an experiment, with precise measures at the start and end of every session.

The new Feeling Great App, now available, gets a mean of 50% or more reductions in seven negative feelings, such as depression, anxiety, and more, in 72 minutes of starting to use the bot. You can check it out for free! Anxiety and depression often co-exist, and the app targets both.

My book, When Panic Attacks, describes my approach to anxiety, based on four models of treatment: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. If you use the search function, you can find podcasts describing those models. Also, there's a free anxiety class on this website.

Thanks, Martín, for your excellent question!

Best, david

3. Can you do Externalization of Voices on your own?

Hi David,

Long time listener of your great podcast and huge fan of your book Feeling Great.

I've often heard you mention that "externalization of voices" is one of, if not the most powerful CBT techniques. I am just wondering if it is still almost as effective when done solo without a therapist i.e. the person takes on both the roles of positive and negative by recording themselves talking or similar?

Also, have you any data comparing the efficacy of TEAM CBT work carried out solo using Feeling Great/your podcast as a guide vs. TEAM CBT performed with a trained TEAM therapist?

I am very much looking forward to the Feeling Great app launch in the UK as hopefully that will be a much more effective way to do personal work without a therapist.

Many thanks,

Eoghan (pronounced Owen)

David's reply

Thank you, Eoghan! Appreciate your support and thoughtful question.

I don't have any data on the use of EOV on your own. One could use a recording device, like your cell phone, and record your negative thoughts in second person, "you," and try to defeat them when you play them back, one at a time.

But in my experience, people nearly always need an experienced role player to do role reversals to show them how to get to a "huge" win. People almost never get a huge win when doing it for the first time, because the therapist (in the role of positive self) can model unfamiliar strategies for the patient.

Generally, a hugely successful response involves a combination of self-defense, self-acceptance, and the CAT, or counter-attack technique. And sometimes other methods as well, like Be Specific, for example

Radical new learning is definitely the key to success with EOV.

Now, thanks to the app, everyone can practice, since we've trained our Obie Bot to role-play with users, do role reversals, give feedback, and so forth.

Great question that I will include in the next Ask David if that's okay!

We are also exploring the combination of the Feeling Great App plus a trained TEAM therapist from the Feeling Good Institute in Mountain View, California.

We are hoping that 1 + 1 may equal 3. Wouldn't that be awesome?

What I've found when doing research is that the results are virtually always wildly unexpected! Somethings come out great, and some things come out dismally. I always tell myself that "the Lord giveth, and the Lord taketh away!"

Seems to be the rule in research! Especially when you're wanting to be guided by the truth, and not so much by your hopes and expectations.

Best, David