Richard Lam, LMFT presents Mind Over Matter: Using CBT to Conquer Temptation and Establish Healthy Habits

In this video, therapists Richard Lam, Stacy Clark and Marshall Pagaling discuss cognitive-behavioral techniques (CBT) to overcome temptation and habits.

The agenda includes identifying tempting thoughts versus negative thoughts, understanding positive distortions, applying the Devil's Advocate technique, and using a vignette for practical application. The goal is to distinguish between negative and tempting thoughts, which can help manage habits and addictions.

Tempting thoughts lead to short-term relief but often result in long-term negative emotions. The session covers the importance of addressing specific moments of temptation and the associated emotions. The Devil's Advocate technique involves challenging these tempting thoughts to prevent harmful behaviors and teaching the audience on how to resist temptation.

A poll reveals common unhealthy habits like procrastination, insufficient sleep, and overeating, highlighting the relevance of these tools. The session throws light on some healthy habits to start and emphasizes that understanding and addressing tempting thoughts and positive distortions can lead to healthier behavioral patterns and better mental health outcomes.

IN THIS VIDEO:

Jill: Hi, everyone, and welcome to Mind Over Matter, Using CBT to Conquer Temptation and Establish Healthy Habits, part of our first Wednesday of the month at noon Pacific time series. And today I'm joined by Richard Lam, Stacy Clark, and Marshall Pagaling. And as as usual, our presentation today is largely based on the work of Dr. Burns, as well as other cognitive behavioral influences. And Richard, you'll forward the slide for me.

So I'm just going to very briefly tell you about Feeling Good Institute, and then I'll introduce the presenters to you and then I'll turn things over to them. So our mission at Feeling Good Institute is to alleviate suffering by elevating the practice of therapy. Feeling Good Institute was started by a group of clinicians mentored by Dr. David Burns at Stanford University.

And we work hard to train and certify therapists in the processes of CBT that are evidence-based and known to be most effective or have the most influence on patient outcome. Things like the use of measurement, empathy skills, increasing motivation and reducing resistance in our patients, and of course, many, many cognitive and behavioral techniques.

The Feeling Good Institute affiliated therapists are highly skilled and vetted, and we all engage in a weekly system of continuous improvement or training using deliberate practice to really kind of fine tune our CBT skills week after week. and we offer flexible services to meet patient needs. So we have video-based therapy across the United States and Canada, and then treatment in actual treatment centers in New York, Silicon Valley, Canada, and Israel.

And we offer both traditional outpatient therapy usually once a week, and we also have an intensive therapy program where patients fly in from out of town or travel from out of town because they're interested in doing work more therapy over a shorter period of time. So we'll see patients in one-on-one individual therapy for many hours a day, many days a week to help them get better faster. And we also have low fee options.

Let me tell you how you're going to get your CE credit today. So many people send me questions about this. So please make sure that you are here for the entire presentation until 1 o'clock Pacific time. At 1255, so five minutes before the end of the presentation, we will drop the link for the CE survey in the chat box.

You have to complete the CE survey today with that link in order to get CE credit, and you will be emailed your certificate of completion within a week. So do not look for your CE certificate today, just make sure you complete it today and then look for the certificate within a week's time. And if you have any issues, you can contact certification at feelinggoodinstitute.com. And I'll repeat that again for you at the end of the day today.

Someone asked if you need to have your camera on. You do not. Okay, Richard, next slide. Oh, wait, where's my presenters?

Introducing the presenters. Oh, we skipped that one. Okay, let me introduce to you today. I'm glad I remember that we missed it. Let me tell you a little bit about today's presenters, and then I'm going to turn things over to Richard to share his story with you.

First, we have Richard Lam, who is a licensed marriage and family therapist at the Feeling Good Institute in Mountain View. He's a graduate of the Palo Alto University and a member of the California Association of Marriage and Family Therapists. He provides short-term therapy for anxiety, OCD, habits, and addictions, depression, and relationship concerns using CBT and the Team CBT model in particular. And Richard is not only a therapist, he's also a dedicated educator. As a trainer and a mentor, he imparts the insights of this Team CBT model. He also hosts the Feeling Good Therapist on YouTube, featuring therapy techniques demonstrated by fellow therapists. He's a certified level five master therapist and trainer and the director of our certification program.

Let me also introduce to you Stacy Clark. Stacy has been a licensed marriage and family therapist for over 25 years with extensive experience in crisis intervention and emergency mental health. She's a graduate of UCLA and holds a master's degree from USC. She really enjoys working with individuals and couples who are struggling with depression, anxiety, relationship and parenting issues, attention concerns, trauma, sexual orientation, and gender identity. She's a level two certified team CBT clinician who practices in person in Southern California and throughout California via telehealth. And Stacy's looking forward to sharing her insights and skills with you here today.

And then finally, we have Dr. Marshall Pagaling. Dr. Pagaling, is a seasoned professional whose resilience and empathy are deeply rooted in his past roles. As a former Marine Corps officer with combat experience in Afghanistan and Iraq, Marshall developed a keen understanding of the complexities of high-stress situations. His transition to law enforcement in Richmond, California, further enriched his insights into diverse human experiences, and these backgrounds significantly influence his current practice in clinical psychology, where he specializes in treating PTSD, substance use, chronic pain, insomnia, and mood disorders. Now away from the VA hospital setting, he continues his evidence-based clinical work and is a Level II certified physician. Team CBT therapist with Feeling Good Institute, where he practices throughout California via telehealth. And he's also really eager to share his experience with you today. So now I'm going to turn it back to you, Richard.

Richard: Great. Thank you for that. Sorry about the missing slide. I think it's because I've been clicking. But let me jump over to this. Always a little embarrassing to put your old pictures on there.

They're really kind of highlights how far I've gone after kind of hearing your introduction there, Jill. But I do want to share this story. And the story comes from my childhood. It really demonstrates how two people with the very exact same temptation has two completely different responses. And it's totally based off of the way that we think. So when I was eight years old, I had steak. For the very first time. My parents, they're immigrants. So they worked two jobs. And they lived paycheck to paycheck. So this was a very special day. And I was at the kitchen table. And I remember I had my first bite. Just remember the char. The smokiness. The rich beefiness. The steak just like melted in my mouth.

I'm just drilling, just kind of thinking about it right now. And I remember after dinner, I looked at my parents and I looked to them and I said, oh, this is so good. I wish I had another one. My dad, he looks at me and he says, you eat mine. I don't like steak. I like cup noodle. Yes. Oh, it was such an amazing day. I get another piece of steak. And I remember after dinner, it was just me and my mom. And I looked to my mom and I said to her, mom, dad is so weird. He doesn't like steak and he just likes cup noodles. She looks at me. She says, you're so stupid. My dad loves steak. That's what my mom was trying to tell me. He loves me more. He gave up the pleasures in life for my happiness. Why would he do this? Because he thought it would make me happy. Because he loves his son. I'm telling you this story because it really highlights that there are two different outcomes based off of the way that we think. My dad and I both actually love steak. My dad was telling himself, give this delicious steak to your son because he will enjoy it and he'll feel so special. While I was telling myself, I need more of this delicious steak. which leads to two very different behaviors. So what we want to go over today is to understand the way that we think so we can change the way that we feel and therefore change the way that we behave, which is essentially the core concept of cognitive behavioral therapy.

So I just want to talk about our agenda for today. First, I'd love to kind of cover the tempting thoughts, identifying different tempting thoughts to really understand what's the difference between a tempting thought and a negative thought and really breaking that down to understand to a greater degree. And then from there, I want to, or rather Stacy will be covering the positive distortions, a really great topic because oftentimes a lot of therapists, they're familiar with negative distortions, but there's a whole nother dynamic. when we think about positive distortions. Then we'll go over the devil's advocate technique. And this one is a really exciting and very paradoxical one, which I'm very excited to share a little bit more about when the time comes. And then lastly, we have this vignette that Marshall will be giving us, just wrapping everything all up together to really understand the step-by-step process of how this would play out in session.

And of course, at the very end, Q&A just to help other people clarify a little more and also answer anything that might be a little confusing. So just kind of going over the learning objectives, just so that way you keep it in mind, is first I want you to describe the difference. Being able to describe the difference of what is a negative thought versus what is a tempting thought. Then we want to identify tempting thoughts and the positive distortions and treatments of habit and addictions. because it really paints out the differences between what a mood problem is versus maybe like a habit or behavior problem. And then lastly, I want you to be able to apply the devil's advocate technique to challenging, tempting thoughts so you can use it with pure patience or even use it for yourselves.

So just keeping that in mind while we kind of go through this entire presentation today. So, one thing that I want to do is to get a poll of unhealthy habits. And if we identify unhealthy habits as someone who's struggling with smoking, drinking, overeating, physical inactivity, insufficient sleep, or procrastination, I want to take a poll of how many of you kind of suffer with one of these or struggle with one of these rather. And for one, I can probably. Raise my hand for a few. But let's let this poll run for a little bit, just so we can understand what's going on here and see how many of us run into some unhealthy habits. I think I'm a big procrastinator at times, just to put that out there.

Jill: We still have a few rolling in. So I'm going to give you guys, how about 10 more seconds? Like almost everyone has entered something on the poll here. I'm not surprised. Okay. Really eager to hear the results here. Then I kind of feel at home with everyone. Okay. I'm going to go ahead and end the poll. We've got most people having responded and then I'll share the results. Can you see that Richard?

Richard: I can. Wonderful. Yeah. It looks like the majority of people suffer with procrastination, just like me. And at the same time, it looks like the next follow-up is insufficient sleep, physical activity, overeating, drinking, and then smoking. And as you can see, a lot of us struggle with these habits. So not only will these tools be helpful for our patients, but it'll be helpful for us as well.

And the reason why I want to share this poll today is actually to really highlight the data behind it, where if we look at it, approximately 36% of people report at least one of these unhealthy behaviors. And about 24% report two of these unhealthy behaviors, while 12% report having multiple unhealthy behaviors, which totals up to 72%. So if you mark down one of these, you're in this percentage, just like me. So that's wonderful. But at the same time, not so wonderful. Because with some habits, if left untreated, it can cause a lot of challenges mentally and physically. I think we all know the research behind why over drinking or smoking could be harmful for our physical health, even potentially mental health as well.

But same thing with procrastination, which can lead to guilt and feeling horrible about yourself, and therefore you kind of go down a downward spiral. So when it comes to these habits, they lead to different results and therefore could cause harm to us, which is why it's important to learn these skills to help change certain behaviors and habits. Next, I want to go over, you guys probably see this right here, identify tempting thoughts. And the reason why we want to identify tempting thoughts is because it really helps us understand to a greater degree. For example, if you were to go to your doctor, and you complained about, oh, my stomach hurts. And the first thing they said was, let's do some surgery. I think I'd be very scared at that point.

But if they try to understand what's going on for you, kind of break it down, ask you more questions, do some testing to understand to a greater level, and then give you the tools, it feels like it'll be an easier process. It feels safer. And this tool in itself, I like the first portion of it because it really helps you understand more before you make any changes. When it comes to understanding things is we all struggle with habits or addictions or even mood. And one of the things that we want to think about is there's so many events that happen in our life that causes problems for us. And if we try to Tackle all the problems all at the same time. It can feel very overwhelming.

It can be very challenging to change everything all at once. So what I like to think about is life as these dominoes. If you remember those dominoes where you line them up and then you push them and they fall over. If each domino represents something upsetting that happens in your life or a tempting situation that happens in your life, there's just so many lined up. And if these are like life-size dominoes, you're just trying to push them all at the same time, you're going to have a very difficult time. It was almost impossible. However, if you focus on just pushing one single domino, knocking down one event, learning all the tools to change this one event, then all the other dominoes will fall down.

All the tools you'll learn in that one single event will apply to all the other single ones as well. And that's why there's a lot of importance in picking a specific moment in time. And after we pick a specific moment in time, we really want to identify the emotions that's happening. We want to understand this event to a deeper level, understanding what came up for them, whether they felt tempted, stressed, bored, whatever information you can gather is going to be very important at this step. And then I want to talk a little bit more about the next part of here, which is the tempting thought. versus the negative thoughts. So tempting thoughts are thoughts that push you to do a certain behavior, while negative thoughts, they generate negative emotions for you. And the challenge here is when it comes to tempting thoughts, it could be thoughts like, oh, just one more TikTok can't hurt, or just one more drink can't hurt. Sounds very similar. But a negative thought might be like, I'm so fat and unattractive. And then that makes you feel worse. And the challenge behind this is understanding the specific moment in time. Because there's two moments in time when this happens. For example, for me, I probably have a tempting, I'm a big fan of hot Cheetos. I don't know how many of you like hot Cheetos, but I love them. So oftentimes I eat it right after dinner because I'm like, ooh, time to snack. And that's the tempting moment for me. And there's probably multiple reasons why I do it.

I feel tempted, stressed, and just kind of feeling a little bit tired and maybe a little nervous at the end of the day. And this is kind of like my event. However, after I eat it, another whole group of emotions come up, which is feelings of guilt and feeling bad and kind of feeling A little embarrassed that I had to dive into this to kind of deal with some stressful, stressful things. So we really want to identify the time before the guilt comes, because those are the moments where you're thinking, oh, I need to do this. I need to go do that. And once you do it, then the guilt and shame comes later. So you really want to identify the specific moment, the thoughts that tempt you to do those behaviors that lead to the guilt and shame and feeling inferior or bad. So the specific moment in time can be right next to each other. It can just be one bite of the hot Cheeto and here's your next event because it generates so much emotions for you. Well, in this situation, me. And you want to think about the tempting thoughts too because the reason why we have these tempting thoughts is because we're always trying to seek relief from something. If you had a long day and you're just thinking one hot Cheeto is going to make me feel so much better, You get that temporarily. Or sometimes it creates tremendous positive emotions for you. For example, it's going to feel so good to, I don't know, smoke weed. And then you're like, oh, I can feel so relaxed and good.

And maybe it generates these positive emotions. And the tempting thoughts always lead to more positive emotions initially, long-term-wise. it could generate a lot of negative emotions, which could create a lot of problems with mental health as well. And this is why it's important to understand this concept a little bit more. So we understand the emotions that lead to certain thoughts that could potentially lead to challenges with mental health. So next slide, I want to pass it over to Stacy, who will do a really awesome job of explaining a little bit more about identifying positive distortions.

Stacy: Great. Thank you, Richard. So yeah, I want to talk about the positive distortions. And most of us who are here are used to working with distortions. We're familiar withthe common ones. But we may not think about the fact that those are actually based on negative thoughts. And there's a whole set of positive distortions that mirror that common list of cognitive distortions. So the reason we're focusing on positive distortions is because, as Richard said before, when we're working with our clients using the habit and addiction log, we're asking them not to list their negative thoughts, but their tempting thoughts. So we need to think about these thoughts a little bit differently and look at the positive distortions within them so that we can help teach our clients how to combat those tempting thoughts, right? Because it's the positive distortions that often fuel these unwanted behaviors. So this may seem a little confusing. It may seem like just semantics that there is an important difference.

The negative distortions actually make you feel worse either about yourself or the world. Things like, you know, I'm a loser. I'm no good. I'll never amount to anything. But positive distortions can actually make you feel good and offer relief. And that is exactly what often leads our clients to make these unwanted choices or choices that lead to unwanted behaviors. So we're gonna go over the list of positive distortions and don't worry, you don't have to write down the definitions because you'll get the slides with the presentation. But what I'm gonna focus on is giving you lots of examples of tempting thoughts that you might see when working with clients. And sometimes you even see these thoughts within yourself, right? And as many of you know, there's a lot of overlap between the distortions.

So you might recognize more than one type of error. But as we talk through these, I want you to think about how each example might make the client feel better about themselves or provide relief. And that is exactly what fuels the unwanted behavior. Okay. So the first one is all or nothing thinking. And this is thinking about yourself or the world in black and white, all or nothing categories, right? There's no shades of gray here. So what you might hear from a client or what you might see on a habit and addiction log is something like, look, I didn't look at porn all week. I don't have a problem. Well, I didn't smoke weed at that party. I did it. I'm not an addict.

And so you might even think, is this really a problem? In fact, that might be true. Maybe they didn't look at porn all week. How is this even a distortion? Well, it's really important to catch these kinds of thoughts because if they go unchecked, they can be really problematic. This kind of thinking, this absolute thinking can help your client to rationalize or justify engaging in their addictive behavior again. So in this case, by overstating or exaggerating the significance of just one instance of restraint, or in this case, you know, even a whole week of abstaining, they might incorrectly conclude that the addiction is permanently resolved or that they don't have a problem.

And this is problematic because it then can open the door to thoughts that justify easing up or letting go of their vigilance or even testing themselves with minor indulgences.

So now let's look at overgeneralization. With overgeneralization, we're used to thinking of it as a negative event that is a never-ending pattern of defeat. But when it comes to positive distortions, we're looking at the opposite. So here a positive event is thought of as a never ending pattern of success instead. So someone might say something like, you know, I've been sober for a month. I'm immune to relapses or I didn't drink last time I was with my friends. So going to the bar with them won't be a problem or even, you know, I've been eating healthy. I finally cracked the code. I know how to make nutritious choices. And so hopefully it's becoming clear how these can kind of work together and, distort someone's outlook when if they're just looking at a single moment of resistance, it's not necessarily signifying a full recovery. And that kind of absolute thinking sets up a dangerous pattern of self-talk that can lead to falling back into that addiction or unwanted behavior. It helped. It does help someone feel better, but they can also ease up on that ongoing vigilance that's needed to make real behavioral change. I mean, you might have even done this yourself. If you've ever jumped into the new year with all the best intentions of sticking to your resolutions, only to find that a couple of months later, you realize that you stopped going to the gym or you're still shopping as much as before. Well, that is all or nothing thinking and overgeneralization coming together to work against you and those goals that you've set for yourself or for clients.

So I think it's helpful to try to catch those things because when we notice it in ourselves too, we can help our clients more effectively. So moving on to mental filter. For positive distortions, we dwell on the positives and overlook the negatives. So you might hear a client say, you know, I've only had a few drinks, I'm still in control. Or it's so hot out, that ice cold beer will be so refreshing in this heat. And so in this way, they're not thinking about any of the negative consequences that they had already identified when they decided to stop drinking or gambling or shopping too much. The next one gets a little confusing because we're used to seeing this as discounting the positive, right?

But with positive distortions is actually the opposite. We're discounting the negative. And this is different from mental filter because discounting the negative in this case has to do with your overall self-image. So discounting the negative is when you tell yourself that the negative facts don't count so that you can maintain a universally positive self-image. So you might hear a client say something like, you know, drinking helps me relax and have fun. I'm so much more social when I drink. The next one is jumping to conclusions that aren't warranted by the facts. And there are two common forms that are called mind reading and fortune telling. In mind reading, you make assumptions about how other people are thinking and feeling. So you might hear a client say something like, you know, my friends love to party with me.

I'm so much more fun to be around when I have a little something to take the edge off. Or people like me more when I'm drinking. And that again fuels that unwanted behavior. With fortune telling, you make dogmatic positive predictions about the future. I do this one all the time when I think, you know, it's been a long day. I just want to relax for a few minutes. I'm just going to look at TikTok for a few minutes. And then I blink and an hour has gone by. So recognizing that and catching myself before I even get started has been really helpful for me. I also do this when I think, oh, I'll just have one cookie when I know that it's almost impossible to stop at just one cookie. Next slide, please.

So the next one is magnification and minimization. And this is when you blow things out of proportion or shrink their importance inappropriately. So it's kind of the binocular trick that looking through a pair of binoculars makes things look either bigger or smaller than they are in reality. So for me, I fall victim to this one a lot. My daughter and I happen to make these incredible brownies that have caramel in the middle of them. And when I think about them, all I can focus on is this gooey, gooey caramel brownie and how incredible it will taste. And I don't think about the fact that I can blow my entire day's calories in one brownie or two brownies, because there's no way I'm stopping at one brownie.

I've already established that. So I really have to watch out for this one for me. And that actually leads us into emotional raising. This is a very common one, especially when working with habits and addictions. And this is when you reason from how you feel. And we know in the cognitive behavioral world that feelings are actually a result of our thoughts. But when your thoughts are distorted, then your feelings are often misleading as well. So you might hear a client say something like, oh, I'm feeling lucky today. I just know that the jackpot is only a few more spins away. Or I'm on a hot streak. I know this next card is the card I need. Hit me. Or even, you know, I'll feel better tomorrow, I'll cook healthy then.

With should statements, this is when you make yourself or others miserable with shoulds, musts, oughts, or even hidden shoulds. So a client might say to you, you know, I should be able to celebrate with dessert, or I've had such a hard day at work, I deserve a beer to help me relax. With labeling, Someone might say something like, look, I'm not an alcoholic. I still go to work every day. I'm a social drinker. And so by not accepting the label of an alcoholic, but instead accepting the label of social drinker, then that might actually fuel them not being vigilant or tempt them more to continue drinking. And the last one is blame. And this is self-blame or other blame. And With habits and addictions, we most often see other blame.

And again, I'm guilty of this as well. You know, during the pandemic, I was working so much more than I ever had before. And it was such a stressful time. I think we can all relate to that. And I ended up using food to help me soothe and put on 50 pounds. So I really had to take a look at my behavior. But one of the things that I kept telling myself was, you know, everyone in my family is overweight. Everyone has diabetes. There's nothing I can do. That's the path that I'm on. But that really kept me from taking a look at my own behaviors and stepping up and making a change. So again, seeing these thoughts and identifying the distortions and helping your clients see the distortions in their tempting thoughts can really help your clients face those thoughts, talk back to them, refute them, and change the way that they deal with those temptations.

So Now, Richard and I are going to show you a demo called the devil's advocate technique that you can use with your clients to help them.

Richard: Before we jump into that demo, I just want to explain what we're going to be demoing. But first, I just wanted to share, Stacey, it's just so common that people gain a lot of weight during COVID. It definitely reminds me of how when you're a freshman in college, you put on 15 pounds and then you get the freshman 15. I think a lot of us got the COVID-15. And this is a really good tool to help motivate you to either exercise more or go on a really good diet in order to decrease the weight. And it's something I personally use myself.

So I wanted to share about this technique that is a really amazing one. I really love this one. It's called the devil's advocate technique. This is actually a very paradoxical technique. Oftentimes with therapists, they feel lulled into helping their patients. And when you try to help your patients overcome addictions, what will happen a lot of times, what David Burns says that happens quite a bit is there's a lot of pushback. There's a lot of resistance to change. And the more we push them to change, the more they'll resist. So instead, what this method does is the opposite. So what you're going to do instead is you're actually going to lean towards the resistance. You're going to voice the resistance to change. And one of the things that you'll kind of see that happens is now the patient starts to fight back on their own and they're ready to kind of take a punch out of this. And this is a really wonderful process to see because at the end of the day, what we're really wanting is for our patients to become resilient and be able to tackle this on their own, to find those words, to fight back against temptation. Because if us as a therapist always offer help, and let's say in a really strange way it worked, then they'll need your help again. And they'll always have to come back to you. And we don't help them create that resilience, the change that will help them become their own person. And then at that point, they'll be dependent on you, which is as a therapist, of course, something that we wouldn't want. So I want to share a little bit more of how this role play technique works.

In this role play, what we're going to do is we're going to play, well, if we kind of think back to our childhood or even now in those cartoons, there's like a little devil of you on the shoulder and a little angel of you on the shoulder. And the devil's like telling you to do all the things that are bad. And the angel's trying to give you good advice to not do those things. We're going to imagine that scenario. However, the angel's on vacation. So it's just your patient and a little devil on their shoulder. So how this will work is you're going to play that little devil on their shoulder and you're going to tempt them using all the tempting thoughts that they've listed on their habit addiction blog, something that we saw earlier and that we'll show you again in just a little bit here.

And we're going to use those tempting thoughts to tempt them to do the behavior that they don't want to do in their job. is to play themselves, to fight back against those temptations. Because if they can't defeat those temptations in session with you, then they 100% won't be able to defeat it when they're on their own. So this is going to be really good practice for them to defeat those temptations over and over again, to create that mindset that will help them get to the goal that they want. And one of the most important things when it comes to creating this self-control thought is what we call it. Rather than a positive thought, we have a self-control thought. And one of the important things of creating the self-control thought is to write it down.

A lot of research shows that when you write things down, it goes into our brain in a more long-term way. And there's so much research that talks about this. So there's going to be a lot of importance in writing things down. Or if you're like me, I love to type things down, which is also a really good benefit too. Something that pairs the physical action with the mental action that will help you remember this. So let's do this role play. I want to show everyone how this works. And I'm going to jump over to the next part of it.

And Stacey, I wonder if maybe you can go over this habit addiction log or addiction habit log with us kind of summarizing each piece of it, so we get a better picture of what's happening before jumping into the role play.

Stacy: Sure, would happen too. As I already shared, this was a real issue for me. So this is actually a copy of my habit detection log that I used to help myself with this. And so one of the things that would be really difficult for me is coming home after a long day of work and it was a very stressful day. And I would very often eat more than I intended or snack a lot on sweets and junk food to help myself feel better. And so that's what I've identified here. And again, as Richard said, it's very important to get specific. So I wrote down my tempting situation was eating sweets or overeating after a long day of work.

And then I went through and identified all of the emotions I was feeling and the percentage I was feeling them. And this is something that you'll work with your clients to be able to do. And then I wrote down a few of my tempting thoughts, which were, which we'll go over in this technique. Do you want me to read the tempting thoughts or? Yeah, absolutely. Let's kind of hear it out. Okay. Yeah. And I felt all of these a hundred percent and it was very significant for me, you know, and I would tell myself things like I deserve to eat it. I've had a very stressful day or, you know, it's so delicious. It'll help me feel better. And it's been, or, or I've been so good all day.

Like when I was at work, I would make really good choices and I could, um, you know, stick to my plan. But it was really when I got home that, you know, I was just tired. I'd made those good choices all day long and it's like my resolve was depleted. And so that's really the time that I focused on. That was when I made the worst choices.

Richard: Absolutely. One thing I just wanted to clarify before we jump into the role play is when we look at the percent before for the tempting thoughts, this isn't how much you believe the thought, This is how tempting the thought is between 0% to 100%. So Stacey, it looks like for you in these moments, these are 100% tempting.

So it's super challenging to defeat these.

Stacy: Very.

Richard: So that being said, are you feeling ready to jump into a role play with me?

Stacy: Yes.

Richard: Great. So in this situation, we're just going to imagine that Stacey is my patient. And I'll be the therapist. Are you ready?

ROLE PLAY

Richard: Well, Stacey, I know. Part of this is you've been struggling quite a bit with eating sweets and overeating after a long day of work. And I know a lot has been coming up for you. Like you felt tempted and just so stressed and bored. Of course, you want to just kind of dive into the sweets, but you've also shared with me that you're also ready to kind of give this up. It's not good for you. You gain 15 pounds and you really need to take a different direction.

Stacy: 50 pounds. Yeah. It was very significant for me.

Richard: So it was quite a bit, 50 pounds. And now you're really wanting to decrease it to a greater level. And I know it's been impacting you quite a bit.

So I have this really amazing technique that could really help you in this situation to start not eating those sweets anymore and therefore help you decrease the weight that you've gained. And the technique I want to share with you, it's called the Devil's Advocate Technique. I want you to imagine in those cartoons when you were younger, there's an angel, a devil on your shoulder. And what's going to happen is the angel is on vacation. And here's this devil here tempting you using all your tempting thoughts.

And that's going to be my role. I'm going to be that little devil on your shoulder. I'm going to be that little devil, Stacy. I'm going to tempt you using these thoughts. And your job is you're going to play yourself. And what you're going to do is you're going to try to fight back against me and fight back against those temptations to create those self-control thoughts. And the reason why we want to do this is because I want you to create the resilience to fight back at this on your own. If you can do this now in session with me, it's going to be so much easier to do it when you're on your own. Is this something you want to try with me? Stacy: Yes, absolutely.

Richard: Wonderful. And just to clarify, so we're on the same page here. What's my role in the role play?

Stacy: You're going to be playing the little devil on my shoulder*, and* that's tempting me.

Richard: Absolutely. And what's your role?

Stacy: I'm going to try to defeat the thoughts, my own thoughts that you're going to give to me and come up with better self-control thoughts.

Richard: Perfect. All right. You ready to dive in? Well, you know, Stacy, you really deserve to eat it, deserve eating those sweets because you had such a very stressful day. So you should eat the sweets.

Stacy: Wow, even now that really resonates with me. And yes, I mean, I did have a very stressful day, but I'm home now. And so I can take a deep breath and refocus on what's really important to me.

And what I really deserve is to focus on the goals that I've set for myself and to follow my plan. Trying to soothe myself through food only works in the short term and is not beneficial for my overall health.

Richard: Awesome. Who won this interaction? Me, the devil, or you?

Stacy: Oh, I did.

Richard: And was that a small win or a big win?

Stacy: A big win.

Richard: Big or huge?

Stacy: Huge, actually. It was really huge to be able to turn that around and see what I really deserve, what I really want for myself.

Richard: That's wonderful. You ready for the next one? Well, you know, Stacey, it's just so delicious. It'll help you feel better. You should go eat the sweets.

Stacy: Yeah. It is really delicious and it will help me feel better. But again, that's just in the short term. And yeah, I've already established that I'm not great at stopping at just one cookie or one sweet. So I know that I can make better choices for myself and it will actually help me feel better in the long term to make better choices now.

Richard: Awesome. Who won that one? You or me?

Stacy: I did.

Richard: Small or big?

Stacy: Big. Huge.

Richard: Okay. Awesome. That's wonderful. You ready to tackle the next one? Or the last one, rather?

Stacy: Sure.

Richard: You know, you've been so good all day. Just eat some sweets.

Stacy: Yeah, you know, I have been really good all day. I've made really healthy choices that stuck to my plan. And that feels really good, especially in contrast to how miserable I would feel, guilty and ashamed if I were to give in. So I'm going to stick to what I've been doing and stick to my plan.

Richard: Awesome. And who won that one?

Stacy: I did.

Richard: Small or big?

Stacy: Big.

Richard: Big or huge?

Stacy: Huge.

Richard: So thank you, Stacey. Let's pause right there. That was such a beautiful role play. Definitely, let's give a round of applause to Stacy.

She did such a good job at fighting back against all the temptations. And as you can see, this is going to be a really powerful technique, one that will help a lot of our patients fight back against each one of these temptations. And if they can do it in session, they're more likely to be able to do it outside.

Part of this is to be able to practice those self-control thoughts because we haven't been able to do it before. And if we practice over and over again, we'll get better with those thoughts. We'll internalize those thoughts in order to see the change that we want. That being said, I'm going to turn it over to the really amazing Marshall, who will tell us a wonderful story just to wrap all the learning that we had into this one vignette.

Marshall: Yes, thank you, Richard and Stacey. And so I just want to take a few minutes and quickly just kind of bridge over what we've been talking about, about kind of identifying what's going on with the tempting thoughts and the positive distortions and talk a bit about how I applied some of these techniques and how I really helped a recent patient kind of really overcome and crush some of these behaviors, which were really plaguing him. And so what we have here is... Bryan, who is a really ambitious kind of wonderful recent college graduate. And so Brian is working hard kind of Monday through Friday. And he has big dreams. Like I said, he's a really talented musician. He wants to not only open a studio, but he wants to kind of bring his music to a lot of underserved communities.

So really wonderful how he wants to bring his talent out out to people who don't have a chance to kind of experience music like he did growing up. And so unfortunately what was happening is his kind of ambition ended up working against him. And so we talked about positive distortions. And so he really was excited to really raise money for the studio, really excited to get it going, but ultimately ended up um kind of falling into some really negative habits, trying to get that money kind of too quickly, trying to um trying to kind of make it big. And so we're going to go over what that situation looked like. And, you know, unfortunately, he came to me feeling not excited or optimistic, but really down and depressed because these tempting thoughts, these things that were kind of leading to some really positive emotions ended up really, really working against him, not only just kind of not getting money, but also kind of wasting a lot of money and driving him into debt.

So he even said to me at one point, you know, it just feels like I'm paying for depression. So I want to bring you through a situation. So like Stacy led us through earlier, really identifying the situation and the event which was leading or kind of starting this gambling behavior and that situation was coming home Friday after a long day of work. And the tempting thought which typically started this is kind of one spin and I can be rich. One spin and I can... I can get my studio off the ground. And so this was really these emotions we identified are feeling excited, feeling optimistic. And then the problem was, and like Richard said, writing these things down are really important because one of the problems here is there's several cognitive distortions with this one spin and I can be rich.

And we went over them early, but quickly, mental filter. So dwelling on the positives, discounting the negative, kind of telling yourself that negative kind of facts around the situation don't count, maintaining kind of this positive stance and really jump to conclusions and fortune telling about what might be happening with this one spin and I can be rich. And not only that, but identifying later on after he's kind of already started losing, which he often would, what's happened with gambling is I can make it all up on the next spin. So really kind of as he's feeling more anxious, kind of like introducing that kind of optimistic, introducing another optimistic tempting thought, which keeps him going. Next slide, please. And so these techniques that were used, once again, just to focus, it's so powerful, putting Brian in the driver's seat, putting Brian in the seat where he can speak back against, so he can really start to demonstrate the resilience that he's going to need when we're not in session.

So we're using that devil's advocate technique, talking to the devil on your shoulder and using also a double standard technique, which is similar, but puts me in a position where I come to him for advice as I'm his best friend. And I say, hey, I have this problem. And I'm kind of speaking the tempting thoughts to him once again. And he would reply similar to the devil's advocate technique in a way which puts him in the driver's seat where he can really develop that resilience and really kind of crush these tempting thoughts, kind of take the lie right out of that. And the next slide, please. So looking at, I just want to kind of finish up here and look at the tempting thought.

This first tempting thought is what's one spin and I can be rich. So we're using the devil's advocate technique here and kind of putting him in the driver's seat where he's really speaking back against his tempting thought and then coming to the self-control thought, writing it down. And that really was the chances of winning big or low. And it's better to save my money. I'm making much more money working at my job, not gambling, and my chances of winning just really aren't there. And then the next tempting thought, the one that really keeps him going into gambling is the one that I can make it all up in the next spin. And so this one, we use more double standard technique where I'm kind of putting myself as this friend and I'm coming to him for advice and saying, hey, I have this problem.

I keep gambling and I really feel like I can make it all up in the next spin. And then he's demonstrated me that resilience, which he's going to need when we're not in session. I don't want him to come to me. He doesn't need me to do it. He's proven to me that he can do it all on his own and saying, and really coming to the self-control thought of, hey, the more I play and the more I'll lose. And I can break this cycle right now. So we're writing that down. Once again, there's a lot of power in writing these things down. So yeah, that's kind of a short wavetop version of how we kind of identified a situation. We named thoughts, which led to these really powerful emotions, these really positive emotions.

And then we kind of applied these techniques, which put him in the driver's seat, devil's advocate technique, double standard technique, put him in the driver's seat to really demonstrate this resilience that he would need to overcome, to really crush these thoughts and kind of, like Jill so wonderfully put, kind of alleviate the suffering, right? Because he was ended up, he started off with this optimistic outlook and ended up, you know, very depressed because he was losing all of his money.

Jill: Great. Let's go to the next slide, Richard.

Richard: Should I describe this, or did you want to?

Jill: You can describe it very briefly.

Richard: So this is just our resources page. So if you want to learn more, here's some really wonderful resource that will teach you a little bit more about habits and how to overcome them.

Questions & Answers Session

Jill: We have a workshop that's coming up that's called CBT for Perfectionism, Mastering the Art of Self-Acceptance that I'll be doing with David Burns and lots of people from Feeling Good Institute will be involved. And there's kind of an early bird pricing.

So if you're interested in registering for that, we would love to see you on March 1st for that seven hour 6CE workshop. And you can register for it on our website at the discounted price right now, which is feelinggoodinstitute.com. And the next slide. We also would love to see you a month from today on March 6th, where the same expert panel will be here to answer your questions. So continuing to answer these questions on temptations and healthy habits, kind of all the things you were wondering about today that we didn't get to. I will save the chat box. We will answer those questions, but we will also be answering questions live. So we would love to engage with you. We can tell you more about

The habit addiction log, people had a lot of questions about the devil's advocate technique. We can do another demonstration and really kind of break it down for you. So I hope that we get to see you for that. And the next slide, how to get your credit. Click on the link in the chat box. Mike, can you drop the link in one more time? The CE survey, if you didn't complete it yet, Mike is going to add it right here. Make sure that you do do it today and then you'll get your CE survey via email. in the next month. And so, yeah, let me finish up by saying first, thank you to our wonderful presenters. I think you all brought a lot to the presentation today.

I did get people in the chat box saying this is really great. And thank you to Richard and Marshall and Stacey. And then thank you to all of you for joining us today. We hope that you found it valuable and that we were able to provide you with just a few practical tools to help your patients with temptation. And again, we're happy to share more with you next month. If you're considering furthering your expertise in Team CBT, we offer certification and training programs.

So if you have any questions about certification or training, feel free to reach out to us at certification at feelinggoodinstitute.com or check out our website. If you know of anyone who'd benefit from our services, whether that's a friend, a family member, or a client, you can see therapists that are available on our website, which is feelinggoodinstitute.com.