Ask David-- The Fear of Happiness!

Although we had five questions for today’s Ask David episode, we spend the entire podcast on the first question from a man with an intense fear of happiness.

He wrote: How can I use exposure to overcome my fear of happiness?

Hi David,

How would you do exposure for the fear of happiness? Whenever I feel happy I immediately feel afraid because I had a very strict religious upbringing where many harmless forms of fun and enjoyment were completely forbidden. Even though I'm no longer a religious believer, the fear remains. Feeling good then makes me afraid, anxious and insomniac.

This often goes on for days after something good happens and it almost seems as if I AM being punished after all! How can I recover when feeling good makes me feel so bad?

Love your work and all that you do.

Best regards,

Tomas

David’s reply

As I have said on numerous occasions, I do NOT recommend “methods” (like exposure) for “problems” (like your “fear of happiness.”) I think your problem is very treatable, but I work with patients systematically, and that doesn’t mean starting out with a “method,” like exposure or any other method.

I use a step by step approach, using T = Testing, E – Empathy, A = Assessment of Resistance, and M = Methods in a sequence. In addition, when I work with anxiety, I always incorporate these four approaches with every patient I work with:

The Motivational Model: I bring Outcome and Process Resistance to conscious awareness and melt them away, if possible, using a variety of TEAM CBT approaches.

The Cognitive Model: This involves a well-done Daily Mood Log to identify and challenge the distorted negative thoughts at one moment in time.

The Exposure Model: Facing your fears, or testing them with an experiment. This is frightening, but required of every anxious patient.

The Hidden Emotion Model: This is based on the idea that only “nice” people struggle with anxiety, with only a few exceptions, and that an unacknowledged problem is often hiding right behind the anxiety. The cure requires the Detective Step: identifying what the hidden emotion or feeling is. The Action Step: Expressing the suppressed feeling and or dealing with the problem you are avoiding.

Your fear of happiness is an interesting problem for sure. One of my favorite movies, “Babette’s Feast,” involves this theme.

If you want some help, you could send me a partially completed Daily Mood Log. You will discover that you are the only one who is doing the punishing! It is that belittling, intimidating voice in your own head that is causing 100% of your suffering. I look forward to helping you challenge those voices!

In the meantime, I’ll add this to the latest Ask David podcast questions, in the hopes you might send the DML, and then Rhonda and I can comment in greater depth on the live program.

Best, david

Tomas kindly sent a Daily Mood Log, which you can see if you

CLICK HERE

As you can see, the Upsetting Event is simply “studying mathematics,” something he loves. However, he has the belief that if he allows himself to enjoy this or any activity, something terrible will happen to him. He traces this to a strict religious upbringing, and perhaps also to bullying he endured as a kid.

You can see that this is intensely upsetting to him. If you look you will see that in 8 of the 9 categories of emotions on his Daily Mood Log (DML), he scores in the range of 80 to 100, which is intense and severe to extreme. The only emotion category that is not extremely elevated is the anger cluster, which he rated at only 40.

You can see as well that his negative thoughts all involve the theme of punishment and destruction if he allows himself to feel happiness and enjoyment of life, or if he advances himself in life. In some of the emails he sent me, he traces this back to being bullied when young. . . possibly by kids who were jealous of his high IQ.

As mentioned above, I don’t throw methods (like exposure) at people based on a problem or diagnosis (in his case a phobia, the fear of happiness.) I also mentioned that I go through the T E A M model in a sequence, starting with Testing and Empathy, followed by the Assessment of Resistance and culminating in Methods. In addition, I always treat anxious patients with four powerful models, including the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. I described these models above.

The Motivational Model

The Outcome Resistance has to do with the fact that Tomas may resist treatment because of his fear of the consequences of successfully achieving happiness. We will deal with that with Positive Reframing, including the Miracle Cure Question, the Magic Button, Positive Reframing, and the Magic Dial.

In addition, we’ll have to deal with Process Resistance. At some point, we will have to use exposure techniques, and we will want to find out if he’s WILLING to do exposure even though it may be extremely anxiety provoking at first.

We can dangle the carrot, letting him know that we anticipate a positive outcome, but also understand that facing his worst fears may be terrifying at first, and very uncomfortable. I will not try to persuade him to use any of the many versions of Exposure. He will have to persuade me that he’s willing to do it.

I suspect he will be, because he is asking for exposure, but if he says he wants to be treated without exposure, I will have to let him know I am not a good choice as a therapist for him! That’s because I don’t know how to defeat any form of anxiety without exposure.

Of course, I cannot treat Tomas, or anyone, through an Ask David, but can only make teaching points. But I am teaching self-help techniques that have been helpful to many people.

In an email, I asked him the Magic Button question, and he said he didn’t think he’d push it. This indicates some understandable resistance that has to be dealt with.

Positive Reframing is one way to deal with Outcome Resistance. The goal is not only deeper empathy but also helping patients “see” that the negative thoughts and feelings they are struggling so desperately to overcome are actually positive in many ways.

Once they “see” this, it is kind of a pleasant shock to the system, and their resistance to change typically disappears. Then we ask them to set goals for each negative feelings—a lower level of each feeling that would allow them to feel better and not lose all the wonderful positives we have discovered. That’s why it’s better NOT to push the Magic Button.

To help Tomas or anyone see and list the positives in their negative thoughts and feelings, we ask two key questions about each one:

What are some possible advantages, or benefits, of this negative thought or feeling? How might it help me?
What does this negative thought or feeling show about me and my core values as a human being that’s positive and awesome?

Typically, this leads to list of 10 to 20 positives that have three characteristics. To give you an example, his intense loneliness is an expression of his love for people and the great value he sees in meaningful relationships. And his anxiety serves to protect him from danger, and is therefore an expression of self-love.

And his feelings of inferiority—in spite of his tremendous intelligence—show humility, which is not only a spiritual quality, but also can make a person of great intelligence more accessible, more vulnerable, and more attractive. Inferiority may also be an expression of his honesty and willingness to acknowledge his shortcomings, as well as his accountability.

We could easily go on and on, and it might be a great exercise for you to try find the positives in several other of his negative thoughts and feelings by asking those two questions.

Once my patient and I have listed 10 or more positives, I ask if these positives are

True and valid?
Powerful?
Important?

Nearly always, I get a resounding YES to each question. Then I use the Magic Dial to see what they might want to dial each negative feeling down to in the % Goal column of the Daily Mood Log.

Is this Positive Reframing process straightforward? Easy?

Not really. I make it look easy, because when I teach I want people to understand, but “seeing” these positives is, in reality, incredibly challenging for most people.

In fact, You can see the Positive Reframing that Tomas completed on his own if you

CLICK HERE

As you can see Tomas almost completely missed the boat when he tried to identify the positives in his negative thoughts and feelings. I mention this because it is a CRUCIAL step in TEAM CBT, and people often have a tremendously hard time “seeing” the positives in their negative thoughts and feelings. A big part of the reason is that society teaches us the opposite. In fact, negative feelings are Labeled as a bewildering array of more than 200 so-called “mental disorders” by the American Psychiatric Association in their “bible,” the DSM (Diagnostic and Statistical Manual of Mental Disorders.)

But here’s something even MORE surprising. Rhonda—a highly respected and admired TEAM CBT therapist and teacher—also struggles to find the positives during today’s podcast. Once someone has pointed them out, you can suddenly “see” them. But on your own, you may have a lot of trouble at first with Positive Reframing, which is anything but simple, but extraordinarily powerful once you “get it.”

I recently told my weekly Tuesday psychotherapy training ...