What self-help advice is actually useful?

Finding self-help and cataloging techniques

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0:42These are the words that psychologist Jeremy Stevenson uses to describe himself in his younger years. There was no shortage of suffering in my childhood. Probably, you know, similar types of suffering that other people experienced, like anxiety and shame and approval-seeking. It's a weird thing because I don't think I was aware of it as approval-seeking. All I was aware of was that social interactions could be stressful. They were stressful because while he would be having these interactions, he couldn't bring himself to just be himself.

1:18Instead, he'd be obsessing about how he was coming across, and whether the other person thought he was boring, or cool, or something else. And that led to all sorts of consequences where I would be hiding my identity and my true opinions, or even worse, exaggerating or being dishonest about my opinions. This is hardly a fun way to live. It's certainly not authentic. And Jeremy may well have continued like this, if not for the fact that in his early 20s,

1:50he came across some self-help writing that changed his life. I stumbled upon this blog that explained why approval-seeking destroys your self-esteem. And it sounds quite obvious now when I say it, but at the time, when I was, I think I was 21, it just struck me so hard that it sent me literally staggering across my room with my head in my hands, and I was trying to fathom everything I just understood, and it felt like this scene from The Matrix where everything was coming together.

2:21And it was the start of this beautiful chapter of life where I came out of my shell and started expressing myself more and getting out of my comfort zone and forming my own identity.

2:34Not too long after that, I also stumbled upon this book called A New Guide to Rational Living by a couple of psychologists, one of them, Albert Ellis. And it introduced this technique called cognitive restructuring, which is a core part of cognitive behavioural therapy. And I just spent like two weeks on my parents' couch, enthralled by these ideas of how thoughts affect feelings, unhelpful beliefs cause suffering.

3:05And if you can challenge those and reframe them, then you can reliably reduce your misery. And it really helped me. It also inspired him to go back to university and study psychology. And now, a blog, a book, a whole PhD later, Jeremy is a clinical psychologist and the co-author of his own self-help book. Except his book is more of a synthesis of self-help. Because, I don't know if you've noticed, but the self-help landscape is vast.

3:35There's just this wall of books, you know, atomic habits and the courage to be disliked and the subtle art of not giving an F-bomb and so on. And it's not just books, because there's all these therapies with all those acronyms as well, like acceptance and commitment therapy, cognitive behavioural therapy and dialectical behavioural therapy and so on. And then there's all these podcasts and YouTube channels. So, it is pretty overwhelming. Me included in that constellation, I suppose. Yeah, yeah, yeah. So, Jeremy wondered, could all the advice out there essentially boil down to a few core techniques?

4:11Turns out, kind of. This is All in the Mind from ABC Radio National. I'm Sana Kadar. Today, we are sifting through the self-help soup. We're cutting through the crap. We're mixing metaphors. And we're finding out some of the key strategies that can improve your life.

4:33So, yeah, even though I had had some really good experiences with self-help, I still recognised that techniques were hard to find. I remember once picking up this book on shame, which was this emotion that captured so much about the type of suffering I experienced when I was younger. But the excitement I had quickly began to fade as the more I read chapter after chapter, I just found theory and motivational material.

5:04And even when I got to the final chapter on healing shame, there were no tangible techniques of, you know, clear instructions of what to do. And I think that's pretty common. But the other weird thing about self-help that a lot of people have probably noticed is the more that you consume, the more that you start to notice patterns. So, once you get past the theory and stories, you get to the techniques and they just seem familiar. And you can even find this in therapy. So, a lot of therapies will promote themselves as revolutionary.

5:37But again, once you get past all the mechanisms and theories and so on, you find that the techniques are actually quite similar. They might just be repackaged with different names. Yeah, I've definitely noticed that over the course of doing the show as well, that the same kind of core themes pop up again and again. Yeah. But then especially in the popular psychology world, in the self-help world, that is often where I see a lot of branding and new buzzwords come into play that actually at their core are like concepts that have been around for a long time.

6:08Exactly. It can end up being a little bit confusing. Yeah, confusing and overwhelming. One example of this is The Let Them Theory by motivational speaker Mel Robbins. Her book has sold millions and millions of copies worldwide. But The Let Them Theory is basically radical acceptance, which is a core concept in dialectical behavior therapy. There are some other psychological concepts thrown in there, like internal versus external locus of control. But the point is, the content isn't all new and revolutionary.

6:38It's just the packaging that's different. That doesn't make it wrong or bad or unhelpful necessarily. It's just worth knowing. And so as part of the research for this book, you at one point, I think, had a spreadsheet of more than 500 techniques you catalogued across various self-help books. Is that right? Yeah. So the research process was we started analyzing self-help books and therapy protocols and other resources as well, like case studies, research articles and so on. We, I should note, refers to Jeremy and his co-author, Spencer Greenberg.

7:12The process was every time we came across a technique, we put it into this database. And that database grew and grew until we had nearly 500 techniques in there. And at that point, which was about after two years, we had hit saturation. So we found we weren't finding meaningfully new techniques anymore. They were just variations of ones we'd already seen. And that's where we made the core discovery of the book. We didn't know what to expect. It could have been three categories or 50, but it collapsed into 12 broad psychological strategies.

7:47The result is titled The 12 Levers, the complete psychological toolkit for improving your life.

Unraveling causes with ABC analysis

7:54And lever one, unravel the causes, understand the problem. If you've done therapy before and you've had your therapist get up on the whiteboard and drop a diagram of your problem, you've seen this lever in action. And it's a good starting point because a natural sequence is first you understand and then you intervene. And one helpful way of unraveling the causes of your problem is called an ABC analysis. Where the A stands for activating event, B stands for belief, C stands for consequences.

8:27The ABC analysis comes from CBT, cognitive behavioral therapy, which itself is one of the most thoroughly researched and evidence-backed psychological treatments out there. And as Jeremy writes in the book, this method, this tool is useful for understanding almost any psychological problem, from intrusive thoughts to depression to relationship conflict. Let's say I did one of those when I was younger. So an activating event might have been, you know, something objective like talking to someone that intimidated me in a social situation.

9:03And then I might have had some beliefs or thoughts go through my mind like, you know, I need to get this person's approval. It would be horrible if they judge me badly. And then consequences might be, you know, something emotional like feeling anxious or stressed or even ashamed. And then the behavioral consequences obviously would be approval seeking, which that could be exaggerating, lying, inhibiting myself, hiding things about myself. Once you've got an ABC analysis, you've got this causal sequence.

9:34So one thing causes another, which causes another, which causes another. And then you can analyze it for the most important detail, which is identifying the controllable parts of it. Not everything is going to be controllable. You can't necessarily change all the activating events if there, but often the controllable pieces show up in the beliefs and the behavioral consequences. Because the beliefs, you know, we can challenge them, reframe them, and the behavioral consequences, we can target those to change them. Because often they reinforce the problem. Right. And so then how do you go about actually creating action and changing those things?

10:07So that's where the other levers can come in handy. So the other levers are more focused on the intervention piece. This lever is more focused on the understanding piece. But say you've identified that you've got a bunch of unhelpful beliefs. So, you know, it would be horrible if I get judged negatively by people. That would be a good target for you could use lever seven, which is steward your thoughts. And you could use a technique like cognitive restructuring where you could change these thoughts to be more helpful because the way you think affects how you feel.

10:41So if you can change those thoughts, you're probably going to reduce some of your stress. There might be some activating events that stand out that you're really afraid of. So maybe there's certain social situations you're terrified of. And that could be a good basis for lever five, which is about confronting your fears, doing exposure therapy. So you could use them to plan out some exposure therapy where you're gradually confronting social situations that incrementally trigger your anxiety so that you can overcome the anxiety.

11:14So the ABC analysis can give you different targets that you can then use different levers on to intervene and change them. We have covered both cognitive restructuring slash CBT and exposure therapy previously on All in the Mind. But given these are techniques that self-help books return to time and time again, they're worth revisiting. Plus, what we haven't covered is the fascinating, sometimes disturbing origin stories of these treatments.

11:46Like, did you know we basically have a traumatized baby to thank for exposure therapy? I'll explain more in a moment.

Cognitive restructuring and metacognitive beliefs

11:54But first, cognitive restructuring. How to do it and its origin story and the question that changed psychology forever.

12:04Yeah, so in the late 1960s, there was this psychiatrist, Aaron Beck, and he was in session with this woman. And I should just give credit to the podcast Invisibilia for this story. They did a really good job on this. So he was in session with this woman who was recounting being at a party. And she suddenly got overwhelmed by all these negative thoughts about how she was bad at talking to people and how no one cared about her. And so she left the party and went home. And at that point in the session, Beck could have done what he'd always done and what he'd been trained to do, which was psychoanalysis.

12:42So he could have asked if people at the party subconsciously represented people from her childhood and how that impacted her. Right. But for whatever reason, thankfully that day, he didn't. He chose to do something different. And he asked her, how do you know those thoughts are true? And he started asking her for evidence for these thoughts. And as they explored the evidence, her beliefs began to shift and weaken. And Beck started to do this with other patients as well.

13:15And amazingly, what he found was that his patients started to get better in months rather than years. And so it developed into this technique called cognitive restructuring, which is a core part of cognitive behavioral therapy these days. The core principle is that thoughts affect feelings. And it's something that ancient Stoics noticed themselves, that it's not events per se that cause how we feel. It's our interpretations of events. And that is really empowering because there's a huge amount of scope we have to reframe how we're seeing reality.

13:52And we can all think of examples of people who have excellent conditions in their lives and are unhappy and the opposite. A related sort of area with stewarding your thoughts is metacognitive beliefs. I feel like a lot of people have heard of, you know, CBT. They've heard a lot of sort of the other things you're talking about, but metacognitive beliefs, perhaps less so. Yeah. So this idea comes from a therapy that a lot of people are less familiar with. Even therapists tend to be less familiar with this.

14:24It's called metacognitive therapy. And it comes from Adrian Wells, who's this British psychologist. And he was doing research in the 90s, I think it was. And he began to suspect that cognitive therapy was missing something important because he recognized that basically all of us have negative thoughts, but not everyone gets stuck in them. When he was researching and exploring things, one major contributor to getting stuck in prolonged worry and rumination is what he called metacognitive beliefs.

15:01And it's a jargony name, but what it means is beliefs about our thinking. So some common examples are worrying is uncontrollable or worrying is helpful or rumination helps me understand things from the past. And as you can imagine, if you believe these meta-beliefs really strongly, it's going to make it more likely that you engage in prolonged overthinking. Like if I believe that worrying is helpful, then I'm probably going to do it more.

15:32And the wonderful thing about, so postponement is the third technique in lever seven of steward your thoughts, where you set aside your unhelpful thoughts until a later pre-specified time. What you can find is that when you sit down to finally go through these worries you had, they can seem almost ridiculous. You can find that you're no longer worrying about them at all. And then you don't need to address them. You just move on with your life. You just probably shouldn't set that time to be right before bed, right? No, yeah, that's the one caveat we have is like, don't do it before bed because, you know, the worries might stick around.

16:07You're listening to All in the Mind from ABC Radio National. I'm Sana Kadar. Today, self-help simplified. We're looking at some of the key techniques that lie at the core of pretty much all self-help books.

Exposure therapy and its origins

16:24Okay, another technique that you focus on relates to fear and anxiety. And I want to sort of start by going back to 1920 to an experiment by John Watson and Rosalie Rayner that you describe in the book. What did they do? So it was a horrible experiment that would never get replicated now because it was highly unethical. But the background at the time was that psychologists believe that fear was innate. So we were just born afraid of certain things like heights or dangerous animals.

16:56But Watson and Rayner wanted to test this. So what they did is in a lab, they got this one-year-old kid called Albert and they put a furry white rat in front of him. And initially, little Albert wasn't afraid of the rat, so he would reach out to touch it. But every time he would do that, Watson would diabolically whack this steel bar with a hammer just next to him and create this loud noise and little Albert would get upset and cry.

17:28And after repeating this a few times, something really interesting happened where Watson could then present the rat without striking the steel bar and little Albert would still get upset and cry. And then even more crazy was his fear seemed to generalize it. They would present other things like, you know, a rabbit or a dog or even a furry coat. So things that superficially resembled the original trigger. And little Albert would also get upset and cry.

18:00So this challenged the view that fear was innate and changed the trajectory of psychology to the position that fear is actually something that can be conditioned or learned. Yeah, reading this part of the book was wild because, first of all, that poor little boy, I can't believe, yeah, this would never happen now, thank goodness. But then there was another researcher, Mary Cover-Jones, who did a follow-up experiment, which was kind of almost in reverse, that also involved a child, but it wasn't so bad.

18:31What did she do? Yeah, so thankfully she caught wind of this study and a few years later she, like you said, she basically did the reverse, where she took this kid called Peter, who's three years old. Peter was already afraid of rabbits at the time for whatever reason. And so she started by, in a lab, putting Peter on one side of the room and then the rabbit in a cage on the other side of the room. And Peter would get upset and cry for a while, but then he would calm down.

19:04And after he calmed down, then Jones, the researcher, would raise the stakes a bit by moving the rabbit a bit closer and then repeat the same process. Peter would get upset, cry, but then calm down, and then she could move the rabbit closer. So she kept doing this again and again, and eventually the climax of the experiment was that Peter apparently had this rabbit on his lap, nibbling on his finger. And so he had overcome his fear, and it was this other great, more inspiring lesson that fear could actually be overcome.

19:39It could be deconditioned and unlearned, and that was the basis for exposure therapy, which is the most scientifically validated treatment for anxiety in the world. Yeah, it was, as I said, wild to read that. We have a one-year-old, a traumatized one-year-old, and a three-year-old to thank for exposure therapy. Yeah, we do have a lot that we owe those kids. I should also say there were, I'm not sure about Jones' study, but definitely with Watson and Rainer's study, there were definitely holes in the study that people found.

20:10But those kind of findings have now been widely replicated, so it's strongly accepted that, you know, fear is something that can be learned and conditioned. And so exposure therapy is something people engage in a lot with psychologists, but it is something that people can sort of try on their own at home as well. Can you talk about how someone can go about doing exposure therapy with themselves? The idea is that you want to find the triggers of your anxiety, whatever the trigger is.

20:42So the first step is you build a exposure hierarchy. So let's take something simple, like if you're afraid of public speaking, the first step on the hierarchy could be just doing a presentation to yourself in front of a mirror. For some people, that alone might trigger anxiety. And then it could be doing a presentation to one person, you know, your best friend. And then you keep scaling up. Eventually, over the course of a few weeks or a few months, you know, the climax might be doing a presentation to your colleagues at work.

21:15And you don't want to be in your panic zone and you don't want to be in your comfort zone either, but you want to be in this nice middle range, this stretch zone. So you're pushing yourself out of your comfort zone. And ideally, what you want to see is that you put yourself in this situation and you're expecting that your anxiety will spike or go up. But after some time, assuming that nothing bad happens, nothing interferes with the process, then eventually your anxiety will come downwards. I have to say, reading this part made me kind of think about a slightly funny example from my own life in that living in this country for the last 15, 16 years has been like a long process of exposure to cockroaches.

21:58Oh, really? Like the size of the cockroaches in Australia are so terrifying to me as a Canadian. The first time I ever saw one in 2011, my first year living in Melbourne, I was so afraid I could barely breathe. I leapt screaming from where I was. Like it was just pretty embarrassing. And over the course of this 15 years, you know, I've had cockroaches land on my head. I've had them crawl across me. I've seen plenty. I've stepped on them in sidewalks. And I always hate it. But now I have reached a point where if I see one, I don't have a full meltdown.

22:31Like I can manage okay. I can get a shoe over it. I can, you know, that's like my example. Yeah. And did you do that in any structured way? No, that was just like constant exposure every summer. So that wasn't very structured exposure therapy, but that was, you know, unstructured. Yeah. And I do think that is how you can make people connect with the practice because all of us would have done some version of exposure in our lives. Like most of us have learned to drive or swim in deep water or go to parties or whatever it is.

23:01And initially for, you know, a lot of us, certain of those things would have been really scary at the start. But just through doing them, we got over the fear. And so exposure therapy is just doing that in a more deliberate, structured way. Yeah. All right.

Behavioral activation for depression

23:16I want to move on to the final lever I want to talk about, which is glad you did it, activities. You write about the experiments of Neil Jacobson in the 90s. What did he do and what did it change about our understanding of depression? So our understanding in the early 90s was that if you want to overcome depression, you need to change how you're thinking. You need to overcome your negative thoughts. And this came from the gold standard treatment at the time, which was cognitive therapy, an earlier version of cognitive behavioral therapy.

23:48And so the primary technique taught in cognitive therapy was cognitive restructuring, what we mentioned earlier. So you're challenging your negative thoughts. But cognitive therapy also had this secondary technique called behavioral activation. And the idea behind behavioral activation is that when we feel depressed, we tend to withdraw from the things in life that make us feel good. So behavioral activation is about gradually reengaging with the things that make us feel good. But behavioral activation was like the supporting act to the main event.

24:22So if you went and saw a cognitive therapist back in the day, the majority of the time you would be working on your thinking and then only a minority of the time you would be doing behavioral activation. And this is because of an assumption that cognitive change or changing in your thinking was more important than behavioral change or behavioral activation. So Jacobson wanted to test this assumption. I think I read somewhere that he was driven by this compassionate skepticism that his colleagues described. So he and his team recruited 150 people with depression and they randomly assigned them to one of three groups.

24:58And two of the groups were roughly the same. They were cognitive therapy, so mostly working on thoughts, a little bit of behavioral activation, just that one of the groups went a bit deeper into core beliefs. And then there was this third group that was pure behavioral activation. So 100% focus on behavior change and zero focus on changing your thinking. And as you can imagine at the time, basically everyone predicted that the behavioral activation group would fail. But almost everyone was wrong. So when the results were unveiled in 1996, I think it was, all three of the groups performed just as well as each other.

25:34So the behavioral activation group performed just as well as the other two groups. And there were a lot of big reactions and skepticism and so on, but it's a result that has been widely replicated and supported. And I think it's encouraging because not everyone likes working with thoughts. You see this often in therapy. It's good to have an alternative approach where if it just feels more practical to work in behavior, you can do that as well. And the other encouraging thing is that it's not just for depression.

26:04So people have now done research on behavioral activation among people without any disorders at all, and it makes them happier. So these days it's also considered a positive psychology technique. So it's not just about reducing suffering. It's also about increasing happiness. And why does behavioral activation help prevent a depressive spiral? The vicious cycle we often refer to in therapy to explain one, probably the most common cause of depression I see is that it all starts with something bad happening, which could be some sort of loss, like you lose your job or relationship or something to do with your health.

26:41And that will naturally make us feel worse. We might have a period of time where we feel down or depressed. And then just in terms of the way we've evolved, when we feel down or depressed, we tend to become less active. So we withdraw from things. Now, for most of us, that's going to be temporary. But for some people, their activity levels will drop, then their mood will drop further, and then their activity levels will drop further, and it will just keep going around in this cycle. A big principle that drove our book and the reason we focused on techniques was the importance of focusing on what is actually controllable.

27:18And if you examine this vicious cycle, you know, you can't go back in time to change the thing that happened originally. Right. And you can't directly change your mood. That's why we need techniques in the first place. But you can change your activity levels. So that's the controllable part of the cycle that we target in behavioral activation.

Reflecting on psychological tools

27:37And you talked about at the beginning how, as a teenager and young person, you know, you dealt with a lot of anxiety, a lot of shame, a lot of worry and rumination. How would you describe yourself now? How much are those kinds of things present in your life now? I would say that many of the common types of problems I used to struggle with, like approval-seeking, low mood, depression, shame, anxiety, self-criticism especially, I think a lot of them have come down a large degree.

28:12And that's why I'm thankful to have found a lot of the tools. And, yeah, this book is, in effect, the kind of book I wish I could have gifted myself, you know, when I was a teenager who was starting to realize his mind was fairly neurotic.

28:30So, yeah, I'm glad I found them in some shape or form. And it's good to try and put them into one place.

28:38That is Jeremy Stevenson, a clinical psychologist based in Adelaide. He's also the co-author of the book, The 12 Levers, the complete psychological toolkit for improving your life. Now, in our show notes, we are going to link to some previous episodes of All in the Mind on exposure therapy and CBT. So, if you're interested in learning about those levers in particular, head to the show notes. Thanks to producer Rose Kerr and senior producer James Bullen. I'm Sana Khadar.

29:09Thanks for listening. I'll catch you next time. You've been listening to an ABC podcast. Discover more great ABC podcasts, live radio and exclusives on the ABC Listen app.