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Published: Feb. 19, 2024, 9 a.m.

Can You Treat ADHD with TEAM? Does Humor Play a Role in Therapy? What's the Difference between Rejection Practice and Shame-Attacking Exercises? Featuring Dr. Matthew May

Note: Not all of the information covered here is in the podcast, and much of what we discuss in the podcast is not covered here.

Questions for the next two Ask David Podcasts:

1. Rich asks how you treat ADHD in TEAM.
2. Hwa-Chi Qiu Alvarez asks about the use of humor in therapy.
3. Rima asks about the differences between Rejection Practice and Shame-Attacking Exercises.

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1. Rich asks: How do you treat ADHD?

From Richard: How about a podcast concerning ADHD? I feel that applying TEAM would work. No? I mean \u201cdisorders\u201d arise from distortions\u2026so what does a distraction \u201cdisorder\u201d arise from?

Thanks for all you do David,

Rich

David\u2019s reply:

Hi Rich,

I don\u2019t treat \u201cdisorders,\u201d I treat individuals at specific moments when they\u2019re struggling and wanting help! Hope that helps.

As an aside, if you or a friend, colleague, or patient have ADHD and you can describe a specific moment when that person was struggling, I would love to hear about it! Then you\u2019ll see how TEAM works it\u2019s magic by focusing on individuals, and not \u201cproblems\u201d or \u201cdisorders,\u201d etc.

TEAM is a \u201cfractal psychotherapy.\u201d I will explain!

Warmly, david

Matt\u2019s Take: Thanks for the question, Rich! I love what David is saying, about treating the individual, not the diagnosis.

There are a lot of things that can interfere with focus and attention, such as. medical problems, sleep difficulties, toxin exposure, substance misuse, and relationship problems. In addition, depression and anxiety can interfere with concentration and contribute to ADHD symptoms.

Below, I\u2019ve listed many of the distracting thoughts that my clients have had. Along with a list of some good things about being Distracted.

Hope you enjoy!

Matt\u2019s A \u2013 Z List of Distracting Thoughts:

1. I don\u2019t feel like doing this
2. This is boring and no fun
3. I never get to do what I want
4. It\u2019s not fair
5. I\u2019ll do it later
6. There\u2019s plenty of time
7. Best not to rush things
8. I might be missing out on something interesting or important
9. I\u2019ll check my phone one more time, real quick, and then get right back to work
10. This time will be different. Seriously. I mean it.
11. Actually, I\u2019m feeling too tired to concentrate
12. I\u2019ll just take a quick, 5-minute nap
13. I\u2019ll get to work when I feel more rested and motivated
14. I\u2019ve had a hard day and deserve a little break and some fun
15. Tomorrow\u2019s going to be really hard, so I need to rest up
16. I just *can\u2019t* concentrate, at all
17. There\u2019s something seriously wrong with me
18. I lack willpower / I have no ambition
19. I shouldn\u2019t have to do this
20. There\u2019s no point doing this
21. I\u2019ll never be able to do this
22. I need to be doing important, interesting things
23. It would be really exciting and fun to \u2026 x, y, z, instead
24. I need to tidy up a bit before starting this big project
25. I don\u2019t know where to get started / don\u2019t want to mess up
26. I\u2019ll be too distracted if I don\u2019t take care of this one thing, first

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Matt\u2019s A \u2013 Z List of GOOD Reasons to be Distracted

1. I can be spontaneous, have fun and be present, in-the-moment
2. I won\u2019t miss out on something interesting and important
3. I won\u2019t waste my life doing boring stuff that leads nowhere
4. I\u2019ll focus on what makes me happy
5. I won\u2019t let other people control me or make my decisions for me
6. I like to feel powerful and in-charge; I call the shots
7. This is my time, nobody controls me
8. It\u2019s calming to know that I\u2019m in-control
9. I want to treat myself with respect
10. I want to be free, not shackled
11. It\u2019s important to take breaks
12. I want to maintain a good work-life balance
13. It\u2019s fun and exciting to be a bit of a \u2018rebel\u2019
14. I\u2019m my own unique person, doing things my way
15. I just want to \u2018go with the flow\u2019, it\u2019s easier
16. I want to be safe, protected me from failure. I can\u2019t really fail if I don\u2019t give it my all
17. I can get instant relief from the pressure anxiety when I outsource this task to \u2018future me\u2019
18. I deserve to do what I want, when I want to; I\u2019m sticking up for me
19. I can reject others\u2019 advice and feel superior
20. I don\u2019t know where to start
21. I can have more time to plan
22. I\u2019ll be less likely to mess up if I consider my approach carefully
23. I don\u2019t want to do an average job, this needs to be amazing
24. I can prepare, talk, plan and complain; that\u2019s more interesting and fun than doing
25. I don\u2019t have to face how dull and boring some parts of life can be
26. I can daydream about a better life

On the live podcast, Matt and Rhonda gave examples of individuals diagnosed with \u201cADHD\u201d who all needed completely different and highly individualized treatment, which is what TEAM is all about.

Matt described treating a boy with ADHD who would get anxious in class when he was called on to read out loud. He was afraid he\u2019d get nervous and make mistakes, and the other students would judge him.

The technique that helped him was the Feared Fantasy.

Matt also described a fellow with ADHD who had trouble keeping appointments and getting places on time. He was helped by the technique I have called \u201cLittle Steps for Big Feats,\u201d and the treatment was similar to the methods we used to treat procrastination.

Rhonda described someone with ADHD who felt anxious in social situations, and he was helped with the same types of techniques we would used to help anyone with social anxiety.

The bottom line: treat the person, not the so-called \u201cdisorder\u201d!

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1. Hwa-Chi Qiu Alvarez suggests: An episode focused on humor and its uses/impacts could be interesting, I didn't find any. What are some strategies for when humor backfires? How did you learn to appropriately use humor with patients?

David\u2019s reply will include:

1. First, time I \u201cdiscovered\u201d humor when teaching the psychiatric residents with Aaron Beck.
2. How I think about my own use of humor: I just kind of blurt out things that are outrageous.
3. Buddhists have concept of \u201cLaughing Enlightenment,\u201d which occurred during the Terri jumping jacks video.
4. What laughing creates is the experience of not taking ourselves so
5. The time I laughed with a patient during the entire session.
6. When NOT to use humor, and what to do when it backfires.

During the live podcast, Matt, Rhonda and David talked about why and how humor can be helpful\u2014in therapy, in teaching, during podcasts, and in life in general.

David talked about how he \u201cdiscovered\u201d humor when teaching a group of psychiatric residents at the University of Pennsylvania, and how he used a humorous Feared Fantasy to help a depressed FBI agent who was demoralized because he didn\u2019t have a sense of humor. This was a problem because the men at work of joked around the water or coffee pot during breaks. When David modeled how to accept the fact that he had no sense of humor during the Feared Fantasy, it struck his funny bone, and he laughed so hard he fell out of his chair.

This was a paradox, since the very moment he accepted the fact, without shame, that he had no sense of humor, he suddenly discovered his awesome sense of humor! I, David, call that the Acceptance Paradox.

David also described how humor helped a woman who had struggled for ten years with terrifying panic attacks and extreme depression.

David also warned about the pitfalls of using humor with angry or severely depressed individuals who feel intense grief or extreme worthlessness and hopelessness.

Matt\u2019s Take

I\u2019ve noticed that if you\u2019re \u2018supposed\u2019 to laugh, you won\u2019t. But, if you\u2019re not supposed to laugh, you probably won\u2019t be able to stop laughing. Maybe that\u2019s why, when we tried to talk about it, on the podcast, it was really dry and unfunny? Normally I\u2019m hilarious.

1. Rima asks: I believe rejection practice is a fine art and I\u2019m just trying to understand the specifics a little more, and how it differs from Shame Attacking Exercises.

David talks about some of his male patients doing rejection practice by\xa0asking as many women out as possible\xa0and collecting no\u2019s from them. The way David explains it, it seems standard practice for the patients\xa0to\xa0self disclose to\xa0the women that they\xa0are doing the rejection practice and are collecting no\u2019s.\xa0My question is, if you disclose this information, would that be considered a safety behaviour and maybe less powerful exposure than not\xa0disclosing what you are doing?

I\u2019ll give you a personal example that hopefully will clarify more. I have been doing my own rejection practice to experience how it feels\xa0for myself. One of the things I set myself\xa0was to ask someone to sing a duet with me. I found that a little daunting\xa0so to make it easier for myself, I\xa0disclosed to a woman\xa0that I\xa0am doing shame attacking/rejection practice and thus would she help me and sing with me. I felt I was using a safety behaviour and protecting myself from certain\xa0judgements from her. Therefore, I\u2019m wondering if the patient\xa0disclosing what they are doing would be as helpful exposure as not disclosing.

David Comment

You are confusing Rejection Practice with Shame Attacking Exercises. They are actually very different.

You can do Rejection Practice with or without telling the person what you are doing.

Shame Attacking is just done without giving away what or why you\u2019re doing it. For example, if you want to sing in public, you can just do that. Or you can approach a person or couple and offer to sing for them, and then when done hold out your hand as if asking for a tip.

There are certain general guidelines for Shame Attacking that we can mention, as they are very important.

You can also do with as a duet with someone you know, so you are doing Shame Attacking together. But in this case, you are definitely not confusing it with Rejection Practice.

During the live podcast, Matt discussed the pros and cons of two different styles of Rejection Practice, and David and Rhonda and Matt sharpened the contrast between Shame-Attacking Exercises and Rejection Practice, which are actually quite different, although there is clear some overlap.

Rhonda described a Shame-Attacking Exercise that David persuaded her to do after a Sunday hike, in a Chinese restaurant when everyone was ordering dim sum. Rhonda went to a nearby table and asked the people who were seated if she could taste their food!

This was almost impossibly anxiety provoking, but to Rhonda\u2019s surprise, they let her tase one of their dim sum and she said it tasted great. They asked if she wanted more! It was a great exercise in overcoming social anxiety.

Matt described one of his outrageous Shame-Attacking Exercises in a grocery store, lying on his back making angels in the snow in the produce section, talking loudly about what an awesome grocery store it was.

He said that he was surprised and relieved to discover that no one seemed interested in what he was doing. He said that one of our illusions is that people are incredibly interested in us, whereas in reality, most people are mainly interested in themselves!

Quite a useful discovery.

Matt\u2019s Take

Hi Rima, thanks for this nuanced question, I can tell you\u2019ve been paying close attention!

As a little background, the fear of getting rejected can cause a lot of suffering and deprivation, both emotionally and in the form of loneliness, relationship problems and career development. Overcoming this fear can improve one\u2019s social life, relationships and career. However, there\u2019s a \u2018necessary\u2019 part of overcoming any fear, which people don\u2019t want to do. It is to lower our defenses and face the fear directly. This is the only way to prove that we are, in fact, \u2018safe\u2019, for example, when we are rejected.

Rejection Collection (getting rejected frequently and regularly, and counting these as \u2018wins\u2019) is a powerful social exposure method that has helped many people, including myself, overcome the fear of getting rejected. \xa0Huge thanks to David for helping me overcome my resistance to trying this (extremely challenging) exercise. Doing so has helped me overcome my fear and has radically improved many aspects of my life.

Exposure may not work, however, for a variety of reasons. A common one is motivational. For example, we may not want to feel ok, if we\u2019re getting rejected. We might prefer to feel upset, perhaps as a motivator to improve.

Surprisingly, there are many good reasons to base some portion of our worth on the approval of others: Wanting to live up to their expectations, wanting to be open to feedback, wanting to avoid conflict, wanting to be maximally motivated to work hard, in our relationships, to be mature and responsible.

TEAM therapy stresses the importance of raising these motivational elements to the surface for discussion, in an admiring way, before deciding whether to change anything about a person.

If someone can still convince me that they want to overcome the fear of rejection and are willing to do the hard work, rejection collection is extremely effective and powerful. It\u2019s good to know that one\u2019s nerves won\u2019t be the thing that gets in the way of developing a wonderful social life.

Rejection collection can still fail, however, for other reasons. For example, it\u2019s common to focus too narrowly on only one method. There are many, many methods that can help, and may be necessary, to overcome a fear of rejection. Just in the category of \u2018Social Exposure\u2019 there are quite a few:

TEAM Therapy Social Exposure Methods:

• \u2018Smile and Say Hello\u2019 practice
• \u2018Talk Show Host\u2019 technique
• \u2018Self-Disclosure\u2019
• \u2018Flirting Training\u2019
• \u2018Survey Technique\u2019
• \u2018Shame attacking\u2019
• \u2018Rejection Collection\u2019
• \u2018Rejection Feared Fantasy\u2019

You\u2019re correct, too, Rima, about the problem of \u2018safety behaviors\u2019. Even if \u2018rejection collection\u2019 were the method that could lead to a cure, it still might fail if we are, in some way, \u2018protecting\u2019 ourselves, during the rejection collection exercise. The most common form of \u2018safety behavior\u2019 I\u2019ve seen, when doing \u2018rejection collection\u2019, is to rush the process. Then, we can tell ourselves, \u2018well, if I\u2019d really tried and put in the time and all my effort, I wouldn\u2019t have gotten rejected\u2019. This defeats the most liberating experience of, \u2018I got thoroughly rejected, despite my best effort, and it\u2019s totally fine\u2019.

You asked, is it would be a \u2018safety behavior\u2019. if you said this to a stranger: \u201cPlease reject me, to help me get over my fear of rejection.\u2019,

I would not necessarily label it as a safety behavior, unless it was the only thing that was said. I would consider this to be \u2018Self Disclosure\u2019 (talking about oneself in a vulnerable way) combined with rejection collection. If this were the only thing you said to someone, then I\u2019d agree that it\u2019s a \u2018safety behavior\u2019, as there\u2019s a rushed element to it, as opposed to a \u2018best effort, still failed, it\u2019s fine\u2019 experience.

The liberation of a \u2018real\u2019 rejection is a glorious thing and is, in my experience, most often achieved by combining multiple of the above techniques, starting with, \u2018smile and say hello\u2019, \u2018talk show host technique\u2019, \u2018flirting\u2019, self-disclosure, survey technique and only then asking for a rejection. Practicing this for a bit using the \u2018Rejection Feared Fantasy\u2019 (a role-play/practice exercise with one\u2019s therapist) is often great preparation for the real-life experience.

We thank Rhonda for recording for us today, when she is just starting to recover from COVID, and the day before a trip to visit her son, daughter in law, and two wonderful grandchildren.

We love you Rhonda, and wish you the best for a wonderful month!

Thanks for listening today, and thanks for submitting your excellent questions.

Stay tuned for more answers to your questions next week, including these:

1. Magellan asks about the effectiveness of TEAM without the guidance of a therapist.
2. Werner asks about the differences between Positive Reframing and the Positive Thoughts you record on the Daily Mood Log.
3. Anonymous asks several questions about the Feeling Great App.

Matt, Rhonda, and David

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