What self-help advice is actually useful?

Today, we're making sense of the tips, tricks and treatments that the self-help landscape has to offer. So whether you're keen to try exposure therapy, tackle your need for validation or restructure your thinking, we'll unpack the psychology so you can improve your life. Guests: Dr Jeremy StevensonClinical psychologistCo-author, The 12 Levers: The Complete Psychological Toolkit For Improving Your Life https://drjeremystevenson.com/ Credits: Presenter/producer: Sana QadarSenior producer: James BullenProducer: Rose KerrSound engineer: Roi HubermanRelated episodes: Managing your emotions so they don't manage you https://www.abc.net.au/listen/programs/allinthemind/managing-your-emotions-dont-manage-you/105309084'What if I'm a paedophile?' The intrusive thoughts that haunted Uma https://www.abc.net.au/listen/programs/allinthemind/taboo-intrusive-thoughts-unspoken-aspects-ocd/105872038Healing from self-hatred https://www.abc.net.au/listen/programs/allinthemind/healing-from-self-hatred/105872080The cognitive distortions of a high achiever https://www.abc.net.au/listen/programs/allinthemind/cognitive-distortions-high-achiever/105884544Hypochondria and cyberchondria: the many ways to worry about health https://www.abc.net.au/listen/programs/allinthemind/hypochondria-cyberchondria-health-anxiety/107099522Facing fears and phobias https://www.abc.net.au/listen/programs/allinthemind/facing-fears-and-phobias/11823034

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

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• 0:37Sana Qadar?

  Small, sensitive, desperate for approval. These are the words that psychologist Jeremy Stevenson uses to describe himself in his younger years.

• 0:48Speaker 06

  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.

• 1:11Sana Qadar?

  They were stressful because while he would be having these interactions, he couldn't bring himself to just be himself. Instead, he'd be obsessing about how he was coming across and whether the other person thought he was boring or cool or something else.

• 1:27Speaker 06

  And that led to all sorts of consequences where I would be hiding my identity in my true opinions. Or even worse, exaggerating or being dishonest about my opinions.

• 1:41Sana Qadar?

  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 twenties, he came across some self-help writing that changed his life.

• 1:54Speaker 06

  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. And 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.

• 2:34Speaker 06

  Not 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. And if you can challenge those and reframe them, then you can reliably reduce your misery. And it really helped me.

• 3:13Sana Qadar?

  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.

• 3:36Speaker 06

  There'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.

• 4:01Sana Qadar?

  Me included in that constellation, I suppose.

• 4:03Speaker 06

  Yeah, yeah, yeah.

• 4:04Sana Qadar?

  So Jeremy wondered, could all the advice out there essentially boil down to a few core techniques? Turns out, kind of.

• 4:14Sana Qadar?

  This is All in the Mind from ABC Radio National. I'm Sana Qadar. 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.

• 4:34Speaker 06

  So 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. And 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.

• 5:14Speaker 06

  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. But 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.

• 5:48Sana Qadar?

  Yeah, I've definitely noticed that over the course of doing this show as well, that the same kind of core themes pop up again and again.

• 5:55Speaker 06

  Yeah.

• 5:55Sana Qadar?

  And then, but then especially in the popular psychology world and 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.

• 6:08Speaker 06

  Exactly.

• 6:09Sana Qadar?

  It can end up being a little bit confusing.

• 6:10Speaker 06

  Confusing and overwhelming.

• 6:13Sana Qadar?

  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 behaviour 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. It's just the packaging that's different. That doesn't make it wrong or bad or unhelpful necessarily, it's just worth knowing.

• 6:49Sana Qadar?

  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?

• 6:57Speaker 06

  Yeah, so the research process was we started analysing self-help books and therapy protocols and other resources as well, like case studies, research articles and so on.

• 7:08Sana Qadar?

  We, I should note, refers to Jeremy and his co-author Spencer Greenberg.

• 7:12Speaker 06

  The 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.

• 7:47Sana Qadar?

  The result is titled The 12 Levers, The Complete Psychological Toolkit for Improving Your Life. And lever one, unravel the causes, understand the problem.

• 7:59Speaker 06

  If you've done therapy before and you've had your therapist get up on the whiteboard and draw up 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.

• 8:15Sana Qadar?

  And one helpful way of unravelling the causes of your problem is called an ABC analysis.

• 8:21Speaker 06

  Where the A stands for activating event, B stands for belief, C stands for consequences.

• 8:27Sana Qadar?

  The ABC analysis comes from CBT, cognitive behavioural 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.

• 8:51Speaker 06

  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. And 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 judged me badly. And then consequences might be, you know, something emotional, like feeling anxious or stressed or even ashamed. And then the behavioural consequences obviously would be approval seeking, which that could be exaggerating, lying, inhibiting myself, hiding things about myself.

• 9:30Speaker 06

  Once you've got an ABC analysis, you've got this causal sequence. So one thing causes another, which causes another, which causes another. And then you can analyse it for the most important detail, which is identifying the controllable parts of it. Not everything's going to be controllable. You can't necessarily change all the activating events if they're... But often the controllable pieces show up in the beliefs and the behavioural consequences. Because the beliefs, you know, we can challenge them, reframe them. And the behavioural consequences, we can target those to change them. Because often they reinforce the problem.

• 10:03Sana Qadar?

  Right. And so then how do you go about actually creating action and changing those things?

• 10:07Speaker 06

  So that's where the other levers can come in handy. So the other levers are more focused on the intervention piece. This lever's 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. So 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.

• 10:51Speaker 06

  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 that anxiety. So the ABC analysis can give you different targets that you can then use different levers on to intervene and change them.

• 11:25Sana Qadar?

  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. Like, did you know we basically have a traumatised baby to thank for exposure therapy? I'll explain more in a moment. But first, cognitive restructuring. How to do it, and its origin story, and the question that changed psychology forever.

• 12:04Speaker 06

  Yeah, 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, what he'd been trained to do, which was psychoanalysis. So he could have asked if people at the party subconsciously represented people from her

• 12:48Speaker 06

  childhood and how that impacted her.

• 12:50Sana Qadar?

  Right.

• 12:51Speaker 06

  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?

• 13:01Speaker 06

  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. And 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 behavioural therapy these days. The core principle is that thoughts affect feelings. And it's something the ancient Stoics noticed themselves, that it's not events per se that cause how we feel, it's our interpretations of events.

• 13:43Speaker 06

  And that is really empowering, because there's a huge amount of scope we have to reframe how we're seeing reality. And we can all think of examples of people who have excellent conditions in their lives and unhappy, and the opposite.

• 14:02Sana Qadar?

  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.

• 14:16Speaker 06

  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. It'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 recognised that basically all of us have negative thoughts, but not everyone gets stuck in them.

• 14:49Sana Qadar?

  Hmm.

• 14:50Speaker 06

  When he was researching and exploring things, one major contributor to getting stuck in prolonged worry and rumination is what he called metacognitive beliefs. And it's a jargony name, but what it means is beliefs about our thinking. So some common examples are worrying is uncontrollable.

• 15:11Sana Qadar?

  Hmm.

• 15:11Speaker 06

  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 it's, you know, I'm probably going to do it more. And 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.

• 15:56Speaker 06

  You just move on with your life.

• 15:58Sana Qadar?

  You just probably shouldn't set that time to be right before bed, right?

• 16:01Speaker 06

  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.

• 16:10Sana Qadar?

  You're listening to All in the Mind from ABC Radio National. I'm Sana Qadar. 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. Okay, 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?

• 16:38Speaker 06

  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 believed that fear was innate. So we were just born afraid of certain things, like heights or dangerous animals. But 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.

• 17:15Sana Qadar?

  Hmm.

• 17:16Speaker 06

  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. And 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 generalise. 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.

• 18:00Speaker 06

  So 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.

• 18:13Sana Qadar?

  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. What did she do?

• 18:32Speaker 06

  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. And 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

• 19:16Speaker 06

  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, it 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.

• 19:51Sana Qadar?

  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.

• 20:00Speaker 06

  Yeah, we do have a lot that we owe those kids. I should also say, there were, I'm not sure about Jones's study, but definitely with Watson and Rayner's study, there were definitely holes in the study that people found. But 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.

• 20:19Sana Qadar?

  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?

• 20:34Speaker 06

  The idea is that you want to find the triggers of your anxiety, whatever the trigger is. So 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, the climax might be doing a presentation to your colleagues

• 21:14Speaker 06

  at work. And 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 the situation, and you're expecting that your anxiety will spike, it will go up. But after some time, assuming that nothing bad happens, nothing interferes with the process, then eventually, your anxiety will come downwards.

• 21:44Sana Qadar?

  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.

• 21:58Speaker 06

  Oh, really?

• 21:58Sana Qadar?

  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. Like, I can manage okay, I can get a shoe over it, I can, you know. So that's like my example.

• 22:36Speaker 06

  Yeah. And did you do that in any structured way?

• 22:38Sana Qadar?

  No, that was just like, constant exposure every summer. So that wasn't very structured exposure therapy, but that was, you know, unstructured.

• 22:46Speaker 06

  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 learnt to drive, or swim in deep water, or go to parties, or whatever it is. And 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.

• 23:12Sana Qadar?

  Yeah.

• 23:15Sana Qadar?

  All right, I 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?

• 23:29Speaker 06

  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, and earlier version of cognitive behavioural therapy. And 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 behavioural activation. And the idea behind behavioural activation is that when we feel depressed, we tend to withdraw from the things in life that make us feel good. So behavioural

• 24:12Speaker 06

  activation is about gradually re-engaging with the things that make us feel good. But behavioural activation was like the supporting act to the main event. So 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 behavioural activation. And this is because of an assumption that cognitive change, or changing in your thinking, was more important than behavioural change, or behavioural 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

• 24:54Speaker 06

  people with depression, and they randomly assigned them to one of three groups. And two of the groups were roughly the same. They were cognitive therapy, so mostly working on thoughts, a little bit of behavioural activation, just that one of the groups went a bit deeper into core beliefs. And then there was this third group that was pure behavioural activation, so 100% focus on behaviour change, and zero focus on changing your thinking. And as you can imagine, at the time, basically, everyone predicted that the behavioural 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. So the behavioural activation group performed just as well as the other two groups. And

• 25:38Speaker 06

  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 behaviour, you can do that as well. And the other encouraging thing is that it's not just for depression. So people have now done research on behavioural 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.

• 26:20Sana Qadar?

  And why does behavioural activation help prevent a depressive spiral?

• 26:24Speaker 06

  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. And 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

• 27:06Speaker 06

  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. And if you examine this vicious cycle, you know, you can't go back in time to change the thing that happened originally.

• 27:24Sana Qadar?

  Right.

• 27:25Speaker 06

  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 behavioural activation.

• 27:39Sana Qadar?

  And 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?

• 27:52Speaker 06

  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. And 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 realise his mind was fairly neurotic. So yeah, I'm glad I found them in some shape or form, and it's good to try and put them into one place.

• 28:38Sana Qadar?

  That 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 Qadar. Thanks for listening. I'll catch you next time.