Practical Tools for a Less Anxious Life - Donald Robertson

1. 0:00 – 15:40

   How Does Anxiety Really Work?

   1. CWChris Williamson0:00

      What do you wish more people knew about how anxiety works and what causes it from your perspective?

   2. DRDonald Robertson0:08

      Gosh! Well, anxiety used to be my specialism, although now I focus a bit more on anger these days. Um, but they're both, they're two of my favorite, uh, emotions. The main thing I think that people should know about anxiety, uh, is it's- we tend to think of emotions, uh, in a very simplistic way in our society. We have very simplistic language for emotions, and most people buy into something that psychologists sometimes call the hydraulic model of emotion, which is the idea that emotions are just like a blob of energy that sort of wells up inside you, and you can sort of try and push them down, or you can sort of vent them or whatever, and that's wrong. That isn't how our emotions work, basically. It's massively overly simplistic, unfortunately. That's what we sometimes call the folk psychology or kind of default psychology. So we get off to a bad start by not having the faintest idea how our emotions work in the first place. So the main thing I would say is I, I think of a, an emotion like anxiety, more like a recipe for baking a cake. Like it's got milk and sugar and eggs and raisins and whatever else you might put in. So the thoughts, actions, feelings, mental images, memories, all these things kind of get mixed together, and that bakes the cake of whatever type of anxiety that you've got. And the main thing people should know about treating anxiety, I'll hammer this home because it really is one of the main things. Uh, I like to call this the most robustly established technique in the entire field of psychotherapy research. How would you like to hear about that, right? And that's no exaggeration. So there's a thing that we use in CBT that we've known about for, like, well over half a century, maybe it's cracking on like seventy years or more now that it's been used in therapy, called exposure therapy, right? And it's probably the most reliable type of therapy that we have basically. It's used for phobias and other types of anxiety as well. So Chris, what would happen if you take someone that's got a cat phobia? Animal phobias are generally considered to be pretty much the simplest type of anxiety. It's pretty straightforward. There's other types of anxiety. It comes in flavors like social anxiety, panic attacks, PTSD, stuff like that, right? But we'll start off with a nice, easy snake phobia or, uh, cat phobia. So you get someone with a cat phobia, right, and you sling them in a room with a bunch of cats. What's gonna happen to their heart rate, for a start?

   3. CWChris Williamson2:39

      It's gonna go up a lot.

   4. DRDonald Robertson2:41

      It's gonna go up. So it's probably gonna almost double, Chris, like as if you're sprinting or something like that, and it'll do that in less than five seconds. And that's a pretty robust measure of anxiety, generally speaking, certainly for phobias, it is, right? So that's easy. We start off with an easy question to kind of lure you in, buddy. Now I'm gonna ask you a slightly trickier question. What happens next?

   5. CWChris Williamson3:03

      Does it stay there?

   6. DRDonald Robertson3:05

      Forever.

   7. CWChris Williamson3:06

      Uh, well, until the cats are removed?

   8. DRDonald Robertson3:08

      [chuckles] Until the cats are removed. Yo, what goes up must come down, right? So we could wait. We could wait as long as we like. Like, is it just gonna stay there forever? Like, it's probably gonna start to come down eventually, right? And it'll return probably to almost its starting level if we wait long enough, right, and nothing catastrophic happens. Actually, the first thing that will happen is this cat phobic is gonna want to get out of the room desperately, right? But they can't, 'cause we locked the door, so tough.

   9. CWChris Williamson3:38

      [laughing]

   10. DRDonald Robertson3:41

       Right? Right. But there'll be an urge. This is why people often don't overcome their fears, right? 'Cause there'll be a powerful drive to avoidance, obviously.

   11. CWChris Williamson3:49

       Mm.

   12. DRDonald Robertson3:50

       Um, so interestingly, what, what's one of the main things that would encourage somebody to stay in the room, even though they desperately want to run out the door, would be the presence of another person encouraging them to do that. Now, that might be somebody that's getting paid money for doing it, like a therapist or whatever, you know, good for them. But back in the day, when you were just little, Chris, it might have been your mum or dad, basically, that was encouraging you to do things that were maybe making you feel unnecessarily anxious at first. They were saying, "Chris, it's gonna be okay. You don't need to be scared. It'll be fine. You know, you'll get used to, you know, do- playing a sport or petting a big dog," or whatever it is you're a bit nervous about initially. So the presence of another person can be a game changer in getting people to stay there for longer. So the heart rate's probably gonna come down, right? How long do you think that might take?

   13. CWChris Williamson4:41

       Two hours?

   14. DRDonald Robertson4:43

       Maybe. If it's a really severe phobia, it could take two hours. It might take... usually, it'd be less than an hour. It might-- in some cases, it might even just be, like, ten, fifteen, twenty minutes if it's, kind of, milder phobia, right? So let's assume that's what happens, you know, 'cause that's generally be- that's generally what we'll find maybe at least ninety percent of the time, right? Unless there's some kind of complicating factor. So what happens if you manage to get a hold of this woman and you bring her back, and you do the same thing the next day?

   15. CWChris Williamson5:12

       Heart rate doesn't spike as high and doesn't stay high for as long.

   16. DRDonald Robertson5:16

       Well, you're getting better at this. You're learn-- you learn fast. Right, so her heart rate will go down, and then day three, you bring her in, it won't go up as high again. It'll come down faster. Like, I like to call it like a stegosaurus' tail, you know? Like, it kind of the smaller spikes, and then it kind of fades over time. There's a very low relapse rate for animal phobias, unless there's some kind-- unless you get attacked by a cat or something like that, it traumatizes you again. But generally speaking, if you overcome an animal phobia, ninety percent of the time it will stay gone, right? Basic kind of Pavlovian conditioning, essentially. So one of the main things, the fou- one of the foundational gold standard things in anxiety is that this process happens. It goes by various names. It's sometimes just called emotional habituation. Like, it's very well-established. If you think about it-... animals would need to experience that for adaptation to occur. Like, if you-- do you remember back in the day when we were all, like, little furry animals, like, and we lived out in the African plains or whatever, right? So you're going to the place that you usually get your nuts and berries or whatever, a tree falls down or something, and it freaks you out. Like, you run away, and you go back again the next day, but you're kind of anxious 'cause you don't want to get squashed by a tree. But nothing happens, right? So then you go back the next day, like, and maybe your anxiety's gone down a bit, and then you go back the next day, and you're still not getting squashed by trees. Your anxiety goes down, and eventually you're getting your nuts and berries again, right? The point being, the anxiety, we would hope, would wear off naturally, like, through repeated, prolonged exposure to the triggers if nothing bad actually happens. Otherwise, you'd just be trapped where by anxiety, it wouldn't be very flexible or very ad-adaptive. Um, and so all forms of anxiety pretty much respond to exposure. Um, with some things, it's trickier. My favorite example would be social anxiety. That was my specialism years ago as a, a clinician at a clinic in Harley Street in London, and I mainly treated social anxiety for a long time. People with social anxiety don't have a phobia for other people's faces, right? It's not exactly the same as an animal phobia, but it's similar. Like, they have more what you can describe as fear of negative evaluation. It's what psychologists call it. So if I have social anxiety, I'm worrying about what you might think of me and how I come across to you, and what you guys might say about me afterwards, and things like that. So it's more cognitive, like, it's kind of hypothetical. So exposure therapy is a little bit trickier in that case, right? Because I'd need to kind of expose myself to maybe embarrassing situations or expose myself to the idea that people are thinking critically of me. So exposure therapy for animal phobias has, like, a ninety percent success rate within about three hours now, when it's done optimally. With social anxiety, it takes a bit longer, but its success rate's on average about seventy-five percent-ish, like a bit lower, but still pretty high. How-how's that for a crash course in anxiety? That's what I want people to know about anxiety. Those are some of the things, anyway.

   17. CWChris Williamson8:25

       Unbelievable. Um, a couple of things. Uh, first off, when you were talking about somebody in the room with you helping, uh, one of the first places that my mind went to was soldiers in battle, medieval battle, being next to each other.

   18. DRDonald Robertson8:40

       That's where your mind went?

   19. CWChris Williamson8:42

       Well, look, I'm-

   20. DRDonald Robertson8:43

       Medieval to medieval, wow!

   21. CWChris Williamson8:44

       ... I'm used to speaking to you, I'm used to speaking to you about fucking ancient history and-

   22. DRDonald Robertson8:47

       [chuckles]

   23. CWChris Williamson8:47

       -swords and gladiators and stuff. Forgive me for my Pavlovian conditioning-

   24. DRDonald Robertson8:52

       Go on, then

   25. CWChris Williamson8:52

       ... when speaking to you. So, uh, that was the first thing that I thought of.

   26. DRDonald Robertson8:55

       Uh.

   27. CWChris Williamson8:55

       Um, the habituation thing, um, I then thought: Well, what if every time that you went back to this place, a bad thing happened? Um, every time that the owner-

   28. DRDonald Robertson9:07

       Yeah

   29. CWChris Williamson9:07

       ... comes home, the dog is mistreated. Every time that you have a conversation with your partner, you're, uh, disappointed or made to feel sad, or you're abused or neglected-

   30. DRDonald Robertson9:19

       Yeah
2. 15:40 – 25:55

   Is Self-Help Actually Helpful?

   1. CWChris Williamson15:40

      It's interesting to think about, uh, how intervening with the thing that's happening and pushing it away, uh, I'm gonna do breathwork, I'm gonna meditate myself away from this thing, uh, I'm going to not look at the person... I'm gonna expose myself to the situation, but not the specific part of the situation, which is what I'm concerned about. Gonna overprepare-

   2. DRDonald Robertson16:02

      Yeah

   3. CWChris Williamson16:02

      ... so that I try and reduce down my error rate moving forward. Um, that seems to me, at least from a little bit of the research I did this year, like a, a big element of acceptance and commitment therapy.

   4. DRDonald Robertson16:13

      Yeah.

   5. CWChris Williamson16:13

      And I'm interested in the sort of whether there is something from ACT which is missing from CBT or if, uh, how you come to think about that when it's, uh, relating to anxiety.

   6. DRDonald Robertson16:25

      Well, that, now we're getting pretty nerdy, right? So I, I like that. Like, let's go for it. Like, ACT is a state-of-the-art form of behavior therapy, basically, but it didn't come out of nowhere, Chris. Like, it didn't spring fully armed and armored from the womb, like the goddess Athena, right? It kind of evolved out of stuff that was already happening, and actually standard CBT, Aaron T. Beck's cognitive therapy, the earlier form of cognitive therapy for anxiety already, I think by the 1980s or whatever, was incorporating some of these kind of acceptance techniques and stuff like that. So were other therapies. So ACT, you could see, is the kind of culmination of things that were already happening in the evolving field of psychotherapy. Psychotherapy, clinical psychology, don't stand still. You know, there's research studies coming out every day, and things are naturally progressing, but the general public often don't really hear about that, and they kind of things gen- sort of filter down maybe decades later. Um, but I think another way of putting that would be most CBT practitioners now have progressively moved towards a broadly similar set of views about... You know, and they maybe put slightly different emphasis on things. ACT is part of a cluster of different therapies that are u- usually lumped together under the CBT umbrella, and we call them the third wave in CBT. So the first wave is early behavior therapy. The second wave is your classic Beck and Ellis kind of cognitive behavioral therapy, as most people think of it. And then the third wave is sometimes called the mindfulness and acceptance stuff, and ACT would be one of the leading forms of that, although there's, like, a bunch of other variations of it. So I mean, it is, a, a lot of researchers and clinicians were kind of arriving at similar conclusions, maybe putting a slightly different spin on it, but thinking, "Looks like maybe acceptance is a thing-... from different perspectives. We know, for example, that people who answer, who strongly agree with the statement, "Anxiety is bad," in questionnaires, that statement alone correlates with poorer mental health outcomes in the longer term.

   7. CWChris Williamson18:38

      [chuckles]

   8. DRDonald Robertson18:39

      Like, that's pretty revealing, right? But Chris, you'll notice a paradox here. Like, people that come to therapy generally do think anxiety is bad. You know, in a way, that's almost what they assume the whole thing is about. And self-help, you know, traditionally encouraged it. So in some ways, ACT is, you know, in a sense, we're shaking things up because certainly there's been a tendency, at least, you know, superficially, for people to assume most therapy and self-help is about getting rid of these feelings and, you know, figuring out ways to suppress them. I thought you were also maybe you're gonna say, "Donald, what you're saying, it kind of sounds like you're slagging off self-help and stuff." You know-

   9. CWChris Williamson19:20

      Mm.

   10. DRDonald Robertson19:20

       ... maybe some of it backfires. Um, but there is, there are problems with self-help. I'll point to the really- I'll start off by pointing out the really obvious one, Chris, right? When I was a wee boy, that was a long time ago, you know. Do you remember when everything was made of wood?

   11. CWChris Williamson19:35

       [chuckles]

   12. DRDonald Robertson19:35

       That was, that was when I was a wee boy, right? [laughing] And, and I'd go in the bookshops. This is before the internet, right? And, you know, we didn't, like, we didn't have much... We just had- there was nothing in Scotland except sheeps and whiskey. I'd go in the bookshops, and there'd be, like, one or two self-help books if you were lucky, right?

   13. CWChris Williamson19:56

       Mm.

   14. DRDonald Robertson19:56

       Now, you guys are drinking from a fire hose of self-improvement bumf, like, twenty-four seven. If you like, you can do courses, watch videos, you know, listen to podcasts. People consume way more self-improvement and self-help stuff than they did in the past, at least when I was growing up, right? So you think, "Well, this is awesome, man. Everybody must be improved significantly." And, you know, the thing is, it wouldn't be too contentious to say they haven't improved though. Like, society consumes all this self-improvement and self-help stuff, but rates of depression, anxiety, mental health problems in general are escalating every year. Like, there's no evidence that people on the whole are, like, culturally are being improved by self-help and self-improvement content, and I think there are probably multiple reasons for that, right? But one of them is that some of the techniques that people learn are, are actually just maladaptive. Although I think that, you know, the, the, a more annoying point is that you could take almost any good piece of advice and turn that into bad advice, you know? So there are techniques and strategies that potentially can work, but sometimes they need, like, a little bit of nuance, and that kind of gets lost a little bit in the messaging. And so people will kind of take away maybe what could be an effective technique, but they misapply it, and then it ends up backfiring for them if they're not careful.

   15. CWChris Williamson21:27

       Mm. This episode is brought to you by Gymshark. You want to look and feel good when you're in the gym, and Gymshark makes the best men's and girls' gym wear on the planet. Let's face it, the more that you like your gym kit, the more likely you are to train. Their hybrid training shorts for men are the best men's shorts on the planet. Their crest hoodie and light gray marl is what I fly in every single time I'm on a plane. The Geo seamless T-shirt is a staple in the gym for me. Basically, everything they make is unbelievably well-fitted, high quality, it's cheap. You get thirty days of free returns, global shipping, and a ten% discount site-wide. If you go to the link in the description below or head to gym.sh/modernwisdom, use the code MODERNWISDOM10 at checkout. That's gym.sh/modernwisdom and MODERNWISDOM10 at checkout. [swoosh] It also could be that the modern world is anxiety-inducing and that self-help is an artificial solution to an artificial problem, that how bad could it be without all of the breathwork-

   16. DRDonald Robertson22:23

       Yeah

   17. CWChris Williamson22:23

       ... and the, the, the, the, the other strategies?

   18. DRDonald Robertson22:28

       We- I mean, I was kind of- I was- now you've got me thinking about medieval knights again, and I was like, "Was their world any less anxiety-inducing?" I think it would be pretty- Do you not think it'd be scary to live before there was a police force? Like-

   19. CWChris Williamson22:41

       Yeah, that was-

   20. DRDonald Robertson22:41

       ... you got to the edge of your village, and you're like, "The brigands might come and slit my throat if I- [chuckles] want to walk to go see my granddad," you know?

   21. CWChris Williamson22:50

       Well, we're often told about-

   22. DRDonald Robertson22:51

       Pirates.

   23. CWChris Williamson22:52

       We're often... You get pirates as well. Unless you're- Well, you just move away from the coast, right?

   24. DRDonald Robertson22:56

       Yeah.

   25. CWChris Williamson22:56

       It's the same argument that's made about climate change. "Move away from the coast." Um, absolutely. I wondered then why, why the chronic anxiety, chronic stress thing seems to be bandied about much more in the modern world, and there's an assumption that at some point in the past, being a caveman and not having reliable, reliable heat to make it through the winter, um, presumably we couldn't have been chronically stressed because we would've, it would've just been so maladaptive, it would've been selected against.

   26. DRDonald Robertson23:27

       Mm. I think... And, and it, it's a tricky question. It is a very good question. You know, a lot of people, I think, intuitively feel that there's something a bit wrong with modern society in this regard. Um, I feel it's lazy to blame the internet, but I can't help but feel that social media is contributing to some of our psychological problems. I think there's some evidence to substantiate that, although there's still a little bit of debate about how to interpret it. Um, we do live in a society where I think people increasing, increasingly, uh, think about things without necessarily learning how to cope with them, right? So in the past, you know, people encountered threats and risks at more of a visceral, in a practical level, whereas we watch it on the news now and read about it on social media. And I think this kind of abstract, kind of verbal processing is harder for us to deal with in some ways.

   27. CWChris Williamson24:24

       Mm.

   28. DRDonald Robertson24:24

       We- so we talked about flavors of anxiety earlier, right? Phobic anxiety-... like will tend naturally to reduce over time as long as you actually face your fears. It's a simpler type, comes from a simpler age, a simpler world, when you get a phobia, and then you deal with your anxiety, right? But another type of anxiety I didn't mention yet is worrying, right? And by worrying, we're usually referring much more to a, a cognitive process. Dogs don't worry as far as I know, but they might get phobias, right? Worrying is like a conversation that you're having with yourself, and it you- it stereotypically, it sounds like this: "What if this happens? What if that happens? How am I gonna deal with it?" And it goes round and round like that, you know, about hypothetical things, you know, uh, catastrophes, basically. Worrying is a trickier problem, and we have a, a lower success rate in treating it, unfortunately. Um, it's a paradoxical thing because people can spend many hours a day worrying about stuff, and you'd think again, then they, they would figure out solutions or they'd adapt to the stuff that they're worrying about. But what worrying seems to do is maintain anxiety at a kind of moderate level, chronically, if you're not careful.

   29. CWChris Williamson25:49

       Mm.

   30. DRDonald Robertson25:49

       And I think social media and the news cycle and stuff like that probably fuels worrying.

3. 25:55 – 39:22

   Why Avoidance is the Worst Coping Strategy

   1. CWChris Williamson25:56

      What are the bad strategies for dealing with anxiety? If those are some of the good ones, what are some of the bad ones?

   2. DRDonald Robertson26:04

      Bad strategies for dealing with anxiety, everybody's fav- this is a boring answer in a way, but everybody-- the number one most popular coping strategy in the world is avoidance, right? So generally speaking, avoidance is a problem because, uh, it prevents habituation from happening. It prevents you demonstrating to yourself or discovering that nothing catastrophic happens, assuming it's an irrational or an unfounded fear. So you carry about certain false assumptions or unrealistic assumptions that never get disproved in practice. It prevents you from evaluating your coping ability and maybe refining and improving your coping skills, basically, which would be another key thing. So you face your fears enough time, you kind of figure out ways of dealing with them. Basically, you don't get a chance to do that. You get zero practice or time on task if you're avoiding stuff, and it increases, uh, sensitization to the, the cues over time. So anxiety really is the root of all evil from a kind of, uh, uh, avoidance, sorry, is the root of all evil. I mean, the... you'll notice the paradox here is that most people assume anxiety is the problem and maybe avoidance is a way of coping with it, but it might be that anxiety in itself isn't actually that bad, and that avoidance is the bigger problem, right? Because avoidance damages your life and relationships. It prevents you from applying for jobs. Like, it changes your behavior in ways that have a wider impact and a longer-term effect on your ability to flourish as a human being. You can do a lot of stuff while feeling anxious. Anxiety isn't as bad as people think, right? Once you get used to it, you think, "So what? My hands are sweating and stuff." Like, you know, "My heart's beating a little bit faster." You can even reframe it as excitement. You just say: "It's just an adrenaline rush." Like, it's not a big deal. So you'll see a lot of performers will just ride out their anxiety, especially comedians, stand-up comedians. Like, if you go and see them live, like, uh, I think I used to go and see a lot of shows in London, and those guys, often maybe were the ones I saw weren't as experienced, just in function rooms above bars and things like that. Well, like, probably the majority of them looked terrified, right? But they just kind of incorporated that into their act a lot of times. So I think you can, uh... first of all, we've got to deal with avoidance, right? Distraction techniques, um, suppression of the feeling, uh, using drugs and alcohol to cope, like impulsive behaviors, like masturbation. Um, but also worrying itself is kind of like a maladaptive coping strategy.

   3. CWChris Williamson28:51

      Mm.

   4. DRDonald Robertson28:51

      Worrying is kind of like failed problem-solving or it's kind of overlaps a bit with op- over preparation and stuff like that. There's a guy called Tom Bur- Borkovec, who's, uh, one- basically probably the leading researcher on worry, and he forwarded a theory called, uh, conceptualizing worry, um, as a form of avoidance. He calls it the cognitive avoidance model of worry. So people, when they worry about stuff, they, they kind of trick themselves into thinking they're facing the problem. "I've got, I've got to think about this problem. Like, to kind of-- I've got to figure out a solution, buddy. Like, oh, man, I'm up, I woke up at three in the morning, Chris, and I'm like, just thinking about a mistake that I made in my taxes or something. I was up all night, like, worrying about what if this happens, what if that happens, how am I gonna cope with it? Trying to figure out a solution." And, uh, but what worrying does is it causes you to kind of jump around in an abstract way. Like, so it prevents you from really confronting your problems in a concrete way, where your anxiety would spike, and then you'd get through it, and it... so it kind of maintains anxiety at a moderate level. So it's actually more like a kind of weird-- it's like avoidance in disguise. You think you're facing problems and trying to solve them, but you're not-

   5. CWChris Williamson30:08

      Mm

   6. DRDonald Robertson30:08

      ... really doing it. Like, and so the anxiety never really extinguishes. I'll well, I'll back that up with a weird piece of research, right? I talked to you earlier about the woman with the cats. With most forms of anxiety, heart rate is a pretty robust measure. Um, researchers looking at people who experience severe pathological worrying have GAD, generalized anxiety disorder, right? It's sometimes called the worrying disorder. So with those people, you can induce-- you can get them to practice worrying about stuff, um-... and just worry episodes and, you know, measure their heart rate and galvanic skin response, their respiration and stuff like that, do brain imaging and stuff. And what researchers found was these people will say, "My level of anxiety is a hundred percent. I'm up to high doe," as we say in Scotland, like, "I was freaking out," right? "So my anxiety is really high, like I'm having an anxiety attack," they'll sometimes say, but their heart rate doesn't go up that much, and the other physiological signs of anxiety don't really appear. Like the w- the women with the cat phobia, Chris, um, pretty much guarantee you your heart rate's gonna show up, right? Someone with a panic attack, pretty much guarantee you their heart rate's gonna go through the roof. But somebody who's in a worry episode, the heart rate doesn't really go up that, and sometimes it even goes down slightly, which is pretty paradoxical, right? There's one symptom of anxiety that appears consistently in worry episodes, and that's muscular tension. So people that are worrying tend to tense up their neck and shoulders, and they tense their forehead muscles, like other muscles around their body as well, for some weird reason. Like, so they're kind-- that's fuels the idea that maybe they're not really engaging with their fears sufficiently to actually process them emotionally. I'll tell you, what we tend to do with worrying that works pretty well, in the 1980s, researchers introduced a protocol, most clinicians call it worry postponement. Um, it was originally called the stimulus control method, right? And it sounds odd at first. It's, it's the most effective treatments in the history of psychotherapy tend to be the simplest ones, in all honesty. Not like, you know, Sigmund Freud, with his Oedipus complex and the interpretation of dreams and all that kind of stuff. The things that actually perform best in clinical trials are usually incredibly simple, and, you know, and we just kind of figure out this is like exposure therapy, right? Worry postponement, you could write the instructions almost on the back of a business card. They gave instructions to college students in the '80s, and this has been replicated many times. We now use this method not only for GAD or pathological worrying, but it's also used in even in treating clinical depression and treating anger, like modified versions of it, because it's been found such a robust technique. So the instructions are: you need to spot when you're beginning to worry and catch it early, and then you say to yourself, "I'm not in the right frame of mind to think about this right now. I'll come back to it later at a planned worry time that I've set aside, like seven o'clock this evening, when I like to do my worrying." Right? So I'll maybe write down on a bit of paper, worrying about taxes, worrying about what-- w- I'm worrying about running out of things to say to Chris, right? I'll write that down on a bit of paper, stick it in my pocket, come back to that later, right? And then at seven o'clock or your, whatever your prescribed worry time is, you sit down. If it's still a real problem, you sit down and problem solve it or, like, think about it. If it doesn't seem like it's a real thing, then you just kind of forget about it, and that's more or less all there is to the simplest version of the protocol. That reduces the frequency, intensity, and duration of worry episodes by roughly fifty percent within two or three weeks, right? You think, "What the hell is going on there?" Right? It doesn't seem like they're really doing all that much. But the trick is that worrying feels like you're fixing a problem, but you need to understand that your brain goes into different states of functioning. It's like being drunk versus being sober or being drowsy versus being fully awake. So when anxiety is triggered, fight or flight response is triggered or whatever, you think, "I'm gonna-- I need to solve this problem urgently." But you're not in the ideal problem-solving state of mind, because anxiety biases your thinking, it causes you to exaggerate the severity and probability of risks, causes you to underestimate your coping ability. You revert back to more simplistic black-and-white thinking, because you've basically flipped a switch and turned on the emergency mode. Your amygdala is kind of like starting to hijack your thinking. So you're now thinking in low bandwidth, rapid terms and extreme terms. Like, you're not-- your brain isn't in the right mode of functioning to engage in problem-solving, especially for, like, complex interpersonal problems and things like that. So that's partly why you'll go round in circles, right? But if you say, "I'll come back to this later. Seven o'clock tonight, I'm gonna sit down, uh, I'll put on my favorite worry music. Like, I'll slip into my, my comfy worry slippers and put on my little, uh, worrying hat that I like to wear, and I'll sit and have a good old think about my worries." Right? But when you're doing that now, you're using your neocortex, your prefrontal cortex, the part of your brain that's actually designed for problem-solving and looking at the bigger picture and thinking rationally. So now, because you're choosing when you're going to do it, the, the trick is you're using your, your brain in a different mode of functioning, basically, and you're probably going to think things through in a more balanced, nuanced way, and that's why it tends to work better. Some people think it seems weird to postpone thinking about problems. But if you were drunk, Chris, you just had a bottle of whiskey, right? You wouldn't sit there and think, "Well, this is a good time to get on my motorbike or operate heavy machinery or whatever." You'd think, "I should probably just wait until I sobered up." And you might think, "It's not a good time to phone up my sister that I haven't spoken to for years and, and have a, a debate with her about our, like, family, uh, feuds and things like that." You may think, "I should wait until I sobered up," right? In the same way, we postpone thinking about things, uh, all the time. Like, the best and simplest example would be the middle of the night. So people with pathological worrying almost always have incipient insomnia as well. They can't get to sleep.... usually, like, 'cause they, they lie in bed worrying about stuff. Whereas normally, what the normal people do, they think, "Oh, man, maybe I've got something wrong in my tax returns or whatever." They'll think, "Yeah, but it's like two in the morning. I'll think about this tomorrow." Like, so they, they kind of set shelf it, and they'll go come back to it later. But some people find that they can't do that. They don't have the, the cognitive skills to be able to postpone thinking about things-

   7. CWChris Williamson37:10

      Hmm.

   8. DRDonald Robertson37:11

      -so their, their worrying spirals out of control. 'Cause you're half asleep as well, it's not really an appropriate time. But if you were telling your kids a bedtime story and you suddenly thought, "Oh, man, like, I still haven't figured out what, what questions I'm going to ask Donald in that interview that I'm, I'm doing tomorrow," or whatever, you wouldn't think, "Hang on, kids, like, let me just go away and worry about this for a bit, and then when I've finished, I'll come back and finish your story." You would say to the thought, "I'll put a pin in this, and I'll come back to it later-

   9. CWChris Williamson37:40

      Hmm

   10. DRDonald Robertson37:40

       ... 'cause I'm kind of busy right now." Like, so it's actually completely natural to postpone responding to intrusive, anxious thoughts until a more appropriate time. But a lot of people don't know that. They don't tell kids that at school, you know? And some people just get in the habit of allowing their anxious thoughts to hijack their thinking, right? So that simple skill alone can make a, a big difference. Um, and it shows, you know, uh, worrying in a way can be seen as, uh, a problem of, of avoidance because we- we're thinking about things, and we feel that we're solving a problem, but we're not in the right state of mind to do it, and we're doing it in such an abstract way, usually it's not really beneficial.

   11. CWChris Williamson38:23

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4. 39:22 – 48:47

   Useful Skills to Tackle Your Anxiety

   1. CWChris Williamson39:22

      [whooshing] You mentioned that some people who have anxiety struggle to be able to deploy that worry time delay strategy. What if someone says, "Okay, I realize I'm worrying too much. I have intrusive thoughts. I'm ruminating. I don't get to choose when it happens," and when I say, "I'll do this at seven PM tomorrow," my brain goes, "Okay," and then just goes straight back to worrying about the intrusive thoughts over and over again?

   2. DRDonald Robertson39:49

      Well, they need to learn certain metacognitive skills or whatever you like, like cognitive skills. Um, so they- you can learn how to do that, right? You- they need a lot of that training, right? This is the other reason self-help has some limitations, 'cause some of the techniques that you would learn from a therapist, I guess it would be like going to a fitness instructor or something. There's certain exercises that might benefit people, but they probably need to be taught how to do them properly, and they maybe need a bit of preparation, like, before they kind of get fully into, to doing them. So they might-- to do worry postponement effectively, you might need a bit of preparation, a little bit of coaching, a little bit of training to actually get the most out of the techniques. So short answer, they need to probably develop a skill that we call cognitive defusion. Uh, there's different names for it, right? Sometimes it's called cognitive distancing or verbal defusion. It's a big part of ACT, acceptance and commitment therapy, that you mentioned earlier. There's like half a dozen or more, like, strategies for doing it that are commonly used in therapy. So it's an important concept, so I'll explain a little bit about it. Normally, when people have thoughts, they kind of look at the world through the lens of the thought. So it's like you're looking through a telescope or something, right? You're not looking at the telescope, you're looking through the telescope, like at things way off in the distance. When you're catastrophizing about the future, you're look- kind of looking through catastrophic binoculars or a catastrophic telescope. Like, "Oh, man, what if that happens? That would be awful. How am I going to cope with it," right? So defusion would be taking a step back and looking at the telescope. It's observing your thoughts kind of from one side almost, or sometimes you would say it's like observing your thoughts as a process or an activity that's taking place in the present moment in your mind, rather than allowing your attention to be funneled or channeled through those thoughts. It's a little bit of a weird concept at first, but in a way, it's a simple concept. You know, some of the things we know about psychology are, like, kind of simple ideas, but we don't re- always have good language to articulate them. And so again, that's another reason people sometimes need a lot better coaching to get the knack of it. But defusion is a simple thing. You could... The simplest way to do it would be just to say to yourself, "Right now, I notice that I'm worrying about paying my taxes." Right? And that forces you into metacognitive awareness or, like, this kind of detached perspective, observing your own thoughts, and then it becomes easier to disengage from them, basically. Or you might say, another trick you can play is you could say, uh, "Right now, I notice that Donald is having the thought, 'What if this happens? What if that happens?'" And by... That pushes me into a third-person perspective by referring to myself in the third person, like using my name, like, or using, like, third person pronouns or whatever. I can trick myself to- into stepping to one side and becoming an observer of my thoughts. Then I might say, "Uh, right now, I notice Donald's worrying about his taxes."... I don't need to think about that right now. I'll let, set it aside and back to it later when I can give it my full attention. So again, there's a subtle point here. That someone would easily turn that into an avoidance technique, but the point is to emphasize that you're gonna come back to it later and give it your full attention. So, uh, you might- sometimes there's a knack to turning what seems like avoidance in- into its opposite, into a form of acceptance.

   3. CWChris Williamson43:19

      Hmm.

   4. DRDonald Robertson43:19

      Like, I want you to think about this properly, so I'm gonna come back to it later when can I- when I can give it my full attention. So that way you're kind of affi- you're not sending the message to your brain that you're scared of these thoughts or that they're dangerous or a problem. You're saying, "No, I want to look at them. I'm gonna look at them actually more fully, like in a more committed way." And that takes the... That tends to create a sense of confidence, and it takes the, uh, edge off the anxiety as well.

   5. CWChris Williamson43:44

      What's the CBT process for someone who says, "I know it's irrational, but I still feel it," right? It's gone below the neck now. It's in the body, and I'm feeling it here.

   6. DRDonald Robertson43:55

      Like anxiety. I've just got this kind of visceral feeling of anxiety. Well, the c- I mean, different CBT practitioners will maybe say different things about that, depending what flavor of cognitive therapy, uh, or behavior therapy they're into, right? Some people would say, "Okay, well, let's just teach you relaxation techniques then to lower nervous arousal if that's what you need." Like, someone who's more behaviorally inclined would do that maybe, um, or coping skills. Someone like Beck in traditional cognitive therapy might say, "It may be that you've got automatic thoughts that you're just not fully conscious of," right? "So you need to kind of, like, just pay closer attention and catch those very rapid, preconscious thoughts when they're flashing through your mind." Someone like Albert Ellis, who's more philosophically inclined, would say, "Well, your beliefs might not be fully conscious," right? Most of our beliefs aren't. They may be implicit in your behavior and in your feelings. How, like, for example, Chris, how many beliefs do you have, buddy?

   7. CWChris Williamson45:00

      Millions. Millions.

   8. DRDonald Robertson45:01

      Loads! Too many, probably, right?

   9. CWChris Williamson45:04

      Yes.

   10. DRDonald Robertson45:04

       Yeah. So you don't count them, so you don't go around repeating them all in your head all of the time, right? You've probably got loads of beliefs that you haven't even really formulated in words. They're just kind of implicit-

   11. CWChris Williamson45:16

       Mm-hmm. Mm-hmm

   12. DRDonald Robertson45:16

       ... in your personality and your behavior and stuff, and that's what Ellis was more focused on. He'd say, "You've got these underlying beliefs and attitudes that we could target." So maybe it kind of feels as if you're demanding that you have to get things right, otherwise it would be a catastrophe. Doesn't mean that you necessarily say that to yourself, but that might be how you're acting and feeling, and so those beliefs could be disputed, even though they're maybe not things that are taking the, the, the form of conscious sentences that you're repeating to yourself, right? Or you can just, you know... So like I said, some people might just teach you tension release, um, relaxation, uh, techniques. I feel inclined to say something about that as well, like, you know, just to kind of highlight, uh, there's another example of an area. The guy that developed the main relaxation techniques that are used in CBT was a professor of physiology called Edmund Jacobson back in the 19, uh, 20s, one of the pioneers of biofeedback. And Jacobson, uh, studied muscle relaxation in minute detail, and what he discovered was a paradox. He found that most people can relax to a kind of medium level, but then when they try to relax deeper, they actually tense up.

   13. CWChris Williamson46:33

       [chuckles]

   14. DRDonald Robertson46:33

       And he said that they're committing, right? He said they're committing what he called the effort error. So they're like, "I'm trying really hard to relax, goddamn it!"

   15. CWChris Williamson46:42

       Yep. Yeah.

   16. DRDonald Robertson46:43

       Like, and then they-

   17. CWChris Williamson46:44

       Wu Wei-

   18. DRDonald Robertson46:44

       ... have a kind of rebound

   19. CWChris Williamson46:46

       .. in, uh, ancient, uh, s- yeah, philosophy.

   20. DRDonald Robertson46:50

       Wu Wei.

   21. CWChris Williamson46:51

       Trying not to try.

   22. DRDonald Robertson46:51

       Wu Wei, yeah. Yeah, you have to, uh, reduce the effort somehow. And so Jacobson thought, "Well, like, how can you carry on relaxing but without trying to relax?" And so his technique, he figured out a way around that, which is that you tense your muscles, and you study the feelings of tension for, like, 30 seconds or whatever, um, and then you, you let go of the tension. So you focus on tensing up first, and then the feeling of letting go of that. And by doing that progressively, you should be able to let go more deeply each time. But it-

   23. CWChris Williamson47:27

       Why is bodily relaxation, why is relaxing of the muscles so important?

   24. DRDonald Robertson47:32

       It tends to lower sympathetic nervous system arousal. Uh, and so it could be- it's one way of potentially damping down the kind of physiological side of anxiety. But again, you know, that can- sometimes that can backfire 'cause people might use relaxation as a way to try to get rid of their anxiety.

   25. CWChris Williamson47:50

       It's another avoidance strategy.

   26. DRDonald Robertson47:51

       Maybe actually- it could be an avoidance strategy, right? But you can- I believe there's some debate about this. This is where we get into the kind of nerdville of, like, therapy, therapists just not disagreeing with things and, like, putting different spins on them. Arguably, you can kind of just modify it a little bit, and you could say, "Well, what if the goal is to let go of the muscular tension and kind of relax into acceptance of the other symptoms of anxiety?" So my heart's beating really fast. What if I kind of let go or what if I just think of myself as not tensing up in response to that, and kind of letting go and relaxing into the feeling of my heart beating fast and the other involuntary sensations of anxiety, right? But if I think I'm trying to relax away the feelings of anxiety-

   27. CWChris Williamson48:38

       Mm-hmm

   28. DRDonald Robertson48:38

       ... that might backfire.

   29. CWChris Williamson48:39

       Different.

   30. DRDonald Robertson48:39

       If I imagine myself as relaxing into them, then it could actually be turned into a form of, uh, emotional acceptance technique, arguably.

5. 48:47 – 1:03:08

   Top Down vs Bottom Up: What’s the Best Approach?

   1. CWChris Williamson48:47

      Obviously, there's a lot of, uh... I guess up until maybe about ten years ago, if we were having a conversation about anxiety, a lot of it would have felt very top down. Now, I'm seeing increasing amounts of nervous system regulation, dysautonomia, uh, vagus nerve stimulation, bottom-up approaches to this. Um, what's your perspective on-... how the blend, what, what the proportion is of bottom up versus top down for something like worry or anxiety?

   2. DRDonald Robertson49:20

      I still, I c- I'll lean more towards the cognitive perspective. Like, I mean, I, and, uh, to be truthful in practice, like, both approaches can work, right? But what we lack, annoyingly, is we've got loads of really good research in psychotherapy, but the one thing that's trickier is longer term follow-up research, like a year later, two years later. Um, so there is an argument that certain types of cognitive change might be more lasting. Like, learning to regulate anxiety by relaxation techniques or acceptance techniques, and things like that, like, those ta- those skills can be powerful, and those can change your beliefs, 'cause you can prove to yourself that you're capable of coping and enduring the feelings, for example. If you apply those skills in the right kind of way-

   3. CWChris Williamson50:08

      Mm

   4. DRDonald Robertson50:08

      ... you know, they can change your thinking. Um, but they can also be ways of dealing with a problem temporarily, and then when you maybe encounter a more stressful event in the future, like, that overwhelms your coping strategies, you might potentially be back to square one. Um, or you might- some people might... Well, one problem with coping skills is that people just stop using them after a while. Like, so that's one of the things that we've found potentially. But, and, and sometimes people get lasting benefits, you know, from managing, uh, how they feel. So it varies a little bit, but cognitive and kind of behavioral changes overlap quite a lot and interact with each other, so it can be a little bit tricky to tease them apart. But I believe, say, for example, your underlying attitudes, Albert Ellis was the one that probably went most to the extreme in trying to aim for very general underlying cognitive change. Like, so Ellis would say to people, "You know, not just that maybe you're exaggerating how bad particular situations are, or you're misinterpreting them," which is one way of doing cognitive work. Um, but Ellis would say, "Are any situations really intrinsically awful?" Like, "Are you making a kind of error by, like, projecting subjective values onto external situations? Are you causing that by imposing rigid demands, like that I almost must succeed, and I must never make mistakes," for example, that are bound to make you feel anxious about your performance. So E- Ellis thought these kind of rules that people have, that shape their character and their feelings in a very general way, needed some attention. And it may be like, that that has more general benefits and more lasting benefits than the more kind of coping skills or emotional self-regulation kind of approach that, that you're talking about.

   5. CWChris Williamson52:11

      It's not just how you feel, it's how you think.

   6. DRDonald Robertson52:15

      Yeah.

   7. CWChris Williamson52:15

      Why is that, why is that such an important sentence?

   8. DRDonald Robertson52:19

      Because emotions aren't just like a blob of energy. Like, they're, they're cognitive, you know, they're intertwined with our thinking, and we have a lot of control over our thoughts and beliefs. We can change them. Like, we- as soon as we realize that our anxiety often, like, is very closely intertwined with catastrophic thinking, for example, we open up a whole toolbox of cognitive therapy techniques that allow us to begin working on that. We can change our perspective. We can challenge our beliefs. Like, we can write different scripts. We can gain verbal defusion or cognitive distancing. The whole way- we have a much bigger toolbox of techniques that we could potentially use then for a start. And also, it might be that somebody, for example, manages their anxiety, but they could still have other problems, like they might still be exhibiting avoidance. So you get guys that are like, "I don't really feel any anxiety anymore, 'cause I drink so much whiskey." Like-

   9. CWChris Williamson53:21

      [laughing]

   10. DRDonald Robertson53:21

       ... "I'm pretty much anxiety-free." Like, you go, "But, you know, you've got o- you've got other problems now, and also you're still kind of avoiding, like, I don't know, asking girls out on dates or whatever it is." You know, like, you've got kind of false courage. It's not, you know, it's not really benefiting you in other ways. Um, so addressing the cognitions can sometimes help us to get more deep and pervasive improvement, especially if we go for these real underlying attitudes by certain, um, tendencies that are very, very common that we all exhibit. Um, I'll give you an example. You know, you could work on anger management with people and teach them coping skills, like, spot when your anger's beginning to rise, catch it really early, nip it in the bud. Uh, take three deep breaths to kind of downshift your nervous arousal a bit, to put your prefrontal cortex back in control. Buy yourself some time, like, so that you can think of a different way to respond. There's a kind of, kind of coping skills approach, right? But you might still think, um, if somebody, uh, insults me, then that just means that they're a total jerk, right? If Chris says something I don't like, it means he's an asshole.

   11. CWChris Williamson54:42

       Mm.

   12. DRDonald Robertson54:42

       Right? So I might have a tendency, there's a tendency, cognitively in anger, to, uh, reduce people's personality to a single negative trait.

   13. CWChris Williamson54:52

       Is that similar to the fundamental attribution error?

   14. DRDonald Robertson54:56

       Yeah, I guess it's... You know, maybe it's related in some ways.

   15. CWChris Williamson54:59

       It's not-

   16. DRDonald Robertson54:59

       It's like an attribution error.

   17. CWChris Williamson54:59

       It feels like a reductionist... Yeah, yeah, yeah.

   18. DRDonald Robertson55:02

       Yeah.

   19. CWChris Williamson55:02

       Yeah, yeah.

   20. DRDonald Robertson55:03

       It's a kind of a, a, I guess it's related to, to attributional style in a sense. Um, it's also related to- philosophers have written about it, um, many different authors have approached it from different perspectives. So you could describe it as a form of objectification.... of the other person as well.

   21. CWChris Williamson55:23

       Mm-hmm. Mm-hmm.

   22. DRDonald Robertson55:23

       We don't really perceive them anymore as a living, breathing human being. If somebody's just an asshole, right, or just an idiot, or just a jerk, they're not really a fully formed human being in our eyes anymore. So it, it kind of distorts the nature of our relationship, and you might- some people, especially angry people, will tend to think that that's fine. "He is a total jerk," right? And the, I think the best way to respond to that is, it's one of the reasons that when people get angry, their problem-solving ability tends to be impaired. So if you can't empathize with people or put yourself in their shoes, you can't really anticipate their actions or understand their motivations. So it makes it pretty hard to actually deal with them effectively, or negotiate with them, or problem solve. You're gonna basically be stuck with pretty crude and simplistic solutions, like punching the guy in the face or something like that.

   23. CWChris Williamson56:15

       Mm.

   24. DRDonald Robertson56:16

       You know? So that reductionist way of looking at people, um, individually, also, you could argue, affects society as a whole, you know. We maybe think of whole other nations and groups of people in a reductionist way sometimes. So social psychologists, um, and, you know, other researchers have talked about this kind of objectifying tendency as being the basis of a, a more serious problem, which is called dehumanization. Um, throughout history, you know, people have had moral codes. Um, you know, most societies agree that it's wrong to steal from people or to kill them, um, with one exception, which is, uh, if they're, if they don't count as fully-fledged human beings, then it's fine.

   25. CWChris Williamson57:08

       Yeah.

   26. DRDonald Robertson57:08

       Right? Throughout... In the ancient world, those were barbarians. So the Greek word, uh, barbaroi, do you know what it means originally? Like-

   27. CWChris Williamson57:18

       Uh, rodent, non-human, vermin?

   28. DRDonald Robertson57:23

       No, it's better than that. It's onomatopoeic, Chris, right? It means people that go, "Blah, blah, blah."

   29. CWChris Williamson57:30

       Sheep?

   30. DRDonald Robertson57:31

       It... No, it just mean, it just literally means people that talk nonsense.
6. 1:03:08 – 1:11:14

   Were the Stoics the Original Psychotherapists?

   1. CWChris Williamson1:03:08

      What are the differences between beliefs and feelings? Are they, are they an im- an important distinction between those two?

   2. DRDonald Robertson1:03:15

      It's hard to define what's meant by feelings. You know, this, and also some of these concepts are really debated to this day by a lot of contemporary, uh, psychologists. So, and also, we- b- partly because in English, we use some of these words quite vaguely-

   3. CWChris Williamson1:03:32

      And interchangeably.

   4. DRDonald Robertson1:03:34

      Eh, and, and we can use them interchangeably. I would say that generally speaking, if we're talking... We, we might, by feelings, we might mean physical sensations.

   5. CWChris Williamson1:03:42

      Mm.

   6. DRDonald Robertson1:03:43

      Um, or you might be talking about emotions, for example. Particularly if we're talking about emotions, generally speaking, I would say there's probably quite a pronounced cognitive element. There'll be a lot of beliefs tied up in them. And throughout history, people have defined emotions cognitively. The Stoics did. They sat down and wrote almost like kinda dictionary definitions. They'd say, "Anger is the desire for revenge. Fear is the belief that something bad is about to happen and that you should flee from it."

   7. CWChris Williamson1:04:15

      Mm.

   8. DRDonald Robertson1:04:16

      But, and so they-

   9. CWChris Williamson1:04:17

      Well, I can see-

   10. DRDonald Robertson1:04:18

       They-

   11. CWChris Williamson1:04:18

       Just to interject, uh, I can see the desire for doing that because when you think about what a feeling is in your body, you have some sort of an emotion. It is this global, foggy-

   12. DRDonald Robertson1:04:33

       Yeah

   13. CWChris Williamson1:04:33

       ... slippery, ephemeral, fucking morphing and mutating thing. And-

   14. DRDonald Robertson1:04:39

       Yeah

   15. CWChris Williamson1:04:40

       ... you know, I, I use this bit in my live show, where I actually I don't anymore, but I used to, where I was talking about why you could understand why the ancients would think that mortals were the gods' playthings. Because rage doesn't just feel like some neurochemical imbalance inside of-

   16. DRDonald Robertson1:04:57

       Yeah

   17. CWChris Williamson1:04:57

       ... my brain and body. It feels like I've been possessed, imbued with this, you know, strange, like, parasite demon thing that's taken over me, or, oh, the deep depression, you know, it's sort of its weight, the gravity is heavy. It's more than-

   18. DRDonald Robertson1:05:13

       Yeah

   19. CWChris Williamson1:05:13

       ... a sensation, and I think that the desire to try-

   20. DRDonald Robertson1:05:15

       Yeah

   21. CWChris Williamson1:05:15

       ... and bring into the, um, easily communicated, transferable, "Oh, when you say that, do you mean the same thing as me?" Me and you have never had to have a debate really over-

   22. DRDonald Robertson1:05:27

       Yeah

   23. CWChris Williamson1:05:28

       ... whether that football is a ball. Well, you know, when you say ball, that's what I mean when you say ball. Yeah, of course, 'cause you can-

   24. DRDonald Robertson1:05:33

       Yeah

   25. CWChris Williamson1:05:33

       ... touch it, feel it, and assess it. But because it's-

   26. DRDonald Robertson1:05:35

       Yeah

   27. CWChris Williamson1:05:35

       ... so internal and so, uh, challenging to show objectively to other people, you need a way of being able to-

   28. DRDonald Robertson1:05:43

       Yeah

   29. CWChris Williamson1:05:43

       ... exchange and, and communicate this.

   30. DRDonald Robertson1:05:46

       Yeah, and, and arguably, that's how we figure out how to use the words, is by having some kind of definition that our society agrees on. You sound like an effective neuroscientist. So sometimes they'll say, you know, the, the kind of raw affect that emotions are, are, are built out of, they- some psychologists will say it's like color words, like red and blue, right? How do I know that what I mean by red is the same as what you mean by red?
7. 1:11:14 – 1:26:42

   Why Everyone Hates Exposure Therapy

   1. CWChris Williamson1:11:14

      so you mentioned that the stuff that can be written on the back of a business card-

   2. DRDonald Robertson1:11:18

      Uh-huh

   3. CWChris Williamson1:11:19

      ... tend to be the most effective strategies. I have to assume that that's because even if there was something more effective, compliance and the ease of the patient to be able to recall-

   4. DRDonald Robertson1:11:31

      Yeah

   5. CWChris Williamson1:11:31

      ... what it is that they're supposed to do has got to be-

   6. DRDonald Robertson1:11:34

      Yep

   7. CWChris Williamson1:11:34

      ... probably the single biggest determinant about- if you don't- it doesn't matter how great the technique is, if you don't do it, basically.

   8. DRDonald Robertson1:11:40

      That, that could be it. That's a problem in some areas of psychotherapy, 'cause there are techniques that work well in clinical trials, and then sometimes clients like doing them, and then there's other techniques that people hate doing and have a very high dropout rate.

   9. CWChris Williamson1:11:52

      What, what is a, what are some of the examples of techniques that are very successful, but people fucking hate?

   10. DRDonald Robertson1:12:00

       Exposure and response prevention for OCD, obsessive compulsive disorder. It's, like, one of the most effective techniques. For someone who's got bacteriaphobia, which is like a form of OCD, you'd get them to kind of put their hand in toilet water and things like that, or, you know, like lick the bottom of their shoe or whatever.

   11. CWChris Williamson1:12:16

       Mm.

   12. DRDonald Robertson1:12:16

       Like expose themselves to things that they think have got bacteria. If they do that repeatedly, like eventually they'll habituate to it. They'll prove to themselves that nothing catastrophic happens. Like, and so it has a very high success rate, but it's so aversive that that approach, like in real-world settings, often has a very high dropout rate. So we're like, "Oh, man, we know that if you did this-

   13. CWChris Williamson1:12:37

       Yeah

   14. DRDonald Robertson1:12:37

       ... you would get over your anxiety," but it's really hard to kind of drag people kicking and screaming sometimes into-

   15. CWChris Williamson1:12:42

       Presumably, that would be a place for something like a, a retreat or a, uh, an intensive. You know, if you said, "Hey, uh, your OCD is stopping your life. Come and live at this retreat for four weeks, and we will slowly coach you through it, because we know that your-

   16. DRDonald Robertson1:12:56

       Traditionally

   17. CWChris Williamson1:12:56

       ... compliance on your own would be..." Yeah, it would. [laughing]

   18. DRDonald Robertson1:13:00

       It is.

   19. CWChris Williamson1:13:01

       What a great way to spend the summer.

   20. DRDonald Robertson1:13:03

       Yeah, the OCD hotel, like-

   21. CWChris Williamson1:13:05

       Mm

   22. DRDonald Robertson1:13:06

       ... something like that.

   23. CWChris Williamson1:13:07

       Yeah, I can see that.

   24. DRDonald Robertson1:13:07

       That'd be, that'd be fun.

   25. CWChris Williamson1:13:09

       Yeah.

   26. DRDonald Robertson1:13:09

       They- there are- I definitely think there are advantages. Uh, I mean, sometimes I thought the main way that we could probo- improve traditional psychotherapy would be just not doing it in a consulting room for an hour, like on a weekly basis with a client. Like, but I just think breaking out of the consulting room in some ways, you know, rather than just coming up with loads of different variations of things that we can do in a consulting room-... like would potentially open up a lot of opportunities. And I, researchers and, and clinicians do do that to some extent.

   27. CWChris Williamson1:13:41

       Mm.

   28. DRDonald Robertson1:13:41

       Um, they do group stuff. They take clients out on kind of exers- behavioral exercises out of the ... I used to take clients who had, uh, social anxiety into Starbucks or whatever, and like I'd spill my coffee or whatever, or like I'd get them to practice going up to people on the street and asking them what year it was. And, you know, these are kind of typical shame attacking or like behavioral experiments that we get people to do.

   29. CWChris Williamson1:14:11

       Mm.

   30. DRDonald Robertson1:14:11

       But you have to go out the consulting room to do that, which is sometimes a little bit tricky to organize. I went into so many shops in Oxford Street, um, and told them with clients that had IBS, one of their problems is they have almost a phobia often of, uh, but not always, of, uh, losing control of their bowels or whatever, needing to use a bathroom, not being able to do it. So I used to go around and go into shops and with the client and say, "Listen, I'm, I'm really embarrassed. I've kind of had an accident, shat myself. Like, is there any chance I could possibly use your washroom?" The client's would be like, "There's no way I'm doing that."
8. 1:26:42 – 1:41:01

   Should We Prioritise Targeting Anger?

   1. CWChris Williamson1:26:42

      It's an interesting challenge because the, the compartmentalization-- I certainly know for me, I relied on a morning routine for fucking ages, and that was nine gratitude meditation journals in a row, every, like, six months worth, nine of them, uh, and like, thousands of sessions of meditation and breathwork and reading and note-taking and yin yoga and all of this stuff. Um, but I was very much treating it like, because it's so detached from the situations that you use it in, like, you think about something that you're grateful for or that you're hopeful for, or your plans for the day or whatever, but then when something to be grateful for or to not be fearful for or a plan for the day appears, you're not in the same location, mind space, q- like regulation, like-

   2. DRDonald Robertson1:27:35

      Yeah

   3. CWChris Williamson1:27:35

      ... signature. You're not feeling that. So taking it off the cushion, as it's known in meditation, is, uh, that is the skill, and that's the same as what we said before. If you can write it on the back of a business card, your compliance and therefore your application are going to go up.

   4. DRDonald Robertson1:27:50

      You get state-specific learning, or it gets compartmentalized-

   5. CWChris Williamson1:27:54

      Much better way to put it.

   6. DRDonald Robertson1:27:55

      There you go.

   7. CWChris Williamson1:27:55

      Yep.

   8. DRDonald Robertson1:27:56

      Um, so the most effective treatment, for example, we talked a little bit about anger, and that's, I said that's kind of like my hobby at the moment. The-

   9. CWChris Williamson1:28:05

      Are you still doing your, are you still doing your book on anger?

   10. DRDonald Robertson1:28:08

       I'm doing it. I'm working on it. It's gonna take forever, right? But I'm working on a book about anger. It's gonna be like the greatest book ever written on anger, basically, 'cause, uh-

   11. CWChris Williamson1:28:16

       If anyone's gonna do it, I back you to do it.

   12. DRDonald Robertson1:28:18

       I'm gonna do it. I'm gonna write a book all about anger. It's my favorite thing. Like, uh, it's quite a exciting emotion, right? It's colorful, right? So there's a lot of interesting things, and we have this whole book by Seneca called On Anger, which is really good, like about what the Stoics said about anger, and we can compare that to CBT. CBT for anger works pretty well. Like, it's actually... Here's something about for your self-improvement audience, right? Anger, uh, the success rates in treating anger with CBT are about, uh, seventy percent mean, uh, success rate in terms of, like, measures of clinical- significant clinic- clinically significant improvement. It's about s- about a seventy percent rate across the board. The largest meta-analyses, like, these are studies that combine statistically lots of RCTs, like randomized controlled trials. It's the gold standard for doing clinical research. The- there are about fifty in the main ones. I think more recently, there are about, like, seventy individual studies that they pull data from, and from that, they have, like, a, a mean success rate of roughly seventy percent. So interesting, but a trivia for you, right? CBT for anger has a higher success rate than CBT for depression or PTSD or a bunch of other common problems, right? People with PTC- PTSD and depression often have anger problems, right? So there's a low-hanging fruit argument, which would be: you should treat the thing first that has the highest success rate potentially.

   13. CWChris Williamson1:29:56

       Ah, because it's gonna make everything else after that become a little bit easier. It's a blockage that you've managed to get rid of more quickly.

   14. DRDonald Robertson1:30:03

       Yeah, you'll get some kind of knock-on benefit, but also you become more skilled at using the techniques, and your confidence grows in using the techniques that you're learning, right? So it tends to start a domino effect, right? So there, there's an argument there, like, there's, there's good reason to argue that in many cases, it might be an idea with people that have anger and other problems to target the anger first. But another argument when you're prioritizing things clinically is you might go for low-hanging fruit, fruit. You might also go for dealing with something that's most urgent. Well, you know, it's- anger potentially is an urgent problem because it can lead people to harming themselves, harming other people, destroying their relationships.

   15. CWChris Williamson1:30:49

       Mm.

   16. DRDonald Robertson1:30:49

       Like, so you get potentially more bang for your buck in therapy terms by fixing that problem, like, 'cause the consequences of not fixing it might potentially be worse in many cases. Not always, like, but it's a serious contender for thinking we should probably do something about that first before your wife divorces you, right?

   17. CWChris Williamson1:31:09

       Mm.

   18. DRDonald Robertson1:31:09

       Or, or you, or you traumatize your kids or get yourself killed in a road rage incident or something like that. So you might say, "Well, hang on a minute, uh, people, guys out there that are drinking from this fire hose of self-help stuff online and self-improvement, maybe they should be targeting their anger." Like, I think of it in some ways as the sort of royal road to self-improvement. It's maybe one of the areas where there's the most room for improvement. It's the forgotten problem, the forgotten emotion, because for a start, and why would that be, right? You don't see that much-... self-improvement content about anger. You have a few anger management books, but it's a drop in the ocean, buddy.

   19. CWChris Williamson1:31:53

       Mm.

   20. DRDonald Robertson1:31:54

       Right? People generally ignore it because it's an externalizing emotion. There's something about the very nature of anger that makes people say, "If I'm angry, Chris, I'm gonna think you need therapy, not me, buddy." Right? "It's 'cause it's all your fault that I'm upset, obviously," -

   21. CWChris Williamson1:32:10

       Mm

   22. DRDonald Robertson1:32:10

       ... "right? 'Cause you're a jerk."

   23. CWChris Williamson1:32:11

       Mm.

   24. DRDonald Robertson1:32:11

       "Well, you didn't send me a Christmas card."

   25. CWChris Williamson1:32:13

       Mm.

   26. DRDonald Robertson1:32:13

       "Now I'm pissed off. It's your fault. You should be in therapy, not me." So angry people tend not to self-refer for treatment, and they tend not to use self-help unless their anger reaches a kind of critical point, and then often it's at the behest of someone else, like their wife says, "You need to go and do something about your anger," or their-

   27. CWChris Williamson1:32:33

       What anger?

   28. DRDonald Robertson1:32:34

       What anger? Or- [laughing]

   29. CWChris Williamson1:32:36

       [laughing]

   30. DRDonald Robertson1:32:37

       ... or in prisons or in schools, like in institutions, people get sent for anger management, or a court might mandate it, right?
9. 1:41:01 – 1:52:24

   Why Donald Quit Psychodynamic Therapy

   1. CWChris Williamson1:41:01

      Hmm. Why did you give up on psychodynamic and psychoanalytic therapy after so long?

   2. DRDonald Robertson1:41:07

      That was ages ago. We're going back a ways now. [chuckles] Like, so I started off doing psycho, uh... I did a master's degree in psychoanalytic theory, and this is, like, 25 years ago or something, and I practiced psychodynamic therapy for, like, a year. The reason that I, I- there were multiple reasons why I quit. I wonder, um, some of them maybe I can't share in public. I got a bit disillusioned with my own personal training analysis and with, uh, the approach that I was studying, and also some of the stuff that I was reading. Um, the last book- the last journal article that I read, I can remember vividly. Uh, the last article I read was by a s- very, like a well-known psychoanalytic theorist, who wrote an article about, uh, sublimated anal masturbation.

   3. CWChris Williamson1:42:02

      [laughing]

   4. DRDonald Robertson1:42:03

      He believed- [laughing] and he believed that golf-

   5. CWChris Williamson1:42:10

      Okay

   6. DRDonald Robertson1:42:10

      ... is a form of sublimated anal masturbation.

   7. CWChris Williamson1:42:14

      Okay.

   8. DRDonald Robertson1:42:14

      Um, 'cause he'd analyzed, like, one client or whatever, and this is what emerged from it. So he decided he was gonna write, like, a paper theorizing this or whatever. Because you have to put- he said, and I'm not kidding, I'm repeating his words, not mine. He said, "You have to repeatedly put your fingers in and out of dirty holes," like when you're going around the golf course taking the, like, the golf ball out of the, out of the hole after you've taken a shot.

   9. CWChris Williamson1:42:41

      Okay.

   10. DRDonald Robertson1:42:42

       And I read that, and I thought, "I think I'm done with this." Like, "I can't, I can't really take this seriously anymore." So I mean, that's the more extreme end of psychoanalytic interpretation, right? Some of it is a lot more down to earth. Like, definitely in recent- since the, probably since the 1950s and '60s onwards, and particularly more recently, there are forms of psychodynamic therapy that are much more down to earth. But even when I was training in it, we read Lacan, we read Klein, we, we still were reading Freud and stuff, and so a lot of the literature we were reading was kind of bonkers-

   11. CWChris Williamson1:43:19

       Mm

   12. DRDonald Robertson1:43:19

       ... really, and based on, like, zero evidence as well. Freud, do you know how much clinical research Freud did to develop his theories?

   13. CWChris Williamson1:43:28

       Zero?

   14. DRDonald Robertson1:43:29

       Zero. Nothing!

   15. CWChris Williamson1:43:31

       Wow.

   16. DRDonald Robertson1:43:31

       Like, he literally wrote The Interpretation of Dreams after his father died, and he sat and analyzed his own dreams, and that was how he basically came up with most of the stuff. So it wasn't based on any client work at all, really. Like, it wasn't based on any clinical research whatsoever. Freud was pretty much dead against that, and yet he produced volumes of stuff and this tradition that went on for ages.... so there were some personal reasons why I kind of got a bit disillusioned with it, and I thought, "This is, this isn't really sitting comfortably with me." Um, I'll tell you another little anecdote that I can share with you as well. Like, so when I did my master's degree, uh, some of the, the lecturers were really into Jacques Lacan, who's a small philosophical French post-structuralist, uh, psychoanalytic theorist who was big in the '60s, early '70s, and stuff, right? And, uh, we read this book by a guy called Dylan Evans, uh, who it was a dictionary of Lacanian thought, and this was the main reference book. And I and some of the other people, particularly people that were working in psychiatric nursing and therapy and stuff, we'd sit there every week in a little seminar room, and the guy that was teaching us would go on about Lacan or whatever, and we'd sit there scratching our heads, being like, "We can't really... uh, for this doesn't make any sense. It doesn't bear any resemblance to what actually happens with our clients, and we can't really make head nor tail about what this guy's going on about." And I remember our- the, the guy teaching us said to us once, he got frustrated, and he said, "You guys just don't get it, do you?" Right? And we were all thinking, "And then, like, maybe there isn't anything to get, right? But okay, you seem to believe that this is, you know, it's not the emperor's new clothes or quote, you know, or anything like that. Like, there's something to get here that we don't understand." So I thought, "Ah, I give up on this. It's not really panning out for me." You know, cognitive behavioral approach appealed to me a lot more. Years later, I was reading a, a newspaper, and I saw a column by Dylan Evans, and he was talking about, I think he might have mentioned CBT, and he was talking about evolutionary psychology and stuff. So I emailed the guy, and I was like: "Hey, I thought you were into Lacan." And he said, "I get this, uh, question asked to me all the time," and he emailed me back a biographical essay that he'd written. And in it, he said that he trained as a Lacanian therapist, and he was practicing in the NHS, doing Lacanian analysis. And he said that none of his clients were getting any better. His own personal therapy, after so many years, he'd figured out wasn't really doing him any good. He wrote this book to try and sort out in his own head what Lacan was talking about, but by the end of writing it, he'd basically just convinced himself there was nothing there, like, and it didn't make any sense. And so he reached this kind of crisis point, and he thought, like me, in a way, he threw the towel in on the whole thing and gave it up, right? And I thought, "I wish I'd known that" when we were sitting, reading this book and studying at a university, and the lecturer was like: "You guys just don't get it," right? Because the guy that wrote the textbook had become completely disillusioned with the whole thing and thought it didn't make sense. And we are sitting there going, "Maybe we're just too thick to understand it, Chris," you know?

   17. CWChris Williamson1:47:06

       That is usually the, uh, default assumption.

   18. DRDonald Robertson1:47:10

       Maybe I'm just too thick. I don't understand what this guy's going on about.

   19. CWChris Williamson1:47:13

       Right. Okay.

   20. DRDonald Robertson1:47:14

       Uh-

   21. CWChris Williamson1:47:14

       So the fear of being too thick and the concern of autoerotic anal masturbation-

   22. DRDonald Robertson1:47:21

       Yeah

   23. CWChris Williamson1:47:21

       ... th- from golf, those were the, the two-

   24. DRDonald Robertson1:47:25

       That was-

   25. CWChris Williamson1:47:25

       -nails in the coffin.

   26. DRDonald Robertson1:47:26

       Helped me. And also, I got- I started to learn about CBT, and it, it resonated more with me. I'll tell you another story. Like, so when I was a kid, I was very angry, right? So I'm a little bit, in some ways, like a recovering alcoholic in that regard. So I, I was saying the other day, I, I thought about it, and I realized some of the people... 'cause people ask me occasionally on podcasts, they'll say, "Who's your role model, you know, uh, from the perspective of Stoic philosophy or the people that you particularly admire?" And they want me to say Nelson Mandela or something like that, right? And I think, "Well, I've never met any of those guys, right? So I don't really know." But the people that impressed me most were guys that you wouldn't have heard of. And if I think about it, like, some of them were people that were recovering drug addicts or alcoholics that I've met, or in some cases, people that were really angry and had maybe got into trouble with the law but then had turned their life around.

   27. CWChris Williamson1:48:20

       Mm.

   28. DRDonald Robertson1:48:20

       And I started to think, it may be like that some of the wisest people that I've met, and the ones that I think exemplify the best character traits, are actually people that were really angry previously but overcame their anger. And I thought, well, maybe also because that's the kind of journey that I went on. I started off being really angry.

   29. CWChris Williamson1:48:40

       Mm.

   30. DRDonald Robertson1:48:41

       And then, like an alcoholic, you know, I reached a point where I thought, "This is... I need to do something about this. It's too much. It's kind of getting out of control, and it's gone on too long." And so then I thought, "I have to dig really deep to get myself out of this hole." And in doing that, you know, I guess I changed my whole philosophy of life in some ways.
10. 1:52:24 – 1:52:56

    Where to Find Donald

    1. CWChris Williamson1:52:24

       Donald Robertson, ladies and gentlemen. Donald, you're so great. Uh, where should people go-

    2. DRDonald Robertson1:52:27

       Thank you, Chris. A pleasure

    3. CWChris Williamson1:52:28

       ... to watch, read, listen your things? Where, where do you want to send them?

    4. DRDonald Robertson1:52:32

       On Substack. Like, I do everything on Substack now. They can just find me on there. I've got lots of articles and things.

    5. CWChris Williamson1:52:39

       Beautiful. Mate, until next time, I appreciate you.

    6. DRDonald Robertson1:52:41

       [upbeat music] Awesome. Cheers, Chris.

    7. CWChris Williamson1:52:43

       Congratulations! You made it to the end of an episode. Your brain has not been completely destroyed by the Internet just yet. Here's another one that you should watch. Come on.

Episode duration: 1:52:56