Low self-esteem and perfectionism cycles
Tim LeBon: Self-esteem is another vicious cycle; it’s a bit of a puzzle otherwise. So a parent, when you were a kid, told you that you weren’t good enough. But you’re 40 now — why do you still think that? It’s because you’re looking at the world as if this belief is 100% true, and you’re interpreting everything as if it is true, and you’re doing stuff that actually sometimes makes it true.
Rob Wiblin: So any contrary evidence in any specific instance, you disqualify, and say, “Well, here’s the alternative reason why.”
Tim LeBon: Yeah. “They only accepted me because I was nice to them.” That kind of thing.
People with low self-esteem, they might very often have periods where they seem to be OK, although they generally won’t be flourishing as much as they would be otherwise. But they will also be prone to periods of anxiety and depression, as can people with clinical perfectionism, because it’s a bit of a puzzle as to why people are both anxious and depressed at various times. But both of these possibilities explain it.
Rob Wiblin: Yeah. It suggests that one of the core ways that you might try to have more robust mental health is to set up the exact reverse system, where you need to have negative feedback loops: where if you feel bad, then you need to lower your standards, for example, and be far more nice to yourself — be particularly compassionate and particularly accommodating of yourself in those times, in order to lift yourself back up.
And maybe to some degree, the reverse: when you start feeling maybe a bit too good about yourself and a bit too confident, then you need to remember that maybe things will go worse in future and tempering down your expectations.
Tim LeBon: Exactly. Very often, once you’ve mapped out someone’s particular cycle, the solution is to do the opposite. For instance, if you’re ruminating about all the bad things that have happened, you’d stop doing that and maybe think of all the good things that have happened. Part of the treatment for low self-esteem is a positive data log, which is thinking of all the good things you’ve done — particularly things that contradict your negative belief about yourself.
Again, all those thinking traps we mentioned earlier — like discounting the positive, mindreading, fortune telling, jumping to conclusions — people with low self-esteem do a lot of those things. You’d teach them how to challenge those things so they’d have a more balanced view.
How 80,000 Hours contributes to moral perfectionism
Tim LeBon:What concerns me, potentially, is that idea of “doing the most good”. I think the way that we’re designed as human beings, we’re going to favour ourselves to some extent. We’re going to favour those nearest and dearest to us. Even if logically we should be totally impartial, there’s going to be a bit of our brain that rebels against that, I suspect.
So having it as an imperative to “do the most good you can” all the time — even if that isn’t actually what is meant, I think some people might take it to be that — then that potentially makes them very vulnerable.
And then if there are people in the organisation — coming back to that mythical survey we spoke about — who would answer, “Oh, you’re a terrible person because you did such and such or didn’t do such and such,” then that’s not going to be great either. Again, I certainly hear clients fearing that that might be the case, but I don’t know to what extent that really is the case.
Rob Wiblin: Yeah, I don’t think it is true. I mean, I can only speak for 80,000 Hours, but I think if you did a survey like that, you’d find that everyone is extremely tolerant of the lifestyles that other people want to lead. I mean, even people who do nothing to improve the world, to be honest, are perfectly accepted as friends.
I think there’s a perception that there would be enormous amounts of moral judgement. And I’m sure that’s true of some people, but at least I have friends out there who have virtually no interest in altruism or doing good. And to be honest, it doesn’t bother me. It almost doesn’t bother me to a remarkable degree.
Tim LeBon: But they’re friends. What about if they were working for 80,000 Hours?
Rob Wiblin: If you had a colleague? Well, I suppose I’ve learned from experience with these issues that in general, it’s extremely counterproductive to have a mentality that you always have to be giving the absolute maximum to work. I guess on pragmatic grounds, I think it’s foolish to have these kinds of standards, certainly among a group of people who are already quite inclined towards altruism and perfectionism to start with. It’s just throwing too much fuel on a fire that’s already burning perfectly healthily.
On top of that, just speaking for myself, I feel I no longer have the energy for massive amounts of moral judgement about people’s work. I just have other things going on, and I guess I don’t find it that fulfilling or satisfying to think about ways that other people are failing morally anymore. I think maybe 15 years ago I had more fire in my belly about this, not that I was ever super judgemental. But I guess there’s just interpersonal variation on how agreeable you are, and how much you think about this.
Tim LeBon: Exactly. So as I said, most of the people I’ve encountered as clients are very lovely people and haven’t got that OCD personality, where they’re insisting other people have the high standards. My worry would be that it’s just there in the ethos, as it were: that’s what we think is expected of us.
The importance of enjoying what you do and having a holistically good life
Tim LeBon: With regards to careers advice — and again, I actually don’t know what you say to people that come for careers advice — if it was hypothetically, “I’ve done this little calculation, and this is the job where you’d do the most good, and this is what you’ve got to do,” that would worry me. Because the way I like to think of it is there’s kind of Venn diagrams of a job that you can have a high impact in, a job that you’re good at, a job that you would actually enjoy and find personally satisfying, and a job that would pay the bills.
So those four things. And I think you want the bullseye, rather than just doing a job because it’s the one with the most impact — and you hate it, or it doesn’t pay any of the bills you need. Again, I don’t know the type of advice that you give, but I would be concerned if it was too prescriptive and too much just discounting: “You’d probably enjoy it, but you’ve got a moral imperative to do good.”
Rob Wiblin: Yeah. I think in practice, if people got one-on-one advising or they read the website carefully, they would find that this personal fit and the importance of enjoying what you do and having a holistically good life is emphasised quite a lot. I would be shocked and a bit dismayed if anyone had a one-on-one session where they were ever told, “Here’s the job that you should definitely take.” Maybe you would get, “This might be the job that is highest impact, but you have to consider all of these different other factors as well.”
It’s extremely hard to have a message that is suitable and beneficial for everyone, given the enormously different starting points that people are coming from. Part of our message is about doing the most good, and you can have a really big impact with your career. That’s partly orientated at people who have never thought about this at all and maybe are not really aspiring necessarily to help people at all with their career.
Of course, the same message falls on the same ears of people who are already very concerned about how much good they’re going to do, and already have extremely high expectations about what they might accomplish in their career. And for them, it’s like it’s too much: you’re overloading someone with particular thoughts that they’ve already got a good level of, or maybe they already have too much of it. Whereas there’s other people potentially who — in our view at least — should think about this more, because they’re currently not thinking about it almost at all.
Yeah, that would be my model: that it’s just extremely hard to have a message that is beneficial to everyone and doesn’t backfire in some cases.
Tim LeBon: I think that’s right. It’s almost like, I’m thinking of a temperature gauge, and there’ll be someone at this end who needs to go in that direction, and someone at that end that actually may need to go in this direction. And whatever general message you’re giving, if it’s taken too literally or people think it’s about them, or they misread it, or misunderstand it, then it could backfire.
Rob Wiblin: Yeah. One thing I might add before you go on is just that I waste an ungodly amount of time, and I spend lots of time just doing stuff that I enjoy — that I don’t think makes the world a better place necessarily, except by making me happy. I spend lots of money on myself, and I don’t feel guilty about it at all. My colleagues seem completely fine with this. I’ve never gotten a hard time from anyone.
So, I suppose, as a listener, if your perception was that if you did that, I would think negatively of you, or that working at 80,000 Hours would be terrible because everyone would just be breathing down your neck all the time about how you’re not the ideal moral person, I think at least that perception is not the case. Though I know that won’t necessarily make everyone feel completely better.
Tim LeBon: Yeah. It’s good to get that message across, I think.
Guided discovery and cognitive restructuring
Tim LeBon: There’s a mix of guided discovery or Socratic questioning, which means you’re not telling the client something; you’re helping them learn from the experience. So let’s go to that: it’s called a “behavioural experiment.” The behavioural experiment that this client set was to deliberately have a spelling mistake in a couple of emails. And so: “Did you do it?” “Yes.” “What happened?” “Well, I did it and I was nervous, but then nobody seemed to notice.” “Nobody noticed. So how did you feel then?” “Well, maybe it doesn’t matter so much.” “So what do we learn from that?” “Maybe I don’t have to spend 20 minutes checking every email so much.”
That’s guided discovery. Because you could straight out go and tell someone, “Oh, I never bother to check my emails to see whether anyone’s made a mistake, so stop checking.” But if I did that, how would you feel? If I lectured you like that, how would you most likely feel?
Rob Wiblin: Maybe irritated. Or not convinced, anyway.
Tim LeBon: Exactly. There’d be some resistance. Whereas if it’s set up as an experiment, there’s two benefits. One is you’re discovering it for yourself. The other thing, which is beautiful about cognitive behavioural therapy, is that sometimes there’s an unexpected outcome. Now, suppose this person comes back and says, “Why did you tell me to do that, Tim? My boss was furious with me.” Well, that’s not a great outcome, because you don’t want the boss to be furious with them. But you’ve learned something: you learned that their boss is possibly someone with that OCD personality we were talking about — and so there is a reality to their precautions.
Rob Wiblin: And maybe that’s how they’ve ended up with this concern.
Tim LeBon: Possibly. It might be that that’s true of the whole workplace. Absolutely. So you try and do a lot of that guided discovery.
But there is a place as well for what’s called “didactic.” Which might be, for instance, if you’re teaching someone a relaxation exercise. You can do it kind of socratically, and say things like, “How do you relax? What’s your best way of relaxing? Why don’t you try that again?” The problem might be that someone just hasn’t got that skill in their kit bag.
So there’s certainly a place for saying something like, “Do you think that a relaxation exercise would be useful before you’re doing this big presentation?” If they said yes, you’d say, “Well, there’s a couple you might choose from. There’s guided relaxation, there’s breathing, there’s something called progressive muscle relaxation. Have you ever tried any of those?” They might say, “Yeah, I tried the progressive muscle relaxation. I didn’t like it.” “OK, so should we try one of the other two?” And you probably try in session, and then see how they got on, do a little bit of coaching to help them. Then the home practice might be to do that breathing exercise every day, for example.
Tim LeBon: That’s why it’s an important part of treatment, say, for anxiety, to do exposure work. Sometimes it’s in the session — in vivo exposure work — where you’re actually experiencing the thing you’re anxious about.
Something that I treat quite a lot in the NHS is obsessive-compulsive disorder. I haven’t treated it amongst many effective altruists — I don’t know why that is, interestingly.
Obsessive-compulsive disorder can take various forms. It might be someone who cleans a lot, and they might also have an intrusive thought, which is the house will burn down, and then the response would be to do a lot of checking. They would check all of the electric sockets to check they’re all turned off. And then another doubt would creep in, and they’d have a kind of “better safe than sorry” attitude and then say, “Let’s check them another time.” They go back in and worry again and check it. We’ve all done that to some extent. Not that exactly, but we probably particularly if we’re stressed.
If we’re on holiday, we think, “Oh, have I shut that window?” Sometimes we might even get halfway to the station and go back to check we locked the door. So when we’re anxious, we tend to think that more. But people with OCD, they get into a real horrible pattern of having those intrusive thoughts and then doing the compulsive behaviours. The problem is that those compulsive behaviours are then rewarded, because it reduces the anxiety — and so you can almost get addicted to them.
Now, the reason I was mentioning OCD is that you draw out the map. You would say, “OK, what’s your intrusive thought that causes your anxiety? And then you do the compulsive behaviour, which then relieves it?” You might even get people to see that the intrusive thought is just a thought, and it’s probably not true. You might get them to see, in theory, that they don’t need to do the compulsive behaviour. That’s what you would do as the first step of therapy. But you won’t really crack the OCD until they are able to resist the temptation to do the compulsion when they’re really triggered.
Now I just work remotely; I just work via Zoom. But before the pandemic, I remember being in actually a doctor’s surgery I worked in, in one particular setting, and this person was worried about dirt, so went outside and she got her hands full of mud. And normally she would spend hours washing repetitively, sometimes with bleach, until they were all kind of sore. This time she just washed once and then sat with the discomfort.
So that is something called exposure. Actually, it’s called exposure and response prevention (ERP): It’s exposure, and then you prevent the response. The normal response would be the compulsion. You do the exposure, then you don’t have the reaction. Gradually, you break the cycle. You want to do it, but you tolerate the distress. The more you do it, the easier it is to tolerate the distress.
The most important quality needed by CBT therapists
Rob Wiblin: There’s a tension in counselling or therapy of this kind, it seems, where you don’t want to tell your patients or your clients what to think. Because that would be, well, one thing is it might not work — because obviously just lecturing people doesn’t tend to go down super well. At the same time, of course, you do have ideas or conclusions that you’re kind of expecting or hoping that they might reach.
It seems like in order to avoid this just being a sort of con — where you’re leading people to particular predetermined conclusions, and you wouldn’t accept things otherwise — you have to actually embody the attitude of what the person might say. Like: “No, I think that work is 90% important and family and friends and being nice don’t matter.” If that was what came out of their analysis of their own values, you’d be like, “OK, we’re just going to work with that, and I’m going to accept that because it’s not my place to tell you what to think or what to value.” Do you understand the tension I’m gesturing at?
Tim LeBon: Yeah. What do you think is the number one quality that is needed by CBT therapists? Which could be one of those examples of a leading question, but I genuinely don’t know what you’re going to say.
Rob Wiblin: Well, it sounds like the thing that would be very useful in this case is not having too strong of views about what values everyone else ought to have, or how everyone else ought to live.
Tim LeBon: Yeah. And in general, curiosity. Curiosity is a really helpful feature. You’re absolutely right: there is a tension. And again, particularly when we’re short of time as therapists and we see someone in real distress, we really want to help them, and we think we know what the answer is. Maybe we’ve seen someone like them before, and our pattern matching, our thinking fast, says, “Oh, they’re just like Client X. Client X was really helped by telling them to socialise more, so let’s tell them to socialise more.” But it may be that this person is depressed because the people they’re socialising with are really toxic and causing the problem.
So it really is important to slow down and be curious. That’s what the formulation is about, that map. We’ve got our general map, but what is going on for this person?
When it comes around to values, yeah, as well as it being counterproductive, there’s also an ethical concern that, as therapists, we’re trained not to just impose our values. It would be somewhat problematic for me to just challenge someone’s ethical views because I disagreed with them or I thought they were wrong.
Stoicism and the dichotomy of control
Tim LeBon: There you are, you’re stuck in traffic. You can’t change the fact that you’re stuck in traffic now, but what you might be able to do — if you can do so safely — is contact the people who are expecting you and tell them that you’re going to be late. What you might do in the future is set off earlier or go by train. What you might do if you feel strongly about it, is have some campaign for a better transport system in the country.
So that’s why it’s not about stiff upper lip or quietism, because there’s this very important branch about aspects of a situation that you can change — where you want to do your best to change it, if it’s worth changing. Does that make any sense?
Rob Wiblin: Yeah, completely. The case of being angry when you’re stuck in traffic — I often get frustrated or anxious or even a bit ashamed when I’m running late for something, and I do have to stop myself. The interesting thing is the feelings, the negative feelings that you’re having, they have this intense feeling of being useful somehow. You feel like this is an appropriate reaction, and to simply remain calm would be negligent somehow, or failing to accomplish something. I suppose often it actually is directly accomplishing nothing; it’s actually just causing you harm.
I suppose the Stoic approach would be to say, “Well, what actually could we do?” Maybe you should learn a lesson about next time you need to leave earlier, rather than just accept the motions. Think about what actions or what changes could be made, and then what dispositions would help to serve that.
Tim LeBon: Absolutely. The Stoics, of course, didn’t know their neuroscience, or hadn’t read Kahneman and Tversky, et cetera, but we could say this is our old-brain creating these emotions, or creating these automatic thoughts, which actually aren’t helpful for us in modern-day life. They might have been helpful in prehistory, I don’t know, but they’re not helpful now. We have to have that detachment to get our neocortex working, and actually decide what is functional here.
That’s the same kind of thing that one would do in a STOPP that we talked about with CBT. Obviously the two — CBT and Stoicism — are quite closely related. So it doesn’t come naturally very often, and it does require some awareness.