EP68: Dr. Jacob Towery on shame attacking and mindset shifts

Shame is overrated, according to Dr. Towery, who recently won the 2022 Shame Attacking World Championship! Dr. Towery also goes over mindset shifts as related to the growth mindset, and how thoughts shape feelings as well as behaviors. Dr. Jacob Towery, MD is Adjunct Clinical Faculty at Stanford University School of Medicine. He has been featured in The New York Times and The Washington Post. He received his Bachelors of Science in Psychology from Duke University and then attended the University of Virginia School of Medicine. He completed residency as well as a fellowship in adolescent psychiatry at Stanford Hospital and Clinics. He is extensively trained in TEAM-CBT and is the author of The Anti-Depressant Book. He is also the winner of the 2022 Shame Attacking World Championship. 

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[00:00:00] Christine Ko: Welcome back to SEE HEAR FEEL. Today, I am with Dr. Jacob Towery. Dr. Jacob Towery is an Adjunct Clinical Faculty at Stanford University School of Medicine. His work has been featured in The New York Times as well as The Washington Post. He received his Bachelor's of Science and Psychology from Duke University and then attended the University of Virginia School of Medicine. He completed residency as well as a fellowship in Adolescent Psychiatry at Stanford Hospital and Clinics. He is extensively trained in TEAM-CBT and is the author of The Anti-depressant Book. He is also the winner of the 2022 Shame Attacking World Championship, which I'm not sure what that is, and I'll have links to some of his articles in the show notes.

[00:00:48] Welcome to Jacob. 

[00:00:50] Jacob Towery: Thank you, Christine. I appreciate you having me. 

[00:00:53] Christine Ko: Thank you for coming on. To start off, would you mind telling what this shame championship is?

[00:00:59] Jacob Towery: Sure. Shame attacking is a technique that was developed by Albert Ellis, I think in the 1930s or '40s. It was specifically designed for people who have social anxiety; they're overly concerned what other people think about them. You can learn how to care less what other people think of you by going out and doing shame antagonizing exercises, which is where you go out in public and you do ridiculous or silly things on purpose to draw judgment from other people. I try to practice what I preach and entered this contest to do my own shame attacking exercises.

[00:01:33] Christine Ko: That's cool. I've never heard of that. What's an example of an absurd thing you've done? Do you mind sharing? 

[00:01:40] Jacob Towery: I've sang many different songs in a terrible singing voice in public. I've juggled with one ball while holding it. And people think I'm just a really bad juggler. I've done terrible mind reading magic tricks. I'll dress in really absurd ways. A classic one is people put a string on a banana. They'll walk their banana down the street and talk to it. You can make animal noises. Pretty much anything that is silly or ridiculous, that doesn't hurt other people, counts. 

[00:02:18] Christine Ko: I'm really fascinated by that because I spoke to Dr. Will Bynum, and he researches shame in medicine. Especially early on as a medical student or resident, it probably would've benefited me to do some shame attacking. 

[00:02:36] Jacob Towery: You can still do it. It's not too late. Shame as an emotion is generally overrated. Anything that reduces shame for people is usually a good thing. 

[00:02:43] Christine Ko: When you say shame is overrated, do you mean that we put too much stock in it? 

[00:02:48] Jacob Towery: Due to various cultural influences and religious influences, people can sometimes get the message that they're a bad person when they've done pretty ordinary things that are not bad. That's generally harmful to people to believe that they're a bad person. A much more healthy thought is something like, oh, I regret that I did this particular behavior. Or, I did this thing and it upset someone, and I'll try and do that behavior less in the future.

[00:03:14] This idea that we're a bad person is a vast oversimplification and leads to terrible feelings that can last for years. 

[00:03:21] Christine Ko: Yeah, that makes sense. Going back to shame and medicine as a learner, if I could just think, I regret that I didn't read that article, so that I would know this. Or, I regret, if I'm a trainee, I regret I didn't do the reading last night, and I have no idea what any of the answers [absolutely] are today. But it's nothing with whether you're good or bad person. It's nothing to do with that. 

[00:03:45] Jacob Towery: The first time I did an arterial blood gas in internal medicine, I remember I hurt the person and I was like, jabbing 'em. I didn't do a great job, but instead of thinking that means I'm a bad person, I could think, I'm a learner, and with time I'll get better at doing arterial blood gases. It's a bummer that this person experienced pain, and this is a natural part of the process of becoming better at any sort of procedure. 

[00:04:08] Christine Ko: Thanks for explaining that. Do you mind explaining what TEAM-CBT is? 

[00:04:13] Jacob Towery: It's a confusing acronym cuz sometimes people think, oh, that means you do cognitive behavioral therapy on a team or in a group? No, it's an acronym. T-E-A-M stands for Testing, Empathy, Agenda setting, Methods. This was a type of cognitive behavioral therapy developed by David Burns, who is a Professor Emeritus at Stanford and was one of my main mentors. It means that you do Testing at the beginning and end of every session, so you actually have data on how your patients are doing, and how they're progressing over time, and how they're feeling about you. How's the therapeutic alliance? Then you do Empathy. So whenever people come in, you empathize with them about whatever is going on, and you strengthen the relationship and help people feel validated. And then you do Agenda setting, or it's now also known as Assessment of resistance, and you figure out what are all the reasons people might not want to move towards some particular goal or change some particular behavior or thought or feeling. You explore that with people and see if you can help reduce the resistance. And then M is the Methods, which is anything that you do to help people towards whatever their goal is. And then the C-B-T is Cognitive Behavioral Therapy.

[00:05:18] Christine Ko: That's a good segue into how thoughts affect what we feel versus our behaviors? Can you talk about that? 

[00:05:26] Jacob Towery: Sure. Probably one of the biggest delusion - I don't know if delusion is too strong a word; it might be too strong a word, but maybe not - that most of us can suffer from is we can think that events determine how we feel. We can think, oh, because this happened, that's why I feel this way. But it's actually fairly rare that an event determines how we feel. It's much, much more common that our thoughts or our interpretations of an event determine how we feel. I'll just use a simple example. Let's pretend the event was I'm coming on the podcast with you today at 10 o'clock my time. Let's say that was the event for two different scenarios. Let's say in one scenario I had the thought, oh no, I'm doing a podcast. It's gonna be terrible. I'm gonna screw it up. I'm gonna botch my words. It's gonna be ,very stressful. I'm gonna say stupid things, and then no one will ever want to come and see me ever again, and it'll be on the internet forever. And I'll have, said all these ridiculous things. Then I might feel scared, sad, upset, hopeless. And then maybe that would influence my behaviors. Maybe I'd email you and be like, I can't do it, or it's too much, or let's reschedule or something. And then I might have thoughts like, I'm such a loser, I can't even do a podcast. What's wrong with me? I suck. I'm so cowardly. I always back out. And then I might feel even more bad or embarrassed or guilty or shamed. And this can become a cycle, right? 

[00:06:52] But exact same event. Me getting ready to do a podcast with you. Let's say instead I have the thoughts, like, this is gonna be fun. I'll get to talk about things that I'm interested in. Christine seems really nice. I bet the podcast will be fine. It's no big deal, right? Then I might feel calm, relaxed, excited, and then I might have behaviors like, I show up, and I do the podcast, and I have fun with it. And then I might have thoughts like, I'm capable of doing a podcast, this is fine. Life isn't that big a deal, right? Things don't have to be super stressful. And then I feel even more calm, happy. That too can become a cycle.

[00:07:31] People can get tricked into thinking it's events that determine how we feel, but it's far more common than our thoughts, our interpretations, determine how we feel, which in some ways is great news cuz you and I have little control over earthquakes and tsunamis and trains and all sorts of things in the world. But we can learn how to have more control over what thoughts we tell ourselves in our mind. 

[00:07:51] Christine Ko: The podcast example makes sense to me. What about, though, say, like a medical diagnosis, diabetes or high blood pressure or cancer; it's not really your choice. And I get that you can choose how to think about it. Is that kind of what you're saying? 

[00:08:10] Jacob Towery: Yeah. I'll use an example. I'll leave out a name for privacy; I'll err on the side of caution and leave out the name. A good friend of mine got diagnosed with cancer, and there's many different ways people could respond to getting diagnosed with cancer, right? It would be totally understandable if someone responded by thinking, this is terrible, now I'm gonna die. My life is over. This is horrible. There's nothing I can do. It's gonna be painful. This is the worst thing that could ever happen. And that could lead to feeling sad, hopeless, helpless, depressed, bad, scared, right?

[00:08:47] But there are people that are able to, at least sometimes, have thoughts like my friend had a thought like, okay. I've got cancer. Let's see what I can do about this. Let's see, who are the experts out there that know about my type of cancer? I'll get a second opinion. Make sure it's cancer. Okay, who can I find that knows something about this? What articles can I read to learn more about my possibilities? How can I enjoy the time that I have left on this planet as much as possible? How can I savor time with my relationships with other people? How can I make the best of whatever time is there? And then even get like a new lease on life, see the world with fresh eyes, and be like, okay, my time is limited. Which in many ways is actually the situation we're all in, right? We can get deluded into thinking, I've got another 40 years, I've got another 50 years, I got 60 years... you and I might have 10 more seconds, and then maybe we'll die.

[00:09:39] In some ways, it's actually adaptive and healthy to be like, Hey, my time's limited. I really need to savor this and make the most of it and enjoy it. There are people with cancer that have said, This diagnosis was the best thing that ever happened to me. It helped me really treasure my relationships with other people, savor my food, take a trip I never took before when I thought I had forever. So even that, depending on what we do with it.... I'm not saying it's great to get diagnosed cancer, right? I'd love for no one to ever have cancer ever again, or any sorts of hardships. But, if one does have a hardship, if it's possible to change those thoughts, it can be really cool. And if you find this topic interesting, David Burns has a podcast Feeling Good, and there was a wonderful woman named Marilyn who came on the podcast and talked about having Stage 4 cancer, and she was able to change her thoughts and change her feelings and have a really different experience and different relationship to it.

[00:10:33] No matter what the situation is, how we orient to it, our attitude about it, can have a profound impact on how we experience it. 

[00:10:42] Christine Ko: Absolutely. I was recently diagnosed with breast cancer in November. 

[00:10:45] Jacob Towery: Oh, I'm sorry to hear that.

[00:10:47] Christine Ko: I wrote a children's picture book [Cool.] about a mom having cancer and telling her kids. I was trying to say, This can be a good thing. There's not exactly a line like that, but the review that came back from the agency was like, No one believes this; cancer is never a good thing. And, I'll take the feedback, but I was like, it's not like I want people to get cancer, not like I would choose it over and over and over again. I don't wanna have a recurrence like next month, next year, next...

[00:11:18] Jacob Towery: Yeah, I'm so sorry to hear about your diagnosis, and I really admire how you're thinking about it. You turned it into a children's book. For some people, this actually could be a good thing, or it could be a mixed thing, where there's elements of it that suck, but there's elements of it that are exciting and give someone a new outlook on life. I've definitely seen people who repaired relationships that had been long left neglected because they were like, I'm gonna die soon. I wanna repair this. I think you're doing a beautiful job of handling it and adapting to it. 

[00:11:48] Christine Ko: Can you explain how a mindset shift works and how to try it? 

[00:11:54] Jacob Towery: Sure. So I'll give a personal example. I have this really adventurous psychiatrist friend, and he was like, Jacob, you have to get this inflatable surfboard. It's amazing. You don't even need a car rack. So I did. I bought this eight foot, two inch inflatable surfboard. I bought a wetsuit, and then I went out, and after an hour of like vigorous trying, I caught like one wave. I got knocked off the board a lot, and I wiped out, and I had water in my sinuses, and I was coughing up water. I went out another time and caught zero waves. I had thoughts like, I suck at this. I'm not athletic enough. I'm never gonna be able to surf. Maybe I'm not cool enough to be a surfer. This is so hard. All these kind of fixed mindset thoughts, right? I had plenty of those. And then, it took me a little bit, but then I thought, maybe that's not true. Maybe it's just that right now I'm not a very good surfer, and it's hard to surf on an eight foot two board, and maybe there's things I could do. So I decided to take my first ever one-on-one lesson down in Santa Cruz, and I got on a huge 10 foot foam board, which is much easier to surf on than 8 foot 2 board. And it was fun and I caught a really good wave. And then I was like, what if this is just my journey in learning how to surf, and it's gonna take a little while, and that's okay, and that doesn't have to mean anything about me. And then I rented a board. This was maybe a week ago. I rented a 10 foot board and I went out, and I had the best surf session of my life.

[00:13:20] I caught 14 waves and like six of 'em were really good form, and it was fun. And then I rented another 10 foot board again a few days later, and I caught some waves. And then I decided to push myself maybe five days ago. And I rented a nine foot board, and it was really hard. It was harder to stand up and my balance was off and it was not as stable, but I caught a few waves and I pushed myself, and I kept going. And it was fun. And now I'm like excited. I'm orienting my workouts around getting more stretching and strengthening and balance, and I'm excited, and it might take me a while, but I'm okay with that. So my surfing: nothing profoundly changed in terms of an event, but how I oriented to it was less, "I'm bad at this", or "I could never get better" and more, "with enough practice, with enough persistence, with enough determination, I think I could become better at this, and I could try to have fun with it, and I could see it as okay that I'm not very good at it right now." And that's made it a more fun journey, and I'm actually a little better at surfing than I was before with that other mindset. I'm excited to see where it goes. 

[00:14:22] Christine Ko: That's awesome. The mindset shifts your behavior. You went to the 10 foot, then you went to the nine foot. You mentioned the fixed mindset. Does the mindset shift relate to Carol Dweck's work with the growth mindset? 

[00:14:34] Jacob Towery: Yeah. Carol Dweck, who's at Stanford. She's probably done the most research on mindset, and she has the book, Mindset. Fixed mindset is this idea that our capacities are really limited, and they're set at birth, and we can't really grow or change that much. If we mess up, that means that we're bad, or that means there's something bad about us. Growth mindset is in many ways the opposite. It's that, almost any of us, with almost any ability or skill, could become better at it with enough persistence, effort, getting feedback, determination, patience.... could become better at cooking or surfing or playing the piano or karate or public speaking or whatever it is, right? And that then if we mess up, instead of being, that's bad, it might be, that means that I was too far forward on my board that time, or I was too far to the left, or I waited too long to get up on the board; rather than, I'm a bad surfer. It's just a specific behavior. So when you have a setback, you see it as, okay, I learned that in this particular instance I could do this thing different. That's okay. I'll just do that thing different more in the future. And then it makes learning more fun, and I think helps people self-actualize more when they have that mentality. It makes the world more like a playground where you can go out and get better at singing or kite surfing or whatever it is, rather than staying in one's narrow bubble.

[00:16:02] Christine Ko: Yeah. Or get better at shame attacking. 

[00:16:04] Jacob Towery: Get better at shame attacking. Yes. 

[00:16:07] Christine Ko: Do you have any final thoughts? 

[00:16:09] Jacob Towery: It sounds nice to shift one's mindset. A lot of people might be listening to this and thinking, yeah, that sounds good. I like the idea of a growth mindset, but how do I actually get a growth mindset or how do I actually change that?

[00:16:19] And that's part of what makes cognitive behavioral therapy fun is, people learn this technology of how to change their thoughts because none of us are born knowing how to change our thoughts. There are resources. I mentioned David Burns. He has books out there people can read and then do the writing exercise in them, and they can learn the technology of changing thoughts. We can all learn how to shift our mindset, change the sort of thoughts if we want, and then I think we can have less shame, sadness, anxiety, and more joy and happiness in life. 

[00:16:47] Christine Ko: That's a good way to end. Thank you so much for your time. 

[00:16:51] Jacob Towery: You're welcome. Thanks for having me, Christine. This was fun.