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We just published an interview:  Hannah Boettcher on the mental health challenges that come with trying to have a big impact. You can click through for the audio, a full transcript, and related links. Below are the episode summary and some key excerpts.

Episode summary

We’re in a universe where tradeoffs exist, we have finite resources, we have multiple things we care about, and we have incomplete information. So we have to make guesses and take risks — and that hurts. So I think self-compassion and acceptance come in here, like, “Damn, I so am wishing this were not the case, and by golly, it looks like it still is.”

And then I think that it’s a matter of recognising that we aren’t going to score 100% on any unitary definition of “rightness.” And then recognise that, “Well, I could just look at that and stall out forever, or I could make some moves.” And probably making moves is preferable to stalling out.

- Hannah Boettcher

In this episode of 80k After Hours, Luisa Rodriguez and Hannah Boettcher discuss 4 different kinds of therapy, and how to use them in practice — focusing specifically on people trying to have a big impact.

They cover:

  • The effectiveness of therapy, and tips for finding a therapist
  • Moral demandingness
  • Internal family systems-style therapy
  • Motivation and burnout
  • Exposure therapy
  • Grappling with world problems and x-risk
  • Perfectionism and imposter syndrome
  • And the risk of over-intellectualising

Who this episode is for:

  • High-impact focused people who struggle with moral demandingness, perfectionism, or imposter syndrome
  • People who feel anxious thinking about the end of the world
  • 80,000 Hours Podcast hosts with the initials LR

Who this episode isn’t for:

  • People who aren’t focused on having a big impact
  • People who don’t struggle with any mental health issues
  • Founders of Scientology with the initials LRH

Get this episode by subscribing to our podcast on the world’s most pressing problems and how to solve them: type ‘80,000 Hours’ into your podcasting app. Or read the transcript below.

Producer: Keiran Harris
Audio Engineering Lead: Ben Cordell
Technical editing: Dominic Armstrong
Content editing: Katy Moore, Luisa Rodriguez, and Keiran Harris
Transcriptions: Katy Moore

Gershwin – Rhapsody in Blue, original 1924 version” by Jason Weinberger is licensed under creative commons


What makes therapy more or less effective?

Hannah Boettcher: So broadly speaking, we have known for a long time, and it’s not controversial, that psychotherapy is efficacious and effective — so under control settings and less controlled settings. And in meta-analytic evidence, the effect size of psychotherapy is approximately 0.8 in comparison to no treatment — and that’s conventionally considered a large effect size. Another way to say this would be that in comparison to not getting therapy, getting therapy explains 14%ish of the outcomes in randomised controlled trials. 14% might not sound great, depending on what your priors are, but this is actually really good for healthcare: it’s on par with or better than effects of medications, both psychiatric and medically, and it’s superior to plenty of medical interventions that are considered effective.

Luisa Rodriguez: What do we know about how effective different types of therapy are? Are those compared in studies?

Hannah Boettcher: Yes, these are definitely compared head to head. And something that’s really interesting here is that specific treatment ingredients or therapeutic “modalities” are actually not strong predictors of better outcomes in psychotherapy.

Luisa Rodriguez: Right, this is a thing I’ve actually heard before, and it basically totally blew my mind. I don’t know where I got it, but I just really strongly had the impression that CBT, for example, was like a much more evidence-backed therapeutic approach than some others. So is it that any kind of therapy is just equally good, or is it that there are other things that explain variation in how helpful people find therapy?

Hannah Boettcher: Well, you’re definitely not alone in having that impression. Academic psychology and practicing clinicians don’t do a great job of communicating this idea that different modalities don’t predict better outcomes. And CBT is an example where there happens to be a tremendous literature on CBT being efficacious, but that’s not the same thing as saying that it’s better than all other modalities. So what’s going on here is that there are other factors that contribute more to outcome, basically, and they don’t seem tethered to exactly what modality is being done.

Luisa Rodriguez: Yeah. That’s wild. Can you say what those other factors are?

Hannah Boettcher: Yeah. Most of it is related to the therapeutic relationship. There’s the therapeutic alliance, which is like a sense of being collaborative and on the same team with your therapist. Empathy is huge here, a big predictor of outcome is the client perceiving their therapist as empathetic. Similarly, a sense of genuineness, trustworthiness, and engagement. And expectancy is really important too. So the client going in and thinking, “This has a chance of helping me,” and having a coherent story about how that might be the case.

Luisa Rodriguez: Right, OK. So it kind of sounds like: Do you like your therapist? Do you get on and trust them? Do they seem genuine and authentic to you? Do you feel like they care about you? And then do you think it could help you? Like, do you think it’s going to work?

Hannah Boettcher: And all of this cashes out in greater engagement and input and retention, where the client is sort of actively participating in their therapy.

Moral demandingness and slack

Hannah Boettcher: I think we have to acknowledge that we are under conditions where in fact there is not a fully satisfactory choice available: we’re in a universe where tradeoffs exist, we have finite resources, we have multiple things we care about, and we have incomplete information. So we have to make guesses and take risks — and that hurts. So I think self-compassion and acceptance come in here, like, “Damn, I so am wishing this were not the case, and by golly, it looks like it still is.” And then I think that it’s a matter of recognising that we aren’t going to score 100% on any unitary definition of “rightness.” And then recognise that, “Well, I could just look at that and stall out forever, or I could make some moves.” And probably making moves is preferable to stalling out.

Hannah Boettcher: This is a belief, actually, that I struggle with, that’s like: “If there is capacity left on the table, there has been a moral error.” I mean, it’s really quite a defensible position. The logic is like, “I do, in fact, wish to use resources for a purpose. Look, some unused ones: we should allocate them.”

Luisa Rodriguez: Yes. Concretely, I very much have this if it’s the end of a workday, and I have any more energy and I’m not totally spent, I could obviously do a bit more work. Or just money: like, if I have any savings, that feels wrong. And then what do we do?

Hannah Boettcher: Well, I think we have to get clear on two things that are true here alongside the very appealing philosophy proof. One is that following that rule positions you to be in a constant state of just barely OK, right? Like, every time you get a unit of mental health from the wellness factory and you’re like, “Immediately distribute to impact!” then you’re basically almost empty, or like a little bit in the red all of the time. And that’s just very risky and costly. It’s obviously painful, but it’s also going to put you at risk for burnout and for needing to take longer breaks to basically recover and care for yourself.

It’s also, in my view, needlessly painful as a matter of subjective wellbeing, to be in a constant insufficiency state. Every time you have a sense of ease, if you’re rehearsing, “There’s been a moral error,” this is just a terrible way to live as a matter of your own internal experience.

This is a hard one though. It feels so compelling. And the thing I remind myself of is that that feeling of compellingness is simply an incomplete description of what’s true. It does feel really compelling to use 100% of my capacity, and I do really feel that urge to allocate capacity whenever it shows up. But if and when I ever do this — which I do occasionally try versions of it — I end up feeling the effects, and it is not preferable. It’s almost like I have to tell myself, “You’re not well calibrated on this. You think that you want zero slack and ease, but you want an amount.”

Hannah Boettcher: So yeah, what’s the cost here? The cost is that I look at my calendar, and part of my mind is like, “You could do more. It kind of looks like you want to just have fun and chill.” And I kind of have to unhook from that thought, and just be like, “I see you. I see what you’re pointing at. You’re naming something that matters. And by the way, workability is also here.” So it’s an ongoing balance.

Self compassion

Luisa Rodriguez: I have to admit that I, for a long time, have just really bounced off the idea of self-compassion and off of compassion-focused therapy. It came up a number of times, and I kept being like, “No, I don’t want to do that.” My reaction to the idea of being more compassionate toward myself was like, that sounds like lowering my standards or letting myself off the hook or like some kind of over-the-top self-care that I don’t identify with. A little bit of like, “That sounds weak. I want to be strong.”

Hannah Boettcher: Yeah. That sounds like things I’ve heard inside my head and from clients before.

Luisa Rodriguez: OK, so it’s not just me. To some extent, I’ve made some progress on this. I don’t have those associations quite as strongly. But for listeners who do still have some of that, can you help us have a different framing?

Hannah Boettcher: Absolutely. The thing we’re aiming for is not “anything goes” or “my standards don’t matter.” The thing we’re aiming for is: No matter where I’ve set the standard, how can I show up for treating myself well and kindly and effectively along the way?

And let’s also be clear that self-compassion is actually useful. First of all, it’s justified. We’ve said this already: we are the sorts of creatures that suffer, and we suffer for reasons out of our control that we didn’t choose. In my view, that justifies compassion. But even separately from that, self-compassion works better than self-loathing and self-berating. When you’re in a constant state of self-criticism, this is kicking up additional suffering that you then have to metabolise. Whereas when you can relate as a matter of self-compassion, this actually enhances performance more than self-criticism does, and it makes for a better subjective experience.

Luisa Rodriguez: A better experience. Yeah, OK. That sounds totally right. Then I guess we’ve got to go all-in on self-compassion. Something more like: You are doing something super important, super brave, super valuable. Thank you for doing it.

Hannah Boettcher: Yes, yes. And you are materially creating a world where a lot of people are pushing toward impact, and that is worth being part of.

Why effective altruism can amplify imposter syndrome

Hannah Boettcher: I also think there are some cultural norms that are common in high-impact spaces that can amplify imposter syndrome a bit. So the sorts of questions that people are well-practiced asking about their projects — like: Where are the top problems? Which of these is neglected? How could we be doing better? If we’re doing things that aren’t a value add, we need to stop doing them — these sorts of questions that are useful for impact can easily start being applied to the self, where they pull for a deficit frame.

Then there’s also this sort of cultural norm or virtue around self-critique and humility. So if you’re complimented for your work, somebody in a high-impact space is probably going to be ready with an internal “Yeah, but…” Right? Because that’s a move that’s really well-practiced in these spaces.

Luisa Rodriguez: Totally. Just to dig in a bit more on a few of those things, some people are trying to do a lot of good, and some people are trying to do the most good they can — and in either case, maybe much more than is typical, we end up asking things like: Is what we’re doing good enough? Could we be doing more good? Do we have the right beliefs, or could we have the righter beliefs? Is this project that I’m working on going fine? How can I guess all the ways it could go wrong, so that it could go better?

And I guess it’s such an optimisation framing that ending up anywhere below optimal — which we don’t even know what optimal is, oftentimes, so it’s often pretty easy to tell a story where we are below optimal — then we’re setting ourselves up to feel inadequate, I guess.

Luisa Rodriguez: I think I both stand by the goal of trying to find ways to do better and to do more good. But how do you do that in a way that doesn’t also end up making you feel kind of chronically inadequate? Because you could always have done the project better or you could always be kind of reflecting more on your beliefs to make sure that you’ve got the right ideas about what the most pressing problems are or something.

Hannah Boettcher: I think we are aiming for a place where we can decouple the scorecard from our worthiness. So it’s of course the case that in trying to optimise the good, we will always be falling short, right? The question is how much, and in what ways are we not there yet? And if we then extrapolate that to how much and in what ways am I not enough, that’s where we run into trouble. And I think that we miss the fundamental difference between performance and worthiness, and that we want to keep that difference vivid.





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Sorted by Click to highlight new comments since:

We received the following response to a survey, and I think it is relevant, given the topic of this episode:


Re: my impact. It wouldn’t let me put in my answer: -$100000. I’d pay to undo my involvement in EA. 

Context for survey analyzers:
Andy, -------, Kyle, --- are great overall. I hear great things about them whenever I run into people who go to EA events, and they are warm and welcoming. I mostly see them at social events and I like them. I appreciate what you do for people and the causes you care about!

Gender: I’ve had no problems at EA events. I know of one woman who was hit on several times after meeting a guy at an EA event, didn’t like it, and wasn’t sure how to handle it. Organizers helped and he stopped hitting on her when he was asked to stop. From what I know, organizers handled it well. Good work.

My impact: (long answer)
My impact clearly went down as my involvement in EA went up.
I pretty desperately wish I could *pay* ~1/3 of my net worth to undo the negative consequences of my EA involvement, and go back to being productive and happy in a perfectly good career that is low impact by EA calculus. It was way better for me, EA friends and colleagues, and the world 
when I unabashedly loved my old job and was a happy, productive human. 

I first got involved via an EA DC reading group and a CEA fellowship in 2020. I read and talked to EA “bigwigs” a bunch around the world and was convinced by rational arguments and EA people that I was Needed in EA and it was The Right Thing To Do for someone with my rational+altruistic values, so I left my “low impact” career. That went badly. I was not productive, generous, or happy anymore and that lasted years. A lot of EAs I knew were suffering and still doing the work though, so I kept on. It got bad eventually and I tried to go back to my old career (working with kids), but I psychologically am not able to perform as well in my previous career either anymore. I have no other equivalent options. My planned lines of retreat if EA things failed (family support and going back to my old career) are not viable for unexpected reasons. I care a lot about career performance, so this has crashed my mental health and self-confidence and finances too.
My remaining options (much lower pay for more hours in a less interesting career) are clearly worse for professional and altruistic goals than what I was doing before, and may not even be possible. My life plans mostly went backwards.

I don’t want organizers to feel bad. I do want someone else to have a different experience. I was a rational person but I was not strong enough against rational arguments that I Was Needed In EA. I can instead point to ways that my head was convinced (via BOTECs, 80k, etc) to override clear data from my heart about what was not good for me personally to do. 

What would have helped instead:
- asking me and others about Agreeableness or Neuroticism and present strong counterarguments to EA thought for those of us who are high in one or both
- Ask me where else I’m already volunteering or donating and *encourage me* to keep doing that. At first, only ask me to work on EA projects without dropping any other things. See how that goes first. 
- Regularly present the counterargument to the EA approach of Maximizing Good at Scale via Your Career. Stop telling me I’m Needed in EA without first encouraging me to improve my current path a bit and see if that sticks. Find someone smart to be in regular conversation with new EAs and organizers who can remind people to *be patient*. Yes you may have short timelines, but I’m not ok with being collateral damage for the cause. Wait to see if people who contribute their time to other causes will *independently* choose to work on EA projects in a way that seems better for their life overall, before asking them to stop contributing time elsewhere to give to EA. 
- Practice humility and gratitude aloud and often for people who keep the world running outside of EA. I’m really glad EAs are trying to keep it all from disappearing, but we do still need a bunch of other people who are keeping civilization running in the meantime. It’s a collaboration. Say that kind of thing aloud often to balance out this sort of thing — 
- I overheard an AI-related EA organizer once say, “That would be stupid!” because someone suggested they should stop working unproductively on EA projects that were also making them miserable. Afaik, that was years ago and they are still unproductive and miserable. I heard another well-liked EA say to a friend who was considering a great non-EA job, “That’s nice, but what does that have to do with saving the world?” 
I get where comes from but it’s not smart or healthy. People are different; they should not all do EA things. 

Many EA organizers seem convinced that what worked well for them will work for others, and that anyone smart and interested in EA who is uncertain or unsatisfied with their current career should be nudged or pulled into an impact-oriented career (impact according to EA definitions). ‘The potential stress will be worth it!”

This is wrong. With some people (like me!) it is Bad for the world when we leave our existing careers.

I wish we told people this earlier and often:
When people are bored or unsatisfied with their job or the scope of their impact, that’s not necessarily a sign that EA will be better for them.

Boredom and frustration and inefficiency are part of a lot adult jobs, even EA jobs! It’s part of adulthood for most people to be bored and annoyed with the limited impact of their work sometimes, and when EAs are allergic to that fact, it’s at least partly a negative symptom of being a youth movement. It doesn’t always go deeper than that. 

I admire people who shoulder ‘boredom for a cause.’ I admire and am thankful for people who make that cause “being able to care of and support myself and my family, plus maybe a few other people.”
It takes a lot of work to get to that point and sustain it for a lot of people in today’s economy. I’m thankful to people who find ways to give within work, and then ‘do more’ to give back outside of work after they’re professionally stable. They often have accumulated wisdom and slack in their life that I no longer have, which they can share with others. 

I was seriously an all-around better person with a better life before I chose to prioritize EA goals over my other goals. That may be true for others too. 
No one wanted it to turn out that way. But it did. 

While EA orgs and work in EA cause areas sometimes are really cool, and it’s satisfying to choose problems to work on carefully and to be around lots of motivated people. But a lot of those orgs are also young and inexperienced still testing out healthy workplace culture and trying to do too many things. EA org staff are busy and their analysis of their impact is often not actually much deeper than a BOTEC and a prayer. I want people to learn that EA work is not necessarily Better or worth the sacrifice, even by EA metrics!

For many people, the Best Career Answer, the Most Good answer for them and for the world is for them to stay excited about the ways they can find satisfaction with the impacts they can have on colleagues and customers in their current career, set some clear professional and personal goals, gain skills to incrementally increase efficacy at work, draw self-esteem from being an ethical and reliable adult professional with interesting/useful hobbies, and increase the sources of satisfaction they have outside of work, including via donating or volunteering for things related to their areas of expertise.

This is not the sexy, prestigious, most ambitious answer that most EAs want for themselves. That’s ok, some EA-sympathetic people should go against the grain and truly decide for themselves what is Good for them. Healthy and smart EAs really really hope people will do that. People need to see and hear this message.

“EA Lite” (having a bit more impact wherever you are) has some good tools for thinking about work satisfaction. God, I’d be excited for the future of EA thinkers if there was at least one prominent, funded, ex-EA or EA-adjacent advocate who was working a “regular job” and creating content in the EA Lite vein for prospective and flailing EAs who really need to consider this line of thought for themselves. 

For example, in Intro to EA Career content, get successful EA-adjacent people with “regular jobs” to regularly and persuasively argue that “EA says it’s rational to maximize how much good your job does. Conventional wisdom is not that. It may go badly for you to try to do that. Really consider conventional wisdom before you discard it. Conventional wisdom and data on life satisfaction data that jobs can be just stable jobs that support your goals, and Good Careers can take lots of forms.”…. Get someone successful who actually believes this to say it. 

*Then* get someone successful who believes 80K stuff to present that. 

Lastly, I know EAs are not going to evangelize fewer career changes. “Plan changes” are incentivized as a measure of impact and most EAs believe that what they believe is Good. But my plans changed and it was bad. How is that counted? I wanted that to be counted in this survey. It’s a number that should be credited to CEA and 80K too really, not solely EA DC. It was CEA fellowships, 80K, EA reading groups, and EAG(x)s as much as DC EA that got to me.

I am pretty [expletive] up now but I hope others figure out how to be less so. 

Whoever reads this has permission to publish it in whole or in part somewhere.

Thanks so much for sharing this. It’s really heartbreaking to hear that someone’s encounter with the community was so painful and costly. I can relate to EA making my life worse in some ways, though I’m fortunate to have found a way to keep EA in my life in a way that’s healthier now. I’m trying to do more to support people who struggle with similar experiences, in part by doing things like the interview in this post.

80k does have some articles on the site that we think could be helpful to people in a similar position to the person who wrote that response. We address issues like how you can have an impact in any job, why personal fit for your career is so important, and why we think it’s helpful to not treat impartial impact as the only goal in life (a bunch of related ideas here, here, and here). But I’d love to find ways to do more to make sure the people who need to hear those messages are actually exposed to them — it’s clearly the case that some people’s experiences in the EA community, and the pressure they feel to have an impact, can be really dispiriting (again, this has definitely been the case for me). I’ll continue to look for opportunities to talk about these things on the podcast, but if people have other ideas for how to support people with these kinds of experiences, I’d love to hear them (and I know my colleagues would as well).

Hi Louisa - when you have a minute, could you edit your comment to add links to the 80k articles that address these issues? It'd be an easy step towards connecting those messages with the people who could benefit from them (and who may well be inclined to read this particular Forum post and comments).

Thank you!

Good point! Added a few!

This is really strong, and I think the practical takeaways are pretty good. Kyle, maybe you want to publish this (or only their "impact" section) as a full-on post? 

That was sad to read :(

Kind of nerdy point, but I think the 0.8 effect size is likely inflated. A recent analysis of the meta-analyses on psychotherapy for depression found that the average summary effect size for meta-analyses was 0.56. 

There seemed to be evidence for publication bias:

Meta-analyses that excluded high risk of bias studies, mean g=0.61, 95% CI (0.27, 0.95) with k=2413 included samples, produced larger effect size estimates than meta-analyses including only low risk of bias studies, mean g=0.45, 95% CI (0.19, 0.72) with k=1034.

Also, many studies used improper controls:

Meta-analyses that included samples compared with a wait-list control group, mean g=0.66, 95% CI (0.35, 0.96) with k=836, produced larger effect size estimates than treatments compared with care-as-usual, mean g=0.52, 95% CI (0.22, 0.82) with k=1194.

This analysis was specifically on therapy for depression, but I would expect the main criticisms/reasons for effect size inflation would apply to other mental health problems as well. FWIW, therapy for anxiety seems to have larger effect sizes than therapy for depression, so I would expect better performance on anxiety even when taking into account possible publication bias and inadequate controls. 

It might be worth introducing Hannah at the start of the post. It's likely that many prospective users don't know who she is.

Who this episode is for: [...]

  • 80,000 Hours Podcast hosts with the initials LR

Who this episode isn’t for: [...]

  • Founders of Scientology with the initials LRH


I laughed out loud at this, incredible xD (Excited to listen to this!!!)

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