Live at EA Global - The future of U.S. foreign aid (with Dean Karlan)

1. Balance Acceptance & Change

Actively assess situations by asking what you can change and what you must accept, as much of everyday suffering comes from trying to change the unchangeable or failing to change what’s possible. This dialectical approach helps you get unstuck and reduce misery by effectively responding to problems.

2. Prioritize Evidence-Based Therapy

If therapy doesn’t work, don’t conclude it’s ineffective for you; instead, question if your therapist is using evidence-based approaches and has high-quality training. Many people don’t receive quality therapy, and manualized treatments are generally more effective for mental health problems.

3. Practice Radical Acceptance

Completely and totally accept the present moment or situation exactly as it is, recognizing that it could not be any other way. This reduces suffering by distinguishing it from inevitable pain, as suffering often arises from resisting reality or trying to change what cannot be controlled.

4. Validate Others Effectively

Communicate understanding and acknowledgment of another person’s thoughts, feelings, and behaviors, especially in challenging interpersonal situations. When people feel understood, they are more likely to engage in conversation and collaborate, leading to more effective outcomes.

5. Practice Self-Validation

When experiencing difficult emotions, tell yourself, ‘It makes sense that I feel this way,’ instead of using ‘should’ statements like ‘I shouldn’t be so upset.’ This fosters self-understanding and can lead to self-compassion, opening up possibilities for new perspectives.

6. Plan Difficult Conversations

Before engaging in challenging interpersonal interactions, use a structured approach like the ‘DEAR MAN’ skill to plan your communication. This preparation helps you think through how to be most effective, reduces impulsivity, and increases the likelihood of achieving your goals.

7. Embrace Dialectical Thinking

Strive to see things as more complex than just right or wrong, incorporating other aspects of what’s happening to have a non-judgmental interpretation of situations. This critical thinking skill helps you move beyond black-and-white thinking and recognize multiple truths.

8. Seek Solutions for All Problems

Adopt a problem-solving mentality, believing there are always different ways to respond to a situation, even if the core problem cannot be entirely eliminated. This empowers you to suffer less by finding healthier ways to process and react to challenges.

9. Embed Evidence in Aid Strategy

Integrate evidence and cost-effectiveness thinking from the very beginning of strategy, rather than as an afterthought in evaluation. This ensures that aid programs are based on what’s most effective for addressing problems and guides where new evidence needs to be produced.

10. Center Partner Governments in Aid

Emphasize strengthening partner governments and their delivery of services and policies in foreign aid initiatives. This approach is absolutely critical for the long-run development of countries and helps integrate learning into their own delivery processes.

11. Choose Manualized Therapy

For greater mental health problems like depression and anxiety, seek manualized treatments that have standardized protocols and have been studied for effectiveness. These treatments are generally more effective than non-specific therapy.

12. Look for CBT Homework & Goals

If pursuing Cognitive Behavioral Therapy (CBT), ensure your therapist assigns homework and works with you to establish clear goals that are consistently revisited. Homework is an integral part of CBT, and clear goals ensure focused, effective treatment.

13. Consider DBT for Emotion Control

If you struggle with strong emotions or feel a lack of control over them (emotion dysregulation), Dialectical Behavioral Therapy (DBT) may be a more suitable starting point than CBT. DBT is a skills-deficit model designed to teach people how to manage emotions and respond differently.

14. Understand Therapy’s Lasting Impact

Recognize that therapy teaches people tools to change how they behave and respond, leading to longer-lasting effects even after treatment stops. In contrast, medication effects often cease when discontinued because it doesn’t impart new skills.

15. Prioritize Bipartisan Aid Programs

When rebuilding an aid agency, identify and protect a core set of programs that have common, bipartisan agreement. This ensures continuity and support for essential initiatives, focusing on shared public interest rather than political division.

16. Seize Systemic Change Opportunities

Recognize that moments of disruption or a ‘blank slate’ offer a critical opportunity to implement long-term, evidence-based changes in large organizations or systems. Invest in systemic improvements now to have a lasting impact in the future.

17. Use Cost-Effectiveness Thinking

When evidence is lacking for big decisions, apply cost-effectiveness thinking by outlining a theory of change (a chain of events) and estimating the magnitude of each step. This provides a reality test for whether an idea is likely to pay off and guides resource allocation.

18. Fund Local Innovation in Aid

Help fund innovation and tests in partner countries to assist their governments in integrating evidence-based thinking into policy design. This strengthens local capacity and promotes effective, context-specific solutions for development.

19. Improve Evidence Synthesis

Address the gap between academic research and practical application by working hard on meta-analysis, synthesis, and mapping research lessons to actual procurement needs. This ensures that the vast amount of evidence produced effectively informs and improves aid programs.

20. Avoid “Expert-in-Everything” Therapists

Be cautious of therapists who list many different types of therapies, especially those with conflicting approaches like cognitive behavioral and psychoanalytic therapy. This can be a red flag, suggesting a scattered approach that may not lead to effective, comprehensive change.

21. Recognize Therapy’s Common Factors

Understand that empathy, listening, validation, and a strong therapeutic alliance (the relationship between therapist and client) are common factors necessary for therapy to be helpful. These form a foundation, though more severe problems often require specific, manualized treatments.

22. Be Aware of Therapy’s Challenges

Recognize that therapy can bring up painful memories, experiences, or shame, and engaging in new behaviors is a challenging, non-linear process. These ‘side effects’ are an inherent part of the therapeutic journey towards change and growth.

23. Avoid Transactional Foreign Aid

Do not approach foreign aid in a purely transactional way, such as exchanging aid for mining rights, as this undermines the relationship with partner countries. Such an approach yields only what is negotiated and is detrimental to long-term development.