Tips, Ideas & Recommendations in CBT Treatment

TEAM-CBT is a framework for providing evidence based psychotherapy. It was developed by Dr. David Burns, MD, Adjunct Emeritus Professor at Stanford School of Medicine. 

What is Evidence-Based Practice in Psychotherapy?
Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences.  It leverages evidence-based treatments. This designation describes specific clinical interventions that have been validated as efficacious for certain mental health conditions under rigorous academic research. Many cognitive and behavioral interventions (e.g., thought re-structuring, exposure therapy) are recognized by the American Psychological Association as evidence-based treatments.

What is CBT?
​Cognitive Behavioral Therapy is a type of evidence-based treament. It examines our thoughts processes - our idiosyncratic way of seeing the world around us -, our typical behaviors or actions, and our emotions in defined moments in our lives. It then providers actionable, well-defined, and simple ways of modifying thoughts and behaviors, with the ultimate goal of changing our feelings - for the better. It is focused on the here and now and aims to deliver symptom reduction in a fast but sustainable way.

What is TEAM-CBT?
TEAM, as mentioned above, is a framework for compiling cognitive and behavioral therapy interventions and delivering them through powerful, results-driven psychotherapy. TEAM stands for four key elements in this therapeutic approach:

T = Testing
In this type of therapy, clients are asked to gauge their level of distress and life satisfaction on a regular basis. Looking at metrics over time, the client and therapist can then determine whether their work together is helping the patient objectively improve their well-being.

E = Empathy
Before the more active part of the therapy begins, it is imperative that the therapist and the client be on the same page. TEAM-CBT offers specific techniques for increasing openness, authenticity, and vulnerability in the therapy sessions.

A = Agenda Setting
This is where TEAM combines evidence-based practices of traditional CBT with elements of Motivational Interviewing, a therapeutic method that works on facilitating and enhancing intrinsic motivation within the client in order to change behavior. The client and the therapist develop a shared agenda for the overall work and for each session where the client is effectively arguing for change - and thus melting away the psychological resistance to upset the status quo. 

M = Methods
TEAM brings together over 50 cognitive and behavioral methods for change, from traditional thought analysis and behavior experiments to innovative role playing techniques, compassion-based techniques, communication training, and much more. For each angle of unhelpful thought processes, TEAM has a number of powerful techniques that can help the client find more constructive alternatives.

The goal of TEAM therapy is to help the client, over time, become their own therapist. For individuals motivated to change their lives, it can lead to meaningful gains in happiness, peace, fulfillment, and contentment in short periods of time. 

To lear more about TEAM therapy, visit Dr. Burns's Feeling Good website or call me for a free phone consultation. 

If you are dealing with many stressors in your life and feeling overwhelmed from time to time, you may have come across a suggestion to start a 'mindfulness' practice. First of all, what is mindfulness? It is a concept describing a state where we pay full attention to the present moment. We don't obsess about the past, we don't worry about the future, we are just focused on the present, in the here and now.  Even further, we try to clear our mind of thoughts and activity for stretches of time when we can just 'be' rather than 'do.' We observe our internal experiences without judging them or trying to change them. Many people achieve this state of mindfulness through meditation.

As I've mentioned recently, there are many confirmed benefits of regular meditation or mindfulness practice. If you want to get started yourself, here are a few pointers:

• Find a quiet space where you won’t be distracted.
• Sit down however you want, as long as it’s comfortable (but don’t get too comfortable and fall asleep!). 
• Set a time goal on your watch or phone so you don't have to worry about checking the time as you go. You can begin with three or five minutes at first and then gradually go longer if you wish. If don't, that's ok too: any amount of time spent meditating will still have a positive impact.
• Close your eyes and direct your full attention to your breath. Notice sensations tied to it and the air goes in and out of your body.
• If your mind wanders, just come back to your breath. Observe your thoughts, feelings, and any sensations without doing anything about it. Observe your thoughts like leaves floating down a stream. No matter where your mind goes, just notice it and come back to your breath and the present moment. 

The more you practice the easier it will get. Just notice your sensations, come back to your breath, and enjoy!  And if you don't want to do all of this on your own, I recommend checking out the Google Play or App Store for popular apps such as Insight Timer, Breathe, and Headspace. 

Dr. Aaron Beck was one of the pioneers in developing the theory and applications behind Cognitive Therapy for the treatment of clinical depression. In Dr. Beck's views, depression does not stem from a 'chemical imbalance in the brain." Instead, it stems from an imbalance in our way of thinking. When someone is depressed, there are usually three common themes to the content of their thoughts:

• Negative View of Self: "I suck..."
• Negative View of the World: "The world sucks..."
• Negative View of the Future: "And it is never going to get better!"

He called these ways of thinking the "depressive triad." Depressed individuals often feel a loss of interest in things that were previously pleasurable or important to them and function at lower levels compared to their former selves. They can also experience noticeable changes in levels of energy, appetite, sleep, and ability to concentrate, while having thoughts of low self-worth, guilt, and, in more extreme cases, suicide. Here is a full list of symptoms of depression as defined by the American Psychiatric Association.. 

In Cognitive Therapy, client and therapist will partner up to identify common thought patterns for the client that relate to their depression. They can then analyze those patterns together, with openness and curiosity, to see what is 'off' about them. With close collaboration and powerful therapeutic techniques such as those in TEAM-CBT, the "depressive triad" can be annihilated.
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Everyone has a sleepless night every now and then. What we do - and don't do - during the day, how we eat, what we drink, how much we exercise, our environment, our mental health, and how much stress vs. pleasurable activities we have in a typical day all influence the quality of our sleep. When insomnia hits for a night or two, it is easy to catch up. But when it becomes a chronic issue, it needs to be addressed before your health starts to suffer. One of the most effective and widely recommended treatments for insomnia is cognitive behavioral therapy (CBT).

There are two models of understanding and treating insomnia in CBT. The first approaches insomnia as the main focus of treatment. It starts by addressing behavioral modification, i.e., how long you stay in bed, and then moves on to address your beliefs about sleep. This line of treatment is often referred to as CBT-I, or cognitive-behavioral therapy for insomnia. CBT-I is shown to work better than sleeping pills, with no side effects! There are several self-help apps and websites for CBT-I. Personally, I recommend cbtforinsomnia.com, a five-week online intervention with some clinical oversight.

A second model of looking at insomnia is to view it as a symptom of another, bigger emotional health problem. Often times, insomnia is a consequence of depression or anxiety. For example, patients with excessive anxiety and worry may have trouble falling asleep as their mind starts racing - worrying about tomorrow's to-dos or ruminating about past events - the minute they lay their heads on the pillow. In this case, treating the underlying disorder (anxiety) with an approach such as TEAM-CBT will lead to the insomnia resolving itself short-term.

In either case, a well trained CBT therapist may be able to guide you on your path to a good night of restful sleep!

With marijuana being recently legalized in California, questions about its positive and negative effects on health overall and mental health in particular have intensified. There is an appropriate amount of debate around it and a growing body of investigative research attempting to arrive at conclusive findings. But in short, we really don't know yet. 

My overall take on the state of the literature is that, like with any other foreign substance that you are introducing into your body, avoid or limit it if you can. However, compared to other drugs that are commonly abused - and particularly alcohol - marijuana has a lower profile of long-term damage and side effects.

The article below does a good job of listing areas of interest in the research of clinical uses of marijuana and where we are in our understanding of them. For example, while we all know that marijuana's THC can have a 'feel good' effect on the brain, it also elevates heart rate and impacts coordination and balance. Cannabidiol (CBD) has been demonstrated to help in pain managemen, but marijuana can also affect memory, mood, and potentially activate  schizophrenic symptoms in those prone to the condition.

https://www.healthiguide.com/health/what-marijuana-really-does-to-your-body-brain/

If you are considering or actively using marijuana for mental health concerns, I suggest discussing it with your doctor to investigate any potential physical health risks and with a therapist to learn additional or alternative ways to manage your pain or mood.

All said, natural, healthy, and drug-free solutions are always best!
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When I worked in Marketing early in my career, one of my PR colleagues used to say "if 4 out of 5 dentists recommend Crest toothpaste, the only one that has something interesting to say is #5!". I often think about that as I am drawn to better understand dissenting views on any given topic. Interpersonal relations and couple's therapy is a complex topic where there are some majority opinions and a few interesting ones that go against the grain. Dr. David Burns, one of the pioneers of cognitive behavioral therapy and mastermind of the T.E.A.M. approach to CBT - and my personal mentor and hero! - has some radically different ideas of why we all have some troubled relationships in our life.  

In one of his podcasts, Dr. Burns discusses the prevailing views of why people in close relationships may not get along. Those include theories addressing i) lack of skills, ii) barriers, and iii) self-esteem. In the first one, authors postulate that we all want loving relationships, we just need to learn better communication skills such as assertiveness or non-violent communication to get there. The barriers theory posits that there are just innate barriers to intimacy such as childhood trauma or different cognitive processing approaches between men and women. Finally, the self-esteem angle demands that you love yourself first, before you can love someone else.

All of these approaches make sense and have some validity behind them. But they don't tell the full story. The missing link is "motivation."  Sometimes, we have the skills and the self-esteem and there are no great barriers, but we still don't want to get close to the other person...until they change first! The reality is, if they were looking to change, they probably would already have. If we are the ones looking for a new dynamic in an old relationship, it is up to us to take the first step to change the existing patterns of interaction. We can do that by providing empathy, using assertiveness, and demonstrating respect regardless of how the other person is behaving.

How to do that? Dr. Burns has a great book on the topic called "Felling Good Together." I recommend starting by reading the book. And if you still think you can benefit from professional help, find a therapist who can help you increase your motivation and put all of those skills and self-esteem to good use!

Mindfulness is "in" these days across health care and business settings. But beyond being cool, does it work? Or better, what is it good for? Always on top of popular trends, the Harvard Business Review published an essay recently by renowned author and psychologist, Dr. Daniel Goleman. In it, Dr. Goleman reviews the scientific literature about the positive effects of mindfulness and draws conclusions about the areas where enough data is available to support its benefits.

According to this analysis of the research, there are four areas where meditation and mindfulness practices lead to better performance and outcomes, as follows:

1. Stronger focus, greater concentration, and less distractibility
2. Calm under stress or lower emotional arousal in the face of potentially difficult situations
3. Better working memory to help with short-term processing and data analysis
4. A kinder attitude 

Altogether, the research indeed corroborates that living a more mindful, present-focused life can enhance mental fitness and wellbeing. If you are interested in starting a mindfulness practice, I recommend checking out the Google Play or App Store for popular apps such as Insight Timer, Breathe, and Headspace. A licensed mental health provider can also help you learn how to use mindfulness to better your mood, change your thought processes, and embrace more helpful everyday behaviors. 

Life can be hard at times. For many of us, hardship comes in the form of a traumatic event that takes place unexpectedly. This could be the abrupt loss of a loved one, a violent assault, chronic abuse, a serious injury, or a car accident, for example. When faced with a dangerous situation, our bodies react automatically by activating the fight-or-flight response. That's usually helpful: it quickly gets us ready to deal with a threatening stimuli and mobilizes our resources to succeed in that endeavor. When things go according to plan, once the threat is neutralized, we go back to baseline and life moves on, hopefully in more positive directions. Unfortunately, in about 1 in every 3 cases, we don't really get back to baseline. We get stuck in the stress of that moment, unable to cope with it.

When this high level of post-traumatic stress lasts for a while (for more than a month), there is a possibility that the set of symptoms experienced qualifies for a diagnosis of Post-Traumatic Stress Disorder (PTSD). According to the DSM-5, the manual used to label and categorize mental health illnesses, the following are conditions necessary for a diagnosis of PTSD:

1. Exposure to trauma, e.g., threat of death or injury.
2. Intrusive memories, flashbacks, repetitive dreams, psychological distress, or physical distress at reminders of the event.
3. Avoidance behaviors such as trying not to think about the trauma or avoiding places that remind you of it.
4. Negative alterations in thought and mood, e.g., amnesia, negative beliefs, distorted views of the world, lack of interest, detachment, estrangement from others, inability to experience positive emotions.
5. Excessive arousal, e.g. irritability, angry outbursts, reckless behavior, hypervigilance, exaggerated startle response, difficulty concentrating, insomnia.

If you have yourself suffered a traumatic event and are struggling with any of the symptoms above, psychotherapy can help. Indeed, talk therapy is considered the most effective first line of treatment for PTSD and several psychological interventions have been tested and proven very effective for diverse patient populations.

To learn more about the different modalities of PTSD treatment, visit the National Center for PTSD from the VA Administration. And call a therapist.

Those of us who are lucky enough to be able-bodied and perfectly capable of putting one foot in front of the other should be walking at least 30 minutes a day, 5 days a week. Why? Because walking brings enormous benefits for our health, both physically and mentally.

​This article from Fresh Daily Health details several ways in which walking can help us lead healthier lives. Benefits of regular walks include:

• Prevents muscle atrophy
• Improves blood circulation
• Builds muscle
• Builds stronger bones
• Lowers risk of several diseases such as heart conditions, cancer and diabetes
• Leads to weight loss
• Prevents dementia
• Boosts Vitamin D levels
• Increases energy levels
• Extends life span
• Boosts mental health

On this last point, it is worth highlighting that walking can help reduce stress, ease anxiety, and combat that nagging desire to do nothing that comes with a clinically significant depression. So, if you can find a few breaks on your calendar daily, even if it is just 10 to 15 minutes two or three times a day, get out there and start putting one foot in front of the other! Your body will thank you.

When presented with important choices in their lives, clients often ask me "Is this the right choice?...Is this OK?..." The clear answer for that is "It depends!!!". What is right for your life obviously hinges on your personal values, dreams, and aspirations. While no one can give you answers on what to aim for, we can suggest parameters to consider when weighing your choices and making important (or even everyday...) decisions.

A "great life," however it looks like for you, should maximize your ratings and satisfaction across the dimensions below:

• Purpose: Finding meaning and enjoyment on what you do every day
• Social: Having important relationships and love in your life
• Financial: Managing your economic life to reduce stress and increase security
• Community: Being engaged and involved with the areas where you live and work
• Physical: Having good health and energy to get things done daily

​In short, choices that increase your purpose in life; social, financial, and physical well-being; or community belonging are likely "right" and definitely "OK." Sometimes we move along these axes in unison, other times we need to make trade-offs among them. But those are the key ingredients in a great life for everyone of us. How you mix them up to create your own unique recipe, it's up to you.