Dr. Levy's CBT Blog
Insights on Well-Being, Contentment, and Cognitive Behavioral Therapy
Before starting therapy, clients often wonder "How long will I be in therapy?" This funny video from The Onion provides a clever satire of the open-ended, long-term model of therapy that is often portrayed by the popular media:
Cognitive behavioral therapy (CBT) tends to operate within a much more short-term, focused model of psychological intervention that aims to reduce current symptoms, address specific problems, and build skills that the client can take with him/her after treatment ends. Hence, treatment length is usually measured in weeks or months, rather than years or decades.
Indeed, there is ample research evidence that response to psychotherapy follows a 'negatively accelerated' curve where more and more effort is required to achieve smaller and smaller changes (that is called a log-normal curve for the math geeks out there). Dr. Ken Howard was the first to analyze this correlation and posit markers for response to psychotherapy according to dosage. Here is his original article.
The original dose-effect study was run in 1986, based on psychodynamic or interpersonal treatment only, with the following findings:
* About 15% of patients improve before the first session of therapy
* 50% of patients typically improve at 8 sessions
* 75% of patients typically improve at 26 sessions
* 85% of patients typically improve at 52 sessions
It is possible that modern psychological techniques have accelerated that theoretical curve in the past 30 years. In practice, however, there are many factors influencing the right dose of psychotherapy for each client, including diagnosis, acuity, readiness to change, social circumstances, and frequency of treatment (more regular treatment is shown to be more effective). But what we can glean from the data above is that longer and longer treatment periods may indeed offer diminishing gains at increasing levels of effort.
With CBT, you and your therapist will have powerful tools for change readily available. The specific length of psychotherapy treatment will vary for each person and each presenting problem. But with commitment and focus in the context of a true partnership, CBT can lead to fast and meaningful change.
Dr. David Burns is a world renowned psychiatrist and one of the pioneers in the development of Cognitive Behavioral Therapy. In the past decades, Dr. Burns has been focusing on advancing the clinical applications of CBT through a new therapeutic approach that he calls TEAM-CBT. You can read more about the elements of TEAM-CBT in one of my early blog posts or on Dr. Burns website.
TEAM-CBT is a framework for delivering evidence-based interventions in psychotherapy (and evidence-based here means techniques that have been corroborated as effective by rigorous scientific research). It combines Routine Outcome Monitoring, Motivational Enhancement, and CBT Methods with a strong focus on empathy and rapport building to deliver meaningful symptom reduction in fast periods of time. Indeed, in his current clinical work, which revolves mostly around training of therapists and professional workshops, Dr. Burns has, on many occasions, observed that individuals who had been struggling with depression or anxiety for years can experience near complete recovery in just a few hours.
To explain how that can happen, and provide more background and perspective on the TEAM-CBT approach, Dr. Burns was interviewed by one of our colleagues, Lisa Kelley. The transcript of the interview is an excellent primer to learn more about this powerful new modality. Here it is:
As a Level 4 Certified TEAM-CBT trainer and therapist, I would be delighted to help you learn more about these tools to to enhance your life or, if you are a health care provider, to revolutionize your clinical practice!
As we go through our busy days, we are asked to form spur-of-the-moment opinions about the events around us. Someone says hi? [They want something from me!] Someone fails to say hi? [I have done something to offend them!] Car doesn't start? [This always happens to me!] Late for work? [The world is conspiring against me!]. We all have these scripts inside our heads that help us evaluate things that happen in our lives quickly and efficiently. Unfortunately, always accurately.
In the process of coming up with these quick appraisals of events happening in our lives, we often take 'shortcuts' that we hope make the evaluation process quicker. It might. But the shortcuts often take us in directions that are not helpful.
In cognitive psychology, we have grouped these unhelpful shortcuts in categories with labels that describe each one of them. They are called Cognitive Distortions. Dr. David Burns describes them as follows:
1. All-or-nothing thinking (also known as 'black and white thinking'): You look at things in absolute, black-and-white categories, e.g. "I never do anything right!" (seriously, never ever??)
2. Overgeneralization: You view a negative event as a never-ending pattern of defeat, e.g. "I can't make anyone happy" (when you have a fight with your boyfriend, without remembering how much you mean to your best friend!)
3. Mental filter: You dwell on the negatives and ignore the positives, e.g. "I am really bad at sports" (you lose a soccer game, and forget how good you are at indoor cycling).
4. Discounting the positives: You insist that your accomplishments or positive qualities don’t count, e.g. "My good grade in this test was a stroke of luck" (after studying two days for it!).
5. Jumping to conclusions: You jump to conclusions not warranted by facts. These include mind-reading (assuming that people are reacting negatively to you) and fortune-telling (predicting that things will turn out badly), e.g. "She doesn't like me" or "I know I will not get this job."
6. Magnification or minimization: You blow things way out of proportion or you shrink their importance, e.g., "This is the only important interview I will ever have."
7. Emotional reasoning: You reason from how you feel: “I feel like an idiot, so I must be one.”
8. “Should” statements: You criticize yourself or other people with “shoulds,” “shouldn’ts,” “musts,” “oughts,” and “have-tos,” e.g., "my life should be way more exciting!"
9. Labeling: You give yourself a label on the forehead. E.g., instead of saying, “I made a mistake,” you tell yourself, “I’m a jerk” or “I’m a loser.”
10. Blame: You blame yourself for something you weren’t entirely responsible for, or you blame other people and overlook ways that you contributed to a problem, e.g., "I am a bad teacher" (when you forget how difficult your students are...) or "They are bad students" (when you fail to analyze your teaching skills beforehand).
We all make these thinking errors on a daily basis. At times, they can go unnoticed. More often, they will lead to feelings of sadness, anger, hopelessness, anxiety and more. The good news is that, with practice, it is easy to identify these distortions and learn how to fix them. Cognitive therapy is just the answer if you are looking to lear more about your thought patterns and how to change them.
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.
Dr. Daniele Levy is a licensed psychologist offering CBT therapy in Menlo Park, CA. Her background uniquely combines leading edge training in behavioral sciences with deep expertise coaching and mentoring working professionals in dynamic organizations.