Dr. Levy's CBT Blog
Insights on Well-Being, Contentment, and Cognitive Behavioral Therapy
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:
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:
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:
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:
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.
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.
In TEAM-CBT, when patients are looking to improve their interpersonal relationships, we first spend some time analyzing the nature of the conflict that they're facing before jumping in to solve it. Even though there are as many different flavors of interpersonal conflict as there are people in the planet, if we look closer, we can find a few broad patterns of common relationship concerns.
If you are having problems with someone close to you (romantic partner, family member, boss, co-worker, etc), odds are that the issue will fall into one of these three categories:
1- Character Issues: they don't see themselves!
These are problems where you firmly believe that the person with whom you are in conflict is just flawed. They may be self-centered, dumb, histrionic, unfair, needy, controlling, unreasonable...and a lot more! For example:
"He is mean and stubborn!"
2- Appreciation Issues: they don't see me!
These are problems where you feel under-appreciated in the relationship. You firmly believe that the person with whom you are in conflict doesn't see you for everything that you do. They may frequently criticize, blame, disrespect, ignore, or belittle you. All said, they either don't value you, don't value your needs, or don't value the relationship. For example:
"They never recognize how much I do for them!"
3- Give-and-take issues: they don't see us!
These are problems where you find a fundamental imbalance in the relationship in terms of the give-and-take. It can be that the other party just doesn't listen, no matter how hard you try to communicate with them. Or they just don't share, regardless of your valiant efforts to engage them. Or it can be that they don't reciprocate when you do something nice for the relationship. For example:
"They ignore my advice!"
There are naturally many other ways of thinking about interpersonal issues. This is just one of them. But the goal here is to recognize that the first step in solving a problem is defining it! If you are suffering because the relationships in your life are not intimate, respectful, and fulfilling, cognitive-behavioral therapy can help.
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.