Archive for CBT

Sep
19

What is CBT Anyway?

by Laura Johnson

Cognitive Behavior Therapy 101

Often in our initial assessment appointment, a new client will ask “so what is Cognitive Behavior Therapy anyway?” Most people have read some about the disorder they are seeking help for and know that CBT is the treatment of choice, but CBT itself can be a mystery.

The CBT Viewpoint

In order to understand what CBT treatment is like, you first need to understand how CBT views problems like anxiety, depression and OCD. There are four parts: the triggering thought or situation, unhelpful or inaccurate thoughts about that situation, negative emotions, and maladaptive coping strategies. Here is the cycle illustrated with two examples:

Maladaptive coping strategies don’t work because they only relieve your negative feelings in the short term and keep you from learning anything new about the triggering situations. These behaviors end up reinforcing your unhelpful thoughts and the cycle continues.

CBT Strategies

Once you understand how CBT view problems, and apply it to the difficulties in your own life, you are ready to look for solutions. There are skills that can help you in each stage of the CBT cycle. No one strategy will work for everyone, but once you acquire some that work for you, you can start to unhook yourself from the cycle and new, healthier patterns develop.

* For the triggering thought or situation we teach mindfulness skills. Here the important thing to do is learn to notice your triggers in an objective non-judgmental way. For example, in the case above of the person having anxiety about giving a speech, we might teach her to notice when the thoughts and feelings creep up and say things like “I’m noticing more worries about this speech”. The key with mindfulness is to notice your symptoms without trying to change them. This nonjudgmental perspective sets the stage for the strategies that come next.

** Next comes cognitive restructuring. Our thoughts have strong effects on how we feel but just because we think something, doesn’t make it true. Cognitive restructuring involves learning to evaluate our thoughts for accuracy and helpfulness and, when we find a thought that is inaccurate or unhelpful, we replace it with something that helps us to see the situation more clearly and to act in accordance with our values.

*** Some of the strategies we use to cope with unpleasant emotions are emotional regulation skills, distress tolerance and activity scheduling. These strategies are aimed at helping you cope with an unpleasant emotions even if you can’t change them.

**** This last category involves changing our behavior response when faces with negative emotions. Often it involves doing the opposite of what our thoughts and feelings try to convince us to do. With behavioral activation, we schedule potentially rewarding and productive activities into the day to break an avoidant cycle. Exposure involves being in a feared situation without trying to escape or avoid feeling anxious. Behavior experiments involve testing out beliefs about ourselves and the world instead of assuming that our thoughts are true.

How to Get CBT for Anxiety and OCD Disorders in San Jose/Los Gatos and Sacramento/Roseville

The Cognitive Behavior Therapy Center specializes in therapy and counseling with adults, children and teenagers. Click to send an email for more information on how we can help you or your family members improve your outlook.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder (OCD) near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US

Click to send an email

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD, worry
Sep
12

Overcoming Unwanted Thoughts

by Laura Johnson

Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts

By: Sally M. Winston and Martin N. Seif

If you have ever struggled with unwanted intrusive thoughts, thoughts such as: “what if I get into a terrible car accident?”, “I could just jump off of this building since there’s no guard rail”, or “maybe I did something illegal in the past and I just don’t fully remember”, you are not alone. Research shows that millions of people are often plagued by upsetting worries that they just can’t shake away or disturbing ideas or images that feel very opposite of their values and character. Many individuals find these thoughts frightening and become concerned that the thoughts could be messages or say something about them as a person. In the book Overcoming Unwanted Intrusive Thoughts: A CBT-Based Guide to Getting Over Frightening, Obsessive, or Disturbing Thoughts, the authors provide extensive education about what intrusive thoughts are and where they come from, helping the reader to understand this very important concept: thoughts are just thoughts, and they don’t have to mean anything at all.

The authors describe in great detail the neurobiology that leads our brains to become more stuck on unwanted thoughts and the common strategies to get rid of these thoughts that tend to backfire, resulting in those thoughts popping up more and more often. They also present and challenge several myths about our thoughts, helping to normalize thoughts that many people may feel too nervous to share with others. Finally, they present a simple, CBT-based approach to coping with these thoughts and bringing your focus and energy back to the things in life that you really value.

How to Get Help for intrusive thoughts – San Jose/Los Gatos and Sacramento/Roseville

The Cognitive Behavior Therapy Center specializes in therapy and counseling with adults, children and teenagers. Click to send an email for more information on how we can help you or your family members improve your outlook.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder (OCD) near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US

Click to send an email

0 Categories : Cognitive Behavior Therapy, Intrusive, OCD
Apr
3

Positive Outlook Is Good For Your Health

by Laura Johnson

CBT Skills and Your Health

In A Positive Outlook May Be Good for Your Health, the New York Times reports that actively enhancing positive emotions can boost your immune system and reduce depression. Studies have shown a link between having a positive outlook and health benefits like lower blood pressure and heart disease, better weight control and healthier blood sugar levels.

CBT Skills that Work

In a research study, participants were encouraged to learn at least three of eight skills and practice one or more each day. The eight skills were:

  • Recognize a positive event each day.
  • Savor that event and log it in a journal or tell someone about it.
  • Start a daily gratitude journal.
  • List a personal strength and note how you used it.
  • Set an attainable goal and note your progress.
  • Report a relatively minor stress and list ways to reappraise the event positively.
  • Recognize and practice small acts of kindness daily.
  • Practice mindfulness, focusing on the here and now rather than the past or future.

How to Get Help for in San Jose/Saratoga and Sacramento/Roseville

The Cognitive Behavior Therapy Center in Silicon Valley (San Jose/Saratoga) and Sacramento Valley (Roseville) specializes in therapy and counseling with adults, children and teenagers. Call us in Saratoga at (408) 384-8404 or in Roseville at (916) 778-0771 or Click to send an email for more information on how we can help you or your family members improve your outlook.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety, Obsessive Compulsive Disorder and Eating Disorders near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety, Obsessive Compulsive Disorder (OCD) and Eating Disorders near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US
Saratoga: (408) 384-8404
Roseville: (916) 778-0771
Click to send an email

0 Categories : Anxiety, Cognitive Behavior Therapy, Depression, Health Anxiety
Oct
9

Using CBT Skills to Become Mindful: The Future of Mindfulness!

by Laura Johnson

Cognitive Behavior Therapy Skills to Become More Mindful and Manage Anxiety

Mindfulness meditation has become equated with being mindful. But there are alternate ways to build your mindfulness skills. Here’s a way to use CBT skills to become more mindful and manage worry. Read the New York Times article Achieving Mindfulness at Work, No Meditation Cushion Required on a new approach. Some of the main ideas in the article include:

  1. Self-Distancing: Talking to yourself as an objective adviser would.
  2. Reasons Why Bad Thing Won’t Happen: Realize that you’ve already made two unrealistic assumptions: that something will happen, and it will be bad. Next, give yourself three reasons the issue you’re worried about might not happen. Notice that it immediately becomes less stressful, because you just went from “it’s going to happen” to “maybe it will happen, maybe it won’t.”
  3. Reasons If Bad Thing Happens That It Could be Good: Now give yourself three reasons that, if the situation does turn out bad, good things will happen. Now you’ve gone from thinking “there’s this terrible thing that’s going to happen” to thinking “there’s this thing that may or may not happen, but if it does, it could have both good and bad outcomes.”

How to Get Help for Anxiety in San Jose/Los Gatos and Sacramento/Roseville

The Cognitive Behavior Therapy Center in Silicon Valley (San Jose/Los Gatos) and Sacramento Valley (Roseville) specializes in anxiety therapy and counseling with adults, children and teenagers. Click to send an email for more information on how we can help you or your family members overcome anxiety.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety, Obsessive Compulsive Disorder (OCD) and Eating Disorders near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US

Click to send an email

0 Categories : Anxiety, Cognitive Behavior Therapy, Mindfulness
Apr
11

The Boy Whose Dreams Came True

by Laura Johnson

Here’s a letter one of male teen clients wrote after successful completion of cognitive behavior therapy. It’s a very motivating letter for all ages even adults!

Dear Self,

The engine of my car rumbled when I came here, but the funny thing was that I didn’t even know where I was going. Then my parents said “Remember those scary pictures the kids showed you and you were very scared about that?” and I said “Yeah…” Then they said “we’re going to do something about that so we’re going to take you to a therapist to deal with that and not be scared about them anymore.”

I had a lot of fears about looking at the pictures because if my parents said I was scared, I knew at some point I’d see those pictures again. I thought Saryna would be very mean, and I didn’t want to have to be one of those people lying down on the couch just talking. I was totally unready at first. I just didn’t want to be here when we started talking. Once we came up with the hierarchy list, I was completely not ready for doing anything on that list. For the first few times we did the hierarchy, I thought I could do them, but I knew I couldn’t do anything above a level 5. Especially with a level 10, I would have run away. But the third time I was here, we already started and I said “It was no big deal” afterwards. After that, I knew I could definitely get through all of these. If I were to do the highest thing on the hierarchy list then, I would have never came back here again. Currently, I am 11 years old and I can look at one of the scariest pictures in the world.

“Just do it. Don’t let your dreams be dreams. Just do it.”
This is the quote you should think about when something that you have great anxiety around happens.

The practices here were like the practices I did for the multiplication test I had in 3rd grade. I was practicing my multiplication tables with my mom every day. The day I took the test, I got a really good score – almost 100%. This reminds me of now and the whole year I was here. At the beginning, I was so scared to see the pictures. Now, it’s like the day I took the test. I may have a little anxiety when I see the pictures, but I can do it easily.

I learned that sometimes I go turtle speed and sometimes I go rabbit speed. Just like a band aid, if you go really slow to take it off, it’s really painful. But if you go really fast, it hurts too. If you go at the right speed, it doesn’t hurt as much. I realized this is my own speed. It’s my speed that helps me do things and doesn’t make me scared.

My fear was that I couldn’t handle myself in the dark, and I was constantly waking up and going to my parents’ bed. It has probably been a year and when I compare my new self with my old self, you can see a huge difference in my levels of anxiety.

There were two ways I realized my brain was tricking me. Recently, I have had many bloody noses in the middle of the night and whenever I had them I would usually depend on my parents to stop the bleeding and take care of it, and then I would go to their bed because I was awake and scared. But the latest one I’ve had was a very surprising experience because I handled the bleeding and my nose all by myself, and once I was done, I realized I didn’t need my parents to do it.
My brain was tricking me about that. I was really proud of myself after that happened because my brain would trick me all the time. Another reason why I learned my brain was tricking me, each time we looked at a cut up picture of the characters I was scared of, I realized I was willing to bring it closer to me. From that, I realized my brain was tricking me to be constantly cautious without being willing to try anything uncertain.

So that’s why I have created a character of my own called Mr. Muntz. Mr. Muntz helped me realize every time my brain kept saying “no you can’t do this!” That’s what Mr. Muntz would be saying. So to prevent that from happening, I created another character called Homeyeggagetasaurous Rex. Homeyeggagetasaurous Rex was a combined character of all of my favorite people and fantasy and real life. When I thought of Homeyeggagetasaurous Rex, it helped me realize that I can conquer whatever Mr. Muntz told me because the reckless dinosaur I created helped me think of a silly, cool, and strong personality of myself and I wouldn’t need to worry about anything that I’ve done or will be doing that would make me feel scared and have a really high anxiety level.

So as you can see, you can always try even if you’re scared of doing it. As I said, you should listen to the quote “Just do it. Don’t let your dreams be dreams. Just do it.” so that you can focus on the happy time and not let your worries control you.

Sincerely,
The Boy Whose Dreams Came True

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), Motivation, Uncategorized
Oct
30

Schema Therapy: Basics and Beyond

by Laura Johnson

I just returned from a two-day Schema Therapy Workshop at the New Jersey Institute for Schema Therapy. The training was led by Wendy Behary, the Founder and Director of The Cognitive Therapy Center of New Jersey and The New Jersey Institute for Schema Therapy and President of the International Society of Schema Therapy. While I have been using Schema Therapy concepts with some clients already, I gained a new appreciation for the complexity, depth and effectiveness of this approach. Starting in March 2015, I am participating in the Advanced Intensive Schema Therapy Training Program. In this article, I will explain some of the basics of schema therapy. Stay tuned for a lot more to come as I work through the intensive training program and get certified!

What is Schema Therapy?

Schema Therapy is an evidence-based approach for long lasting change in the personality dynamics that impact chronic emotional and relationship problems. Schema Therapy was developed by Jeffrey Young while he was at the Beck Institute for Cognitive Behavior Therapy and he eventually branched out on his own. Schema Therapy is considered an integrative model because it draws on cognitive therapy, behaviorism, attachment theory, emotion-focused and relationship-based therapies and other schools of thought. Due to its strong roots in cognitive behavior therapy, I believe it is a natural extension to CBT for helping people who want or need a more depth-oriented approach.

Schema Therapy places emphasis on:

  • Identifying and resolving self-defeating life patterns and deeply rooted emotional themes,
  • Building resiliency and productive responses to life challenges,
  • Drawing out and enabling the strong part of your personality,
  • Employing a variety of cognitive, behavioral and emotional change techniques, and
  • Using the therapeutic relationship as a vehicle for change

What Is the Theory Behind Schema Therapy?

Schema ModelIn Schema Therapy, you will learn which of your schemas are triggered when you notice a strong reaction in yourself. The schema model has identified 18 schemas, typically developed when core emotional needs are not meet in childhood. Some common schemas include abandonment, defectiveness/shame, unrelenting standards, and vulnerability to harm/illness.

In order to cope with the pain when our schemas are triggered, we may develop certain coping styles including:

  • Surrender: giving in to our schemas and repeating them over and over,
  • Avoidance: finding ways to escape or block out our schemas, and/or
  • Overcompensation: doing the opposite of what our schemas make us feel.

When triggered, we may have a strong emotional reaction or mood shift, and we then enter a coping state called a “mode.” There are four categories of schema modes: the innate Child modes (vulnerability, anger, undisciplined/impulsive, contented), the Maladaptive Coping modes (detachment, compliance, overcompensating), the Maladaptive Parent modes (punitive, demanding/critical), and the Healthy Adult mode. The goal of schema therapy is to help you get your core needs met in an adaptive manner by enhancing the Healthy Adult coping mode so your schemas are triggered less frequently and intensely and you can recover more quickly.

Is Schema Therapy Evidence-Based?

I was impressed and pleasantly surprised by the large and growing research base, primarily led by therapists in Europe, where there is support and government funding for longer-term therapies that have been proven effective for deeper and longer-lasting change. In the U.S., most research grants and insurance funding are targeted toward shorter-term therapy approaches for symptom reduction. As a result, schema therapy is not well-known in the U.S. As of this writing, there are no Certified Schema Therapists in California. I hope to change this.

Who Does Schema Therapy Help?

PersonalitySchema Therapy is particularly well suited for adults who:

  • Have recurring depression, anxiety and relationship problems and don’t understand why they stay stuck in the same patterns year after year,
  • Want deeper, more long lasting personality change and relapse prevention after their anxiety, depression and other immediate crises have been resolved,
  • Have chronic anxiety, OCD and depression that does not respond fully to standard CBT, DBT and exposure therapy protocols, or
  • Have successfully completed evidence-based treatment for anxiety, depression, OCD and other problems and want to continue to work on underlying issues in order to improve the quality of their lives and relationships.

Schema Therapy is beginning to be tailored for many populations including children, teens and families. This is an exciting development in Schema Therapy because it will help children and teens develop into healthy adults and prevent them from having chronic anxiety, depression and other problems in adulthood.

What Does Schema Therapy Entail?

Phase 1: Assessment and Education

The assessment phase generally lasts for five to seven sessions and focuses on:

  • Education about the Schema Therapy model.
  • Assessing schemas and coping styles through interviews, inventories and emotional techniques.
  • Scoring and interpreting the results of various schema inventories.
  • Activating schemas using emotional techniques such as imagery.
  • Noticing how schemas show up in the therapy relationship.

Phase 2: Schema Therapy Treatment

As a longer-term, depth-oriented treatment approach for chronic emotional and relationship problems as well as personality change, you can expect the active treatment phase to be about one to two years of weekly therapy. As mentioned earlier, Schema Therapy uses a variety of strategies to contribute to change.

  • Cognitive Techniques: schema diaries, pros and cons of schemas and coping styles, schema dialogues and flashcards.
  • Emotion-Focused Techniques: emotional change through imagery, role plays and two-chair work.
  • Therapy Relationship: empathic confrontation and analyzing schemas when triggered in sessions.
  • Behavioral Techniques: behavioral assignments, skills training and exposure tasks to overcome avoidance of trigger situations.
How to Get Started with Schema Therapy

I hope this article has wet your appetite to learn more about Schema Therapy and perhaps even partake in Schema Therapy yourself. To learn more about Schema Therapy in a self-help format, you can read Reinventing Your Life. If you are interested in starting Schema Therapy, contact the Cognitive Behavior Therapy Center of Silicon Valley at (408) 384-8404 or the Cognitive Behavior Therapy Center of Sacramento Valley at (916) 778-0771 or send us an email.

0 Categories : Cognitive Behavior Therapy, Perfectionism, Personality, Schema Therapy, Uncategorized
Aug
2

Exposure & Response Prevention for Obsessive Compulsive Disorder (OCD)

by Laura Johnson

Exposure and Response (Ritual) Prevention for Obsessive Compulsive Disorder (OCD)

Exposure and Response Prevention OCD PennI recently attended intensive training in Exposure and Response Prevention for OCD at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia. In addition to terrific presentations by Dr. Elna Yadin, OCD Clinic Director, and staff members, we were honored with a Q&A session with Dr. Edna Foa. While I already considered myself a skilled therapist in treating OCD, this training helped refine my skills in systematically implementing a specialized form of OCD treatment called “Exposure and Response (Ritual) Prevention,” also know as EX/RP or ERP.

What is Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder (OCD) is a neurological disorder that causes severe anxiety/distress and affects your thinking and behavior. OCD tends to attack the things you value the most. When you feel anxious, it might feel like you are in danger. OCD tells you to respond, react, protect yourself, and do something to get rid of the distress. You might recognize that the fear is excessive or doesn’t make sense, yet it still feels very real, intense, and true. If you have OCD, the warning system in your brain is not working correctly. Your brain is telling you that you are in danger when you are not.

Common Types of OCD

Obsessions are unwanted, intrusive thoughts, images, or impulses that occur over and over again and feel out of your control. They are disturbing, anxiety-provoking and perhaps even disgusting to you. Common obsessions include contamination from germs, bodily fluids, diseases, or chemicals; causing or failing to prevent harm to others; fear of losing control; sexual, religious or morally offensive thoughts and images; perfectionism; and not-just-right feelings.

Compulsions are repetitive behaviors or mental rituals that you engage in to neutralize, undo or make your anxiety go away. Compulsions can also include avoiding situations that trigger obsessions. Common compulsions include checking, washing and cleaning, repeating an action, putting things in order, praying, counting, mental review, reassurance seeking, apologizing and confessing. These actions are designed to prevent or reduce emotional discomfort and avoid the occurrence of a dreaded event. Compulsions tend to provide temporary relief but the obsessions soon return.

It is important to note that OCD comes in many different forms and no two OCD sufferers are alike in their combination of obsessions and compulsions as well as the meaning they attribute to their feared catastrophe.

What is Exposure and Response (Ritual) Prevention (EX/RP)?

In a nutshell, EX/RP consists of exposing you to the triggers that cause anxiety and fear and teaching you to resist doing any compulsions or rituals to reduce the distress. The basic principles of EX/RP can be boiled down to three steps that need to be practiced consistently to overcome OCD:

  1. Confront the things you fear as often as possible.
  2. If you feel like you have to avoid something, don’t.
  3. If you feel like you have to perform a ritual to feel better, don’t.

With EX/RP, your brain learns that you can tolerate anxiety and that your anxiety will eventually come down without rituals. Your brain will learn that the feared catastrophe does not happen or that you could handle it if it did. And you may start to realize just how ridiculous or unrealistic your obsessional fears are and how much OCD is taking away from your life. Basically, OCD is a bully! We will teach you how to take charge and not give OCD the attention it craves.

The main treatment components of EX/RP include:

  • Assessment, Education and Treatment Planning: We’ll identify all your triggers, obsessional fears and related rituals and make a plan to systematically approach your fears without engaging in rituals. We will also teach you about the sneaky ways OCD tries to trick you and lies to you. You will learn that OCD is like a “tic” in the brain that is trying to protect you but instead OCD is making you a slave and ruining your life.
  • In Vivo Exposure: Exposures are the heart of OCD treatment. In this step, we will expose you to real life triggers that elicit fear, anxiety and/or disgust in a gradual hierarchical manner. We will start with easy exposures and, as you gain confidence you can cope with your anxiety, we will move up the hierarchy to confront situations that are more challenging.
  • Imaginal Exposure: This involves prolonged exposure in your imagination to your worst fears without doing any rituals. We’ll develop a script (or series of scripts) for you to record and listen to every day until you are no longer scared of the content of your obsessions and you can visualize yourself facing your fear without any rituals.
  • Response (Ritual) Prevention: RP is the identification and elimination of all physical and mental compulsions so you can learn you can cope with distress without doing rituals or avoidance. You will learn that while your rituals reduce anxiety/distress in the short term, they are not building your courage that you can handle anxiety without them. Rituals are actually fuel to OCD’s fire and maintain the OCD cycle.
  • Cognitive Processing: The key to long term, permanent change is gaining new beliefs and increasing your self-confidence. OCD is making you believe things that aren’t true and exaggerating the danger of your fears. In order to help you overcome OCD, we won’t tell you what to think because OCD will just argue with you. Instead, we’ll discuss what you have actually learned through your EX/RP activities and reinforce your experiential learning in order to create new beliefs about the meaning of your obsessions.

Treatment Description

In EX/RP, you will purposely experience your obsessive thoughts without ritualizing so you can learn that your discomfort/anxiety will come down and your fear is eventually extinguished. With your therapist, you will develop a hierarchy of exposures that will elicit your obsessional fear and we’ll develop a plan for systematically targeting each of the items. We’ll identify both behavioral and mental rituals to eliminate. EX/RP generally takes about 20 sessions total. We recommend two 75-minute sessions per week to help you maintain continuity and motivation in doing the exposures and to progress more quickly to relieve your suffering.

Initial Evaluation Session

The goal of the initial evaluation session is to learn about your background and history as well as determine what type of anxiety you have. If the diagnosis is OCD, then we will discuss the EX/RP treatment approach and determine if it is a good fit for you. We will also begin to assess your motivation since completing daily exposures in between sessions is essential to success in this program.

Information Gathering and Education

In the next one to two sessions, we will gather a lot of information about the content of your obsessions, types of compulsions/rituals you use to reduce obsessive fears, and the feared consequences if you are unable to perform your rituals. We will use a standardized assessment tool called the YBOCS, which helps us assess all the OCD symptoms and rate the severity of your OCD from mild, moderate to severe. You will also be asked to monitor your OCD symptoms throughout the week. The goal of this phase is to develop a thorough understanding of your obsessions and compulsions and the situations likely to trigger them. We will continue to assess your motivation for treatment and how much support you will need by the therapist and family members in implementing your EX/RP plan.

Treatment Planning

Next, we will spend one to two sessions determining what the feared catastrophe is, creating the hierarchy, identifying and ranking the order of exposures, deciding whether imaginal exposure is needed, creating the plan for reducing and eliminating rituals, and deciding whether exposure requires travel outside the therapist’s office such as a home visit. The question often arises as to whether we need to create different hierarchies for each type of OCD. While this may be helpful when the OCDs seem completely unrelated to one another, it is often not needed because the ultimate fear is often the same for all the OCDs. By creating one master hierarchy and working on fears by level of discomfort/anxiety, you will learn the principles of treatment and the therapy often generalizes more effectively from one symptom to the next.

To create a hierarchy, you and your therapist will generate a list of all the situations that provoke obsessive fear and avoidance behavior. We will then ask you to rate how much distress each situation causes for you on a scale of 0 to 100 and we will place the items in order from easiest to hardest. We generally start working on exposures rated in the 40-50 range and progress to harder exposures and the easier ones are mastered.

Imaginal exposures are used when engaging in the actual situation is not possible in real life, when your feared consequences are so far into the future that they can not be disconfirmed, or when you have so much fear approaching the real life situations that we need to start with thinking about the situation before progressing to actual exposures.

Exposure and Response Prevention Treatment

EX/RP treatment begins when we start working on the first situation on your hierarchy. Generally, 15 exposure sessions are recommended but some people with mild OCD may progress more rapidly while others with more severe OCD may need extra sessions. We will start with doing exposures during the therapy session and then assign the same exposure as homework for you to practice on your own. When your distress significantly declines and you no longer fear the situation, then we will move to the next item on the hierarchy. Since we are starting with items you ranked at a moderate level and only moving up when your distress has declined, it makes working on the harder items on the hierarchy feel much easier. If you find that you are not feeling a reduction of anxiety within 45 minutes, then we have probably underestimated the difficulty of that situation and we would move to an easier item. If we are working at the right pace, you should be feeling challenged in exposure sessions but not so uneasy that you can’t do it.

While doing exposures, you will not be allowed to perform any rituals to undo the anxiety or distress. Sometimes we may allow you to modify a ritual to allow you to approach situations that are more difficult and higher on the hierarchy but our goal will be to quickly eliminate the all rituals associated with that situation. We want your brain to learn that it can face your fears and overcome obsessional fears without doing any rituals.

A key to success in EX/RP is changing how you relate to the meaning of danger created by your OCD. This is called cognitive processing, where we will discuss what you learned from the exposure without doing your normal rituals. We will stress that the content of your obsessions doesn’t matter because OCD will latch onto whatever is important to you. Most people have multiple types of OCD and notice it morphs and evolves over time into new symptoms. We want you to learn the general principles of EX/RP so you can “zap” whatever part of your life OCD wants to target in the future.

We will move up the hierarchy as quickly as you can tolerate it. When all the items on your hierarchy no longer cause distress and you are no longer performing rituals to reduce anxiety, then we can formally end the EX/RP treatment phase.

Relapse Prevention

Generally, we’ll plan on two to three relapse prevention sessions spaced out over time. OCD symptoms often wax and wane with stress and life transitions. Relapse prevention consists of reviewing your progress, identifying the tools you can use to manage any future OCD flare ups, identifying and planning how to handle potential future stressors, and knowing the warning signs of OCD and how you can treat it yourself with your tools, especially self-exposure.

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD, Uncategorized
Jul
8

Not Your Grandmother’s Therapy

by Laura Johnson

My Personal Experience with Cognitive Behavior Therapy

Cognitive Behavior Therapy ModelI’ve had a passion for cognitive behavior therapy (CBT) since the late 1990s when I experienced how broadening my perspective improved my life. I came across CBT in an unusual way. I was attending a four day leadership development seminar. As an introvert, I was struggling in a highly political corporate culture and needed help improving my confidence and relationships at work. Before arriving, I completed a battery of personality tests like the Myers Briggs. On the last day of the seminar, the center brought in a bunch of coaches to help the attendees interpret our results.

Upon meeting my coach, I admired her presence but thought, “How could she possibly understand me? She looks so confident and at ease in public. She can’t possibly know what it feels like to be nervous to speak up at meetings.” To my surprise, I instantly clicked with her when she shared her experience of being an introvert and how she learned to flex her style to the circumstances. I thought, “If she’s just like me, then there’s hope for me too.” I continued to work with my coach by telephone over the next year and a half.

Fixing My Thinking Traps

My coach listened carefully to how I recounted stories of interactions with colleagues and management. Very early on she said, “I notice you’ve come to a conclusion about what other people are thinking in this situation. You might be right. That’s certainly one conclusion. However, are there any other possibilities of what this situation might mean?” Since my coach approached my beliefs in a supportive and nonjudgmental manner, it melted my resistance and helped me be open to exploring other possibilities.

Thinking Traps

At first, I didn’t realize that my coach, also a clinical psychologist, was using strategies adapted from cognitive behavior therapy or even what CBT was. She taught me to test my automatic thoughts by identifying all the possibilities of what something might mean and applying percentages to estimate how likely each conclusion was true. I started to see that my initial conclusion might be true but, realistically, it only had about a 30% chance of happening and that there were other logical conclusions I could draw from the same circumstances. I learned to face and plan for my worst fears, like “What if I get fired?” This reduced my anxiety since I no longer thought my “worst case” scenario was 100% true. And, if it did happen, I recognized that I did have the internal resources to cope.

New Perspectives

For example, I might conclude that my manager didn’t value me because she didn’t invite me to a meeting. My coach would say, “Yes, that might be true but are there any others ways to interpret this?” At first this was hard. I’d say, “Well, I really don’t think she values me because a month ago, I didn’t get invited to another meeting.” My coach said, “Okay, but is there any evidence that she does value you?” I thought for a few minutes and said, “Maybe she doesn’t realize I want to be involved with this project because I’ve never shown an interest in it. She probably thinks I’m too busy with all my other work and has decided to take this one on herself. Oh, and now I remember, just last week she gave me a new project and offered to hire a temporary contractor to help me. So I guess she does value me.” The cognitive distortions in my automatic thoughts seem rather obvious now. I was ignoring the positive evidence that my manager valued me and zeroing in on the evidence that supported my negative belief.

Eventually It Becomes More Natural

CBT Becomes More Natural with Time and PracticeToday, the way of thinking I learned from my coach has become more natural and automatic. I’m less likely to jump to conclusions – or when I do – I can stop and ask myself questions to see other possibilities. I continue to actively use CBT skills when I start to feel negative emotions, like worry or anger, in order to manage my mood before it spirals downward. The greatest benefit has been that I feel more engaged in my life and relationships because I’m able to feel subtle positive emotions, like peace and joy. My self-esteem and confidence have increased because I have re-oriented my brain to notice and appreciate the positive, however small it might be.

More than a decade later, I am no longer in the corporate world. I went back to school and have become a cognitive behavior therapist, inspired by my personal experience and my desire to help other people find greater peace and joy in their lives.

 

Note: This article was first published on MentalHelp.net on December 2, 2010.

0 Categories : Cognitive Behavior Therapy, Uncategorized
Jun
25

Train your Brain for Social Success

by Laura Johnson

CBT and Mindfulness for Social Anxiety

Did you know that by practicing cognitive behavioral therapy (CBT) and mindfulness, you can create new circuits in your brain? You can actually change your brain so it’s more flexible, focused and compassionate.

We’ve known for a while that CBT and mindfulness work for many problems especially stress, anxiety and depression. New research is emerging from Stanford University and elsewhere indicating that CBT and mindfulness are effective for social anxiety.

Social Anxiety Model

Social Anxiety ModelIf you have social anxiety, you know that some key problems include negative thinking about yourself, doubt about whether others like or respect you and whether you fit in, and excessive worry and anxiety before, during and after social situations. The model of social anxiety below shows how social anxiety is triggered and maintained. We experience a social or interpersonal situation that activates negative beliefs and assumptions about ourselves or others. Once triggered, we feel anxious because of the negative meaning we’ve given to the situation. We may use “safety behaviors,” or do things that make us feel less anxiety in the moment, but end up making us feel hopeless and discouraged because we don’t learn that we can tolerate anxiety and nothing really bad or scary generally happens. (The exception would be if you are being emotionally, verbally or physically abused or intentionally hurt in some way.) Once social anxiety is triggered, we become self-conscious, worry about what others are thinking, fear being embarrassed, humiliated or looked down on and our self-consciousness causes us to look inward.

Changing Your Thoughts

An example might be thinking about going to your high school reunion. You tell yourself, ” No one will remember me. I was such a nerd in high school. The other kids used to make fun of my thick glasses. I really don’t want to go and make a fool of myself again.” You perceive the social danger as rejection. You become self-conscious and focus on yourself and your anxiety reactions. You might predict, “I will end up standing in a corner by myself and no one will talk to me. I’ll make a fool of myself. I’ll feel anxious and won’t be able to stand it.” So you don’t go (safety behavior) and stay home alone with a bottle of wine and ice cream, feeling sad and discouraged.

Imagine, alternatively, if you believed the following: “In high school I was very studious and a few of the jocks made fun of my glasses. I’ve changed now. I’ve grown up, have a good job and people tell me I’m attractive. Even though I didn’t have a lot of friends in high school, I did have a few close friends who may end up going. I would really like to see them. Yes, I might feel anxious in the first half hour or so but I know it’ll pass as I start talking to my friends and having fun.” How might the model of social anxiety change if you had these beliefs instead?

Be a Flexible Thinker

CBT helps you learn more flexible and accurate thinking as well as effective behaviors and coping skills. CBT does not discount the negative but helps you put it into perspective and see what information you might be missing that could help you develop more helpful thoughts and beliefs. Mindfulness can complement CBT by increasing your ability to direct your attention to more productive thoughts and activities and reduce anticipatory anxiety and obsessive rumination.

 

Note: This article originally appeared on MentalHelp.net on August 16, 2011.

0 Categories : Anxiety, Cognitive Behavior Therapy, Mindfulness, Social Anxiety
May
31

We are in the Mercury News!

by Laura Johnson

CBT Center in the Mercury News

Read about the opening of the Cognitive Behavior Therapy Center of Silicon Valley in the Mercury News.

 

0 Categories : Anxiety, Cognitive Behavior Therapy, OCD, Social Anxiety
May
20

OCPD vs. OCD: What’s the Difference?

by Laura Johnson

What is Obsessive Compulsive Personality Disorder (OCPD)?

OCPDObsessive Compulsive Personality Disorder (OCPD) is a type of “personality disorder” with these characteristics:

  • Rigid adherence to rules and regulations
  • An overwhelming need for order
  • Unwillingness to yield or give responsibilities to others
  • A sense of righteousness about the way things “should be done”

What are the symptoms of Obsessive Compulsive Personality Disorder (OCPD)?

  • Excessive devotion to work that impairs social and family activities
  • Excessive fixation with lists, rules and minor details
  • Perfectionism that interferes with finishing tasks
  • Rigid following of moral and ethical codes
  • Unwillingness to assign tasks unless others perform exactly as asked
  • Lack of generosity; extreme frugality without reason
  • Hoarding behaviors

What is the difference between Obsessive Compulsive Personality Disorder (OCPD) and Obsessive Compulsive Disorder (OCD)

  • People with OCD have insight, meaning they are aware that their unwanted thoughts are unreasonable. People with OCPD think their way is the “right and best way” and usually feel comfortable with such self-imposed systems of rules.
  • The thoughts, behaviors and feared consequences common to OCD are typically not relevant to real-life concerns; people with OCPD are fixated with following procedures to manage daily tasks.
  • Often OCD interferes in several areas in the person’s life including work, social and/or family life. OCPD usually interferes with interpersonal relationships, but makes work functioning more efficient. It is not the job itself that is hurt by OCPD traits, but the relationships with co-workers, or even employers can be strained.
  • Typically, people with OCPD don’t believe they require treatment. They believe that if everyone else conformed to their strict rules, things would be fine. The threat of losing a job or a relationship due to interpersonal conflict may be the motivator for therapy. This is in contrast to people with OCD who feel tortured by their unwanted thoughts and rituals, and are more aware of the unreasonable demands that the symptoms place on others, often feeling guilty because of this.
  • Family members of people with OCPD often feel extremely criticized and controlled by people with OCPD. Similar to living with someone with OCD, being ruled under OCPD demands can be very frustrating and upsetting, often leading to conflict.

What causes Obsessive Compulsive Personality Disorder (OCPD)?

There is no single, specific “cause” identified. Several theories suggest that people with OCPD may have been raised by parents who were unavailable and either overly controlling or overly protective. Also, as children they may have been harshly punished. The OCPD traits may have developed as a sort of coping mechanism to avoid punishment, in an effort to be “perfect” and obedient.

Therapy for Obsessive Compulsive Personality Disorder (OCPD)

The goal of therapy is to lessen rigid expectations and learn how to value close relationships, recreation, and fun with less emphasis on work and productivity. Therapy can lead to greater insight into how someone’s OCPD symptoms affect others. It often takes the threat of the loss of a relationship or job to motivate people with OCPD seek treatment because they typically don’t think there is anything “wrong” with the way they are. If motivated to change, cognitive behavior therapy, particularly schema therapy, holds much promise.

Getting Help for Obsessive Compulsive Personality Disorder (OCPD)

The Cognitive Behavior Therapy Center of Silicon Valley specializes in long term personality change using CBT and schema therapy. With our convenient location just a 1/2 mile from highways 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us at (408) 384-8404 for more information on how we can help you overcome the rigid patterns related to an obsessive compulsive personality.

0 Categories : OCD, Perfectionism, Personality, Schema Therapy, Uncategorized
May
14

10 Ways to Manage Anxiety, Worry and Stress

by Laura Johnson

Anxiety GirlAnxiety is Sneaky

You’re doing fine, and then suddenly you feel like you can’t breathe. Maybe your chest hurts, and you’re convinced you’re having a heart attack. Maybe something happened, like your car won’t start or you heard layoffs might be coming at your company. Or maybe you can’t pinpoint why you are feeling like you are – you woke up in the middle of the night sweating and with a feeling of dread.

You are probably having an anxiety attack — an extreme reaction to stress. Even if you aren’t having a full-blown panic attack, anxiety can leave you feeling apprehensive, uncertain and fearful, paralyzing you with indecision and avoidance.

What is Anxiety?

It’s normal to feel anxious when facing a challenging situation. However, if your worries and fears seem overwhelming and out of proportion with what’s happening and interfere with your daily life, you may be suffering from an anxiety disorder. Common symptoms of anxiety include a surge of overwhelming panic, feelings of losing control or going crazy, a racing heart, heart palpitations or chest pain, feeling like you’re going to pass out, trouble breathing or hyperventilation, trembling or shaking and nausea or stomach cramps. If you have chronic anxiety, you may feel like you are living with constant feelings of apprehension or dread, have trouble concentrating, feel tense or irritable a lot of the time and tend to anticipate the worst.

Anxiety disorders are the most common mental health problems affecting children and adults. According to the Anxiety and Depression Association of America, an estimated 40 million adults (18% of the U.S. population)  suffer from anxiety disorders. Only about one-third of those suffering from an anxiety disorder receive treatment, even though anxiety disorders are highly treatable. Below are some steps you can take yourself to manage your anxiety.

10 Steps to Reduce Anxiety, Worry and Stress

1. Get Active. Ride your bike, take a walk, go to a yoga class or go to the gym. There’s no better therapy to reduce the physical sensations of an anxiety attack than to get your blood pumping and endorphins moving through your body with exercise.

2. Cut out all caffeine. Caffeine adds to that tense, jittery, anxious feeling. Sources of caffeine include chocolate, beverages like coffee, tea, soda, and some prescription and over-the-counter medications, like Excedrin.

3. Avoid stressful conversations when you’re tired, overwhelmed, or stressed. For instance, tell your kids that you’re simply not available for problem solving after 8 p.m. Try to protect a “trouble free” time, especially before bed, when you don’t address difficulties but focus instead on pure relaxation.

4. Get sleep. Buy a white-noise machine and use it when you go to sleep. The soothing sound will help you fall and stay asleep. A good night’s sleep is critical when you’re stressed, since sleep deprivation fuels anxiety even as anxiety leads to sleep deprivation.

5. Write about one thing that is making you anxious. Sit down and write out all the fears you have about that one thing. If it’s money, write down what would happen if you lose your job and can’t pay your bills. What is the absolute worst thing that could happen? Now look at each item and mark it on a scale of 1 to 10, with 1 being highly unlikely it would ever happen, 10 being likely that it would happen. You’ll be surprised at how few items rank above a 5. This understanding should help reduce your anxiety. If something does rank higher than 5, you may want to develop a coping plan for it. Nothing works better to calm anxiety than turning from pure worry to an action plan.

6. Practice mindfulness meditation. Relax your body from the toes up. Follow your breath as you observe and detach from your thoughts. Center yourself in the moment (e.g., feel your head upon the pillow, or your feet on the ground, etc.). When your mind wanders, don’t judge it. Simply bring your attention back to your breath.

7. Don’t focus on future problems. Many people get into a cycle of predicting and worrying about future concerns. Ask yourself, “Is this something that could actually happen and, if so, can I do something about it right now?” If the answer to either of these questions is no, tell yourself you will focus on it later. Keep a journal of what makes you anxious. Then revisit these same items when you’re feeling calm and develop plans to deal with them.

8. Experience your anxiety for 45 minutes. That’s usually all it takes for you to become used to it and for the anxious feeling to dissipate. The worst thing you can do is try to ignore your feelings because anxiety tends to fight back if you push it down.

9. Talk to yourself. Remind yourself of how you handled similar situations in the past, your strengths, and how long you will need to get through it. Show yourself that this anxiety is manageable and time-limited.

10. Get busy. Go to the museum, see a movie, read a good book, or take up oil painting (or some other hobby). Rent a comedy and watch it. Let yourself laugh out loud. The act of laughter stimulates endorphins that help blow stress hormones out of your system the way a good thunderstorm can blow away hot, humid weather.

How To Get Help for Your Anxiety

The Cognitive Behavior Therapy Center of Silicon Valley specializes in anxiety, worry and stress in adults, children and teenagers. With our convenient location just a 1/2 mile from highways 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us at (408) 384-8404 for more information on how we can help you overcome anxiety, worry and stress.

0 Categories : Anxiety, Cognitive Behavior Therapy, Panic, Uncategorized
Jun
8

Practice Makes Permanent

by Laura Johnson

Practice makes permanentWhen potential new clients call me, they often ask if cognitive behavior therapy (CBT) works and what the success rate is. I say, “It depends on your motivation level and whether you are willing to practice the skills in between sessions.”

Fitness for the Brain
CBT is fitness for the brain. There are many different skills you can learn, like mindfulness, awareness of emotions and thoughts, identifying thinking traps, realistic thinking, decatastrophizing, reducing vulnerability to negative emotions, and acceptance, to name just a few. You can pick up a self help book and learn what these skills are and how to do them by yourself. However, most people don’t. They want my guidance in how to apply these skills to their own situations.

CBT is Not Magic
Sometimes, however, people think there is a magic bullet. They hope if they visit a therapist’s office that the therapist will have a magical way to change their brain without them having to do anything differently. This isn’t how CBT works.

CBT is Active and Collaborative
CBT is a collaborative and active process whereby the therapist helps you to become aware of your thinking and behavioral patterns and, together, you and your therapist identify strategies and tools that can help. Then it is your job in between sessions to practice the skills everyday. You may only see your therapist for one hour a week but there are 167 additional hours in a week for you to practice your skills. Like with physical exercise, if you only workout once a week, your fitness level may improve but it will be limited. However, if you work out a little bit everyday, your fitness level will soar.

CBT Requires Practice
In CBT, “practice” refers to repeating a cognitive or behavioral skill again and again over time. It begins with the intentional rehearsal of the new skill. At this stage, practice is conscious and takes effort. It is not yet natural. You have to remember to use the skill and you may need to read a notecard or write things down in order to remember what to do. Later, as the skill becomes part of your memory, you may start to use the skill more naturally and unconsciously. The quality of your practice and your knowledge base will largely determine the outcome of each practice session.

The old adage that “practice makes perfect” is rarely true. It is very possible to practice the same skill repeatedly with no increase in achievement or accuracy of application. Think of the people you know who have been driving, cooking, or even teaching for many years with no improvement in their skills. Why is this? How is it possible for one to continually practice a skill with no resulting improvement in performance?

What Makes for Successful Practice?
For practice to improve performance, four conditions must be met:
1. You must be sufficiently motivated to want to improve performance. If you have not attached meaning to learning the new skill, then your motivation will be low.
2. You must have the knowledge necessary to understand the different ways that the new skill can be applied.
3. You must understand how to apply the new skill to deal with a specific situation.
4. You must be able to analyze the results of that application and know what needs to be changed to improve performance in the future.

Guided Practice Helps
Practice may not make perfect, but it does make permanent, thereby aiding in the retention of learning. Consequently, we want to ensure that you practice the new skill correctly from the beginning. Early practice that is done in the presence of a therapist (referred to as guided practice) can offer immediate and corrective feedback to help you analyze and improve your practice. When the practice is correct, the therapist can then assign independent practice (usually homework) in which you can rehearse the skill on your own to enhance learning and retention.

Short-Term and Long-Term Practice
Effective practice starts with massed practice for fast learning and proceeds to distributed practice over a longer term time frame for retention and automatic recall. Practicing a new skill during time periods that are very close together is called massed practice. This produces fast learning, as when one mentally rehearses a multiplication table. Immediate memory is involved here, and the information can fade in seconds if it is not rehearsed quickly. Cramming for an exam is an example of massed practice. Material can be quickly chunked into working memory, but can also be quickly dropped or forgotten if more sustained practice does not follow soon. This happens because the material has no further meaning, and thus the need for long-term retention disappears.

Sustained practice over time, called distributed practice, is the key to retention. If you want to remember a multiplication table later on, you will need to use it repeatedly over time. Thus, practice that is distributed over longer periods of time sustains meaning and consolidates the learnings into long-term storage in a form that will ensure accurate recall and applications in the future.

0 Categories : Cognitive Behavior Therapy, Motivation
Jun
8

Teaching and Supervising CBT

by Laura Johnson

Beck Institute Group Photo 6-13 cropI just got back from a three-day workshop at the Beck Institute in Philadelphia on Teaching and Supervising Staff in Cognitive Behavior Therapy. While the content of the workshop will help me improve the CBT staff training program at the CBT Center, the most invigorating part of the workshop was the opportunity to learn from the other participants. There were about 50 professors and expert CBT practitioners at this workshop from all around the world, including China, India, Japan, South Africa and Great Britain.

I felt like I was “home” in a group of people who were just as excited about CBT as me and the life-changing impact CBT offers to our clients. Sitting there, I realized that these 50 people – me included – will be impacting thousands of lives, not only through our direct client care but, more importantly, by training other therapists in CBT. There continues to be a deficit in well-trained CBT therapists who actually practice evidence-based CBT and offer scientifically-based psychotherapy to their clients. The Beck Institute is going to develop a list serve and other ways for our group to stay connected over time. This was a pleasant surprise of attending the workshop. In addition, I made a few new friends with whom I hope to keep in touch.

By far, the highlight of the workshop was the opportunity to spend two hours with Dr. Aaron Beck. For a CBT therapist, this is like having a meeting with Freud. Dr. Beck is credited as the father of cognitive behavior therapy and has done more than any other single individual to disseminate evidence-based therapy. Dr. Beck talked to us about the past and future of CBT. He said in the early days of CBT, he felt very lonely since other schools of psychotherapy were rejecting of CBT. He said talking to his teenage daughter, Judy, inspired him to go on with his research. By the way, Judy is now the leader of the Beck Institute and will carry on Dr. Beck’s work for the next generation.

Dr. Beck said, in the the future, he believes there will be one broad unifying theory of psychopathology but he still thinks there will be a variety of evidence-based treatments for different problems since different strategies need to be emphasized for different problems and client styles. He said therapists should base interventions on the overall psychological conceptualization of the individual client and then consider evidence-based strategies for specific disorders. Techniques need to be adapted to the case formulation and to patient’s learning capabilities. He told us to not be technique driven or beat a technique to death but, rather, have some variety in our treatment approaches and suit them to the client’s needs.

I feel like I am coming back from a spiritual journey to Mecca or Lourdes or the Holy Land. Every time I go to the Beck Institute, I am re-inspired for the work I do everyday with my clients and the staff at the CBT Center of Silicon Valley.

0 Categories : Cognitive Behavior Therapy
Mar
31

Be Good or Get Better?

by Laura Johnson

carrying computer up hillAre You Focused on Learning to Be The Best or Trying to Prove You Already Are?

“Be Good” goals are about proving yourself (being good). When you are striving to “be good,” you are focused on showing yourself and others that you are already completely competent. You are focused on the end result of your performance and showing everyone that you are already the best at whatever you are doing. Mistakes are awful because they contradict the image of yourself as perfect. In contrast, “Get Better” goals are about improving yourself (getting better). When you are focused on getting better, you are interested in learning and growth. You are okay with making mistakes because you know that you don’t know everything. Mistakes are seen as opportunities to learn.

“Being Good” Works When Times are Good

Wanting to “be good” is very motivating and can lead to excellent performance, provided that things don’t get too difficult, according to Heidi Halvorson PhD, author of Succeed. Unfortunately, she says, when the road gets rocky, people who are focused on proving themselves tend to conclude that they don’t have what it takes and give up too soon.

“Getting Better” is Better When You Face Challenges

When we focus on getting better, we take face difficulty with greater calm and use the experience from our learnings to fuel our improvement. Halvorson has found that people who pursue growth often turn in the best performances because they are more resilient in the face of challenges.

“Getting Better” Helps You Enjoy the Journey

sun over umbrellasWhen your goal is to get better rather than to be good, you tend to enjoy what you’re doing more and find it more interesting. In other words, you appreciate the journey as much as the destination, says Halvorson. You also engage in deeper, more meaningful processing of information and better planning for the future. You are even more likely to ask for help when you need it, and more likely to truly benefit from it.

“Getting Better” Reduces Anxiety and Depression

If your goals are more about self-growth than self-validation, you will be able to deal with depression and anxiety in more productive ways. Feeling bad will make you get up and take action to solve your problems, rather than just lie around and feel sorry for yourself. Not surprisingly,  you will be less depressed than other people who are constantly trying to prove they are capable and worthy, says Halvorson.

Try to Focus on “Getting Better”

The bottom line is, whenever possible, try to turn your goals from being good to getting better. Rather than complain about all the ways in which you, your job or your relationships aren’t perfect, focus on all the ways in which they are going well and can be improved. At work and at school, focus on expanding your skills and taking on new challenges rather than impressing everyone with how smart and knowledgeable you are. When your emphasis is on what there is to learn rather than what there is to prove, you will be a lot happier and will achieve a lot more.

Adapted from Succeed: How We Can Reach Our Goals by Heidi Halvorson PhD (2010).

0 Categories : Cognitive Behavior Therapy, Motivation
Oct
4

Playing the Anxiety Mental Game

by Laura Johnson

Anxiety Mental GameIn July, I had the privilege of traveling to Chicago to observe a two-day intensive live Anxiety & OCD treatment group led by Reid Wilson, Ph.D. There were eight people in the group with anxiety and OCD, many of whom had been suffering for years with chronic anxiety, panic, social anxiety, depression, obsessive thoughts, mental rituals and/or compulsive behaviors. I was skeptical the morning of the first day. Reid Wilson was making some big claims like “You will need to trust me. You can listen and think you will work on it later…and you will fail. Or you can listen and act – today – and begin your healing.” Given the severity of this group’s long-standing problems with anxiety and OCD, I didn’t believe that these folks could achieve significant progress by the end of a two-day, 16 hour treatment group. Boy was I wrong!

Steps To Playing the Anxiety Mental Game

Dr. Wilson spent the first four hours introducing the concepts behind the Anxiety Mental Game and enhancing motivation to play the game. He said, “You have OCD or Anxiety. You’ve been working on it, struggling with it, worrying about it, trying to control it, and you haven’t won yet.” Dr. Wilson said the only way to win against anxiety is to follow some paradoxically absurd strategies. He outlined three steps:

  • The first step is to identify how anxiety is ruining your life and to identify how your future will be different if you face your fears. This step creates your reason or motivation for wanting to play this game. You need to have a compelling reason because this game is hard.
  • The second step is to understand the principles behind playing the anxiety game. You need to be able to gain a mental shift from “I must avoid anxiety at all costs” to “I want to seek out anxiety (frequency), I want it to be strong (intensity), and I want it to last (duration).” And you need to learn that “whatever happens, I can handle it.”
  • The third step is to provoke anxiety. Instead of avoiding, resisting or simply tolerating anxiety (which is where anxiety wins), you need to proactively invite more anxiety into your daily life. This means being able to genuinely believe and tell yourself, “I really want anxiety to keep happening. I win if it keeps happening” and then to go out and actually create opportunities (called “exposures” or “behavioral experiments”) to feel anxious.

You might be thinking, “I am already doing the things that make me anxious. How can doing more of them help?” The difference is you are probably muscling through your daily life if you aren’t actively avoiding. You are probably telling yourself, “This is uncomfortable. My anxiety is unbearable. I can’t handle this anymore. I need relief from anxiety.” And you might go into anxiety-provoking situations with some subtle safety behaviors to try to protect yourself, like over-preparing, not talking, leaving early, sitting in a place where you won’t be noticed or distracting yourself during the situation.

Preparing to Play The Anxiety Mental Game

To prepare for the Anxiety Mental Game, the group members were asked to identify and review their hierarchy of anxiety-provoking content and to pick one item that they would practice experiencing at lunch time. Every time the group member could enthusiastically say things to themselves when they felt anxious like “Excellent! Just what I wanted,” or “I can handle this,”  or “Give me your best shot. I want my life back,” they would get a point. Dr. Wilson gave each group member a clicker to keep track of their points. After lunch, they came back and reported on how many points they had accumulated. Some of the folks had 80+ points in just two hours!

In addition to the new self-talk, the participants were also coached about where to put their attention while they were playing the Anxiety Mental Game. Dr. Wilson said, “The problem is not what you think it is. The problem is not the content of your fears. The problem is where you put your attention. You will either pay attention to the content (i.e. your list of anxiety-provoking fears, worries and other negative thoughts) or you will pay attention to anything else. You will decide – moment by moment. You have to choose to withdraw your attention from your content. That is your job here.”

Rules for Winning the Anxiety Mental Game

Winning the Anxiety Mental GameThe way to win the Anxiety Mental Game is to change your frame of reference from “This is serious and dangerous” to “This is a mental game.” The new rules you need to learn are:

  1. Do not pay attention to your content.
  2. Accept obsessive and anxious thoughts when they pop up.
  3. Want to make yourself uncertain about the content.
  4. Want to be anxious and stay anxious.
  5. If necessary, make rules and follow them (to get you through the exposures).

By the end of the two-day treatment group, all the group members reported some amount of reduction in their anxiety and fears. Through the exposures, they learned that “This is hard and I want it” and “I can handle this.” By observing the group members’ improvements, I became a believer in the power of playing this mental game to beat anxiety and OCD.

You can listen to Reid Wilson talking about the Anxiety Mental Game by clicking to listen to this Anxiety Mental Game podcast. If you are interested in learning to play the Anxiety Mental Game, call us at (408) 384-8404 to set up an appointment with one of our therapists.

0 Categories : Anxiety, Cognitive Behavior Therapy, OCD