Cognitive Behavioral Therapy
Our thoughts impact our emotions and behaviors. If this seems surprising, it is because our thoughts are automatic; we are often not even aware of what we are telling ourselves. Let’s take the following scenario:
You saw a good friend walking across the street and you call their name and wave, and they do not respond. How would that make you feel? Angry, rejected, lonely? How might you respond? Ignoring your friend’s calls, eating a chocolate bar to make yourself feel better?
Taking a step back, what were you telling yourself? “[Friend’s name] must be mad at me or doesn’t like me.”
However, what if your friend later tells you that he/she was not wearing their glasses and did not see you? How would you feel then? How would you respond then?
Our minds are constantly coming up with narratives for different situations, which then impact how we feel and what actions we take. CBT teaches you to slow your thoughts down and put them on trial for accuracy. You will learn to look for unhelpful thinking patterns, challenge them, and reframe your thoughts to be more balanced and realistic. Furthermore, you will learn various coping strategies to break negative behavior patterns. CBT has been shown to help with a wide array of concerns from everyday stress to depression. I will guide you through these strategies, so you can become your own thought therapist.
Cognitive Processing Therapy
One of the symptoms that block people from the natural recovery process following a traumatic event are the development of negative beliefs about self, others, and the world. Some examples of these beliefs may include “I am a terrible person,” “No one can be trusted,” and “The world is completely dangerous.” These beliefs then limit an individual from functioning fully in their everyday lives and can cause problems in relationships, work/education, and household tasks. Cognitive Processing Therapy (CPT) is a form of cognitive-behavioral therapy that targets these negative beliefs, or “stuck points.” It teaches you to challenge and reframe your stuck points to be more balanced and realistic, so you can get back to your life.
Click here to listen to This American Life podcast about one individual’s experience going through CPT
Note: Listen with caution as details of a trauma are described
Another symptom that block people from the natural recovery process following a traumatic event is avoidance. Internal avoidance is when people attempt to suppress the memories of the traumatic event and associated negative thoughts and feelings. However, the very act of avoiding the memories makes them more powerful and prevalent (try NOT to think about
a pink elephant for 1 minute and see how you do). Suppressing negative emotions can numb individuals from all emotions, including positive ones, and can become exhausting, like holding down a floating ball in the ocean that keeps trying to pop-up to the surface. External avoidance is when people attempt to evade people, places, objects, and situations that have the potential to trigger the traumatic memory. This approach may relieve some anxiety in the short-term, but actually can have negative long-term effects on your functioning in multiple areas of your life.
Prolonged Exposure (PE) is a form of cognitive-behavioral therapy that targets avoidance. It teaches you to approach the memory of the traumatic event through verbal re-tellings called “imaginals,” so you can process and release the associated negative emotions and re-encode the memory without such strong emotions attached to it. PE also teaches you to approach the external situations you may be avoiding in a gradual and systematic way, called “in vivos,” so you learn that these situations are not dangerous and gain confidence in your ability to handle them.
Click here for a Dateline segment of one individual's experience going through PE
Note: Watch with caution as details of a trauma are described
COncurrent Treatment of substance use disorder and PTSD using PE
One common way individuals avoid their trauma memories and associated thoughts and feelings is through the abuse of substances, such as alcohol, marijuana, and illegal drugs. In fact, estimates suggest that nearly 50% of individuals with a lifetime prevalence of PTSD also have a substance use disorder (SUD). Not only can you become addicted to these substances, you then feel worse as your body metabolizes them out of your body…and the trauma memories, thoughts, and feelings are still there. Substance use in conjunction with PTSD can have detrimental effects on your life socially, occupationally, financially, and even legally.
SUD and PTSD are typically treated separately, which leaves an individual with these co-occurring conditions more vulnerable to relapse and the treatment being less effective. COPE is a form of cognitive-behavioral therapy that tackles both problems simultaneously using the strategies of PE outlined above for PTSD and a harm reduction approach for SUD, providing you with techniques to help manage cravings and thoughts about using substances and coping skills to help prevent relapse.
Mindfulness is about being fully awake in our lives. It is about perceiving the exquisite vividness of each moment. We feel more alive. We also gain immediate access to our own powerful inner resources for insight, transformation and healing.
Mindfulness is an ancient concept grounded in Buddhist traditions that has been practiced for centuries. Only in the last few decades has mindfulness gained traction in the U.S. when Jon Kabat-Zinn brought the practice of secular mindfulness through his Mindfulness-Based Stress Reduction program. Since then, a plethora of research has shown the benefits of mindfulness for not only mental health concerns, such as depression, anxiety, PTSD, and stress management, but also for physical ailments, such as chronic pain, heart disease, tinnitus, and immune functioning. Furthermore, research has demonstrated tangible changes in the brain among mindfulness practitioners and improved cognitive functioning, such as concentration, working memory, and problem-solving.
Due to its many benefits, mindfulness is considered a trans-diagnostic and resource-building approach to improve overall well-being and resiliency for whatever life throws your way. In this way, mindfulness can be integrated into any treatment to help improve its effectiveness. Mindfulness is commonly defined as “the awareness that emerges through paying attention on purpose, in the present moment and non-judgmentally to things as they are” (Jon Kabat-Zinn) Cultivating mindfulness can occur through several different types of practices, including formal meditations and informal activities (e.g., being mindful while brushing your teeth or eating a meal). With advanced training in mindfulness, I will work with you to explore and tailor the practices that fit best with you and your lifestyle.
Click here for a Psychology Today article about mindfulness
Your real influence is measured by your treatment of yourself.
A. Bronson Alcott
Suffering is part of the human experience. But how often do we judge and criticize ourselves for our suffering? Thoughts, such as “You’re so disgusting!,” “No one can understand me,” “Suck it up!” and “You are such a loser!” can run like a constant commentary in our minds, which can lead us to feel worthless, unmotivated, and isolated. You are your own worst critic as the saying goes, and it’s true. We live in a culture where we are defined by our achievements, perfectionism, and evaluation against others, and self-criticism is used as a safety mechanism to beat others to the punch when we don’t meet these high expectations. For example, when we mess up on a big work project, we might say “I’m such a failure!” before someone else can tell us so, which may elicit sympathy versus rejection from others. However, imagine that a good friend, co-worker, or family member was in the same situation. How might you respond to them? Would you yell, “you are such a failure!”? I didn’t think so. So then why do we need to be so harsh on ourselves?
Compassion is literally defined as “suffering together,” or the feeling that arises when you are confronted with another’s suffering and feel motivated to relieve that suffering. Self-compassion is the extension of kindness, care, warmth, and understanding (instead of criticism) towards oneself when faced with suffering and a desire to help yourself alleviate that suffering. There are three core components of self-compassion:
Mindfulness: The ability to pay attention to and sit with your suffering without
ignoring or exaggerating it…in other words, non-judgmentally.
Self-Kindness: The ability to respond to your suffering with kindness and
Common humanity: Remembering that everyone fails, makes mistakes, and gets it wrong sometimes, we are not alone in our suffering.
As an extension of mindfulness, self-compassion is considered a trans-diagnostic and resource-building approach that has been shown to have many benefits and can also be integrated into any treatment. There are several techniques to cultivate self-compassion, such as meditations with warm and compassionate stances, anchor phrases (e.g., “May I be kind to myself in this moment of suffering.”), and soothing touch or activities. I will work with you to cultivate your inner self-compassion through personalized practices and exercises.
Our sleep functions on two biological systems—sleep drive and circadian rhythm. Sleep drive is like any other human drive (e.g., hunger) in that the less we have, the stronger the drive. Sleep also functions on a 24-hour circadian clock and involves the secretion of hormones that signal alertness and sleepiness. We have the best chances of a good night's sleep when our sleep drive and circadian rhythm are aligned (i.e., our sleep drive is strongest at the same time our body sends sleep signals). When we begin to have difficulty sleeping, we may engage in behaviors that actually serve to worsen our insomnia. For example, we may sleep-in, which serves to disrupt the circadian rhythm, or take naps during the day,
which serves to weaken the sleep drive. In addition, we may lay in bed trying to sleep, which actually taps into one of the ways humans learn—association. That is, you begin to associate your bed with being awake rather than being asleep. All of these behaviors may reinforce negative beliefs surrounding your sleep, such as “I won’t be able to function after a poor night sleep” or “I am losing control of my ability to sleep,” which can activate alert signals while you are trying to sleep.
In CBT-I, you will first track your sleeping patterns and habits by keeping a sleep diary. As an active treatment, you will then implement a sleep routine and various small changes to your sleep behavior to regulate your sleep drive and circadian rhythm, and to re-associate your bed with sleep. You will then learn to challenge and re-frame your negative beliefs about sleep to be more balanced and realistic. I will work with you to identify your key behaviors and beliefs that can be adjusted to get you back to having restful sleep.
Click here for more information on what to expect and
one patient’s experience going through CBT-I
Cognitive Behavior Therapy
for Chronic Pain (CBT-CP)
A negative feedback loop between chronic pain, mood, thoughts, and behaviors can occur. For instance, when you are in pain, you might feel sad, worried, or irritable and have thoughts such as “I can’t do anything with this pain” or “This pain will never get better.” Because of these thoughts and feelings, or because of the fear of doing further harm, you might cancel plans, call in sick to work, lay in bed, etc., which can then worsen your mood and your pain. And the cycle continues…
CBT-CP aims to reverse this negative feedback loop by giving you strategies to gradually relate to your pain differently, increase your activity safely, and challenge negative beliefs surrounding your pain. These strategies have been shown to make the body’s natural pain relief system more powerful and improve functioning. In fact, research has shown that CBT-CP is at least as effective, or even better, than other treatments, like medication and surgery, with far less risk and side effects. CBT-CP can also work in conjunction with medical interventions to increase their effectiveness. I will work with you to determine how the negative feedback loop shows up in the context of your chronic pain and teach you the strategies your need to help decrease your pain and improve your quality of life.
Acceptance and Commitment Therapy (ACT)
There are many things in our lives that are out of our control—diagnosis of a chronic condition, death of a loved one, getting fired, etc. Yet, in an attempt to control the situation, we might try everything in our power to resist it and suppress the associated negative emotions that comes with this new reality. It’s like being in a tug-of-war with this uncontrollable thing; so much of your energy is being directed toward it that you miss out on everything around you.
Combining mindfulness and behavioral strategies, ACT teaches you to drop the tug-of-war rope. Yes, this uncontrollable thing will still there, but you will now have more space and energy to direct towards the things that are important to you. ACT is an evidence-based treatment that has been shown to be effective for a wide-range of issues, including depression, anxiety, coping with a chronic illness, and workplace stress. Acceptance is not something you just check-off a list, but a process that I will help guide and support you through. I will then work with you to figure out what is important to you and to develop tangible steps towards committing to meaningful activities.
Click here to learn of one individual’s journey towards acceptance of chronic pain
Mental health has traditionally taken a disease-oriented approach—there is something wrong that needs to be fixed. In contrast, positive psychology focuses on what is right, maximizing your strengths and fulfillment in life. It takes you from the mentality of just merely surviving to thriving!
Positive psychology teaches you strategies that improve your overall well-being and resiliency within five areas—positive emotion, engagement, relationships, meaning, and accomplishment. I will work with you to identify which of these areas could be maximized and the specific strategies that are the best fit for you and your goals.
Our nervous system is made up of two parts. The sympathetic nervous system, also referred to as the fight-or-flight response, is our body’s response to stress, and involves physiological changes, such as increased heart rate, shallow and rapid breathing, and muscle tension. The parasympathetic nervous system, also referred to as the rest-and-digest system, is the state our
body is in when it is relaxed and promotes longer-term functions, such as digestion, immune functioning, and cellular repair. Our bodies work optimally when these two systems are in balance. Unfortunately, we are evolutionarily hard-wired to have a more active fight-or-flight response because it was more adaptive for our hunter-gatherer ancestors to be constantly scanning for survival threats.
Though we continue to scan for threats that activate our fight-or-flight response in today’s society, we are not typically faced with survival risks on a daily basis. Thus, we must be proactive in practicing relaxation to increase activation of our rest-and-digest system. I will provide you with tangible strategies to check-in with your body to determine if you are in a state of stress or relaxation and set you up with tools that promote relaxation. These relaxation skills are best practiced on a regular basis so that you develop the awareness and “muscle memory” to utilize them when faced with everyday stressors.