Author: Kari Kagan, Psy.D.
Being hard on ourselves is a universal experience that has more harmful effects than we think. Yet, so many people believe that the harder they are on themselves, the more motivated they will be. While there might be some validity to that some of the time, this article explains the harmful effects of chronic and severe self-criticism, the kind that elicits a deep sense of shame and failure. This article also reviews the antidote to self-criticism: self-compassion. While this might be a familiar term, it is likely a foreign practice. Before dismissing it as "going too easy on yourself", I encourage you to read more about it in the link below and consider making a commitment to practice self-compassion for one day (or even one hour!).
Author: Katie Leoni, Psy.D.
Exposure therapy is an evidence-based treatment used by the clinicians at SF Bay CBT to help our clients struggling with anxiety. Avoidance is a strong component of anxiety and it is common for people to avoid something that makes them anxious or fearful. In exposure therapy, clients are asked to directly confront the anxiety and avoidance. The idea is that the more you expose yourself to whatever it is that is making you anxious (i.e., social situations, taking BART, public speaking) the more opportunities you have to modify your automatic thoughts and beliefs and create a more balanced and rational mindset. If this sounds nerve-wrecking to you, you’re not alone! It is natural to feel nervous and worried about confronting your anxiety triggers. A saying often used in exposure therapy is “short term pain for long term gain” which acknowledges the willingness to tolerate discomfort in the moment in order to overcome and effectively manage your anxiety in the long term.
Rationale for Exposure Therapy
Physiological changes happen in the body in response to danger. The fight or flight response is our body’s way of reacting to life-threatening situations and taking immediate action to keep us safe. Your amygdala is activated and you either stay and fight the threat or flee. This response sends signals to our bodies in order to help shut down unuseful systems and activate survival systems. However, our brain doesn’t always do the best job of distinguishing between actual and perceived danger. Because of this, fear (actual danger) and anxiety (perceived danger) produce extremely similar responses in the body.
For example, if a tiger were to come into the room that you were in (actual danger), your fight or flight response would be activated. You’d notice an increase in your heart-rate, your blood pressure would go up, your mind would go blank, and you’d become hyper-alert. This would be an adaptive response because you have to act quickly to the life-threatening danger in the room. The signals that your body is giving you physically would cue you to move out of the way, or avoid, in order to keep yourself safe. It’s based on survival. Now, imagine you are extremely anxious about public speaking. Public speaking is uncomfortable for many but is not a life-threatening situation. However, people’s bodies can react in ways that make it seem this way and thus, become anxiety provoking for that person. When you stand up in front of a room full of people, your body will react as if a tiger just came into the room and in order to prevent this response from happening, you do everything in your power to avoid public speaking. When you avoid or escape the trigger, the physical symptoms decrease, and you feel relieved. But you also teach your mind and body that those physical symptoms really were a sign of danger, and you strengthen the association between public speaking and that uncomfortable physical response. Avoiding only reinforces the idea that public speaking is dangerous and your ability to cope with it is low.
In exposure therapy, we work on educating clients about this response and help to retrain the mind and body when faced with perceived dangerous situations. Chances are you’ve been anxious about this thing/situation for some time and thus, it takes time to retrain your brain and central nervous system to differentiate between fear and anxiety and to respond accordingly to the threat that is present. In order to do this, a person must activate the fight or flight response, which is done by exposing oneself to the perceived danger/anxiety provoking situation.
What Does Exposure Therapy Look Like?
There are several different types of exposures that exist and ways in which they can be practiced in therapy. Usually it is a gradual build-up (called a hierarchy) to the situation that makes you anxious. For instance, if you have a phobia of spiders, being asked to hold a spider would not be the first step. To start, you may be asked to think of spiders or look at pictures of spiders. This still activates the fight or flight response but in a way that allows learning to take place so that you are prepared to work through your hierarchy. The key in exposure therapy is to confront the avoidance and test out beliefs about perceived dangerous situations that may be distorted.
Types of exposures often used:
You might have to do things in session or exposures outside of sessions on your own. It depends on what your specific anxieties are. You and your therapist will collaboratively identify useful exposures for you based on your needs. Another important component of exposure therapy is learning relaxation techniques and other coping skills to help you before, during, and after exposures. Again, your therapist will work with you to teach you these helpful tools. If you’d like to learn more about exposure therapy and how it can help you, please contact us for a free phone consultation.
Author: Diana Corwin Gordon, Psy.D.
Many clients come to us with concerns about overeating, binge eating, and feeling out of control around food. Clients often recognize that their concerns about eating are complex, and that they overeat or binge for a variety of reasons. Sometimes these reasons are psychological in nature, and other times they are situational, but many clients feel frustrated by how difficult it is to change their eating habits.
We work with our clients to identify all of the factors that are contributing to their problem, and we use evidence based interventions to target them. Using intuitive and mindful eating approaches, we teach clients to identify their triggers, tune into their natural hunger/fullness cues, and feel more in control of their food choices. In this blog post, we will explain how we use a two pronged approach for treating these concerns: 1) identifying and treating common reasons for overeating/bingeing and 2) introducing intuitive and mindful eating principles. Taken together, these two areas of focus often help our clients reduce episodes of overeating and binge eating, and help them feel more in control and confident around food.
Common Reasons for Overeating/Bingeing
We work with our clients to understand the thoughts, feelings, and situations that trigger overeating or bingeing. We encourage clients to notice what's going on for them emotionally when they feel out of control around food. We meet urges to overeat or binge with curiosity and compassion, rather than judgement, and try to help our clients see these experiences as opportunities to learn more about their own needs. Depending on the specific triggers, we use a variety of evidence based techniques to alleviate the underlying causes of bingeing and overeating, including:
-Treatment for underlying psychological conditions
-Collaborative CBT problem-solving (helping clients determine all of their options for solving a problem, and the pros and cons of each)
-Thought modification (helping clients think more rationally)
-Emotion regulation skills (helping clients develop a toolkit of strategies for dealing with complicated emotions)
-Body acceptance and body image improvement
Our goal is to help our clients understand themselves better, and to help them address the underlying causes of overeating and binge eating. When these underlying causes are addressed, the urge to overeat or binge naturally diminishes.
Introduction to Intuitive and Mindful Eating
Intuitive Eating, initially developed by dieticians Elyse Resch and Evelyn Tribole, is an approach to eating that helps people tune into their internal cues of hunger and fullness. Many psychologists, physicians, and dieticians have put their own twist on this approach, but all share an emphasis on mindfulness, body awareness, and internal cues. We draw from many different theorists to offer a personalized and comprehensive approach to intuitive/mindful eating for each client.
Intuitive and mindful eating approaches teach clients to trust themselves about how, when, and what to eat to feel physically and emotionally satisfied. We work with clients to develop health affirming behaviors, such as eating foods that make them feel good and exercising in ways that feel energizing, rather than focusing on weight loss. Some goals of intuitive and mindful eating include:
-Tuning in to natural hunger and fullness cues
-Learning to stop eating when you feel satisfied
-Eliminating forbidden foods
-Developing confidence and trust in one’s own body and instincts
-Developing a healthy set of beliefs about food
-Finding true satisfaction and enjoyment in food
-Discovering ways to be healthy and happy, regardless of body size, weight, or other numerical indicators
-Read more about the principles of Intuitive Eating here
Using intuitive and mindful eating strategies, we strive to help our clients develop a happy, healthy, and satisfying relationship with food. As psychologists, we are uniquely qualified to treat overeating and binge eating, because we can offer a multifaceted approach to treating these concerns. We treat the underlying psychological conditions that make binging and overeating more likely, as well as providing practical strategies for getting in touch with your own internal cues. When appropriate, we coordinate care with dieticians, physicians, and other members of your medical team to ensure that you get the best care possible.
If you are interested in learning more about our approach to reducing binge eating and overeating, please contact us for a free phone consultation. We’d be happy to tell you more about our approach and to determine whether our services are a good fit. Stay tuned for part 2 of this blog post (coming soon), which will outline some practical strategies for incorporating intuitive and mindful eating principles into your daily life.
Author: Kari Kagan, Psy.D.
What is Behavioral Activation?
Behavioral Activation (BA) is an evidence-based treatment approach for depression. One of the hallmark symptoms of depression is experiencing little interest or enjoyment in activities that used to be considered enjoyable. When we look at patterns that maintain depression, dis-engagement in our lives is one of the most significant contributing factors to getting stuck.
BA operates on the understanding that what we do and how we feel are directly related. When people are feeling depressed or down, they tend to lack motivation to engage in their life in the way they do when they are feeling neutral or happy. When depressed, people simply don’t find enjoyment in activities that they usually do enjoy. As such, it can be difficult to find the motivation to engage in those activities, which contributes to the negative feedback loop that maintains depression. Behavioral activation is a treatment approach that works from the outside-in, meaning it focuses on getting people to do more as a means of helping them to feel better. The method behind behavioral activation is “act first, motivation follows”. Although much easier said than done, it is not much different than taking medicine. When we are feeling sick, we take medicine to help us feel better; we don’t wait to feel better to start taking medicine. In depression, people often “wait” to feel better in order to start re-engaging in their lives. However, it is this waiting period that actually contributes to the vicious cycle of depression. BA is like taking medicine, doing it when you are feeling depressed is the way to start feeling better.
How Behavioral Activation Works:
On a biological level, BA works similarly to antidepressants. As people become more active, it affects the same chemicals in the brain that antidepressants do.* On a behavioral level, engaging in more activities gives a person who is depressed more opportunities for positive reinforcement. For example, when staying at home isolated, someone might think that they have no friends and that no one likes them. And of course, the more that person stays at home, the more they will believe that thought. However, if that person were to go out and spend time with friends (even when they don’t feel like it) they would have the opportunity to learn that maybe they are more likeable than they think!
*Please note that while research supports BA as an effective treatment approach for depression, there are smany cases in which a combination of BA (and other forms of therapy) and medications is the most effective treatment approach. We encourage you to consult with your doctor and/or therapist about the best options for you.
Behavioral Activation Tips:
Given that some of the symptoms of depression are low motivation and little interest in previously enjoyed activities, BA is much easier said than done. However, here are some tips that could help you meet your BA goals, regardless of motivation.
1. Start with simply tracking your daily activities. Write down exactly how you are spending your time throughout the day, including as many details as possible. For example, if you woke up, took a shower, ate breakfast, and watched TV, write down all of those details. You could also try rating your mood (on a scale of 1-10) as you do each activity to help you learn more about the relationship between what you do and how you feel.
2. Identify activities you can start to engage in. Consider picking activities in two categories: activities of mastery and activities of pleasure.
3. Create a schedule and put it in a calendar. Research shows that writing down goals and creating a plan increases the likelihood that we will actually stick to them. Try scheduling in each activity, even if it seems like a given (i.e., wake up at 8am, brush teeth at 8:15am, call friend at 9am).
4. Set small, realistic goals. Part of what can contribute to feeling stuck is falling into an “all-or-nothing” state of mind. This might sound like saying, “I don’t even want to start responding to emails until I have time to respond to all of them”. This kind of thinking can keep us paralyzed as we may never have enough time or energy. We can be more productive when we set smaller goals. For example, you could set a goal of responding to two emails per day, or you could set a time-limit goal and set aside 10 minutes to respond to however many emails you can in that time period. In BA, what helps people to feel better is not doing things perfectly or completely, but just doing something.
5. Reward yourself after completing goals. All goals, no matter how big or small, are deserving of a reward. If you went for a walk, call/text a friend letting them know you did it. If you finally cleaned the dishes, reward yourself with a kind and encouraging statement (“way to go! You did it!”). Notice the urge you might have to minimize these accomplishments (i.e., “I should have done that weeks ago”) and recognize those as unhelpful and unproductive thoughts. Acknowledging, rather than minimizing, our accomplishments is what helps to maintain momentum.
6. Problem solve when goals aren’t met. Of course, we should expect that there will be many times that we set certain goals for ourselves that we aren’t able to meet. When this happens, instead of beating yourself up, try solving the problem. Examine what got in the way from a place of non-judgmental curiosity, and see if you can come up with some solutions to that barrier in the future. This helps to empower and encourage us to try again.
Following the tips above can help you to be successful in using behavioral activation as an intervention for depression. If you would like to additional support, feel free to contact us for a free consultation.
Author: Katie Bloom Leoni, Psy.D.
You’ve spent the time and energy researching therapists and setting up phone consultations. You made an appointment with someone that felt like a good fit. In the second part of this series, we will explore what to pay attention to once you meet in person with your selected therapist.
1. During the first 2-4 sessions, tune into the following areas:
2. You’ve decided you want to move forward working with this therapist. As you go on in therapy, pay attention to and talk about the following things:
Author: Katie Bloom Leoni, Psy.D.
You’ve made the decision that you’re interested in beginning therapy but are not sure what to do next. In this two part series, we’ll share some tips to help guide you on your journey to finding the right therapist.
1. The first step is finding a therapist. Here are some tips to begin your search.
2. The second step is setting up and having phone consultations. It is helpful to find two or three therapists that you are interested in and set up a phone consultation with each. Simply talking to a therapist does not mean you have to start seeing them. Most therapists offer a free phone consultation, which allows an opportunity for the therapist to learn more about your concerns and for you to learn about their office policies. Please reach out for a free phone consultation with a therapist at Sfbaycbt to begin this process. Some helpful tips for the phone consultation include:
Author: Diana Gordon, Psy.D.
Many of our clients seek out therapy because they'd like to be happier. Some can identify specific areas of life where they could improve their happiness, and others may feel stuck and unable to figure out what they'd like to change. As CBT therapists, we will work with you to make both behavioral and cognitive changes to improve your happiness and reduce your suffering. In this blog post at Psychology Today, they explore some of the key factors that help people live happier and more fulfilling lives. Contact us for a free phone consultation to learn more about living your happiest life.
Author: Katie Bloom Leoni, Psy.D.
Often times people are referred to a specific kind of therapy but are unfamiliar with the different types of therapy and what they offer. The clinicians at SF Bay CBT practice Cognitive Behavioral Therapy (CBT) as our main theoretical orientation. If you’re thinking about starting treatment with us, you might be wondering what that means, and what your treatment will look like. Read on for more information about the CBT model, which is the core of CBT.
The CBT model posits that our thoughts, feelings, and behaviors are interrelated, and that by intervening to change one of these things we can change all three of them. The way we think about a situation impacts how we feel about it and how we behave in response to it. In CBT, we believe that sometimes the way we think is distorted, or inaccurate. This may be because of our unique upbringing, our life experiences, or our current mental health status. Thinking irrationally is natural and normal, but if we do it too often it can cause psychological distress. As CBT therapists, we work with clients to identify beliefs that are not serving them. We give them tools to evaluate their thoughts and modify those beliefs that are irrational or inaccurate. This can help reduce negative feelings and increase the likelihood of desirable behaviors.
In CBT we also intervene on a behavioral level. We know that when you’re feeling depressed or anxious, that tends to make you want to engage in behaviors that can actually make those symptoms worse. For example, if you’re feeling depressed, you might want to stay in bed or skip social events. While you might feel better momentarily, staying in bed is likely to generate more depressed thoughts, which will make your mood worse. In our work with clients, we work to identify behaviors that are maintaining problematic psychiatric symptoms, and work with clients to modify those behaviors to improve their mood.
The final component of the cognitive triad is feelings. In CBT, we don’t often try to intervene with feelings directly. That’s because, as you’ve probably noticed, simply telling someone to stop feeling their feeling isn’t helpful or effective. However, CBT therapists will teach you a few skills that can help you feel more confident managing big and overwhelming emotions. These skills might include mindfulness, breathing techniques, and problem-solving to help you realize that you have the tools to manage your emotions.
The above is an outline of how we use the cognitive model to treat your symptoms in a comprehensive way. If you are interested in learning more about how CBT can help you, please call us to schedule a free phone consultation. We look forward to hearing from you.
Image taken from: Oak Park Behavioral Medicine (http://www.opbmed.com/cbt.html)
Author: Katie Bloom Leoni, Psy.D.
No one is immune from loss and grief. Losing someone or something you love is very painful and often shocking. Many of our clients are confused about the emotions they feel following a loss and might be worried about talking with others about their experiences. It is important to remember that grief does not follow a straight path as grief is an extremely individual process. There is no time frame for grief just as there is no right or wrong way to grieve.
Elisabeth Kübler-Ross and David Kessler developed the five stages of grief, which encompass common emotions and experiences of people going through the grieving process. You may go through each stage, may stay in one stage longer than another, or may not go through any of the stages at all. Think of the grieving process as a roller coaster, full of ups and downs and highs and lows. Just as Kübler-Ross and Kessler said, “They [the five stages] were never meant to help tuck messy emotions into neat packages.”
The five stages of grief are:
Remember that although the grieving is difficult, letting your emotions out and allowing yourself to feel however you feel is part of the healing process. Treating yourself with compassion and kindness and practicing physical, emotional, and social self-care are important. If you’d like to talk with a professional, we’d be happy to offer you a free consultation in order to make sure you get the support you need.
Author: Diana Gordon, Psy.D.
Many of our clients come to us because they're struggling with feelings of sadness, fatigue, concentration difficulties, or loss of interest in their favorite activities. Often they've heard that CBT is the most effective treatment for depression and seek us out because they want to feel better quickly. Our clients often wonder whether they have clinical depression or whether they are just feeling a little bit down. Whether you have clinical depression or just need some help feeling happier and more engaged in work, social, and family activities, CBT can help. In this article, the Huffington Post examines how depression can present differently across the lifespan. If you're interested in learning more about how CBT can help with symptoms of depression, contact us for a free phone consultation.
Diana Gordon, Psy.D., Kari Kagan Psy.D., and Katie Leoni, Psy.D.
Drs. Gordon, Kagan, and Leoni practice psychotherapy in downtown San Francisco and Oakland. Their areas of expertise include anxiety, sleep, stress, depression, and addiction. They blog about these topics to provide research-based information about common problems and strategies to help manage them.