Author: Katie Leoni, Psy.D.
Therapy session frequency is often a once a week occurrence, however this can vary depending on several factors. Regardless, the time in between sessions is extremely important in order to practice skills, gain confidence in one's ability to cope, and to hone in on what is helpful and unhelpful. Growth and progress happen both in and outside the therapy room. This article looks at the effects of intensive sessions over a short period of time (month or less) on several types of anxiety disorders. The pros and cons of such treatment are discussed and explored.
Author: Diana Gordon, Psy.D.
As cognitive behavioral therapists, the clinicians at SFBayCBT use a variety of techniques to help people cope with distressing thoughts. What we think impacts how we feel, which in turn impacts how we behave. When we can intervene and use strategies to cope with negative thoughts, we can often change both how we feel and how we behave in challenging situations.
Sometimes, we have negative thoughts that are really hard to modify or change. This might be because these thoughts are not actually distorted or inaccurate (as described in this blog post). Or it might be because they are so distressing that it’s difficult for us to calm down enough to engage with them intellectually. One strategy that we use to work with thoughts like this is Cognitive Defusion. Cognitive Defusion is simply the process of stepping back from your thoughts, and recognizing that they only have as much power as you give them. While thoughts can bring up a lot of really difficult feelings, ultimately we decide how much we believe them. They are not always factual. We can have a thought, but we don’t have to “buy” it. We don’t have to accept it as truth. And we certainly don’t have to act on it. Cognitive Defusion strategies allow you to step back, evaluate, and decide what to do next.
Cognitive Defusion can be challenging because when we are having thoughts that bring up a lot of strong emotions, it is really hard to not get caught up in believing everything our mind is telling us. Below, we will outline some great strategies to start experimenting with Cognitive Defusion. Remember that sometimes you might have to try more than one of these before you start to calm down, step back, and recognize that you have control over what you do with these thoughts.
Author: Kari Kagan, Psy.D.
All of us encounter problems in our lives. Problems can range from as simple as figuring out how to change a light bulb to as complex as figuring out how to help a family member who is struggling with mental illness. Not all problems are going to be solvable immediately, or ever. For those problems, there is a different set of strategies to help cope with issues we cannot fix. I encourage you to read more about acceptance here. For those problems that we are able to solve, it is important to take steps toward figuring out how to deal with them as soon as possible. When problems linger and remain unresolved, they can contribute to an increase in anxiety, depression, sleep issues, and other distressing symptoms. Further, as more problems build up, people can feel overwhelmed and engage in unhelpful behaviors that only further distress, such as avoiding dealing with the problems or turning to substances to help them “forget.” As such, this blog aims to provide a step-by-step guide to problem solving that can be applied to any problem, big or small. Below I will walk you through a tool that comes from the DBT Skills Training Manual and will use an example to help demonstrate how to use it.
Figure out what the problem is and describe the situation. Be specific.
Example: I have two different work projects due on the same day. I am worried I will get fired if I ask for an extension on one of them.
Check the facts to be sure you have the right problem situation. The problem to be solved should be based on the facts of a situation, not on parts of a situation that you cannot know for sure, such as what someone is thinking or feeling.
Example: It is a fact that I have two work projects due on the same day as both of my managers told me when they want the project sent to them by. My worry about getting fired is not based in facts but more in my fear of what could happen if I don’t meet expectations.
Identify your goal in solving the problem.
- What needs to happen or change for you to feel ok?
- Keep it simple, and choose something that can realistically happen.
Example: My goal is to try to get an extension on one of the projects in order to allow me the time to do both the projects with full effort and to help reduce my stress levels.
Brainstorm lots of solutions.
- Think of as many solutions as you can. Ask for suggestions from people you trust.
- Do not be critical of any ideas at first. (Wait for Step 5 to evaluate ideas.)
Choose a solution that fits the goal and is likely to work.
- If you are unsure, choose two solutions that look good.
- Do pros and cons to compare the solutions.
- Choose the best to try first.
Example: I am most interested in options 4 and 5
The pros and cons of option 4:
*I will start with option 4 then try option 5 if option 4 doesn’t work.
Put the solution into action.
- It might be helpful to write out a step-by-step plan for how to take action on the solution.
- Take the first step, and then the second . . .
Email managers to set up a meeting to ask for extension
Explain that I have 2 projects due on the same day and more time would be helpful to be able to do the best job I can on each project
Negotiate a reasonable extension that still gets the projects complete in a timely manner
- Evaluate the results of using the solution.
- If it worked, great! Problem solved. If it didn’t work, go back to step 5 and choose a new solution to try.
Example: The first option worked! My managers understood and I was able to get an extension on one of the projects.
To get comfortable with this tool, I encourage you to try it on a relatively simple problem. Even if you think you know the solution without going through all of the steps, practicing using the step-by-step model could help you apply it to the more complex problems that are difficult to solve. If you are struggling to solve problems in your life or are feeling overwhelmed throughout the process, I encourage you contact us or other professional help to learn how to better manage problems.
Author: Katie Leoni, Psy.D.
What Are Cognitive Distortions?
The idea behind CBT is that all of us sometimes think in ways that are inaccurate or irrational. We call these cognitive distortions, and they occur when our mind convinces us of something that is not actually true and we unknowingly reinforce this belief over time. It is normal to have cognitive distortions, no one is immune from them. The difference is in the quantity and the impact these distortions have on a person’s life. When a person is anxious or depressed, they tend to have more irrational thoughts and cognitive distortions. When you’re less anxious or depressed, you tend to have more rational thoughts. This makes sense from a CBT perspective as thoughts, feelings, and behaviors affect one another. The goal of treatment is to teach clients how to recognize certain thoughts that might be getting in the way of living the life they want to live as well as teaching clients how to modify those thoughts to be be more rational.
Common Cognitive Distortions
Identifying cognitive distortions that you engage in is an important first step to balanced thinking. Once you know what they are, you are better able to challenge them and question their truth. Below are common cognitive distortions. Remember, this list exists because we all experience cognitive distortions on a daily basis!
If you are interested in learning more about cognitive distortions and the way they are impacting you, please contact us to set up a phone consultation.
Author: Diana Gordon, Psy.D.
In part 1 of this blog post, we explored how the psychologists at SFBayCBT work with overeating and binge eating using an intuitive and mindful eating approach. In this post, we will talk more about concrete strategies you can use to help increase your mindfulness around food. These are techniques that you can try yourself at home to see whether mindful eating strategies are helpful for you.
Why should you try mindful eating?
Mindful eating can be a great strategy for helping you feel more in control around food. If you have concerns about bingeing or overeating, mindful eating can help you get back in touch with your body and enjoy your food more. This can help you feel more confident in your food choices and develop a healthier relationship with food. If you’re ready to try out mindful eating, read on for some strategies to help you get started. Each of these strategies will give you an opportunity to experiment with eating intuitively and mindfully.
If you’d like to learn more about how we work with overeating and binge eating, or if you’d like guidance about how to implement mindful eating in your life, feel free to contact us for a complimentary phone consultation.
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:
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.