Dr. Levy's CBT Blog
Insights on Well-Being, Contentment, and Cognitive Behavioral Therapy
If you are dealing with many stressors in your life and feeling overwhelmed from time to time, you may have come across a suggestion to start a 'mindfulness' practice. First of all, what is mindfulness? It is a concept describing a state where we pay full attention to the present moment. We don't obsess about the past, we don't worry about the future, we are just focused on the present, in the here and now. Even further, we try to clear our mind of thoughts and activity for stretches of time when we can just 'be' rather than 'do.' We observe our internal experiences without judging them or trying to change them. Many people achieve this state of mindfulness through meditation.
As I've mentioned before, there are many confirmed benefits of regular meditation or mindfulness practice. If you want to get started yourself, here are a few pointers:
![]() When I worked in Marketing early in my career, one of my PR colleagues used to say "if 4 out of 5 dentists recommend Crest toothpaste, the only one that has something interesting to say is #5!". I often think about that as I am drawn to better understand dissenting views on any given topic. Interpersonal relations and couple's therapy is a complex topic where there are some majority opinions and a few interesting ones that go against the grain. Dr. David Burns, one of the pioneers of cognitive behavioral therapy and mastermind of the T.E.A.M. approach to CBT - and my personal mentor and hero! - has some radically different ideas of why we all have some troubled relationships in our life. In one of his podcasts, Dr. Burns discusses the prevailing views of why people in close relationships may not get along. Those include theories addressing i) lack of skills, ii) barriers, and iii) self-esteem. In the first one, authors postulate that we all want loving relationships, we just need to learn better communication skills such as assertiveness or non-violent communication to get there. The barriers theory posits that there are just innate barriers to intimacy such as childhood trauma or different cognitive processing approaches between men and women. Finally, the self-esteem angle demands that you love yourself first, before you can love someone else. All of these approaches make sense and have some validity behind them. But they don't tell the full story. The missing link is "motivation." Sometimes, we have the skills and the self-esteem and there are no great barriers, but we still don't want to get close to the other person...until they change first! The reality is, if they were looking to change, they probably would already have. If we are the ones looking for a new dynamic in an old relationship, it is up to us to take the first step to change the existing patterns of interaction. We can do that by providing empathy, using assertiveness, and demonstrating respect regardless of how the other person is behaving. How to do that? Dr. Burns has a great book on the topic called "Felling Good Together." I recommend starting by reading the book. And if you still think you can benefit from professional help, find a therapist who can help you increase your motivation and put all of those skills and self-esteem to good use! In TEAM-CBT, when patients are looking to improve their interpersonal relationships, we first spend some time analyzing the nature of the conflict that they're facing before jumping in to solve it. Even though there are as many different flavors of interpersonal conflict as there are people in the planet, if we look closer, we can find a few broad patterns of common relationship concerns.
If you are having problems with someone close to you (romantic partner, family member, boss, co-worker, etc), odds are that the issue will fall into one of these three categories: 1- Character Issues: they don't see themselves! These are problems where you firmly believe that the person with whom you are in conflict is just flawed. They may be self-centered, dumb, histrionic, unfair, needy, controlling, unreasonable...and a lot more! For example: "He is mean and stubborn!" 2- Appreciation Issues: they don't see me! These are problems where you feel under-appreciated in the relationship. You firmly believe that the person with whom you are in conflict doesn't see you for everything that you do. They may frequently criticize, blame, disrespect, ignore, or belittle you. All said, they either don't value you, don't value your needs, or don't value the relationship. For example: "They never recognize how much I do for them!" 3- Give-and-take issues: they don't see us! These are problems where you find a fundamental imbalance in the relationship in terms of the give-and-take. It can be that the other party just doesn't listen, no matter how hard you try to communicate with them. Or they just don't share, regardless of your valiant efforts to engage them. Or it can be that they don't reciprocate when you do something nice for the relationship. For example: "They ignore my advice!" There are naturally many other ways of thinking about interpersonal issues. This is just one of them. But the goal here is to recognize that the first step in solving a problem is defining it! If you are suffering because the relationships in your life are not intimate, respectful, and fulfilling, cognitive-behavioral therapy can help. Viktor Frankl, the renowned Austrian psychiatrist and Holocaust survivor pictured above, once said, "Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom." This profound statement encapsulates the essence of human resilience and the potential for personal transformation. It also underscores the core principles of Cognitive Behavioral Therapy (CBT) in creating that crucial space between stimulus and response.
In everyday life, we often react impulsively to various stimuli—whether they are external events or internal thoughts and emotions. However, Frankl's wisdom suggests that we have the ability to pause and consider our responses. This pause is where we can find empowerment and personal growth. It's in this space that CBT plays a crucial role. CBT as a therapeutic approach helps individuals recognize and challenge their automatic thought patterns and emotional reactions. By identifying and modifying these cognitive and emotional responses, CBT assists in creating the vital gap between stimulus and response. Through guided introspection and cognitive restructuring, individuals can develop more adaptive and rational responses to challenging situations. The practice of CBT equips individuals with the skills to choose healthier responses, fostering emotional resilience and personal growth. It allows us to shift from being reactive to proactive, ultimately leading to a more balanced and fulfilled life. Viktor Frankl's insight remains a powerful reminder that we possess the capacity to shape our responses to life's challenges, and CBT provides a practical toolkit to help us do just that. ![]() Anger is a natural and often healthy emotion, but when it spirals out of control, it can lead to negative consequences in both our personal and professional lives. The good news is that there are various psychological interventions to manage anger, and one surprisingly effective tool is...humor. Humor, an universal language that brings people together, can help us gain perspective, reduce tension, and improve overall well-being. Here's how incorporating humor into psychological interventions can make a positive difference in managing anger. 1. Stress Reduction: Laughter triggers the release of endorphins, the body's natural feel-good chemicals, which can alleviate stress and anxiety. In moments of anger, incorporating humor can help you shift your focus from the source of your anger to something more positive, allowing you to better manage the situation. 2. Perspective Shift: Humor helps us see situations from different angles. When you can find the humor in a challenging situation, it can be easier to reframe your perspective and view the issue as less threatening. This can lead to a more rational and less impulsive response. 3. Communication Improvement: Anger often leads to ineffective communication, making it difficult to resolve conflicts. Humor can act as an icebreaker, easing tension and facilitating more open and constructive conversations. It can also make you more approachable, which encourages others to communicate with you. 4. Emotional Regulation: Humor can be a valuable tool for emotional regulation. When you're able to find humor in frustrating or infuriating situations, you can regain emotional control and make more level-headed decisions. 5. Self-Reflection: By using humor to reflect on your own actions and reactions, you can identify patterns in your behavior and take steps to address them. This self-awareness is a crucial component of anger management. It's important to note that the goal is not to make light of serious issues or dismiss valid concerns. Instead, the aim is to incorporate humor as a coping mechanism to diffuse anger and reduce its negative impact on your mental and physical health. Humor can break the cycle of distress and promote healthier responses to challenging situations. Yet, humor can only get us so far in neutralizing the anger. The better alternative, if it is available, would be to avoid moments of excessive anger. That can be done if we understand what is triggering the anger in the first place. That is surprisingly easy to do with good CBT strategies. We look at the situation, the thoughts, emotions, and actions in that particular moment. We figure out what is valid and what can be changed in our thoughts and behaviors. We use targeted techniques and methods to impart that change. We feel different. Picture Credit: CONCEPT at Palo Alto University Distress tolerance is one of the four core skills taught in dialectical behavior therapy (DBT). DBT is a type of therapy that helps people learn to manage their emotions and behaviors in a healthy way. Distress tolerance skills are especially helpful for people who experience intense or frequent negative emotions.
One of the most well-known distress tolerance skills is ACCEPTS. ACCEPTS is an acronym for the following skills:
How to use ACCEPTS To use ACCEPTS, simply go through the acronym and choose the skills that are most likely to be helpful for you in that moment. For example, if you are feeling overwhelmed by anxiety, you might try the following:
Tips for using ACCEPTS Here are a few tips for using ACCEPTS effectively:
Emotions are an integral part of our lives, influencing our thoughts, behaviors, and overall well-being. However, for many of us, managing intense emotions can be a challenging task. Dialectical Behavior Therapy (DBT), developed originally by Dr. Marsha Linehan, offers a comprehensive set of skills to help individuals regulate their emotions effectively. One of these essential skills is TIPP, an acronym that stands for Temperature, Intense Exercise, Paced Breathing, and Paired Muscle Relaxation.
How do TIPP skills work? TIPP skills work by changing your body's physical response to stress. When you are feeling stressed or overwhelmed, your body goes into "fight or flight" mode. This is a natural response that helps you to deal with danger, but it can also be uncomfortable and make it difficult to think clearly. TIPP skills can help to calm your body down and bring it back to a more relaxed state. This can make it easier to manage your emotions and cope with the situation at hand. How to use TIPP skills Temperature One of the easiest ways to use TIPP skills is to change your body temperature. This can be done by splashing cold water on your face, holding an ice pack to your neck, or taking a cold shower. Changing your body temperature can help to activate the parasympathetic nervous system, which is responsible for the "rest and digest" response. Intense exercise Another way to use TIPP skills is to do some form of intense exercise. This could be anything from running or biking to doing jumping jacks or push-ups. Intense exercise releases endorphins, which have mood-boosting effects. It can also help to burn off excess energy and tension. Paced breathing Paced breathing is a simple but effective way to calm down your body and mind. To do paced breathing, simply sit or lie down in a comfortable position and focus on your breath. Breathe in slowly and deeply through your nose, and exhale slowly through your mouth. Try to keep your breathing even and regular. Progressive muscle relaxation Progressive muscle relaxation is a technique that involves tensing and relaxing different muscle groups in your body. This can help to release tension and promote relaxation. To do progressive muscle relaxation, start by tensing and relaxing the muscles in your toes. Then, move up your body, tensing and relaxing the muscles in your legs, stomach, chest, arms, neck, and face. How to use TIPP skills in everyday life TIPP skills can be used in a variety of situations, including:
Here are some tips for using TIPP skills in everyday life:
Self-care is "in." At work, with friends, and even at home, we often hear about and proclaim the benefits of self-care. Popular self-care ideas range from a hot bath or a manicure to a fancy spa treatment or a vacation in Hawaii. All of those activities are useful and effective ways to take a break or disconnect from everyday life.
However, if you catch yourself yearning for that break all the time, that may be a sign that the life you've built is not the life you need. If you need to escape from reality at regular intervals, your reality may be misaligned with your values. In this thought-provoking article, author Brianna Wiest advocates for taking care of yourself every day, not by pampering and withdrawing from your routine but by including healthy and responsible choices in it. "If you find yourself having to regularly indulge in consumer self-care, it’s because you are disconnected from actual self-care, which has very little to do with “treating yourself” and a whole lot do with parenting yourself and making choices for your long-term wellness." If you're looking to take better care of yourself, start by taking inventory of the values that matter to you and then assessing how well your life is aligned against them. If you need support going through that analysis, find a good therapist who can serve as a sounding board. ![]() Anxiety and fear are quite different. To illustrate the difference I normally share a concrete example. Let's say I open my front door and there is a wild tiger right there. I will be terribly afraid. There is a clear and imminent danger I can pinpoint, thus leading to the fear. However, if I step out of my front door, hear a noise or see some movement in the grass, and think that there might be a tiger in there somewhere, odds are I will be feeling quite anxious. I think there might be a threat somewhere, only I cannot see it. I can imagine it. Anxiety is a response to perceived threats that come to us either in the form of thoughts (a story) or images. Because we don’t like the feeling of anxiety, we often avoid thinking about those threats and try to block out the troublesome images. This helps reduce the anxiety in the immediate short-term. But long-term, it is still there. That pesky feeling of foreboding, a tightness in your chest, a lump in your throat. If it’s in your head and it has a negative emotional valence, it will come back at some point. That makes sense, right? I’s your brain trying to keep you safe by reminding you often of the dangers around you. How can you conquer that anxiety? There are several methods in cognitive behavioral therapy (CBT) for anxiety treatment. The most effective one is exposure therapy. This is an approach where, figuratively, you get out of the house, go to where the noises and movement in the grass are, look behind the bushes, and find out that there isn’t a tiger there after all – it’s a kitty cat. To get to this liberating a-ha moment, we do need the courage to be willing to face the tiger. For some types of anxiety such as driving or public speaking, we can actually go out there and do exposure exercises in real life relatively simply. But other times, if our fears involve imagined situations and outcomes that we can’t replicate in the real world, then we have to use the tool of ‘imaginal exposure.’ Imaginal exposure, as the name suggests, involves immersing ourselves in this worst-case scenario fear of how things can turn out badly. For example, if I am constantly anxious about having a deadly disease, I can enter a mental world where that actually happens. If I am concerned about my children having a terrible accident, I can make that true in my head. Imaginal exposure scripts are short stories that we can write laying out what would happen if our worst fears came true. We add what happens in the immediate aftermath and what happens over the long run. These scripts are usually sad and dark because, well, our anxieties are sad and dark. Once an anxiety-provoking imaginal exposure script is written, exposure therapy involves reading that script over and over and over, several times a day for several days, recording the level of distress that it brings up. The objective is to get you habituated to the facts and feelings in the script. After reading a story a few hundred times, it gets boring. Boring is the opposite of anxiety-provoking. Boring is good. Of course, you’ll be well served to have a therapist support you through this unpleasant but highly effective and necessary process. Any well-trained CBT therapist should be able to hold your hand and help you feel safe and cared for as you go face your tigers. Happy hunting! Dr. Kristi Neff is one of the pioneers in the study of self-compassion as a tool for psychological wellbeing. There are many definitions of self-compassion out there, but hers hinges on three tenets: 1) Self-kindness vs. judgment Self-compassion involves being kind and understanding to ourselves, just as we would be to a friend or loved one. It means treating ourselves with the same compassion we would treat others when we are going through a difficult time. 2) Common humanity Self-compassion is not about being selfish or self-indulgent. It is about recognizing that we are all human beings who make mistakes, and that we all experience pain and suffering. When we are self-compassionate, we are able to accept ourselves with all of our flaws and imperfections. We are also able to be more understanding of our own limitations and to forgive ourselves for our mistakes. 3) Mindfulness Mindfulness is the basic human ability to be fully present, aware of where we are and what we're doing, and not overly reactive or overwhelmed by what's going on around us. It entails paying attention to the present moment without judgment. When we are mindful, we observe thoughts and feelings from a distance, without getting caught up in them. This allows us to be aware of our thoughts and feelings while making choices about how to respond to them, without exaggerating or suppressing them. There are many benefits to self-compassion. Studies have shown that self-compassion can lead to:
There are equally many ways to cultivate self-compassion. You can start by being kind and accepting to yourself, practicing mindfulness and loving-kindness meditations, spending time with people who are supportive and kind, and engaging in activities that help you feel good about yourself. You can also practice self-compassion through guided audio exercises such as this one: Self-compassion is a skill that takes time and practice to develop. But it is a skill that is well worth the effort. When we are self-compassionate, we are able to live happier, healthier, and more fulfilling lives. |
AuthorDr. Daniele Levy is a licensed psychologist offering CBT in-person and via Teletherapy in Menlo Park, CA. Her background uniquely combines leading edge training in behavioral sciences with deep expertise coaching and mentoring working professionals in dynamic organizations. Categories
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California License PSY 27448
Copyright © 2014 Daniele V. Levy, PhD Bay Area Cognitive Behavioral Therapy (CBT) Office: 830 Menlo Ave, Suite 200, Menlo Park CA Mailing: 405 El Camino Real #256, Menlo Park CA www.cbttherapy.com |