Behavioral Activation (BA) is a powerful and evidence-based intervention for depression  that focuses on helping individuals re-engage with meaningful activities to improve mood and well-being. Beyond exploring thoughts and emotions, CBT weaves in BA to prioritize action that breaks the cycle of avoidance and inactivity that often accompanies depression. How Does Behavioral Activation Work in Depression Treatment? Depression can lead to withdrawal from daily activities , which in turn reduces opportunities for positive experiences and reinforces feelings of sadness, fatigue, and hopelessness. BA works by identifying and gradually increasing engagement in rewarding activities  to boost motivation and restore a sense of enjoyment. Key steps in Behavioral Activation in depression treatment include: Tracking Activities & Mood : Patients monitor their daily routines to identify patterns of avoidance and inactivity. Identifying Meaningful Activities : Patients pinpoint activities that previously brought joy, fulfillment, or a sense of accomplishment. Setting Small, Achievable Goals : Instead of waiting to feel motivated, patients start small  (e.g., taking a short walk, calling a friend) and gradually increase their level of engagement. Overcoming Barriers: CBT, as the overarching umbrella round BA, helps patients address negative thinking patterns that might prevent them from participating in activities. Reinforcing Positive Changes: As patients ople become more active, they experience small boosts in mood, which creates a positive feedback loop  that counteracts depression. Why is Behavioral Activation Effective? Research shows that BA is an effective element of cognitive-behavioral therapy (CBT)  and even outperforms medication in some cases . It is especially beneficial because it focuses on practical, real-life changes  rather than just talking about events in your life. For those struggling with depression, small steps toward meaningful activity can lead to big improvements  in mood and overall quality of life. If you're feeling stuck, talk to a therapist to see how Behavioral Activation can be a helpful tool to get back on track.

In Acceptance and Commitment Therapy (ACT), values and goals serve different but complementary functions in shaping a meaningful life. Values are guiding principles that define who we want to be and how we want to act in the world, while goals are the concrete steps we take to manifest those values. Dr. Russ Harris , a leading ACT practitioner, explains, “Values are like a compass: they give us direction and keep us on track when life gets difficult. Goals are the things we try to achieve along the way.”  In other words, values are ongoing and never fully completed, while goals have a definite endpoint. For example, if someone values kindness, they may set goals such as volunteering at a shelter or calling a friend in need. However, once the goal is achieved, the value of kindness remains and can continue to inspire new actions. Goals are like milestones along the journey, but values define the path itself. One of the key benefits of distinguishing between values and goals is resilience. If we attach our sense of fulfillment solely to achieving specific goals, we may feel lost or disappointed when circumstances prevent us from reaching them. However, if we focus on living in alignment with our values - regardless of external outcomes - we can maintain a sense of purpose even in adversity. By clarifying our values and setting goals that align with them, we create a life that is rich with meaning and psychological flexibility. As Harris emphasizes, “The moment you start living by your values, you have already succeeded, regardless of the outcome.” Therapy can help you identify, articulate, and embrace a life led by your values.

In Cognitive Behavioral Therapy (CBT), core beliefs are deeply held convictions about ourselves, others, and the world. These beliefs, often unspoken and formed through early life experiences, act as internal lenses. They shape how we interpret events and influence our automatic thoughts and emotional responses. For instance, if you have a core belief of being "unlovable" you might interpret a friend's brief unavailability as personal rejection, and feel anxious or sad. Conversely, another person without this belief might view the same situation as a result of the friend's busy schedule, eliciting no negative emotion. These core beliefs are self-sustaining: like a powerful magnet, they tend to attract evidence that confirms them and dismiss or distort information that contradicts them. This reinforcement can perpetuate unhelpful thinking patterns and emotional distress. Recognizing and challenging these core beliefs is a fundamental aspect of CBT. By identifying and restructuring unhelpful core beliefs, clients can alter their interpretations of events, which in turn can lead to more balanced emotional responses and healthier interactions with the world. Here is a bit more information on this rich topic:

Does the thought of vomiting send shivers down your spine? If so, you might be one of the many people who struggle with emetophobia . Emetophobia, or the intense fear of vomiting, is a specific phobia that can significantly disrupt daily life. This phobia can include the fear of vomiting in public, seeing vomit, watching others vomit, or feeling nauseated. People with emetophobia often go to great lengths to avoid situations that might trigger their fear, which can lead to severe restrictions in social, educational, and professional activities. It can significantly impact your daily life, causing anxiety and avoidance behaviors. Good news: Emetophobia is treatable with effective therapies like Cognitive Behavioral Therapy (CBT) and exposure therapy. Understanding Emetophobia Emetophobes experience intense fear and anxiety around the possibility of vomiting. This fear can be triggered by various situations, such as seeing someone else vomit, feeling nauseous, or even just the thought of vomiting. The fear can be so overwhelming that it leads to avoidance behaviors, such as skipping meals, avoiding social situations, or traveling long distances. How CBT Can Help Cognitive Behavioral Therapy (CBT)  is one of the most effective treatments for emetophobia. CBT works by helping individuals understand the thoughts and behaviors that trigger their phobia. Through CBT, a therapist helps the person challenge and change their unhealthy beliefs related to vomiting, and learn to manage their anxiety. Techniques might include thought restructuring to combat negative thinking patterns and behavioral experiments to test the beliefs in a controlled manner. Exposure Therapy for Emetophobia Exposure Therapy  is another crucial component in treating emetophobia. This therapy involves gradually and systematically exposing the person to the thought, images, or situations related to vomiting. The idea is to desensitize the individual to their fears by increasing their tolerance to anxiety-inducing stimuli. The exposure must be done gradually, starting from less fearful situations to more challenging ones, and is often combined with relaxation exercises to manage anxiety during exposure. For more in-depth guidance and resources on emetophobia, the website EmetophobiaHelp.org  is an excellent place to start. It provides comprehensive information on the nature of emetophobia and details various treatment methods, including personal stories and support options. This site emphasizes the importance of seeking professional help and offers tools and encouragement for those looking to overcome this challenging condition. The Road to Recovery Emetophobia can be a debilitating condition, but CBT and exposure therapy can equip you with tools to manage your anxiety, reduce avoidance behaviors, and live a life free from fear. If you suspect you have emetophobia, reach out to a mental health professional who specializes in anxiety disorders. With the right treatment, you can overcome emetophobia and live a full and enjoyable life.

Everyone has a sleepless night every now and then. What we do - and don't do - during the day, how we eat, what we drink, how much we exercise, our environment, our mental health, and how much stress vs. pleasurable activities we have in a typical day all influence the quality of our sleep. When insomnia hits for a night or two, it is easy to catch up. But when it becomes a chronic issue, it needs to be addressed before your health starts to suffer. One of the most effective and widely recommended treatments for insomnia is cognitive behavioral therapy (CBT). There are two models of understanding and treating insomnia in CBT. The first approaches insomnia as the main focus of treatment. It starts by addressing behavioral modification, i.e., how long you stay in bed, and then moves on to address your beliefs about sleep. This line of treatment is often referred to as CBT-I, or cognitive-behavioral therapy for insomnia. CBT-I is shown to work better than sleeping pills, with no side effects! There are several self-help apps and websites for CBT-I. Personally, I recommend  cbtforinsomnia.com , a five-week online intervention with some clinical oversight. A second model of looking at insomnia is to view it as a symptom of another, bigger emotional health problem. Often times, insomnia is a consequence of depression or anxiety. For example, patients with excessive anxiety and worry may have trouble falling asleep as their mind starts racing - worrying about tomorrow's to-dos or ruminating about past events - the minute they lay their heads on the pillow. In this case, treating the underlying disorder (anxiety) with an approach such as TEAM-CBT will lead to the insomnia resolving itself short-term. In either case, a well trained CBT therapist may be able to guide you on your path to a good night of restful sleep!

Cognitive Behavioral Therapy (CBT) is a powerful tool for understanding the connection between thoughts, emotions, and behaviors. At its core, CBT posits that the ways we interpret events (our appraisals) directly influence our emotional responses. Emotional specificity within CBT takes this principle a step further, proposing that certain classes of appraisals predictably lead to specific classes of emotions. For instance... When someone interprets a situation as involving a significant loss , this appraisal typically gives rise to emotions like sadness or grief. Appraisals of threat , where an individual perceives potential harm to their safety, self-esteem, or values, tend to evoke fear or anxiety. Violation  appraisals, i.e., when someone perceives injustice, disrespect, or betrayal, often result in anger. This framework offers a precise way to dissect emotional experiences. If you struggle with pervasive anger, a CBT practitioner can guide you to uncover whether you habitually perceive situations through the lens of fairness and justice. Likewise, fif you are battling anxiety, examining your tendency to overestimate threats or dangers can reveal the root of their emotional distress. Emotional specificity is also crucial in tailoring interventions. Techniques like cognitive restructuring are most effective when applied to the specific thought patterns tied to the emotion in question. For instance, addressing catastrophic thinking is key for anxiety, while challenging rigid beliefs about fairness may help alleviate anger. By understanding how specific appraisals drive distinct emotions, CBT not only enhances emotional insight but also empowers individuals to reshape their thought patterns. This emotional precision transforms the therapeutic process, enabling clients to respond to challenges with clarity and resilience.

Exposure therapy is a cornerstone of evidence-based treatment for anxiety disorders and post-traumatic stress disorder (PTSD). Its foundation lies in addressing avoidance behaviors and unlearning the fear responses that perpetuate distress. Avoidance, while a natural response to fear, often reinforces anxiety by preventing individuals from realizing that feared situations are not as threatening as perceived. Over time, this avoidance creates a vicious cycle of heightened fear and reduced functioning. For anxiety disorders, such as phobias, panic disorder, and social anxiety, exposure therapy helps by gradually and systematically confronting feared situations or sensations in a controlled manner. Through repeated exposure, clients learn to recalibrate their fear response - a process known as habituation. They begin to see that the anticipated catastrophic outcomes are unlikely, and their anxiety diminishes as their brain "unlearns" the fear association. In PTSD, exposure therapy focuses on processing traumatic memories that individuals avoid. Avoidance can lead to persistent symptoms such as flashbacks, hypervigilance, and emotional numbing. Cognitive Processing Therapy (CPT), a structured form of exposure therapy for PTSD, helps clients safely revisit traumatic events and associated cues to reduce the power these memories hold. Over time, clients gain a sense of control and find relief from their symptoms. The effectiveness of exposure therapy is supported by extensive research. It is recommended by leading mental health organizations, including the American Psychological Association (APA) and the Department of Veterans Affairs, as a first-line treatment. While exposure therapy can be challenging, a skilled therapist can provide a supportive environment, tailoring the process to the client’s pace and needs. By breaking the cycle of fear and avoidance, exposure therapy empowers individuals to regain confidence and live fuller, more engaged lives. It demonstrates that courage, practice, and support can pave the way to meaningful recovery.

TEAM-CBT is a framework for providing evidence based psychotherapy. It was developed by Dr. David Burns, MD, Adjunct Emeritus Professor at Stanford School of Medicine.  What is Evidence-Based Practice in Psychotherapy? Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences.  It leverages evidence-based treatments. This designation describes specific clinical interventions that have been validated as efficacious for certain mental health conditions under rigorous academic research. Many cognitive and behavioral interventions (e.g., thought re-structuring, exposure therapy) are recognized by the American Psychological Association  as evidence-based treatments. What is CBT? ​Cognitive Behavioral Therapy is a type of evidence-based treament. It examines our thoughts processes - our idiosyncratic way of seeing the world around us -, our typical behaviors or actions, and our emotions in defined moments in our lives. It then providers actionable, well-defined, and simple ways of modifying thoughts and behaviors, with the ultimate goal of changing our feelings - for the better. It is focused on the here and now and aims to deliver symptom reduction in a fast but sustainable way. What is TEAM-CBT? TEAM, as mentioned above, is a framework for compiling cognitive and behavioral therapy interventions and delivering them through powerful, results-driven psychotherapy. TEAM stands for four key elements in this therapeutic approach: T = Testing In this type of therapy, clients are asked to gauge their level of distress and life satisfaction on a regular basis. Looking at metrics over time, the client and therapist can then determine whether their work together is helping the patient objectively improve their well-being. E = Empathy Before the more active part of the therapy begins, it is imperative that the therapist and the client be on the same page. TEAM-CBT offers specific techniques for increasing openness, authenticity, and vulnerability in the therapy sessions. A = Agenda Setting This is where TEAM combines evidence-based practices of traditional CBT with elements of Motivational Interviewing , a therapeutic method that works on facilitating and enhancing intrinsic motivation within the client in order to change behavior. The client and the therapist develop a shared agenda for the overall work and for each session where the client is effectively arguing for change - and thus melting away the psychological resistance to upset the status quo.  M = Methods TEAM brings together over 50 cognitive and behavioral methods for change, from traditional thought analysis and behavior experiments to innovative role playing techniques, compassion-based techniques, communication training, and much more. For each angle of unhelpful thought processes, TEAM has a number of powerful techniques that can help the client find more constructive alternatives. The goal of TEAM therapy is to help the client, over time, become their own therapist. For individuals motivated to change their lives, it can lead to meaningful gains in happiness, peace, fulfillment, and contentment in short periods of time.  To lear more about TEAM therapy, visit Dr. Burns's  Feeling Good website or call me for a free phone consultation.

Effective communication is a cornerstone of healthy relationships, and Dr. David Burns, my mentor, friend, and the creator of TEAM-CBT therapy, has articulated five key secrets to mastering it. These techniques are designed to improve how we connect with others, fostering understanding and reducing conflict. Here’s a look at these five secrets: 1. The Disarming Technique: This strategy involves finding truth in what the other person is saying, even if you disagree with their overall point. By acknowledging the validity of their perspective, you can defuse tension and create an environment where both parties feel heard and respected. This doesn’t mean conceding your stance but rather showing empathy and openness. 2. Express Empathy: Dr. Burns emphasizes the importance of empathy in communication. This involves listening attentively and reflecting back the emotions and thoughts the other person is expressing. There are two forms of empathy: thought empathy, where you paraphrase their words, and feeling empathy, where you acknowledge their emotions. This helps the other person feel understood and valued. 3. "I Feel" Statements : Effective communication often requires vulnerability. By using "I feel" statements, you can express your emotions without blaming or criticizing the other person. This technique helps convey your feelings in a non-confrontational manner, fostering a more open and honest exchange. 4. Stroking or Affirmation: Stroking involves expressing genuine, positive feelings or admiration toward the other person, even during a disagreement. This technique softens the interaction, making it easier to navigate difficult conversations with kindness and respect. 5. Inquiry:   Engaging in inquiry means asking gentle, open-ended questions to encourage the other person to share more about their thoughts and feelings. This not only shows genuine interest but also helps you gain a deeper understanding of their perspective, paving the way for more meaningful dialogue. These techniques can help improve your communication with your spouse, coworkers, family members, customer service representatives and even strangers in line ahead of you! Here is an example of an exchange between a husband-wife duo that didn't go so well: Wife: "You never listen to me" Husband: "I listen to you complain all the time" Wife: "You suck!" Here is the same exchange using the '5 secrets' above: Wife: "You never listen to me" Husband: "You are right, it's hard for me to stop and just let you talk (Disarming), and it feels like I never listen to you (Thought Empathy). I imagine you are feeling upset and angry, but also hurt and lonely (Feeling Empathy). I feel sad when I see you sad and frustrated when we can't communicate well (I Feel Statement). I love you so much and you mean the world to me (Stroking); I want to be here for you. Can you tell me more about how you're feeling?" Wife: "Well, I am feeling lonely...(and continues to share, towards a more loving and intimate exchange)" If you want to learn how to use these techniques on your own, you can start with Dr. Burns Feeling Good Together book. And if you need more help after that, you may want to consult with a TEAM-CBT therapist.

I recently finished the book "Dedicated" by Pete Davis , a Harvard Law graduate who gained online notoriety thanks to a viral graduation speech in the youtube video below. Mr. Davis has expanded the concepts in his graduation speech into a bestselling book that questions how we can find commitment and purpose in a fluid society that values open choice, freedom, and individualism. It is an interesting and well-written book, focused largely on civic involvement. But as far as CBT is concerned, the sections about choice are particularly relevant. Mr. Davis makes the case for the impossibility of making "right" choices.  When we call a path the "right" one, we assume that there is only one perfect future and that this one path is the absolute best way to get there.  This is obviously as fallacy, as the future doesn't exist. We make it with our actions today. There are many, many choices that can conceivably lead to great places down the road. Failing to recognize that keeps us stuck in search of that one winning ticket.  If we can't make the "right" choice, what we can do is make our choices right . The book quotes executive coach Ed Batista as highlighting that if we commit to the choices that we make, those choices have a much greater chance of leading us to a positive outcome. So after we make a choice, any choice, the key lever that we have to make it work well is commitment. Commitments, Mr. Davis argues, are living things. And like all living things, a commitment needs to be nurtured and nourished. When we work towards making our choices right, we are feeding that commitment and giving it a fair chance to thrive. We don't constantly revisit the choice, we don't move backwards or in circles, we don't get stuck. We commit and we move. However, like all living things, commitments can sometimes wither and fade, in spite of receiving good care. If or when that happens, it is likely time to let that commitment go, without regrets. And make a new choice. And make that choice right. In TEAM-CBT, we use the Decision Making form to help guide clients through the analytics of of a hard decision. If needed, we can process the emotions behind that choice through empathy or using a thought log. There are many therapeutic tools and interventions that can help us make careful, deliberate, well-intentioned decisions. But it is ultimately the voluntary act of committing to the direction that you choose that will make those decisions right.

Empathy is a fundamental ingredient of any psychotherapy treatment. It is so important in TEAM-CBT that it gets its own letter in the acronym: The 'E' in TEAM actually refers to the phase of treatment when offering and receiving empathy is the main goal. In my experience, it is a necessary - although most often not sufficient - element for successful therapy. Through empathy, the therapist attempts to develop a deeper understanding of the client's idiosyncratic experiences in certain situations. That hinges on the therapist's ability to put themselves in the place of the client, reflecting the client's thought processes and feelings, acknowledging the client's strengths and struggles, and sharing, in a professional manner, the impact that these aspects have had on them, the therapist. With clear communication and a genuine desire to connect, empathy builds a sense of shared experience that allows the therapeutic alliance to flourish. Empathy is not sympathy, though.  Empathy is a process where two people meet at the same level. In sympathy, one 'stronger' player attempts to rescue the 'weaker' one, often times by minimizing their experience in a well-meaning maneuver to quickly sweep away negative feelings.   Renowned researcher Dr. Brene Brown has developed a short video that illustrates this distinction. It's well worth three minutes of your time:

Before starting therapy, clients often wonder "How long will I be in therapy?" This funny video from The Onion provides a clever satire of the open-ended, long-term model of therapy that is often portrayed by the popular media:   Cognitive behavioral therapy (CBT) tends to operate within a much more short-term view. It is a focused model of psychological intervention that aims to reduce current symptoms, address specific problems, and build skills that the client can take with him/her after treatment ends. Hence, treatment length is usually measured in weeks or months, rather than years or decades. ​Indeed, there is ample research evidence that response to psychotherapy follows a 'negatively accelerated' curve where more and more effort is required to achieve smaller and smaller changes (that is called a log-normal curve for the math geeks out there). Dr. Ken Howard was the first to analyze this correlation and posit markers for response to psychotherapy according to dosage. Here is his original article . The original dose-effect study was run in 1986, based on psychodynamic or interpersonal treatment only, with the following findings: * About 15% of patients improve before the first session of therapy  * 50% of patients typically improve at 8 sessions * 75% of patients typically improve at 26 sessions * 85% of patients typically improve at 52 sessions It is possible that modern psychological techniques have accelerated that theoretical curve in the past 30 years.  In practice, however, there are many factors influencing the right dose of psychotherapy for each client, including diagnosis, acuity, readiness to change, social circumstances, and frequency of treatment (more regular treatment is  shown to be more effective).  But what we can glean from the data above is that longer and longer treatment periods may indeed offer diminishing gains at increasing levels of effort.  With CBT, you and your therapist will have powerful tools for change readily available. The specific length of psychotherapy treatment will vary for each person and each presenting problem. But with commitment and focus in the context of a true partnership, CBT can lead to fast and meaningful change.