How do we interpret the events that happen in our lives?  Cognitive theory can help us get a better understanding of how that happens. The first concepts that you want to familiarize yourself with are 'assimilation' and 'accommodation.' Charlotte Nickersen wrote a very informative - and well illustrated - article with a simple overview of these concept.s  When individuals are confronted with new information that is inconsistent with preexisting schemas (i.e., stored bodies of knowledge), one of two processes occurs: assimilation or accommodation. Assimilation is the incorporation or alteration of new information to fit into existing schemas. Accommodation is the modification of existing schemas (and creation of new ones) to incorporate new events and information.   Although accommodation is necessary to integrate a new experience, individuals sometimes over -accommodate when interpreting input in their environment. Over-accommodation occurs when schema changes are inaccurate and overgeneralized . Assimilation is interpreting incoming information in light of prior beliefs: I believe that leaving my car in a dark parking garage in a high-crime neighborhood is dangerous. I do that one day, and my car is broken into. I can easily understand this event within my existing schemas, so it would be assimilated with no adjustment of beliefs needed. Growing up, I was taught to believe that “good things happen to good people and bad things happen to bad people” (also known as a “just world” hypothesis). Then something bad happens to me. To assimilate this event within my schemas, I would then need to tell myself that I must be “bad.” Accommodation is altering beliefs enough to incorporate the new information: Growing up, I was taught to believe that “good things happen to good people and bad things happen to bad people.” Then something bad happens to me. I can accommodate that by finding a new equilibrium in my belief system that states that good and bad things happen to both “good” and “bad” people – the world is not always “fair”. Over-accommodation is altering one’s beliefs about oneself and the world to the extreme in order to make sense of new events and information. Examples of over-accommodation (also known as over-generalization) in the situations above would be: I am not safe anywhere. Since I can’t control what happens to me, what I do and don’t do doesn’t matter at all. One of the goals of CBT is to help you stay away from over-accommodations (and unhelpful assimilations) and find accommodations that are complete, balanced, and useful to you.

Maybe you've heard that a regular mindfulness meditation practice has great benefits for your mental health . Indeed, scientific research shows that mindfulness meditation  is beneficial in reducing the symptoms of subclinical depression and anxiety and can substantially reduce stress.  But with busy lives and competing priorities, finding time to stop and meditate can be stressful in and off itself. However, it doesn't need to be! There are several ways to include mindfulness in your daily routine that don't involve sitting down in a lotus pose in a quiet room! One of the simplest approaches to do that is to do a mindful walk daily. You can do that in 10 minutes or less - and admit it, even walking from the bedroom to the kitchen while working from home can add to 10 minutes on any given day! The folks at the Greater Good Science Center at Berkeley have a good script for a short walking meditation. Here is an overview of the steps: 1- Find a location . Find a quiet and ideally private space that allows you to walk back and forth for 10-15 paces, either indoors or outside.   2-  Start your steps.  Walk 10-15 steps along the lane you’ve chosen, and then pause and breathe for as long as you like. When you’re ready, turn and walk back in the opposite direction to the other end of the lane, where you can pause and breathe again. Then, when you’re ready, turn once more and continue with the walk. 3-  Pay attention to the components of each step.  Walking meditation involves very deliberate thinking about actions that you normally do automatically. Breaking these steps down in your mind may feel awkward. But you should try to notice at least these four basic components of each step: a) the lifting of one foot; b) the moving of the foot a bit forward of where you’re standing; c) the placing of the foot on the floor, heel first; d) the shifting of the weight of the body onto the forward leg as the back heel lifts, while the toes of that foot remain touching the floor or the ground. Then the cycle continues, as you: a) lift your back foot totally off the ground; b) observe the back foot as it swings forward and lowers; c) observe the back foot as it makes contact with the ground, heel first; d) feel the weight shift onto that foot as the body moves forward. 4-  Speed.  You can walk at any speed, but try to go slow and take small steps. Most important is that it feel natural, not exaggerated or stylized. 5-  Hands and arms.  You can clasp your hands behind your back or in front of you, or you can just let them hang at your side—whatever feels most comfortable and natural. 6-  Focusing your attention.  As you walk, try to focus your attention on one or more sensations that you would normally take for granted, such as your breath coming in and out of your body; the movement of your feet and legs, or their contact with the ground or floor; your head balanced on your neck and shoulders; sounds nearby or those caused by the movement of your body; or whatever your eyes take in as they focus on the world in front of you. 7-  What to do when your mind wanders.  No matter how much you try to fix your attention on any of these sensations, your mind will inevitably wander. That’s OK. When you notice your mind wandering, simply try again to focus on one of those sensations. 8-  Integrating walking meditation into your daily life.  For many people, slow, formal walking meditation is an acquired taste. But the more you practice, even for short periods of time, the more it is likely to grow on you.  In fact, over time, you can try to bring the same degree of awareness to any everyday activity, experiencing the sense of presence that is available to us at every moment as our lives unfold. So there you go, now you too have time for a little mindfulness meditation practice every day! Here is a helpful short video to remind you how to do it:

You’ve surely seen a number of mental health apps in your App Store or Google Play. With over 10,000 titles out there, it is nearly impossible to miss them. Indeed, VC investment in behavioral health apps has been growing continuously and the overall market for health and wellness apps is already estimated to be above $1.6B . Should you too be looking for a mental health app? The short answer is it depends. Apps can be quite useful if you’re functioning at a high level, feeling good overall, and just looking for a boost in your mood, relaxation, or a change of pace at the end of the day. If, however, if you’re feeling overly stressed, depressed, anxious, or just not quite yourself, apps alone won’t do the trick. They should be used as an adjunct to psychotherapy with a trained professional. Unfortunately, the behavioral app space is highly unregulated these days. Most apps are for-profit, and have little to no data to support their marketing claims other than their own internal research (or wishful thinking). There are no assurances that HIPAA regulations are observed within the apps. Before you invest your time and money in a new app, it is worth checking out some reputable directories that have already done some of the research for you. I suggest: Mind Apps     One Mind Psyber Guide Department of Veterans Affairs UCSF   In CBT treatment, I often prescribe mindfulness-based apps such as Calm , Insight Timer , and Headspace as nice little boosters to fight anxiety and increase relaxation, but recognize that their benefits are limited if there are more substantial mental health issues at play. If that’s the case, your best bet is to work with a therapist to learn new skills to change old patterns and behaviors first. And then pick an app – or two or three - to support you post-treatment.

If you’re looking for a therapist and getting confused about what those letters after their names mean, you’re not alone. There are a number of therapist credentials in California that allow a provider to offer psychotherapy services to individuals, couples and families. All of them have to do with the kind and level of courses taken in school. Here is a quick (and non-exhaustive) cheat sheet. First, know that all therapists in California must have a graduate degree, supervised clinical experience, and a State license (that is regularly renewed) in order to serve the public. Individuals with only an undergraduate degree cannot be licensed to provide psychotherapy. Within graduate programs, here are some common credentials that you may find. All of them can offer individual, couple’s, family, or group therapy. Doctoral Level 1) PhD: Clinical Psychologists These are professionals who have completed usually five to six years of graduate training, a research-based dissertation in clinical psychology, plus one year of post-doctoral training after graduation before getting licensed. 2) PsyD: Clinical Psychologists Similar to PhDs, PsyD credentials are doctorate degrees in Psychology that follow the same pre- and post-doctoral training, with a lower emphasis in primary research during graduate school. 3) MD: Psychiatrists These are medical doctors who have completed medical school and a specialized residency of four years in mental health. Psychiatrists are the only mental health providers on this list who can prescribe medications in California. Many of them also offer psychotherapy services, although it is not the main emphasis of most programs currently. Master’s Level 4) MFT (or LMFT): Marriage and Family Therapists These are therapists who have completed typically two years of graduate level courses, obtaining a Master’s degree in a mental health-related area, followed by two years or more of supervised practice before getting licensed. 5) LCSW: Licensed Clinical Social Workers These processionals have attended graduate school in Social Work typically for two years, obtaining a Master’s degree in Social Work, followed by two years or more of supervised practice before getting licensed to provide counseling. 6) LPCC: Licensed Professional Clinical Counselor This is a relatively new credential in California, but is similar to the ones above. These processionals have attended graduate school typically for two years, obtaining a Master’s degree in Counseling, followed by two years or more of supervised practice before getting licensed. You can learn a bit more about the differences across these Master’s levels clinicians here . Unlicensed Professionals/Professionals in Training As you saw above, all mental health professionals will practice for a number of years under someone else’s supervision in order to accrue experience and develop expertise in psychotherapy. While these individuals are in training, you may meet them under the following credentials: 7) Psychology pre-doctoral intern (pre-doctoral degree, pre-licensure) 8) Psychology post-doctoral fellow or resident (post-doctoral degree, pre-licensure) 9) ASW: Associate Social Worker (post-master's degree, pre-licensure) 10) MFTi: MFT intern (post-master's degree, pre-licensure) Each one of these professions is regulated by a different Board in the State of California; for example, psychology practice is overseen by the California Board of Psychology whereas MFTs practice according to the regulations of the Board of Behavioral Sciences. You may find the best therapist for you at any of these training levels. Ultimately, you should be looking for someone with whom you connect, who helps you identify actionable treatment goals, and who helps you get there by combining the science of evidence-based treatments with the art of human relations.

The benefits of meditation are well documented by scientists and lay people alike and are probably even greater in crisis times such as in the COVID pandemic. Meditation is the practice of mindfulness, i.e., being in the present moment, not worrying about the future or obsessing about the past. If you can get yourself into a regular meditation practice, hooray! You'll accrue many long-term benefits from it. Yet, many of us can't get into that truly meditative state: legs crossed, thumb and index fingers touching, peace and quiet for a good 20 minutes. But fear not, there are many good alternatives to the traditional take on the mediation practice. For example, there is walking meditation, where we walk mindfully, and meditative movement such as Qi Qong , among many others. One of my favorite new discoveries is the practice of mindfulness (present moment awareness) by focusing on jelly fish. If, like most of us, you don't own a jelly fish, fear not. The nice folks at the Monterrey Bay Aquarium kindly provide us with a "jelly cam" that captures the real-time movement of the thousands of jelly fish in their tanks. Stop and watch the fish. Just pay attention to the fish, notice the colors, the movement, the subtle differences among them. Meditate with the jelly fish. And if your mind starts wandering, as minds often do, just bring your attention back to the jelly fish...and stay with them for as long as you can!   ​

This article in the  New York Times  describes the author's struggles with Obsessive Compulsive Disorder (OCD) and how he managed to overcome it after years of struggles. OCD is a mental health illness that encompasses obsessions, compulsions, or both. Obsessions  are repeated thoughts, urges, or mental images that cause anxiety. Common forms of obsessions include: Fear of germs or contamination Unwanted forbidden or taboo thoughts involving sex, religion, and harm Having things symmetrical or in a perfect order Aggressive thoughts towards loved ones or towards yourself ...and many others! Compulsions  are behaviors that an individual suffering from OCD feels the urge to do in response to an obsessive thought. The function of the compulsion is to alleviate the tension, anxiety, and nervousness that comes with the obsessive thought. Common forms of compulsions include: Excessive cleaning and/or handwashing Ordering and arranging things in a particular, precise way Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off Compulsive counting ...and many others! The author of the article above was able to overcome his OCD on his own, using a form of interpersonal exposure that we call in TEAM-CBT "self-disclosure." He slowly started sharing his deepest fears with his loved ones and learned, over time, that he got support and acceptance in return. That reduced his anxiety and allowed him to manage his OCD. When motivation and self-disclosure alone are not enough to get rid of OCD, exposure therapy (exposing patients to their feared stimuli) combined with a technique called response prevention can help. It is a scientifically proven intervention to help most individuals suffering from OCD to learn how to better manage their compulsions, tolerate the obsessions, and quickly overcome both of those.

Dr. David Burns is a world renowned psychiatrist and one of the pioneers in the development of Cognitive Behavioral Therapy. In the past decades, Dr. Burns has been focusing on advancing the clinical applications of CBT through a new therapeutic approach that he calls TEAM-CBT. You can read more about the elements of TEAM-CBT in one of my early blog posts  or on Dr. Burns website . TEAM-CBT is a framework for delivering evidence-based interventions in psychotherapy (and evidence-based here means techniques that have been corroborated as effective by rigorous scientific research), including treatment for depression. It combines Routine Outcome Monitoring, Motivational Enhancement, and CBT Methods with a strong focus on empathy and rapport building to deliver meaningful symptom reduction in fast periods of time. Indeed, in his current clinical work, which revolves mostly around training of therapists and professional workshops, Dr. Burns has, on many occasions, observed that individuals who had been struggling with depression or anxiety for years can experience near complete recovery in just a few hours. To explain how that can happen, and provide more background and perspective on the TEAM-CBT approach, Dr. Burns was interviewed by one of our colleagues, Lisa Kelley. The transcript of the interview is an excellent primer to learn more about this powerful new modality. Here it is: As a Level 5 Certified TEAM-CBT trainer and Master Therapist, I would be delighted to help you learn more about these tools to to enhance your life or, if you are a health care provider, to revolutionize your clinical practice!

Anxiety is a natural affective and somatic response to a perception of threat. As I mentioned before, it is our body's natural "alarm system" informing us that a potentially dangerous situation lies ahead. It is an uncomfortable feeling - on purpose! It encourages us to get ready, protect ourselves, or run away. A good amount of anxiety can gets us moving. Too much can paralyze us! So, if you are dealing with "too much" kind of anxiety, how can therapy help? Evidence-based treatment for anxiety can take several forms. In TEAM-CBT, we embrace four models for anxiety treatment: 1) Cognitive Treatment for Anxiety : Cognitive treatment of anxiety looks at the precise thoughts that are triggering the distressing emotion. In the case of panic disorder, it is usually a flavor of "I am going to die." For social anxiety disorder, it can be along the lines of "I am going to make a fool of myself." For generalized anxiety disorder, it can be "all sorts of impossible-to-solve problems will come up!" The therapist assists the client in pinpoint those thoughts, analyzing their validity, pinpointing distortions, and generating alternatives. With more balanced, realistic, and helpful thoughts, the anxiety can easily subside. 2) Behavioral Treatment for Anxiety : This is the gold standard for anxiety treatment. Individuals suffering from anxiety have an ingrained habit of avoiding things and situations that trigger their anxiety. Paradoxically, this has the effect of perpetuating excessive anxiety and worrying, rather than alleviate it. The antidote to that is to face one's fears. The most indicated behavioral intervention for anxiety is exposure therapy. In exposure, the client, with support of the therapist, will learn to face their fears head on (through use of images and in real life!). 3) Motivational Enhancement: Just reading the above, it is easy to see that many anxious clients will not be eager to jump into treatment that elicits that more anxiety-provoking thoughts and requires that they finally face their worst fears. In TEAM-CBT, we honor this very valid trepidation. Therapist and client partner up to identify reasons for changing vs. embracing the status quo and analyze whether the client is willing to pay the cost of getting better (not only in terms of treatment costs, but including homework, follow up, and getting in front of scary stuff!). The simple act of articulating and honoring the resistance to change can, most times, melt it away! 4) Hidden Emotion Model: This is an adaptation of the psychodynamic principle that anxiety is often a shield against more powerful - and difficult to embrace - emotions that the client may be struggling with. Another possible treatment for anxiety is to create the safe and warm space where the client can candidly acknowledge the emotions behind the anxiety. By verbalizing and sharing them, they lose their power and the anxiety subsides. It is likely that you'll need to try all of these approaches to find the best way to conquer your anxiety. But conquer it you can!

I'll start with the bad news. If you are standing in one place waiting to find motivation before you take a step in any direction, you won't find it. We all think that we need to have motivation in order to move forward. The reality is, we don't. I imagine that you brush your teeth every day, right? And how motivated do you feel each night before bedtime to pick up your toothbrush? Do you say to yourself, "I am looking forward to brushing my teeth tonight...and tomorrow night...and the day after?..." Probably not. Yet, you still do it. No motivation. Instead, just willingness to do what needs to be done. To move forward in any direction, we need willingness. A stance of seeking movement even when you don't feel like it. Doing things because they need to be done, not because you're excited, giddy, or moved to do it. Odds are that once you get moving, motivation will follow. But you simply don't need it in order to get started. That said, the New York Times just published an interesting article on small tasks that you can do to enhance your motivation. Note that all of them require you to take a step before you are motivated in order to find that motivation. Some ideas include rewards and treats, looking for meaning, relying on social support or competition, and using self-compassion . Check it out here . Along those lines, in TEAM-CBT we have some really cool tools that can help with the  procrastination that comes with lack of motivation, including Cost-Benefit Analysis, Triple Paradox, Devil's Advocate, and Problem-Solution techniques. You can learn more about them in therapy or independently through Dr. Burn's books .

Finding the right therapist is a bit like finding a date. You have to understand what is it that you're looking for and prioritize characteristics such as cost, location, style, and availability. And then do the legwork of searching for them. You can search online at sites such as psychologytoday.com , ask your doctors or friends, call your company's EAP or insurance carrier, or look through neighborhood lists. Many therapists, myself included, will offer a free phone screening consultation in order to get a better understanding of your needs and share more about their background and work style. I highly recommend leveraging this opportunity before making the trek to someone's office. Your first appointment with a new therapist is usually an intake, which is a longer visit focused on getting a history of your current concerns along with an overview of your social, personal, and professional history. Depending on the complexity of the case, a full intake can take up to 2 or 3 sessions, but it is generally quicker. After that, your therapist will discuss a treatment plan with you, which likely will involve regular (weekly) appointments. Most therapists work with a 50-minute visit, although a 80-minute visit can be very helpful in the beginning to get the treatment going faster. For then on, you and your therapist will work to monitor progress against goals and define new steps.  So, it all begins with finding the person that is right for YOU! The New York Times has posted an article discussing one reporter's path to find their perfect match: www.nytimes.com/2017/07/17/smarter-living/how-to-find-the-right-therapist.html Now it's your turn to take your first step to finding yours!

As we start the new year, several of us have 'new year resolutions' that may include goals to eat healthy, exercise more, learn new skills, sleep better, travel, etc. If you picked the exercise category, you will be happy to hear that you are in the right path to improve your mental health along with your physical health.  The power of exercise in preventing depression was documented in a recent study in the American Journal of Psychiatry  that highlights the benefit of regular exercise in the prevention of depressive disorders. Here is an excerpt from the abstract: Undertaking regular leisure-time exercise was associated with reduced incidence of future depression...The majority of this protective effect occurred at low levels of exercise and was observed regardless of intensity...12% of future cases of depression could have been prevented if all participants had engaged in at least 1 hour of physical activity each week.   Easy - and cheap! Now, if you need help overcoming that pesky procrastination habit and changing those behaviors for good, your therapist can give you a much needed push to get finally get started!

Dying for a Paycheck is a book by long-time Stanford GSB professor and business guru Jeffrey Pfeffer. In it, Professor Pfeffer argues that the long hours and round-the-clock availability expectations of today's fast-paced workplaces have led to unprecedented levels of high stress, burn out, disengagement, as well as low physical and emotional health. His findings and viewpoints match well with my own academic research on Work Attitudes and Behaviors Among Professional Women. I posit that it is not simply how much you work, but how you relate to your work that determines its repercussions on your satisfaction and wellbeing. A summary of the study methods, analyses and conclusions is included below. If you find yourself struggling with work culture and your health, take a break, do something pleasurable or meaningful to you, and connect with friends and loved ones. If you find yourself in need of greater support, consider seeking a therapist.