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.

Some clients go through years of psychotherapy without attaining meaningful change in their lives. When we look deeper into those situations, it is easy to understand why. Their reality is such that feeling joyful, free, satisfied just doesn't make sense. For example, if I am failing a class, having conflict in my marriage, or fearing riding any and all elevators, there are very valid and straightforward reasons for feeling distraught. In many instances,  the very feeling of sadness, nervousness, or distrust is a reflection of something beautiful and positive about that person's value system. I would not be feeling sad for failing my classes if achievement and responsibility weren't important to me! When therapists try to change a client's emotional reactions without honoring the positive facets and functions of those reactions in the context of the individual's overall experience, the efforts are doomed to fail. That is why, in TEAM-CBT, we spend a healthy amount of time in Agenda Setting, before moving forward with any attempt for change. Dr. David Burns explains why some clients may not want to change - and why helping is not always helpful - in this insightful article in the latest issue of Psychotherapy Networker: https://www.psychotherapynetworker.org/magazine/article/1076/when-helping-doesnt-help

With marijuana being recently legalized in California, questions about its positive and negative effects on health overall and mental health in particular have intensified. There is an appropriate amount of debate around it and a growing body of investigative research attempting to arrive at conclusive findings. But in short, we really don't know yet.  My overall take on the state of the literature is that, like with any other foreign substance that you are introducing into your body, avoid or limit it if you can. However, compared to other drugs that are commonly abused - and particularly alcohol - marijuana has a lower profile of long-term damage and side effects. The article below does a good job of listing areas of interest in the research of clinical uses of marijuana and where we are in our understanding of them. For example, while we all know that marijuana's THC can have a 'feel good' effect on the brain, it also elevates heart rate and impacts coordination and balance. Cannabidiol (CBD) has been demonstrated to help in pain management, but marijuana can also affect memory, mood, and potentially activate  schizophrenic symptoms in those prone to the condition. https://www.healthiguide.com/health/what-marijuana-really-does-to-your-body-brain/ If you are considering or actively using marijuana for mental health concerns, I suggest discussing it with your doctor to investigate any potential physical health risks and with a therapist to learn additional or alternative ways to manage your pain or mood. All said, natural, healthy, and drug-free solutions are always best!

Life can be hard at times. For many of us, hardship comes in the form of a traumatic event that takes place unexpectedly. This could be the abrupt loss of a loved one, a violent assault, chronic abuse, a serious injury, or a car  accident, for example. When faced with a dangerous situation, our bodies react automatically by activating the fight-or-flight response . That's usually helpful: it quickly gets us ready to deal with a threatening stimuli and mobilizes our resources to succeed in that endeavor. When things go according to plan, once the threat is neutralized, we go back to baseline and life moves on, hopefully in more positive directions. Unfortunately, in about 1 in every 3 cases, we don't really get back to baseline. We get stuck in the stress of that moment, unable to cope with it. When this high level of post-traumatic stress lasts for a while (for more than a month), there is a possibility that the set of symptoms experienced qualifies for a diagnosis of Post-Traumatic Stress Disorder (PTSD). According to the DSM-5, the manual used to label and categorize mental health illnesses, the following are conditions necessary for a diagnosis of PTSD: Exposure to trauma, e.g., threat of death or injury. Intrusive memories, flashbacks, repetitive dreams, psychological distress, or physical distress at reminders of the event. Avoidance behaviors such as trying not to think about the trauma or avoiding places that remind you of it. Negative alterations in thought and mood, e.g., amnesia, negative beliefs, distorted views of the world, lack of interest, detachment, estrangement from others, inability to experience positive emotions. Excessive arousal, e.g. irritability, angry outbursts, reckless behavior, hypervigilance, exaggerated startle response, difficulty concentrating, insomnia. If you have yourself suffered a traumatic event and are struggling with any of the symptoms above, psychotherapy can help. Indeed, talk therapy is considered the most effective first line of treatment for PTSD and several psychological interventions have been tested and proven very effective for diverse patient populations. To learn more about the different modalities of PTSD treatment, visit the National Center for PTSD from the VA Administration. And call a therapist.