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Common Misconceptions of Cognitive-Behavioral Therapy

In this previous post I provided an overview of cognitive-behavioral therapy (CBT), a therapeutic approach based on the idea that our thoughts (i.e., running commentary in our heads), feelings (i.e., emotions), and behaviors (i.e., things we “do”) are all related to and influence each other. To follow up, I thought it would be useful to address some of the common misconceptions people have about CBT. Given how popular it is, there is plenty of information about CBT on the web, not all of it good or accurate.

CBT teaches you to think positively.

Because CBT theory emphasizes the interaction of thoughts and emotions, a major component of therapy is challenging unhelpful patterns of thinking (i.e., cognitive distortions), such as all-or-nothing thinking (“My girlfriend recently broke up with me, I’ll never find anyone to love me”) or catastrophizing (“Since I got a bad grade on this test, I’ll likely fail this class and won’t graduate”). Because the vast majority of these distortions are negative, many people assume that one goal of CBT is to replace negative thoughts with positive thoughts. However, that is not quite correct. The key is the word “distortion” – the goal of therapy is to challenge thoughts that are not rational, helpful, or based on evidence, and replace them with more adaptive thinking. See this video from the Beck Institute for a great explanation of this issue.

CBT is rigid and manual-based.

A common misconception of CBT is that it is a rigid, one-size-fits-all therapy based on manuals. I believe this belief is popular because there are a variety of CBT manuals for therapists attempting to learn the technique and for use in clinical trials evaluating the effectiveness of the therapy. However, well-trained therapists are skilled in tailoring the approach to the needs of individual clients, and most will also incorporate techniques from other therapy approaches as needed (see my example below of how to use motivational interviewing and CBT together!).

CBT only works with motivated clients.

Because it often includes exercises (homework!) done outside the therapy session, it’s commonly assumed that CBT is only effective with very motivated clients. There are a few reasons why this is not true. First, any therapist, regardless of their orientation, should be trained in how to engage clients through the careful use of language, matching their interpersonal style to that of the client, or by leveraging the rapport built in the therapeutic relationship.

Second, many therapists are trained in a range of therapeutic approaches and can combine approaches as necessary to meet the needs of their client. One approach I’ve found effective is blending techniques from Motivational Interviewing with CBT. It’s a relatively common approach (common enough for an entire book to be written about it!). The thing I like most about motivational interviewing is that it is a “meet your client where they are at” approach that is supportive, gentle, and non-judgmental.

Lastly, one nice feature of CBT is the notion that the therapist and client work on small, approachable goals throughout therapy. A client is not asked to take on more than feels manageable or reasonable, and they get to quickly see tangible results of their efforts. This is reinforcing and often strengthens motivation.

CBT is only supported for use with anxiety and depression.

Cognitive behavioral therapy was developed by Dr. Aaron Beck, who originally applied his theory to the treatment of depression. Since then, it has also become recognized as the gold standard for the treatment of anxiety. However, CBT is recognized as an effective therapy for a wide range of psychological disorders including schizophrenia, ADHD, and eating disorders. See this analysis by the American Psychological Association evaluating the evidence supporting the use of CBT for a variety of disorders.

I hope that you have found this blog post helpful today. If you are in the Austin area and contemplating starting psychotherapy, I am happy to speak with you on the phone to answer any questions you may have, including those about CBT. Please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531.

3 Tips for Surviving the Holidays

The holidays are upon us! Social media, TV commercials, and Hallmark movies depict it as “the most wonderful time of the year.” While that may be true for many, for others it is a time filled with anxiety, loneliness, and bad memories. Regardless of if you are filled with holiday cheer or can’t wait for January 2, here are some tips that will make the holidays go a little smoother.

Watch your drinking.

Between the holiday parties and cold nights hunkered down at home, people tend to increase their alcohol consumption during the holidays. Not only does drinking (especially excessively) exacerbate depression and anxiety, it also makes it more likely you may embarrass yourself at the company party, get in a fight with Aunt Jean about politics at the dinner table, or skip that morning run that helps you feel energized and ready to tackle the day.

Keep up your healthy habits.

Let’s face it: between the constant supply of cookies at the office, cold weather, and hectic social schedule, healthy habits tend to fall by the wayside during the holidays. The best way to keep your mood stable is to practice moderation and continue with a healthy exercise, diet, and sleep regimen. Haven’t made these things a priority in 2018? No need to put off making a change until January 1 – now is the perfect time to create new healthy habits.

Say no.

When we overextend ourselves and don’t take the time we need to recharge, those holiday parties end up feeling like a chore. You know yourself – if two parties in a weekend is too much, choose the one that is more important to attend and send your regrets to the other. Or decide you are going to go to each for a set amount of time, say 1 hour.

In addition to social and work obligations, family get-togethers can be extremely stressful. If you find that you are emotionally depleted after a trip home for a few days, limiting your time with your family may be what is best for you. It is better to spend a few hours together and have it be pleasant than stay for several days and end up in an argument or leave feeling depressed.

If adhering to the above suggestions sounds difficult, or you feel too overwhelmed to make those changes on your own, it may be time to enlist help. Just like you don’t need to wait until January 1 to make lifestyle changes, you also do not need to wait until then to start psychotherapy. If you are in the Austin area, please reach out to me at laura@drlaurawahlstrom.com or 512-521-1531 to discuss your situation.

The Power of Breath

Not long ago I was watching the Today Show, and the topic was how to live a longer and healthier life. One of the segments was focused on deep breathing and how researchers believe may play a key role in slowing the aging process. Deep breathing, also known as diaphragmatic breathing (more on that shortly), is one of my go-to skills I teach my clients. Why? It is highly effective, and can be used anywhere, at any time. And, now I may be able to add to that list it helps you live longer!

Our typical breathing tends to be shallow and happens in our chest. When we experience anxiety or stress, our breathing tends to become even more shallow and rapid, and can set off a downward spiral of physical symptoms, thoughts, and behaviors. Hyperventilation (i.e., an imbalance of our oxygen and carbon dioxide levels) may set in, which leads to feeling dizzy or lightheaded, which leads to thoughts that something is wrong with you, which leads to more rapid breathing, which leads to…

You get the idea, right?

One of the keys to stopping this cycle is to change your breathing. This is where diaphragmatic breathing (also known as deep breathing and belly breathing) comes into play. Instead of taking rapid, shallow breaths from your chest, you take slow, deep breaths from your belly. This encourages full oxygen exchange, slows your heartbeat, and lowers blood pressure. All of those scary physical symptoms that are signaling to you “something is wrong with me!” have been thwarted.

What if you don’t struggle with anxiety – can diaphragmatic breathing help you? Absolutely! For those who deal with day-to-day stress, have difficulties, winding down, difficulties sleeping, trouble “shutting your brain off” at the end of the day, diaphragmatic breathing can help you relax.

Diaphragmatic Breathing Instructions:

To start, find a quiet, comfortable place to sit or lie down. Place one hand on your belly, and begin taking a slow, deep breath in. You should feel your chest expand, and your belly rise. Then, slowly expel the air from your chest. Continue breathing this way, counting as you breathe in and out. Each person is unique, so the number of seconds for the in and out breaths do vary some. I usually start with “In… 2… 3… out… 2…. 3” with my clients and adjust from there. You do not want to breathe so deeply that you are feeling dizzy or lightheaded – that is specifically what we are trying to counteract! If you find that happens, breathe more shallow or take shorter in and out breaths.

It is most helpful, especially at the beginning, to have someone else (therapist, friend, spouse) count for you while you breathe. There is also a great app you can download called Breathe2Relax that will give instructions and guide you through diaphragmatic breathing exercises.

There are 2 things I think are crucial for diaphragmatic breathing to be effective:

Expectancies – Simply put, if you believe in the rationale and science behind diaphragmatic breathing, it is more likely to be effective. If you believe it is simplistic or silly, it probably won’t help you.

Practice – How likely do you think it is you would make the Olympic track and field team if you had only run one time in the last year? Just like athletes need to train to improve their physical fitness and skills, diaphragmatic breathing needs to be practiced to be effective. A good place to start is daily practice of 5-10 minutes,during a time you are not in the throws of anxiety or significant stress.

I’ve included some helpful links on diaphragmatic breathing below. If you are interested is learning more about anxiety management and relaxation, and live in the Austin area, please reach out to me at 512-521-1531 or laura@drlaurawahlstrom.com.

Mayo Clinic: Decrease Stress by Using Your Breath

Psychology Today: Diaphragmatic Breathing Exercises and Your Vagus Nerve

The Importance of the Therapeutic Relationship

As humans, we not only desire relationships with others, but need them. Research indicates that social support increases our odds of survival by 50%. So, if we need supportive relationships to survive, it makes sense that we also need a strong relationship with our therapist for treatment to be effective. My blog post today will focus on aspects of the client-therapist relationship that contribute to better outcomes in psychotherapy.

The therapist-client relationship (often referred to as “therapeutic alliance”) has been studied extensively, with data indicating it is a consistent predictor of therapy outcomes. Individuals who have a strong relationship with their therapist are more likely to comply with therapy, experience greater symptom relief, and report a greater satisfaction with the therapy process.

What are some of the therapist characteristics that promote a strong therapeutic alliance?

  • A collaborative approach to therapy, as opposed to an authoritative or direct approach.
  • An ongoing communication of hope regarding the outcomes of therapy.
  • A warm, genuine, and friendly demeanor.
  • Objectivity and honesty (even if sometimes you don’t like it!).
  • The use of plain, straightforward language as opposed to jargon.
  • A flexible treatment plan.

Not all of these qualities are immediately evident when first meeting someone, so what should you be looking for when deciding on a therapist? First, you should look for a therapist who specialize in approaches that fit with your personality and preferences (e.g., does a cognitive-based approach resonate with you, or do you feel a humanistic approach is more your style?). Second, take some time to talk with a potential therapist and ask questions before scheduling a session. While relationships take time to develop, research also suggests our initial impressions of kindness, trust, and compassion are pretty accurate. Don’t be afraid to trust your gut!

Given the importance of the therapeutic relationship, I offer a free 15-minute phone consultation prior to scheduling my first session with any Austin-area client. This gives us an opportunity to learn more about each other, and you a chance to decide if I seem like a good fit for you. If we determine that we aren’t a good fit to work together, I’m always more than happy to help you find someone else in the area better aligned to your personality and therapy goals.

Please reach out to me at 512-521-1531 or laura@drlaurawahlstrom.com if you would like to discuss your situation and see if I may be able to help you!

What IS a Psychologist?

Finding and reaching out for help can be overwhelming. You may already be struggling with low energy, little motivation, and difficulties making decisions, which makes that process feel like you are embarking on a drive from South Austin to Round Rock, on I-35, during rush hour. Then, once you start looking for help, how do you figure out what type of mental health provider to reach out to? My blog post today will explain the education and qualifications required to be deemed a ‘psychologist,’ and the specific ways in which a psychologist’s training sets them apart from other types of mental health providers.

A psychologist has a doctoral degree (PsyD or PhD) in either clinical, counseling, or school psychology. Graduate training is typically between 5-7 years, and includes rigorous coursework in a variety of areas of psychology, research (though less of an emphasis for PsyD), training in assessment and treatment of psychological disorders, and completion of a year-long, full-time clinical internship. Following completion of the doctoral degree, post-doctoral supervised experience is required (typically 1-year) prior to becoming licensed to practice independently. The licensure process differs by state, but Texas requires an individual possess the necessary degree, training, and clinical hours, as well as pass the Examination for Practice in Professional Psychology (EPPP) and a Jurisprudence exam (a test of state laws and rules psychologists must follow). They also previously required an oral exam, but did away with this requirement in 2017. After licensure, psychologists are required to complete a certain number of continuing education hours each year to help them stay current on issues related to treatment, ethics, and cultural diversity in the field.

Does this sound like a long process? Well, that’s because it is! While the type and quality of training a psychologist receives can vary greatly, there are a few things that you can expect when working with a psychologist.

First, the primary thing that sets a psychologist apart from other types of mental health practitioners is training in assessment. This includes intelligence, cognitive, and personality testing, that is often used along with a clinical interview and self-report measures to establish diagnoses and make recommendations.

Second, psychologists are trained to diagnose psychiatric disorders. During graduate school, they take courses on the diagnostic criteria and interviewing skills. These areas are then put into practice during their practicum, where they see clients under the supervision of a licensed psychologist.

Lastly, psychologists are trained in psychotherapy. This includes ways to connect with clients and develop a strong relationship, as well as specific treatment approaches for different problems.

I’ve provided a link below that further explains the different types of mental health professionals. If the type of training a psychologist has sounds like a good fit for your needs and you live in the Austin area, please give me a call at 512-521-1531 or email me at laura@drlaurawahlstrom.com to discuss your situation and see if I may be able to help you.

Types of Mental Health Professionals