#50 Dr. Judith Beck Explains How Everyone Could Benefit From Learning CBT.

0:00 [Music] hello I'm Dr Bridget Nash and I'd like to welcome you to the therapy show a podcast series that seeks to demystify mental health treatment today I'm honored to welcome Dr Judith Beck who is president of Beck Institute for cognitive behavior therapy the Beck Institute is a nonprofit organization which provides training and certification in CBT to health and mental health professionals around the world Dr Beck divides her time between teaching clinical work program development research and writing Dr Beck is also clinical professor of psychology and Psychiatry at the University of Pennsylvania she is the author of the primary text in the field cognitive behavior therapy Basics and Beyond which

0:47 is now in its Third Edition and has been translated into 20 languages Dr Beck's other books include cognitive therapy for challenging problems cognitive therapy for personality disorders the Oxford textbook of psychotherapy and the diet trap solution the online CBT courses she has developed at the Beck Institute have been taken by people in 130 countries Dr Beck welcome to the therapy show thanks so much for having me can you start by telling us a little bit about your personal background and professional development that led to your work on the development of cognitive behavior therapy which is commonly referred to a CBT sure I didn't start out in Psychology or in cogni

1:34 behavior therapy ever since I was a little girl I wanted to be a teacher and I did start out in education I taught young children with learning disabilities to read but I think that served me in really good stead at some point I decided that if I wanted to be more than a classroom teacher that I probably needed to get another degree so I went back to school and started in education and then started to also study psychology and it ended up with a doctorate in both but I find that my background in teaching kids with learning disabilities really helped me learn how to break down ideas so that they were more understandable to first of all to children and later than to

2:21 adults but I think one of my contributions to the field has been to translate some complex Concepts into very practical terms the textbook that I wrote CBT Basics and Beyond which is just coming out this week in its Third Edition really is a stepbystep guide in how to do CBT how would you briefly explain CBT to a nonprofessional well what I usually say is that CBT is a generally short-term therapy actually it's really a time sensitive therapy which means that we try to accomplish therapy in a relatively short period of time and one of the reasons we're able to do that is that our goal is not only

3:09 to use techniques to help people but also to teach them how to use the same techniques so we tell our patients that our goal is to help them be their own therapists now this is what CBT really does CBT does two major things one is it helps people solve the problems that they're facing right now and the other thing that it does is to teach people skills that we hope they'll actually use for the rest of their lives some of these skills are identifying and evaluating their unhelpful or inaccurate thinking and also changing their behavior so that they can act more in accordance with their aspirations and

3:56 their values and so that they can reach their goals can you talk about some of the newest research in the field of CBT well there's been just an explosion of research in the last 25 years or so there are really interesting and exciting developments in neuroscience and neuroscientists have been able to see the actual changes that occur in the brain as the result of undergoing a course of CBT so that's that's one branch another branch is testing the effectiveness of of new technology in a whole variety of ways so there's been a lot of research that shows that certain CBT apps are a terrific adjunct to treatment as usual

4:41 or sometimes even for people to use without treatment there are online courses and programs for people who might be diagnosed with a variety of psychiatric disorders there has been a huge amount of research applying CBT to medical conditions that have psychological components everything from heart disease to HIV to pain after surgery to migraines and so forth and just one more category although there are lots more that I'll mention right now is the research which adapts CBT to people who have been diagnosed with a serious mental health condition such as schizophrenia or

5:27 bipolar disorder who is CBT most effective for and why should people choose a CBT therapeutic intervention well the reason to choose CBT is because there's more research that shows that CBT is effective than there is for any other kind of psychotherapy for most condition CBT is about equally effective as medication sometimes the combination of medication and CBT is better for people especially if the therapist is not very experienced although though we found that the more experienced the more competent a therapist is the less likely that medication will actually be helpful so the major reason to choose CBT is because it is so highly effective and

6:14 it's been shown to be effective for young children for adolescents adults and older adults there's also been a lot of research that shows that it's effective in various settings so it's effective for inpatient treatment for outpatient treatment for day hospital treatment it's effective for residential settings these might be for example adolescents who are sent to a residential setting instead of to jail or it might be residences in which people are recovering from addictions or who have left a psychiatric hospital and now need a protective place to live in the community

7:00 so the research on CBT shows how highly effective it is for a whole range of diagnosis for a whole range of Ages and developmental levels for a whole range of settings and more research has shown that it's effective when adapted appropriately for also a wide variety of cultures and people with individual differences learning how thoughts affect emotion and behavior behavior is such a valuable Concept in CBT I wonder if we should teach these basic CBT skills to children and adolesence in school oh I definitely think that we should and it has been done to some degree most of the research that has been done has been using CBT

7:48 sometimes in group settings in schools for children or adolescence who are at risk for anxiety or depression or who have anger problems or these school children may actually have a diagnosis of one of these things but I think it is so valuable one of the things that we teach our clients is just because we think something doesn't necessarily mean that it's true and I think that that's a very valuable idea for kids to learn it's also very helpful for them to learn the basic cognitive model which is that it's not a situation that directly impacts how someone feels and what someone does but rather it's their perception of the situation specifically

8:36 what they are thinking about in that situation and when people are in a lot of distress often times their thinking is not accurate and certainly it's not helpful one of the things that we do with our clients which could easily be taught in school is to learn how to identify thinking that precedes feeling sad or depressed or anxious or angry so learning how to identify these thoughts and then learning how to evaluate these thoughts here are some of the questions that we use with our clients and they certainly have been adapted for a younger age level as well but let's say we have a teenager who has the thought everything in my life is terrible and

9:22 that thought makes the person feel very depressed and very hopeless so one of the things that we would do is to say well that's an interesting thought so we have the patient recognize that it's a thought an idea not necessarily a truth and then we might say could we just take a look at that thought for a moment what is going on in your life that's really terrible now so in other words what's the evidence for this thought then we might ask them how about evidence on the other side are things going as badly in every area of your life or are there some areas things might not be great but they're not quite as bad and then we might say so things do seem really bad right now how are you

10:09 coping and are there ways that you think you might be able to cope better would you like to hear some of the ways that I think might help and then you can see whether you think they they might or not and I might say so you know the worst is that things are terrible and won't get better but but what's the best that could happen especially if you and I continue to work together in this kind of treatment and what do you think is the most realistic outcome if we continue to work together and then I might say what's the effect of telling yourself over and over again how terrible your life is what might be the effect of changing your thinking and then I might say if you had a you know you told me about your friend Allison if she were in this situation and thought that her whole life was terrible what would you tell her and then finally what

10:56 would you like to do about that this week how would you like to make your life better this week so I think by teaching school children that just because they think something doesn't necessarily mean that it's true by helping them identify the thoughts that are leading either to unhelpful behavior or to distress and then helping them evaluate their thinking and learning how to see things more realistically that these skills will serve them well for their entire lives there there are a lot of other skills that we also teach in CBT as I mentioned before we do a lot of direct problem solving we do a lot of planning for how to have a better week and so forth and so I think all of these things would be helpful to school children and I think school children are

11:43 in the right environment for learning they're already doing worksheets they're already doing classroom work so this would fit perfectly and I see a lot of young people struggling with anxiety and depression so I think this would be a perfect thing to integrate into that developmental state AG I think it could be integrated so well for younger kids but also for high school students when they're studying literature so that they can begin to conceptualize the kinds of thoughts and beliefs that perhaps some of the characters in the books they're reading might have that would then help us understand why the characters are reacting in a certain way why they're feeling a certain way why they're behaving in a certain way and then of course the high school kids could learn how to apply this kind a

12:29 conceptualization to themselves I agree so why is it important that therapists who are using CBT have some formal training in the therapeutic method before they use it with their clients so I always tell people that I'm a much better therapist today than I was five years ago really much better and I hope that I'm a better therapist five years from now and I've been treating patients for probably 30 plus years so so my journey in becoming a really competent CBT therapist has been quite a long one it's important for anyone who wants to deliver effective CBT to really study it formally I know at the Beck Institute we

13:15 have a lot of online courses we have virtual workshops and in-person workshops we have lots and lots of resources for people the best way to get trained I think is to do a lot of reading to attend training training programs and workshops but there's really no substitute for good supervision and most of the supervision that we do at the Beck Institute involves recording actual therapy sessions and then sending these recordings of course with anonymity and with the permission of clients they send recordings to a supervisor every week who listens to the entire therapy session and then conceptualize is what the therapist needs to work on and then

14:02 has a 50-minute phone call with the supervis and this is really the best way to get trained you can learn a fair amount from books and workshops but you really need someone to listen or watch a video of what you're doing and give you specific feedback and then specific practice in the skills that you need to improve in and I think that just one course of supervision isn't enough at the Beck Institute I'm so lucky because we have a case conference once a week and so I meet with the four other experts CBT therapists and we discuss our cases so I always bring my most difficult cases to the case conference and so do they and I've learned so much from the other therapists at the Beck

14:47 Institute so I would like to say not only should you get formal training in CBT but you should really consider how to have a lifetime of learning if you want to continue to improve your confidence in CBT and I think that the more training that you have the more comfortable you'll be in the room with your patient or your client and I think that makes them more comfortable the more training you have the more comfortable you'll be that's what we've seen over and over again so many people say they do CBT and so I've been giving workshops nationally and internationally for probably about three know so I've been treating patients more like for 40 years because I've been doing workshops for 30 years and this is still what happens I ask people to raise

15:33 their hands if they consider themselves to be CBT therapist and then throughout the workshop I ask some questions I'll say now how many of you toward the beginning of every session set an agenda with the client and then prioritize it so you're covering the most important things that the client wants to be able to discuss during the session and then I find that we used to be about 20% of hands go up now about 50% of hands go up and then I'll say and now how many of you structure the session so that at the beginning you're doing a formal mood check you are asking for an update of important things that happened between the previous session and this session you're reviewing the action plan and

16:20 then in the middle of the session you're working very directly on a specific problem or goal that's put on the agenda you get the person to summarize the most important points from this problem or goal when you're finished discussing it you send the client home with therapy notes that include both these most important things they want to remember and also the things that they want to do in the coming week and then at the end of the session you ask for feedback what did you think of this session is there anything you want to do differently next time and so when I go through the standard structure of the session and ask how many people do all of these things usually I only get about 20% of hands going up so this gets back

17:05 to my original point was so many people say they do CBT but they really don't do it fully even if they do it fully it doesn't necessarily mean that they're doing it competently but at least they're hitting all of the the important structural elements of the session I think that it would be like giving you half of the medication that you need for an illness yes I think that's right you know I I give people an analogy sometimes I'll say if you had a really bad headache would you only take half of a Tylenol why not and then they realize well because it wouldn't be effective it wouldn't be effective enough and it's the same thing we really want CBT to be delivered in the most effective way possible and the

17:50 most effective way possible is different today from how it was practiced even 10 years ago because there's been so much more research that shows us what kind of interventions are effective how these interventions should be delivered when they should be delivered and to whom they should be delivered so what's the average length of treatment for somebody working with CBT well it varies quite enormously I have occasionally had someone without a psychiatric diagnosis who's come to see me for a specific problem maybe a relationship problem or a work problem and maybe I just see them twice and they get enough from those two sessions to go ahead and to work on the problem themselves and they don't need any more therapy so that's at one

18:36 extreme at The Other Extreme are people who have been diagnosed with serious mental health conditions who may have been hospitalized for the last 10 or 20 or 30 years but who have not received a new version of CBT that's especially been researched and shown to be effective for them for people like this CBT may be able to move them down a step to less protective care or even getting out of the hospital and into either some kind of protective housing and treatment outside of the hospital or going home to family and so forth and people who are diagnosed with uh serious mental health conditions probably are going to need

19:22 some contact with a CBT therapist for quite a long time and then probably periodically when they meet new stressors in their lives so but the average length of treatment for someone with just a very straightforward depressive disorder or straightforward anxiety disorder for many competent CBT therapists is some place between six sessions and perhaps 20 sessions really depends on how complex the case is whether there are comorbidities with other psychiatric problems what their are life circumstan are and so forth so what skills habits or tactics can patients adopt either during their sessions or in between sessions to improve the effectiveness of CBT and I

20:09 was just thinking the client keeping their own notebook isn't that something that CBT does oh absolutely the research shows that people forget between 40 and 70% of what they hear in their Health Care provider's office we think they forget so much more in a therapy office so our rule of thumb is anything we want a client to remember has to be recorded in some way so in the old days we used to only record on paper so people would have coping cards which would be important things to remember that that they or we write for them on index cards or they might have a notebook or they might have these important notes just on a sheet of paper that we might Xerox so that we have a copy of them too nowadays

20:57 clients sometimes will use their phones in creative ways so they might make themselves virtual coping cards using an app on their phone or they might use the notes section of their phone or if they prefer that we take the notes for them they might take a picture of our notes well I should say this was in the pre-co era when we were still seeing people in person nowadays both the therapist and the client since we're doing a lot of tella Health need to both be taking notes people sometimes also use a recording app on their phone so that the therapist and the client together will discuss the most important points of the session so that the client can listen to these therapy notes in between sessions

21:42 one of the things we tell people is that the way that people get better is by making small changes in their thinking and their behavior every single day there's no really one big answer to how do you get over depression or how you get over an anxiety disorder or an eating disorder or obsessive compulsive disorder or something like that people need to learn things in each therapy session that they put into practice during the week as I mentioned before how do we figure out what's important for patients to remember well we ask them we finish discussing a problem or a goal and we say to them what do you want to remember about what we just talked about when clients come out with a good

22:29 summary we'll say hey that's good let's let's record that and we might also say to them you know I wonder if whether you you also think it would be helpful if you remembered such and such because often the summary that they give us is incomplete and if so then they write down a more robust summary if we think that the summary is not quite on point we might say something like this you know I think it that's close but I wonder if it would be more helpful if he remembered it this way and then we if the client agrees then that's the summary that gets recorded we make sure that this recording also contains the steps the client wants to take to improve his life in the coming week and these steps are again of course are related to the problem or the goal that

23:15 we've been discussing so one of the techniques that clients can use throughout their entire life is to go back and to read their therapy notes when they're relevant to perhaps new problems that have come up another skill as I mentioned before is just learning how to identify and evaluate their thinking and change their thinking around if it's not accurate or not helpful so that they can be thinking in a more productive way we also doing skills training with patients so not all patients need skills training but some of them do for example in being able to use better communication skills and scheduling their activities and budgeting their money in using better self-care habits and so

24:02 forth and these are all things that we hope that clients will keep up for their lifetime as well sounds very collaborative it is very collaborative in fact that's one of the most important parts about CBT is that it is very collaborative so together we make decisions with clients about what to talk about during a session how much time to spend on on each problem or goal during the session how often to meet how long long therapy should last and what clients might do between one session and the next session maybe I could just talk for a moment about how long therapy should last sure so it is a collaborative decision sometimes at the beginning of treatment if you have a very good

24:47 experienced uh competent CBT therapist the therapist might be able to say you know based on other people that I've treated who had similar problems to yours I would get that therapy is going to take between 12 and 16 sessions something like that other times we really can't predict and we say you know really sorry that I can't give you a good prediction of how long I think therapy should last but let me tell you how we'll know when you're getting ready to terminate first of all we're going to look for the signs that you are getting better that you're feeling better between sessions that you're able to follow through with these action plans that I've told you about the things that you're going to do between sessions when you're able to use the skills of CBT

25:34 yourself and when both of us see that happening then we might experiment with going from once a week to once every two weeks for a little bit and if that works well maybe we'll try then once every three weeks or once every four weeks so we'd like to taper off therapy we don't like to go from weekly therapy to no therapy at all and we also like people to come back for booster sessions maybe after 3 months 6 months a year something like that just to make sure that you're still doing well and you're still using your CBT techniques but I won't decide that you should end therapy it will certainly be a decision that the two of us make and if we start to space out sessions and you're not ready for it then we'll just return to more frequent

26:20 sessions so what are some of the most common obstacles that prevent patients from seeing the full benefits of CBT some of the problems are problems that prevent them from seeing full benefit from any kind of psychotherapy they might be in probably the biggest problem is that people's just don't have enough money to get really good Psychotherapy the second is that they may see therapists who are just not very well trained it's so interesting in this country that our least experienced therapists often are asked to see the most difficult clients who are struggling the most which really doesn't make very much sense in England

27:05 particularly that there's a very interesting system of care through the National Health Service where let's say you're depressed and you go to your primary care doctor if your symptoms are very mild then the primary care doctor May recommend that you use a CBT app or that you join a CB CT self-help group or that you do a CBT self-help online program if it turns out that you're more moderately depressed then you might see a CBT therapist who has some training but maybe not a great amount of training and a lot of the therapy will be oriented toward behavioral activation getting

27:51 people to schedule activities and start to function the way they function before they got depressed and it's only the people who have moderate to severe or severe depression who will see people who have phds or who who might see people with a great deal of training and that kind of system of Mental Health Care makes much more sense to me I think in the UK patients too are offered the option of medication alone or medication in conjunction with seeing or getting one one of these levels of care the most common obstacles that prevent people from getting the full benefits of psychotherapy I think have to do with

28:38 money and their mental health coverage and the competence of the therapist that they're seeing another obstacle that can get in the way whether it's CBT or not are beliefs of the client so when someone has been depressed let's say very severe and chronically for many years they have developed certain beliefs about themselves and other people that they bring to the therapy session also very negative beliefs about the future so they may believe especially if they've been in treatment before that therapy can't help that in fact there's nothing that can help them that their present is terrible and their future is going to be

29:24 even worse and that the therapist even if the therapist is well-meaning won't be able to make a difference in their lives so they bring these beliefs to therapy and it's very important that the therapist be able to elicit and uncover these kind of beliefs and help people have a different kind of viewpoint maybe giving this therapy a try before the patients are really going to be able to make very much progress It's also very important for therapist CBT therapists to adapt treatment to each specific person so everyone is different in various ways they have different symptoms they have different aspirations

30:10 and values they come from different cultures they face some of the same problems but some of the problems are unique to patients themselves they come with differing education levels different intellectual ability levels they come with different levels of physical health they come from different upbringings some people have trauma in their background some don't and it's very important for therapists to vary treatment so that it is right for each individual patient and I think that sometimes people do not realize that when you enter therapy your problems can feel or you may experience them as getting worse I correct about that oh you know we find that when CBT is done

30:56 competently that most people don't feel worse at the end of the session in fact one of the things that we have therapists think about throughout the whole session is how can I help the patient feel better by the end of this session and how can I help the patient have a better week but of course there are times when the session is drawing to an end maybe you only have a few minutes left and you still haven't made much Headway on a problem or uh patients negative beliefs are still fully activated so when that happens what I do with my clients is I I'll say to them you know we only have a few minutes left and I can see that you're still feeling pretty distressed about this would it be okay if we stop talking about this now

31:43 because I don't want you to leave the session feeling upset maybe we can talk about something that isn't distressing to you I'd particularly like to hear a little bit more about blank you know something that we decided earlier in the session that you're going to do if you're able to do this how do you think you'll feel and what other bright spots do you think there might be in this week so we'll deliberately change the subject so that patients can leave the session feeling better and then we'll just take up that problem again at the beginning of the following session that's great so can you share any poting examples where CBT had a major impact in someone's life probably the greatest impact is someone who's been in a psych atric hospital for

32:28 20 years and then is able to go home and live with his family so that that's that's really dramatic but I'll just tell you about one of my patients I saw a few years ago and I I I always change some of the details to protect confidentiality but I was treating a woman who was 35 and she had been severely depressed for about six years she had gotten to the point where she was spending almost almost her entire existence in her apartment she would only go out for absolute Necessities like going to you know a convenience store so she could quickly get some groceries and then go back to her house fortunately she had a supportive sister

33:16 who brought her to treatment and it didn't take really very long with her it it took about three or four sessions before she was getting out of her apartment ready L and I think we had a total of about 12 sessions all together and at the end of that time she was working in a volunteer job she had reconnected with people whom she had lost track of she was visiting her sister and some other relatives periodically throughout the week and she had really been able to turn her life upside down and it just didn't take very long she was one who just really glommed on to the cognitive model very quickly

34:01 and she was very quickly able to see that many of her thoughts were depressed thoughts they weren't accurate thoughts and she became very motivated to work toward her values one of the things that had helped her a lot was that she had stopped going to church about four years previously and she was a very spiritual person so one of the first things that we worked on because uh spiritual life was so important to her was to get her back to church and going to services at church and then volunteering at the church she reconnected with people whom she had not been in contact with for at least 4 five years and I think that that also played a big part in her recovery

34:49 but she was just one example of a dramatic outpatient who responded very quickly and very well to CBT treatment who is CBT not appropriate for well we don't really know CBT as I mentioned before certainly has to be tailor to the individual and the way that we do treatment for someone who has panic disorder has some similarities but also has a lot of differences from someone who has a straightforward depression so CBT really has to be varied not only for individual characteristics but also for the problem for which the patient has sought treatment CBT has been shown for the wide variety of psychiatric disorders and psychological problems and

35:36 medical conditions with psychological components to be effective and we don't really know for whom it is not effective if it is appropriately and competently delivered I think that's the main issue is competently and appropriately yeah exactly what are you most excited about in mental health treatment today I'm most excited about recovery oriented cognitive therapy my father Dr Aaron Beck and his team at the Beck Institute have been working to develop this adaptation of CBT for the last 10 or 12 years and I think I mentioned it earlier in our talk that they developed this kind of treatment for individuals who have been diagnosed with serious mental

36:22 health conditions like schizophrenia and bipolar disorder but I and my colleagues at the Beck Institute have now applied the principles of recovery oriented cognitive therapy to our much higher functioning outpatients the recovery movement actually started about 50 years ago and it started by people who themselves were diagnosed with serious mental health conditions and it was kind of a reaction to the medical model in which patients were offered psychiatric medication but for whom effective psychotherapies had not really been very well developed and the definition of recovery is when individuals are able to

37:10 live the life that they really want that they're able to be the way that they really want in alignment with what's most important to them their values and their aspirations the goal in more standard CBT is twofold one is to have the psychiatric disorder go into remission and the second is to prevent relapse there's a slightly different goal when we have a recovery orientation which is to strengthen people's sense of connection and hope and purpose to make them feel empowered and safe to increase their sense of well-being their

37:56 competence and their control and what this means in terms of higher functioning outpatients is at the very beginning of treatment we identify patients aspirations and their values what's really important to them in life what do they really want for their lives and then at every session instead of asking clients what problems they want to put on the agenda we ask them what are their goals for the session now the goals are actually just the flip side of the problem so the problem might be I'm feeling very lonely and the goal might be to reestablish connections with other people or the problem might be my house is a mess and the goal might be to get

38:44 better organized at home once we've established what the goals are we help patients think of what step we have to collect some more information about the goal and what has prevented the patient from being able to work work on the goal effectively himself and then we find out what steps the patient wants to take in the coming week toward achieving that goal then we have to find out what obstacles will get in the way so there are usually three kinds of obstacles that could get in the way let's say getting out of bed every day for a very highly depressed patient and taking a shower getting dressed and going downstairs for breakfast so there are three things that can get in the way one are some practical problems so let's say

39:30 the patient keeps turning off his alarm clock maybe we would suggest that he put the alarm clock across the room so that he has to actually get out of bed to turn it off a second problem might be the patient automatic thoughts such as it's not going to be worth it to get up my day is going to be terrible anyway I don't have enough energy to do anything if I even try to do things today I'll just fail and so forth and so we need to use just regular CBT techniques to help them address their unhelpful thinking and then sometimes it's a matter of uh skills training so let's say we have a person who's highly anxious we might teach them how to do some relaxation skills so there's just a shift in

40:18 emphasis in the session one of these shifts is to identify goals that are in alignment with people's values and aspirations and then figure out how to address the obstacles that are getting in the way of taking steps toward the goals this week and the way that we address the obstacles are using the same kind of CBT techniques that we use in traditional CBT there's another really important difference too at the beginning of sessions in traditional CBT we do say to patients what's important for me to know that happened between last session and this session when you do that patients almost always tell you the negative things that happened and so it's very important to ask them about the positive

41:05 we are much more likely now to dwell on the positive experiences patients have had in the previous week some of these have to do with taking the steps on their action plans that that they had identified they wanted to take in alignment with their goals and some of these are just other experiences in which the patient felt a little bit better or felt a little bit more connected to people felt more sense of control or in which they functioned a little bit better we spend more time talking about these positive experiences and helping the patients draw positive conclusions about them so what does it say about you that you were willing to take the risk of talking to your friend

41:50 at church whom you hadn't really talked to very much before what does this say perhaps about your future of being able to reconnect with this person if you are able to reconnect with her what does this say about your ability to reconnect with other people so we very much help people draw conclusions about these positive experiences in terms of the effect that they've had on the person's sense of self beliefs about other people and beliefs about the future so I have really shifted the way that I do treatment I mentioned before that the way that I do therapy has changed quite a lot in the last 5 years one of these ways has been in being more effective with people who have negative or

42:36 unhelpful thought processes such as rumination and Obsession intrusive thoughts or who have negative beliefs about experiencing negative emotion or physical pain or other distressing internal Sensations and I've learned how to integrate mindfulness into CBT to help those people but for all of my clients I've been putting much more I've been using the principles of of the recovery orientation to improve my confidence in therapy so that's what I'm most excited about in mental health treatment today I really love that it feels so hopeful and I think that it's like you said it could benefit everybody everybody has these issues with their own minds and their own emotions I mean

43:21 that's what makes us human in this covid-19 era one of the things that I advise people people to do whether it's my clients or family members or friends is to really keep track of the positive moments every day people are really struggling quite a lot and it's easy to start seeing our experiences through gray lenses as if we're wearing sunglasses all of the time or even dark lenses and I think it's very important to both create positive moments and also just to notice positive moment moment to draw positive conclusions about the moments and then to tell someone else about the positive moments so I'm encouraging people to take photographs to represent the positive moments and

44:08 sharing the photographs or or even just keeping a physical list and at the end of the day sharing some of these moments with another person and asking the other person to do the same so not only does it help you remember the positive moments and help you draw positive conclusions but sharing them with another person just streng your connection with that person as well I agree so if you had a magic wand and could improve one thing about mental health treatment today what would that be it would really be that in the United States and elsewhere in the world as is happening in the UK in five or six other countries that we have a more sensible delivery format or system I should say for mental health treatment where we do have some kind of triage system so that

44:57 people with the most serious problems are seeing the most well-trained therapists and of course I because the research is so dramatic would hope that these very well experienced therapists be delivering CBT and that those with milder problems be helped especially with all the new technology that's out there these days I would really want to see Mental Health Care Systems be far more Equitable for people I agree so how can my audience learn more about your work either online or in print so the best way is to go to our website Beck institute.org if you go to the website you'll find a wealth of resources we have many different kinds of training programs both for individuals and for

45:44 organizations we have information about how to become a certified beex CBT clinician we have a lot of blogs about research and about treatment we have a complimentary newsletter that we send out once a month that is usually pretty clinically oriented so usually I or someone from our large faculty will write about how to address a certain problem or diagnosis in treatment we have many many videos on our YouTube channels we have uh large presence on social media so you could check out LinkedIn and Twitter and our Facebook

46:31 pages so a good way to start anyway is just going to Beck institute.org and seeing the many different things that are available and and I do hope that some people will take a look at the this new edition of CBT Basics and Beyond in which I have really infused a recovery orientation and and we have in fact been adding this recovery orientation to all of our training as well so Dr Beck on behalf of myself my listeners and all of the people that you've helped your work I want to thank you for your contributions to mental health treatment and for taking the time out of your busy schedule to help me and my audience better understand the field of cognitive behavior therapy well I just want to thank you so much Dr Nash for inviting

47:17 me to do this podcast you got me talking about my favorite topic you know really what what is my passion in life so I've really enjoyed the experience and hope that people who are listening have learned something as well and I'm sure they have because I have and I have been studying this for a long time be sure to check out my website therapy show.com which has many resources about mental health including a page dedicated to CBT there you will also find how to submit questions stories or insights that you have about the mental health system or suggestions about who else I can interview and how I can improve the show I'd like to close by reminding our listeners to Please Subscribe share and review this podcast so you someone you love and people around the world can gain more benefit from therapy there's

48:04 no need to suffer in silence get the help that you need to create the life that you want [Music]