Thoughts on Record: Podcast of the Ottawa Institute of Cognitive Behavioural Therapy

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Rumination in the context of OCD, anxiety & depression is often conceptualized as an automatic & intrusive psychological experience for which there is little relief beyond distraction, mindfulness etc.  Dr. Michael Greenberg, clinical psychologist and Director of OCD Associates, has re-framed rumination as a compulsion which is amenable to treatment via a number of specific techniques.  In this conversation we cover:

• how Dr. Greenberg's conceptualization of OCD differs from traditional conceptualizations of OCD
• the unique contribution and value that psychodynamic models can bring to the conceptualization and treatment of OCD
• the concept of the "core-fear" in OCD
• why rumination is so often thought of as an intrusive thought and the case for re-conceptualizing rumination as a compulsion
• the importance of differentiating between awareness and attention with respect to mental events
• a brief summary of Dr. Greenberg's critiques of Acceptance & Commitment Therapy (ACT), particularly in the context of OCD
• the form and function of rumination for most clients and the principles that need to be taught to clients in order to teach them to stop ruminating
• differentiating between constant intrusive, automatic thoughts & rumination
• a consideration of whether rumination in OCD is functionally or qualitatively different than in depression, generalized anxiety disorder etc. 
• reflective pondering vs. brooding in the context of effective problem solving
• examples of response prevention in the context of rumination and Dr. Greenberg's conceptualization of ERP more generally 
• integration of core belief work/psychodynamic principles for examining stuck points in OCD therapy.

Comments or Feedback?  Email the show: [email protected]

Host note: We will be offering a 6 week essentials of CBT workshop that I will be facilitating beginning March 24, 2023.  For more information and registration, please visit: https://www.ottawacbt.ca/news. 

Dr. Michael Greenberg is a licensed clinical psychologist and the director of OCD Associates, a national telehealth practice specializing in Rumination-Focused ERP.  He holds a PhD in clinical psychology from Fairleigh Dickinson University, where he trained in both Cognitive-Behavioral Therapy (CBT) and psychodynamic psychotherapy. He completed specialized training in CBT for anxiety disorders and OCD at Mount Sinai Hospital, and in the treatment of personality disorders and serious mental illness at Nassau University Medical Center. He completed post-doctoral training at Terrap, one of the oldest and best established CBT centers on Long Island. He is licensed in New York, California, and Virginia.

https://drmichaeljgreenberg.com/ocdassociates/

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While low mood & sadness are very frequently adaptive responses to life's challenges, there are times where this normally adaptive mechanism is applied for too long, at the wrong time, or at the wrong intensity in the form of major depressive disorder.  In our 2nd annual Fireside Chat geared for mental health clinicians and consumers alike, host of Thoughts on Record, Dr. Pete Kelly, C.Psych provides an in-depth overview of depression from a variety of perspectives including:  

• the cognitive, behavioral, physiological & emotional symptoms of depression
• how depression is diagnosed
• depressive episode specifiers/subtypes
• risk factors and warnings signs related to suicide
• a brief description of bipolar disorder
• the evolutionary & functional significance of symptoms of depression
• when and how depression goes from being adaptive to a problem of clinical significance
• the critical role of loss in depression
• risk factors and vulnerability factors for depression
• the central relationship between anxiety & depression
• conceptualizing the mechanics of depression from a CBT perspective (e.g., mood loops, cognitive distortions, TRAP-TRAC model, rumination, values, core beliefs, perfectionism, pain vs. suffering, etc)
• evidence based psychotherapy for depression
• a brief overview of CBT interventions for depression (e.g., behavioural activation, cognitive restructuring, behavioural experiments)
• the case for proactive treatment of depression
• some thoughts on selecting a psychotherapist
• general thoughts on integrating medication into treatment for depression
• recommended self-help resources

Comments or feedback?  Email us at [email protected]

If you are experiencing thoughts of self-harm or suicide please go to your local emergency room.  In addition, the following resources are available:  

Canada Suicide Prevention Service: 1-833-456-4566 (24/7)
National Suicide Prevention Lifeline (United States): 1-800-273-8255
For a list of International Crisis Lines please visit: https://www.opencounseling.com/suicide-hotlines

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Clinical presentations characterized by "overcontrol" of emotions (e.g., OCPD, chronic depression, eating disorders) can present a very unique set of challenges & opportunities within the therapeutic setting.  Psychotherapist, supervisor and trainer, Hope Arnold, LCSW, MA, joins us for a discussion of the promise of Radically Open Dialetcial Behavior Therapy (RO DBT) for assisting these clients.  In this discussion we cover:

• a overview of RO DBT & how Hope became interested in this therapeutic modality
• how RO DBT differs from traditional DBT 
• a brief review of core tenants of RO DBT
• the typical format & delivery of RO DBT
• an overview of "overcontrol"
• the typical clinical presentations associated with overcontrol with a special emphasis on OCPD
• conceptualizing overcontrol including contributions of developmental history, temperament & personality structure
• why traditional therapies may not be poised to provide benefit to clients affected by overcontrol
• typical presentation of clients affected by over overcontrol in session
• how clinicians can build empathy for clients with overcontrol even though it may be difficult to access a client's actual internal experience
• tips for building awareness of one's own proclivity for overcontrol and deactivating the threat system to foster social connectedness

Hope Arnold, LCSW, MA is a Supervisor and Trainer in Radically Open DBT (RO DBT). She began her RO DBT training with Dr. Tom Lynch, treatment developer, in 2016. Hope continues to attend intensive trainings throughout the country and receives regular supervision from Dr. Lynch.  Hope is a co-creator of the RO DBT App for electronic diary cards and skills.  ​In her clinical work, Hope is the founder of RO DBT Denver in Denver, Colorado, a center dedicated to evidence-based care and treating disorders of overcontrol. She specializes in personality disorders (Obsessive Compulsive PD, Paranoid PD, Dependent PD, Avoidant PD), eating disorders, autism spectrum disorders (special interest in female autism), and treatment-resistant disorders (depression and anxiety).  ​Prior to opening RO DBT Denver, Hope was in private practice at the DBT Center of Houston and was the RO DBT Lead Clinician.  She led a team of six clinicians intensively trained in RO DBT and supervised the team member’s skill development. Hope completed her Intensive Training in DBT and Prolonged Exposure Therapy through Behavioral Tech.  Hope is also trained in Jungian Therapy, Cognitive Behavioral Therapy, and Cognitive Processing Therapy  ​Hope graduated Summa Cum Laude from Loyola University in New Orleans with a BBA in marketing. She worked for two of the largest private financial and consulting firms in the world before transitioning to being a clinician.  She has master’s degrees in social work from the University of Houston and psychology from Saybrook University with a concentration in Jungian studies.  ​Hope has presented at the local, national, and international level on topics related to DBT, RO DBT, and Jungian Theory.

www.radicallyopen.net - International RO DBT organization & training
www.rodbtdenver.com - Free Loving-Kindness Meditation download on Client resources page
https://apps.apple.com/us/app/ro-dbt/id1526204265 - RO DBT Diary Card and Skills App 

Comments or feedback?  Email the show: [email protected]

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Clients with both an intellectual disability and mental health diagnosis are among the most vulnerable members of our society; however, these clients often face significant barriers with respect to accessing services for a number of complex reasons.  Dr. Philip Grandia, C. Psych joins us for an in-depth discussion of working with clients with an intellectual disability in a mental health context.  In this episode we cover:  

• a general overview and description of intellectual disability (ID) including diagnostic criteria
• important considerations around differential diagnosis in the context of ID
• mental illness in the context of ID including frequently observed patterns of comorbidity
• the very special concern of trauma & exploitation of clients with ID
• how anxiety and depression presents in clients with ID
• the role and caveats around the use of medication in clients with ID
• assessing one's own competency to deliver psychotherapy to clients with ID
• addressing issues of capacity and consent when initiating treatment
• assessing safety effectively in clients with ID
• clinician perceptions of clients with ID that reflect a barrier to accessing services
• the types of CBT interventions that can be effective and helpful in clients with ID
• rewarding aspects of working with this population

Dr. Philip Grandia is a Clinical Psychologist at The Royal Ottawa Mental Health Centre. Following his first career as an infantry officer in the Canadian Armed Forces, Philip underwent his PhD in Clinical Psychology at the University of Ottawa. He completed his residency and supervised practice at The Royal and subsequently joined the hospital as staff. In addition to his clinical work, Philip is actively engaged in program evaluation initiatives and Psychology training. He currently works on The Royal’s three dual diagnosis teams in the Community Mental Health Program.

Have feedback or comments? Email the show: [email protected]

Please note that while all emails are read, we are not able to reply to all messages that are sent. Emailing Thoughts on Record does not establish a clinician-patient relationship with the Ottawa Institute of Cognitive Behavioral Therapy (OICBT).  Moreover, we are not able to provide any comment or advice with respect to either general or specific clinical or personal situations. If you live in Ontario, Canada and wish to seek clinical services from the OICBT please visit www.ottawacbt.ca. If you are experiencing a mental health emergency, please contact your health care provider and/or proceed to the nearest emergency department.  The following resources are also available:  

Canada Suicide Prevention Service: 1-833-456-4566 (24/7)
National Suicide Prevention Lifeline (United States): 1-800-273-8255
For a list of International Crisis Lines please visit: https://www.opencounseling.com/suicide-hotlines

Comments or feedback? Send us a text!

Conversations around the conceptualization, development & implementation of diagnostic frameworks around mental illness often generate more questions than answers, but are endlessly fascinating in their ability to pull on a number of diverse & interesting threads of inquiry.  Clinical psychologist, professor & former president of the Canadian Association for Cognitive & Behavioural Therapies (CACBT), Dr. Andrea Ashbaugh, C.Psych returns to Thoughts on Record for a discussion of diagnostic frameworks for mental illness.  In this conversation we cover:

• thoughts on the conceptualization of mental illness
• the functional utility/evolutionary significance of mental health "symptoms" - even when frequent and/or intense
• cultural expectations around the experience of psychological pain 
• advantages and challenges of current diagnostic symptoms (e.g., DSM 5, ICD-11)
• mental health consumer expecations around receiving a diagnosis
• potential benefits and harm that can come with a diagnosis
• the emergence of potential dimensional models of diagnosis (e.g., The Hierarchical Taxonomy of Psychopathology (HiTOP))  
• transdiagnostic treatment of psychopathology, with a special focus on managing comorbidity
• consideration of some common diagnostic conundrums e.g., severe symptoms in high functioning clients

Andrea Ashbaugh is an associate professor in the School of Psychology at the University of Ottawa, Director of the Centre for Psychological Services and Research, and is a licensed clinical psychologist in the province of Ontario, Canada. She obtained her master's and Ph.D. in Clinical Psychology from Concordia University in Montreal, Quebec, Canada and completed a post-doctoral fellowship in the Department of Psychiatry at McGill University and the Douglas Mental Health University Institute, in Montreal, Quebec, Canada.

She is director of the Cognition and Anxiety Studies Laboratory (CASL) and the Sex and Anxiety Research Group (SAX-RG). Her research interests as part of CASL centre around understanding the causes and developing treatments for anxiety and fear-related problems. She has recently started a program of research to understand the causes and psychological effects of experiencing traumatic and non-traumatic events that transgress one’s moral beliefs (Moral Injury) in military personnel and veterans. Her research in the context of the SAX-RG centres around the impact of beliefs about arousal sensations and context on the interpretation of arousal, and its impact on sexual interest and functioning. She has received funding for her research broadly including from Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council of Canada.

Dr. Ashbaugh regularly supervises CBT training and teaches courses on psychopathology and clinical psychology at both the graduate and undergraduate level. She has served on the Editorial Boards of Psychological Assessment. She is currently an Associate Editor for the Journal of Behavior Therapy and Experimental Psychiatry and editorial board member for Behaviour Research and Therapy. She is a former president of the Canadian Association for Cognitive and Behavioural Therapies (CACBT) and was seminal in the development of national CBT training guidelines that were released by CACBT in May 2019.

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While most psychotherapists identify with one predominant theoretical orientation, in practice it is common for clinicians to adopt an "eclectic" approach that aligns with the varied lens/interests a clinician might hold as well as to meet the varied needs of clients.  Consultant, coach, author and podcast host, Imi Lo, joins host Dr. Pete Kelly for a very wide-ranging discussion of a variety of topics related to psychotherapy including:   

• Imi's preferred theoretical orientation, conceptual framework and why she has chosen to focus on work with emotionally intense and highly sensitive people
• blending psychodynamic and CBT principles
• a brief discussion of the schema therapy model, with a focus on mode work
• the judgment that can be inherent in the conceptualization of personality disorders
• current conceptualizations of mental illness and the functional utility of "symptoms"
• the inner lives of highly sensitive, intense people
• the notion of emotional "over-control" and a brief consideration of the utility of RO-DBT in this context
• navigating & integrating the ongoing tension between champions of "vulnerability" vs "radical self-responsibility"
• Imi's reflection on process-related aspects of therapy
• managing emotional depletion to avoid burnout
• reflections on principles of acceptance, and not resisting one's experience (for clinician and client, alike)
• description of, and navigation of the so-called "midlife passage" 
• some overall thoughts on current areas of interest and growth in psychotherapy

Imi Lo is a consultant for emotionally intense and highly sensitive people. She is the author of Emotional Sensitivity and Intensity, available in multiple languages, and The Gift of Intensity. Imi is the founder of Eggshell Therapy and Coaching, working with intense people from around the world.  Imi has practised as a social worker and therapist in London (U.K). She has trained in mental health, psychotherapy, art therapy, philosophical counseling, and mindfulness-based modalities. She works holistically, combining psychological insights with Eastern and Western philosophies such as Buddhism.  Imi’s credentials include a Master in Mental Health, Master of Buddhist Studies, Graduate Diploma in Psychology, Bachelor of Social Science in Social Work, Certificate in Logic-based Therapy, and an Advanced Diploma in Contemporary Psychotherapy. She has received multiple scholarships and awards including the Endeavour Award by the Australian Government. She has been consulted by and appeared in publications such as The Psychologies Magazine, The Telegraph, Marie Claire, and The Daily Mail.

eggshelltherapy.com

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Dreams have long been a source of fascination, mystery & intrigue, yet there is now an abundance of scientific evidence to shed light on the origins, nature, and purpose of this captivating aspect of the human experience.  Sleep neuroscientist Dr. Sidarta Ribeiro, joins host Dr. Pete Kelly, C.Psych for an in-depth consideration of many of the themes explored in his book The Oracle of Night: The History & Science of Dreaming.  In this discussion they cover:      

• what led Dr. Ribeiro to write The Oracle of Night and the meaning behind the title
• the definition of a "dreaming" and the functions dreaming may serve
• the underlying neuroscience of dreaming 
• parallels between dreams and what is experienced during psychedelic experiences
• why emotions in dreams can feel so incredibly intense compared to that which is experienced when awake
• the science behind lucid dreaming and tips on how to become proficient in lucid dreaming
• the symbolic meaning and utility of dreams, both individually and collectively 
• the evolutionary significance of dreaming and why has it created an adaptive advantage
• the negative impact of modernity on the quality and nature of dreams and our ability to recall/utilize dream content
• how to better remember dreams and become attuned to dream content 
• how acute sleep deprivation can act as an "anti-depressant" in the context of severe depression
• the importance of REM sleep for emotion regulation
• Dr. Ribeiro's thoughts on the biggest unanswered questions in the field of dream study, including how dream content is selected by the brain 

Dr. Sidarta Ribeiro is a founder and vice director of the Brain Institute at Universidade Federal do Rio Grande do Norte in Brazil, where he is also a professor of neuroscience. He received a PhD in animal behavior from The Rockefeller University. Sidarta is the author of The Oracle of Night: The History and Science of Dreaming, his fifth book, and a contributor for Folha de S.Paulo, Brazil´s largest newspaper.  He is a Member of the Latin American Academy of Sciences (ACAL) since 2016, he is associate editor of the journals PLoS One, Frontiers in Integrative Neuroscience and Frontiers In Psychology - Language Sciences. He is a member of the Steering Committee of the Latin American School for Educational, Cognitive and Neural Sciences and the Center for Research, Innovation and Education in Neuromathematics (NeuroMat). He served as secretary of the Brazilian Society of Neuroscience and Behavior (SBNeC) from 2009-2011 and was a member of the Brazilian committee of the Pew Latin American Fellows Program in the Biomedical Sciences between 2011 and 2015.

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While many parenting books and websites emphasize the critical role of the parent in influencing a child's behaviour, it is frequently overlooked that all children possess a genetically driven temperament which exerts a powerful influence not only on the child's behaviour, but on the behaviour of their parents.  Dr. Danielle Dick, joins us for a discussion of some of the core ideas contained in her new book The Child Code: Understanding Your Child's Unique Nature for Happier, More Effective Parenting.  In this discussion we consider: 

• Dr. Dick's motivation for writing The Child Code despite the current wealth of parenting books available
• a definitive description of the influence of genes on our behaviour, along with a consideration of the actual ability of parents to influence life outcomes
• how the heritability of the traits actually goes up over the lifespan owing to self-selection into environments that resonate with our traits.
• introduction to the "Big Three" dimensions of temperament: Extraversion, Emotionality & Effortful Control
• examples of how to leverage understanding of a child's temperament to optimize the parenting approach to promote "goodness of fit"
• the surprising consequences of parent and child being "over matched" on certain dimensions of temperament 
• tips for parents to manage guilt & distress arising from challenges around fit with one's child, despite an abundance of unconditional love
• the difference between temperament and disorder and when parents should consult a mental health professional
• Dr. Dick's suggestions for managing the complex task of parenting across independent households in the wake of a separation or divorce - especially where  different parenting styles are present
• strategies for helping parents to understand the impact of their own temperament on perceptions of their child

Danielle M. Dick, Ph.D., is the distinguished Commonwealth Professor of Psychology and Human and Molecular Genetics at Virginia Commonwealth University, where she directs a research institute on behavioral and emotional health. She is an internationally recognized and award-winning expert on genetic and environmental influences on human behavior. Dr. Dick has received grant funding totaling in excess of $25 million from the National Institutes of Health, the National Science Foundation, and private foundations. She has more than 300 peer-reviewed publications, and has won numerous national and international awards for her work.

https://www.danielledick.com

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At the beginning of the COVID-19 pandemic, thousands of psychotherapists were forced to migrate their practice to teletherapy or secure video.  While many have embraced this new mode of practice and have even found enhancements to their delivery of therapy, others are eager to return to the office or adopt a hybrid model.  Dr. Hannah Zeavin, author of the The Distance Cure: A History Teletherapy, joins us for a conversation around the history of teletherapy as well as systems-level implications for the wide adoption of teletherapy. In this conversation we cover:     

• the biggest misconceptions that psychotherapists are likely to labouring under with respect to the history and deployment of teletherapy
• a discussion of the reality of every therapeutic exchange - whether virtual, in the office or otherwise - being mediated in some respect and existing within a "frame"
• the evidence-base around teletherapy
• 3rd party payers stance towards teletherapy and whether a distinction between in-office therapy and teletherapy remains relevant
• the dysfunctional focus on "activities" vs "outcomes" in an insurance-driven mental health system and how teletherapy could unwittingly accentuate this dynamic
• consideration of therapy-process related factors in the context of teletherapy (e.g., client seeing the clinician within their home environment & vice versa)
• implications of the the appification/commodification of mental health services via digital platforms
• the dangers of "batch processing" and "gamification" in the provision of therapy within a commodified mental health system
• the potential for the digital distribution of services to create “winner takes all” outcomes and the danger of a cost leader further commodifying mental health via call-center models or similar
• Potential unintended consequences of national licensure around the commodification of mental health services 
• Dr. Zeavin's thoughts on the questions clinicians and practices should be grappling with right now in the context of tele therapy

Hannah Zeavin is a Lecturer in the Departments of English and History at the University of California, Berkeley and is on the Executive Committee of the University of California at Berkeley Center for Science, Technology, Medicine, and Society and on the Executive Committee of the Berkeley Center for New Media. Additionally, she is a visiting fellow at the Columbia University Center for the Study of Social Difference. Dr. Zeavin’s first book, The Distance Cure: A History of Teletherapy is now out from MIT Press, with a Foreword by John Durham Peters. She is at work on her second book, Mother’s Little Helpers: Technology in the American Family (MIT Press, 2023).  Dr. Zeavin serves as an Editorial Associate for The Journal of the American Psychoanalytic Association and is a co-founder of The STS Futures Initiative. Other work has appeared in or is forthcoming from American Imago, differences: A Journal of Feminist Cultural Studies, The Guardian, The Los Angeles Review of Books, Real Life Magazine, Slate, The Washington Post, Logic Magazine, and beyond. Dr. Zeavin received her B.A. from Yale University in 2012 and her Ph.D. from the Department of Media, Culture, and Communication at NYU in 2018.
https://www.zeavin.org/

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While trauma perpetuated by traumatic loss or imminent threat to one’s life is familiar and salient to most psychotherapists, the pervasiveness & severity of trauma precipitated by "moral injury" experienced during and/or after a trauma is frequently underestimated and overlooked as a factor that can exacerbate and/or maintain PTSD.  Internationally recognized expert in PTSD, psychologist, researcher & author, Dr. Brett Litz, joins us for an interview around the Adaptive Disclosure (AD) psychotherapy protocol.  In this episode we cover:  

• the nuances involved with conceptualizing and treating operational stress injuries among military personnel, including a review of the biggest misconceptions that clinicians unfamiliar with this population might harbour and how this could impact treatment
• the definition of a moral injury and an overview of the two major types of moral injury (i.e., moral injury "self" & moral injury "other")
• consideration of the "moral" emotions of shame & anger in the context of moral injury
• challenges of treating moral injury as well as subtle or overt signs that a client might be affected by a moral injury
• the origin of Adaptive Disclosure (AD) and where it departs from other CBT-based trauma therapies such as Prolonged Exposure Therapy or Cognitive Processing Therapy
• the basic theoretical framework/some of the core assumptions of Adaptive Disclosure
• descriptions of some of the core therapeutic interventions in Adaptive Disclosure
• the unique challenges of delivering any psychotherapy - including Adaptive Disclosure - within the context of a military population (e.g., over control, overregulation)  
• a brief outline of the next iteration of Adaptive Disclosure - Adaptive Disclosure Enhanced (ADE), which emphasizes to an even great extent increased flexibility in provision of therapy, an emphasis on functioning (as opposed to symptoms) and integration of compassion training

Dr. Litz is a clinical psychologist and Professor in the Departments of Psychiatry and Psychological and Brain Sciences and is also the Director of the Mental Health Core of the Massachusetts Veterans Epidemiological Research and Information Center at the VA Boston Healthcare System. Dr. Litz is internationally recognized as an expert on PTSD, military trauma, and the early intervention and treatment of trauma, traumatic loss, and moral injury.  Dr. Litz recent work entails the development and validation of a new measure of moral injury as a multidimensional outcome (the Moral Injury Outcome Scale; a public domain scale available by emailing Dr. Litz) and conducting a VA funded multi site clinical trial testing an expanded version of Adaptive Disclosure on Veterans with PTSD. Adaptive Disclosure is a flexible multidimensional psychotherapy that employs different strategies to target threat-based, loss-related, and moral injury-related trauma. Dr. Litz has over 370 peer reviewed publications and is a fellow of the Association of Behavioral and Cognitive Therapies, the American Psychopathological Association, and the Association for Psychological Science.

https://www.bu.edu/psych/people/litzb/

http://www.guilford.com/books/Adaptive-Disclosure/Litz-Lebowitz-Gray-Nash/9781462523290