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

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Tolerating uncertainty, unpredictability and other forms of psychological discomfort is frequently a requirement for being  able to pursue longer-term, values driven goals and activities - especially in the context of challenges related to mental health.   Freelance science journalist & author of the Los Angeles Times bestseller and one of NPR's Best Books of the Year for 2020, The Wax Pack, Brad Balukjian, Ph.D., joins host Dr. Pete Kelly, C.Psych for a wide ranging discussion around:  

• an overview of the origin of his idea for The Wax Pack and why he adopts such a personal tone in the book, including his personal journey with obsessive-compulsive disorder (OCD)
• Brad's reflections on the impact that symptoms of OCD have had on him at various stages of life as well as his experience with cognitive-behavioural therapy (CBT), and in particular, exposure and response prevention therapy (ERP)
• the gifts that can be obtained through tolerating uncertainty, impermanence, uncontrollability and unpredictability, both in the context of OCD as well as life more generally 
• the role of mindfulness and awareness of one's values in helping to cope with uncertainty & uncontrollability
• Brad's creative process, how he managed adversity and rejection in trying to bring The Wax Pack to life and the importance of sticking to one's values/creative integrity, even in the face of seemingly insurmountable obstacles  
• an overview of the The Wax Pack itself, including insights from the process of putting together the book, conversations with the former major league baseball players interviewed, managing impostor syndrome & the importance of vulnerability in building trust    
• managing his own internal expectations for future projects based on the success of The Wax Pack 

Brad Balukjian, Ph.D. is a freelance science journalist and has published over 100 articles in National Geographic, Discover, Rolling Stone, and several others.  His first book, The Wax Pack, reached #7 on the Los Angeles Times bestseller list and was named one of NPR's Best Books of the Year for 2020.  He has a bachelor’s degree in island biogeography from Duke University and a Ph.D. in entomology from UC Berkeley. In addition to teaching at Merritt College in Oakland, California, Brad is the developer and director of Merritt College’s Natural History and Sustainability Program.  

https://bradbalukjian.com/
https://waxpackbook.com/

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Treatment resistance/non-response in psychotherapy is a major contributor of disability and loss of functioning among clients as well as a considerable source of  burnout in mental health clinicians.  Renowned psychiatrist and psychotherapist Dr. Allan Abbass joins us for a discussion of treatment resistance/non-response in psychotherapy which includes: 

• how treatment resistance is defined
• the prevalence of treatment resistance in psychotherapy
• structural factors (i.e., the dose of therapy available in public/private settings) that may contribute to treatment resistance
• the biological & social factors that predict treatment resistance  
• clues that treatment resistance may be attributable to an underlying medical condition 
• how psychosocial overlay to prescribing practices could influence treatment resistance 
• the special challenge that adverse early life events pose with respect to creating non-response to treatment
• conceptualization of non-responding clients from a psychological perspective 
• common maladpative therapist responses to treatment resistance in the context of the treating relationship 
• burnout in the context of treatment resistance clients and what can be done to avoid this
• the active ingredients in Intensive Short Term Dynamic Therapy (ISTDP) that help to address some of the unique challenges experienced by non-responding clients
• analogs in CBT to ISTDP that could be leveraged to address treatment resistance
• general tips/perspectives for clinicians relating to treatment resistance in their clients

Dr. Allan Abbass is a psychiatrist, teacher, and researcher. He is a professor of psychiatry and psychology and the founding director of the Centre for Emotions and Health at Dalhousie University in Halifax, Canada. Dr. Abbass has consulted widely with governments, universities, and health agencies on the cost-effectiveness and applicability of short-term psychotherapy.  He has provided over 300 invited presentations around the world as well as ongoing video-recording-based training to professionals in several countries. In addition, he has been awarded many research grants and has over 200 publications.  He is also the author of Reaching Through Resistance: Advanced Psychotherapy Techniques as well as co-author on numerous other books.  Dr. Abbass has been a consultant to the American Psychological Association on the Unified Psychotherapy Project and to the American Psychoanalytic Association, where he serves on the Scientific Committee. He was a board member of the International Experiential Dynamic Therapy Association. He has been an editorial board member for the American Psychological Association journal Psychotherapy. Dr. Abbass is proud to be the David Malan Professor of Psychotherapy at the Tavistock, London, UK.

http://reachingthroughresistance.com
https://twitter.com/ISTDP
https://www.facebook.com/allan.abbass.7

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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.  Leading sleep & dream scientists Drs. Antonio Zadra & Robert Stickgold join host Dr. Pete Kelly, C.Psych for an in-depth consideration of many of the themes explored in their new book When Brains Dream.  In this discussion they cover:       

• the experiences that led Drs. Zadra & Stickgold to become interested in studying dreams
• a brief primer on the basic architecture of sleep
• the science around why we dream including an elaborated description of their NEXTUP model (Network Exploration To Understand Possibilities). 
• the surprising importance of daydreaming 
• the origin and neurological basis of hypnogogic hallucinations 
• potential science-based frameworks for dream interpretation
• the neurobiology of why emotions and events in dreams can feel so incredibly powerful and significant
• an in-depth consideration of lucid dreaming 
• sleep & dream disturbance in the context of mental illness
• Drs. Zadra & Stickgold's view on the utility of sleep studies
• exploration of the notion of "epic dreams"
• a brief discussion around the biggest unanswered questions around the science of dreaming

Antonio Zadra, PhD, is a sleep and dream scientist at the Hôpital du Sacré-Coeur's Center for Advanced Research in Sleep Medicine and professor of psychology at the Université de Montréal. In addition to numerous publications on sleep, dreams, and dream-related disorders, Dr. Zadra is the co-author of When Brains Dream: Exploring the Science and Mystery of Sleep and the author of The Dreamkeepers, a suspense novel blending sleep science with dream mythology. He lives in Montreal, Canada. 

Robert Stickgold is a professor of psychiatry at Beth Israel Deaconess Medical Center and Harvard Medical School. He has published over 100 scientific publications, including papers in Science, Nature, and Nature Neuroscience. His work has been written up in Time, Newsweek, The New York Times, The Boston Globe Magazine, and Seed Magazine, and he has been a guest on The Newshour with Jim Leher and NPR’s Science Friday with Ira Flato several times, extolling the importance of sleep. He has spoken at the Boston Museum of Science, the American Museum of Natural History in New York, and NEMO, the Amsterdam museum of science. His current work looks at the nature and function of sleep and dreams from a cognitive neuroscience perspective, with an emphasis on the role of sleep and dreams in memory consolidation and integration. In addition to studying the normal functioning of sleep, he is currently investigating alterations in sleep-dependent memory consolidation in patients with schizophrenia, autism spectrum disorder, and PTSD. His work is currently funded by NIMH.

https://antoniozadra.com
https://brain.harvard.edu/?people=robert-stickgold

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It is no secret that working within the mental health care system while rewarding, can at times present significant challenges with respect to the provision of optimum client care as well as the well-being of mental health clinicians themselves.  In this wide-ranging discussion, Dr. Connie Dalton, C.Psych, Co-Founder & Executive Director of the Ottawa Institute of Cognitive Behavioural Therapy joins host & colleague Dr. Pete Kelly, C. Psych to reflect not only on the challenges within the mental health care system, but also opportunities for innovation.  In this episode they touch on: 

• consideration of the current situation for therapists in public and private settings with respect to demand for services, community resources available, ability to refer clients to speciality or intensive services etc.
• factors contributing to mental health being the “orphan" of the health care system with disproportionately less resources devoted to mental health despite being a major cause of disability
• candid personal reflections on the emotional experience of working in the mental health system
• identification of, and ideas around navigating competing tensions and values with respect to providing health care within a fee-for-service environment such as private practice 
• potentially self-defeating emotional and behavioural responses of clinicians to constrained resources and feelings of burnout
• the role of, and opportunities for innovation in psychotherapy with an emphasis on a stepped care model of service delivery
• the emergence of iCBT and its role (and limitations) in the innovation landscape  
• reflections on building a private practice that is suited for 2021 and beyond

Dr. Connie Dalton is Clinical Director of the Ottawa Institute of Cognitive Behavioural Therapy and a Clinical Professor in the School of Psychology at the University of Ottawa.  She also served at the regional clinical lead for the Ontario Structured Psychotherapy Program at the Royal Ottawa Hospital from 2018 to 2020. Over the past 15 years, Dr. Dalton has delivered numerous CBT workshops and training seminars in CBT and has actively involved in the supervision and consultation of mental health professionals in CBT including physicians, nurses, social workers, and psychologists at various stages of training.  She has expertise in the treatment of mood and anxiety disorders and has helped to develop and establish CBT programming at the Royal Ottawa Mental Health Centre. Dr. Dalton is currently involved in the development of innovative methods for the delivery of CBT within the community, including home and community-based services, group therapy programs, virtual reality therapy and intensive day treatment programs for mood and  anxiety disorders, OCD and PTSD.

https://www.ottawacbt.ca/dr-connie-dalton

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The emergence and research of psychedelic-assisted psychotherapy has yielded a number of  insights with respect to potential mechanisms of change in psychotherapy.  The experience of "love" (including perceiving the love of others, self-love or even being love) has been identified as a particularly powerful element in some forms of psychedelic assisted psychotherapy.  In this episode, clinical psychologist, research scientist and author Dr. Adele Lafrance and host Dr. Pete Kelly explore the role of love in psychotherapy including:  

• the personal and professional origins of Dr. Lafrance's interest in psychedelic-assisted psychotherapy
• a brief consideration of the kinds of mental experiences reported by clients during psychedelic-assisted psychotherapy, including love from others, self-love or being love
• important caveats around safety & potential disruption in psychedelic-assisted psychotherapy 
• the difficulty in discussing "love" in psychotherapy both among professionals as well as with clients, with an important focus on what is meant by the term "love" in the context of psychotherapy (i.e., not romantic love), professional boundaries,  client perceptions, working with vulnerable populations etc.
• love as a form of truth & relationship to ideas around consciousness   
• the critical importance of self-love in psychotherapy 
• how clinicians can foster self-love as a way of bolstering self-care

An important disclaimer: today’s episode is for general information only.  Although we are discussing insights gained from formal scientific research of psychedelic-assisted psychotherapy, it needs to be underscored that psychedelic compounds are powerful psychoactive chemicals that can carry significant risk of harm for certain vulnerable individuals, especially those with active symptoms of psychosis or bipolar disorder or a clinical or a family history of psychosis or bipolar disorder.  Use of these compounds outside of research settings is also currently illegal in many jurisdictions. As such, in the discussion of psychedelic assisted psychotherapy we are in no way endorsing or encouraging the use of psychedelic compounds for any particular individual. If you are interested in further information around psychedelic assisted psychotherapy please see below for suggestions around sources of reputable information around ongoing research trials in this area. 

Dr. Adele Lafrance is a clinical psychologist, research scientist, author and co-developer of emotion-focused treatment modalities, including Emotion-Focused Family Therapy.  A frequent keynote speaker at professional conferences, Adele has published extensively in the field of emotion and health, including a clinical manual on EFFT published by the American Psychological Association. She is passionate about helping parents to support their kids in a way that is informed by the latest developments in neuroscience. The knowledge and tips in her book, What to Say to Kids When Nothing Seems to Work is an effort to do just that.  With colleagues, she also makes a wealth of caregiving resources available at no cost at Mental Health Foundations. Adele is also a leader in the research and practice of psychedelic medicine, with a focus on ayahuasca, MDMA, psilocybin and ketamine. Currently, she is a collaborator/clinical supervisor on the Imperial College study for psilocybin and anorexia nervosa. She is a founding member of the Love Project.  Adele has a particular interest in mechanisms and models of healing, including emotion processing, spirituality and family-based psychedelic psychotherapy. She is a frequent contributor in the media relating to emotion, health and the science of psychedelics.
https://dradelelafrance.com
https://mapscanada.org
https://maps.org

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"Success" is something that many strive for, but a deeper consideration of success yields a number of interesting conundrums and considerations around what success actually means and how one might actually go about achieving it.  Best selling author, management consultant and entrepreneur Mr. Richard Koch sits down with host Dr. Pete Kelly, C.Psych for a discussion around: 

• caveats and conundrums around defining "success"
• signs of healthy vs. unhealthy processes around the pursuit of success
• balancing internal (e.g., meaning) vs. external (e.g., recognition) pulls in the context of success
• the importance of leveraging both self-belief and self-doubt to achieve success
• the importance of process vs. outcome for avoiding stagnation
• a brief summary of the 4 pillars of Richard's roadmap for success 

Richard Koch is a former management consultant, entrepreneur, and writer of several books on how to apply the Pareto principle (80/20 rule) (including the international bestseller "The 80/20 Principle") in all walks of life.  His latest book, Unreasonable Success, outlines a roadmap for success drawn from the life, actions and perspectives of several prominent figures in history from a variety of fields who have realized what Richard has coined “Unreasonable Success”.  Richard has also used his concepts to successfully invest in several private equity investments. Richard’s investments have included Filofax, Plymouth Gin, the Great Little Trading Company and Betfair. Previously he had been a consultant at Boston Consulting Group and later a partner at Bain and Company, before leaving to start management consulting firm L.E.K. Consulting with Jim Lawrence and Iain Evans.

https://richardkoch.net/

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The “classical” model of emotions which emphasizes the innate, universal (and even primitive) nature of emotions has been the basis for psychoeducation provided by clinicians to clients about the nature of their emotional experiences. However, there is a very large body of evidence to suggest that emotions are, in fact, constructed concepts that are “wired-in” by culture and reflect consensus-based social realism rather than innate processes. Acclaimed author, professor,  and neuroscientist Dr. Lisa Feldman Barrett joins us for an absolutely fascinating discussion of her constructed model of emotions including:  

• an overview of the classical model of emotions
• an in-depth review of Dr. Feldman Barrett’s constructed model of emotions
• myths about the classical model of emotions that are relevant for clinicians & mental health consumers
• the important role psychotherapy plays in constructing emotion concepts 
• a consideration of the neurobiological mechanics around unconscious processes and actual (vs. theorized) mechanisms of change in psychotherapy
• conceptualizing psychopathology and therapeutic intervention from the lens of the constructed model of emotions
• a neurobiological explanation for the experience of “knowing” one thing, but “feeling” another with implications for therapeutic interventions.         

Lisa Feldman Barrett, PhD, is among the top one percent most cited scientists in the world for her revolutionary research in psychology and neuroscience. She is a University Distinguished Professor of Psychology at Northeastern University, with appointments at Harvard Medical School and Massachusetts General Hospital. She is also Chief Science Officer for the Center for Law, Brain & Behavior at Harvard University.  In addition to the books Seven and a Half Lessons About the Brain and How Emotions are Made, Dr. Barrett has published over 240 peer-reviewed, scientific papers appearing in Science, Nature Neuroscience, and other top journals in psychology and cognitive neuroscience, as well as six academic volumes published by Guilford Press. She has also given a popular TED talk with nearly 6 million views. Dr. Barrett received a National Institutes of Health Director’s Pioneer Award for her revolutionary research on emotion in the brain. She also received a Guggenheim Fellowship in 2019.  She is also an elected fellow of the American Academy of Arts & Sciences and the Royal Society of Canada.

https://lisafeldmanbarrett.com/

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There has recently been a tremendous increase in awareness and acknowledgment of the systemic oppression and challenges faced by racialized populations not only generally, but in the context of mental health.  Clinical psychologists Drs. Mandisa Peterson & Jude Mary Cénat join host Dr. Pete Kelly for a very important discussion around:    

• the prevalence and nature of mental health challenges among racialized populations
• the important contribution of chronic stress stemming from racism & intergenerational trauma on mental health in racialized populations
• caveats, conundrums & guidance with respect to employing current diagnostic frameworks with racialized or diverse populations
• examples of the everyday challenges that are faced by racialized populations from the lens of racism and discrimination
• Drs. Peterson &  Cénat’s experiences of racism, both personally & professionally 
• barriers to accessing mental health services among racialized populations
• themes to be aware of around cultural differences that can exist with respect to symptoms, help-seeking etc.
• promoting greater access to diversity in training experiences
• structural racism within mental health settings
• resources that are available to help promote better insight and awareness among clinicians as well as reflections on having difficult conversations

https://mentalhealthforeveryone.ca
https://www.changingmindscanada.org
For a full list of resources related to racism and mental health click here.  Sample resources: 

• Racism in Psychiatry by Morgan Medlock
• Black Pain: It Just Looks Like We’re Not Hurting by Terrie Williams
• How to Provide Antiracist Mental Health Care Free Training Modules
• Manual for CBT for English-Speaking People of Caribbean Origin

Dr. Peterson is the co-founder and director of Changing Minds, a not-for-profit organization dedicated to addressing barriers to accessing evidence-based mental health care in the Ottawa area (changingmindscanada.org).  She provides psychodiagnostic assessments as well as individual and group therapy treatment for diverse adult populations. Her primary approach to therapy is cognitive behavioural and she has experience and training in a number of evidence-based approaches, including dialectical behaviour therapy, mindfulness, and acceptance and commitment therapy. Dr. Peterson has a particular interest and experience working with posttraumatic stress and forensic issues. She is involved in the supervision of doctoral students in clinical psychology. She is also committed to continuing program development and evaluation in the community in an effort to develop more effective and accessible mental healthcare programs.

Dr. Jude Mary Cénat is an Assistant Professor in the School of Psychology and the Director of the Vulnerability, Trauma, Resilience & Culture (V-TRaC) Research Laboratory at the University of Ottawa. His research program explores factors associated with vulnerability, trauma, and resilience, with a particular interest in the role of cultural factors. Dr. Cénat conducts research on racial disparities in mental health and social services, the impact of natural disasters and infectious disease outbreaks on mental health, interpersonal and non-interpersonal trauma, and overall mental health. He conducts research in North America, Europe, Africa, and the Caribbean.

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Eating disorders are among the most serious of mental health challenges, and yet are mired in stereotypes, stigma and misunderstanding.  Clinical Psychologist Dr. Meagan Gallagher joins us for an in-depth discussion of eating disorders which covers:  

• How Dr. Gallagher became interested in treating eating disorders from a personal and professional perspective
• An in-depth clinical consideration of the most common eating disorders in adults
• Conceptualizations around the clinical presentation of eating disorders, including misleading stereotypes
• Core-interventions/phased-treatment approaches for eating disorders
• Opportunities & caveats around the integration of family members into treatment
• Managing the special challenges with respect to insight/willingness that can at times characterize eating disorders
• Effectiveness of available treatment and how to shape expectations about outcomes for client and clinician alike
• Addressing "social contagion" considerations around eating disorders as well as navigating unhelpful online influences and communities with respect to eating disorders
• How to help children and adolescents think critically about societal messaging with respect to body types, body ideals etc.  

Dr. Meagan Gallagher is a clinical psychologist who works with adolescents, adults, couples, and families who are experiencing a range of difficulties related to mental health concerns.  She provides psychological assessments and treatment using evidence-based approaches including Cognitive Behavioural Therapy (including Exposure and Response Prevention Therapy and Prolonged Exposure for Post Traumatic Stress Disorder), Emotionally Focused Therapy, Dialectical Behaviour Therapy (DBT) and Mindfulness. Dr. Gallagher has specific interests and extensive experience in the assessment and treatment of Eating Disorders and body image concerns, Anxiety Disorders, Obsessive Compulsive Disorder, Post-Traumatic Stress Disorder, Mood Disorders, and adolescent mental health. She is currently in private practice at Integrated Wellness Ottawa.

https://integratedottawa.ca

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Helping clients to develop their own solutions to challenging problems as well as work through a variety of perspectives when considering an important decision are among the most important functions of therapy.  Building on their Applying the 80-20 Rule to CBT episode of Thoughts on Record, OICBT clinicians Drs. Jeff Perron, C.Psych & Pete Kelly, C.Psych explore effective decision making and problem solving from a CBT lens.  In this wide-ranging discussion they cover internal & external factors influencing decision making and problem-solving including:   

• Core beliefs 
• Values & resolving conflict between values
• Self-justification & cognitive dissonance
• Actor-observer bias/fundamental attribution error
• Sunk cost fallacy
• Endowment bias
• Hedonic adaptation
• “Summit fever”/overidentification of goals    
• Affective Realism/Cognitive distortions
• Learning how to engage in constructive conflict 
• Being effective vs. being right
• Decoding hidden incentives/explanations for the behaviour of others
• Mentalizing/Empathy
• A policy of radical personal honesty around observed patterns of behaviour
• Acceptance to reduce suffering

In addition, they review practical tips borne from clinical experience to implement the concepts, tools and strategies described above.   

Dr. Jeff Perron provides clinical psychology services to adults, with a particular focus on the areas of mood and anxiety disorders.  Guided by client goals and presenting concerns, he applies the range of evidence-based Cognitive Behavioural Therapies, including Schema Therapy and Acceptance and Commitment Therapy.  Dr. Perron completed his Ph.D. in Clinical Psychology at the University of Ottawa.  He completed his doctoral residency at the OICBT and his doctoral thesis research focused on the development of a measure related to assessment of readiness to change.  He also holds an MBA from Wilfrid Laurier University and has a background in Human Resources.

https://www.ottawacbt.ca/dr-jeff-perron