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

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The past 2 years appear to have precipitated an unprecedented rise in the dissemination and propagation of misinformation and conspiracy theories, leading to considerable distress and uncertainty around consumers of traditional media platforms as well as social media. Psychiatrist and professor, Dr. Joe Pierre, joins us for an extensive discussion of conspiracy theories in which we cover: 

• Dr. Pierre's thoughts on the nature & severity of challenges involved in navigating the current information landscape
• an evolutionary perspective around our biological capacity to effectively manage the amount of information we are exposed to on a daily basis
• Dr. Pierre's  assessment of the health of society’s cognitive, emotional and behavioral coping strategies at the present time
• tools/mindset that we can deploy to effectively navigate the massive amount of (mis)information that is out there.  
• why psychiatric terminology is often misused and why terms like "mass delusion" and "mass psychosis" are not appropriate terms to describe widespread false beliefs (such as conspiracy theories)
• how to balance engagement with media to remain appropriately informed without unduly evoking distress and a sense of helplessness/hopelessness
• the environmental and psychological conditions under which people are most likely to be susceptible to misinformation and/or conspiracy theories
• predatory use of misinformation and conspiracy theories by political entities 
• critical consideration of whether conspiracy theories are more prevalent today
• the personality traits and features that reliably predict engagement in conspiracy theories
• distinguishing between extreme/rigid ideological beliefs and delusions
• the role of the occasional validation of a conspiracy theory (i.e., variable reinforcement) in promoting belief in conspiracies  
• consideration of the evidence that psychological interventions can be helpful in managing dysfunctional belief in conspiracy theories
• strategies for mental health professionals and family members to best assist clients who are consumed by a conspiracy theory

Feedback or comments?  Email the show: [email protected].  A review on Apple Podcasts is always appreciated!

Dr. Joe Pierre is a Health Sciences Clinical Professor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at UCLA. He is a graduate of MIT, the UCLA School of Medicine, and the psychiatry residency training program at the UCLA Neuropsychiatric Institute. He has extensive clinical experience working with individuals with psychotic disorders, substance use disorders, and those with “dual diagnosis.”  He has authored over 100 papers, abstracts, and book chapters related to schizophrenia, antipsychotic medications, substance-induced psychosis, delusions and delusion-like beliefs, auditory hallucinations and voice-hearing, and a variety of other topics including the neuroscience of free will and culturally sanctioned suicide. He also writes the Psych Unseen blog at Psychology Today and is working on a forthcoming book with the same title about the psychology of false beliefs.  Dr. Pierre serves as an expert witness and consultant in forensic/legal cases involving schizophrenia, the intersection of psychosis and religion, delusion-like beliefs and conspiracy theories, and the side effects of antipsychotic therapy. He has also been featured in numerous interviews for print media, radio, television, and a documentary film.

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Engaging in regular exercise is a frequent recommendation of mental health clinicians as a way to address symptoms of anxiety & depression; however, despite clients almost universally voicing a strong belief in the benefit of exercise, it is often challenging for clients (and let's be honest, clinicians) to implement.  Professor, neuroscientist and author, Dr. Jennifer Heisz joins us for a discussion of themes contained in her new book "Move the Body, Heal the Mind".  In this discussion we cover:

• what motivated Dr. Heisz to write her book
• the specific mechanisms by which exercise promotes mental health
• the kinds of activities & dosages of exercise that have been found to be effective in promoting symptom reduction, brain health etc.
• evolutionary lens on the importance of exercise
• the evidence/effective size with respect to the link between exercise and mental health
• why exercise is often one of the hardest behavioural changes to get clients to engage in 
• the importance of exercise evoking some level of physiological stress in order to generate benefits (and how could this could help clients to reframe their experience of discomfort during exercise)
• employing exposure-informed paradigms to help clients engage in exercise
• why rest & recovery are overlooked, but are very important aspects of training
• compulsive vs. healthy exercise
• the potential benefits of wearables for biofeedback, tracking sleep, measuring stress levels etc. 
• tips for accessing the benefits of exercise when feeling depressed or anxious and energy/willpower may be hard to come by
• the emergence of hot/cold therapies as analogs to exercise via hormesis (i.e., gently stressing the body to generate helpful adaptations)

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

Dr. Jennifer J. Heisz is an expert in brain health. She is Associate Professor in the Department of Kinesiology at McMaster University (ranked Top 25 in the world) and directs the NeuroFit Lab, which has attracted nearly $1 million to support her research program on the effects of exercise for brain health. Dr. Heisz received her Ph.D. in Cognitive Neuroscience (McMaster) and completed a postdoctoral fellowship in Brain Health and Aging at the Rotman Research Institute at Baycrest Hospital (Toronto). Dr. Heisz's research examines the effects of physical activity on brain function to promote mental health and cognition in young adults, older adults and individuals with Alzheimer's disease. Many honors and awards recognize Dr. Heisz for her outstanding contributions to research including the Early Researcher Award from the Government of Ontario and the Petro-Canada Young Innovator Award.

https://www.jenniferheisz.com

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While at times a difficult topic to broach, men's mental health reflects an important area of both clinical and research interest.  Moreover, despite the strong emotions that can be evoked by this subject, it is an issue which must be successfully integrated into the current discussion around mental health and wellbeing.  In this wide ranging discussion, professor, author and documentary producer, Dr. Rob Whitley and men's mental health advocate, keynote speaker and panelist, Mr. Jean-Francois Claude join us for a discussion of men's mental health.  In this conversation we cover:  

• the most common sources of challenge with respect to men’s mental health
• common misconceptions that clinicians and/or the average lay person may hold with respect to men’s mental health
• why men’s mental health can feel at times a “radioactive” topic to discuss
• why men do not disclose their mental health issues to family and/or health care providers 
• discussion of the term “toxic masculinity” 
• considerations around discussing the realities of men’s mental health without alienating the equally unique circumstances and burdens of other groups, including women
• opportunities for men to take responsibility for their mental health at the individual and group level 
• why men are often viewed as disposable (by themselves and others)
• how men relate to therapy and current norms in the delivery of psychotherapy as well as innovations in the delivery of mental health services for men
• the importance of vulnerability in seeking help vs. the reception that men get when demonstrating vulnerability (e.g., military and police clients  and so-called “broken toy” syndrome)

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

Jean-François Claude regularly shares his lived experience of Persistent Depressive Disorder and Generalized Anxiety Disorder as a bilingual mental health keynote speaker and panelist, leveraging the power of storytelling to help reduce the stigma of mental illness. In 2017, for his advocacy work and anti-stigma efforts in the area of men’s mental health, Jean-François was awarded a Meritorious Service Medal by His Excellency the Governor General of Canada, and was named a Leading Canadian Difference Maker for Mental Health by the Centre for Addiction and Mental Health.

Rob Whitley is an Associate Professor in the Department of Psychiatry, McGill University, and a Research Scientist at the Douglas Research Centre. He is the author of a new book Men's Issues and Men's Mental Health (Springer 2021).  He is currently a Fonds de recherche du Québec-Santé Senior Research Scholar, and an Honorary Principal Fellow at the University of Melbourne. He has also held honorary appointments at King’s College London, Dartmouth Medical School (New Hampshire) and Howard University (Washington DC). He has published over 135 academic papers in the field of social and cultural psychiatry; and has written over 100 mental health related articles for lay audiences in diverse venues including Psychology Today, the HuffPost, the Montreal Gazette, the Vancouver Sun and the National Post. Whitley is also a video-producer and script-writer, and has produced several documentaries and short fictional films related to mental health that have been featured in film festivals across North America.

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Unfortunately, many mental health clinicians will experience a client’s suicide in the course of their career.  The loss of a client to suicide often reflects  a life changing experience which can require considerable processing to reconcile and reach some kind of understanding.  In parallel, risk assessment can reflect a major source of distress, not only for clinician trainees but likewise for seasoned clinicians.  Clinical psychologist, professor and author, Dr. Lisa Cohen, joins us for a very important discussion around novel ways of conceptualizing suicide and suicide risk assessment which focus on when a client may be at most risk for suicide as opposed to who is at most risk over the course of their lives.  This novel way of conceptualizing suicide may allow for more effective, well-placed interventions as well as augment clinician confidence in their risk assessments.  In this conversation we cover:      

• the prevalence rates of suicide and how the risk stratifies by age & gender
• the most common mental disorder comorbidities of suicide
• what is known about individuals who complete suicide with little to no apparent warning "out of the blue"
• a brief review of some of the proposed constructs that have emerged for characterizing pre suicidal mental state  (e.g., Suicidal Behaviour Disorder, Suicide Crisis Syndrome, Acute Suicidal Affective Disturbance)
• how these constructs differ from “longer-term” considerations of predictive risk around suicidality that most clinicians would be familiar with (e.g., hopelessness etc.)
• how assessment of risk should be undertaken as a function of what is known about shifts in cognitive, behavioural and emotional patterns in the days leading up to a suicide attempt
• the kinds of psychotherapeutic or psychiatric interventions that flow from perhaps a higher resolution picture of what the days or hours leading up to a suicide crisis look like
• measures that are available to assess acute risk
• an overview of the Narrative Crisis Model 
• how clinicians can emotionally relate in a healthy, balanced and sustainable way to the ongoing risk of losing a client to suicide
• the value of safety plans/contracts 
• misconceptions that clinicians may be laboring under with respect to the risk assessments they are undertaking 

Dr. Lisa J. Cohen is clinical professor of psychiatry at the Carl Icahn School of Medicine at Mount Sinai, working at the Mount Sinai Beth Israel location.  Dr. Cohen has long been involved with clinically relevant research in a wide range of topics relevant to psychiatry and psychology.  Her more recent research domains have included the risk assessment and psychological correlates of suicide, risk factors for and differential diagnosis of personality pathology, the adult psychological sequelae of childhood maltreatment, as well as the childhood antecedents, psychological correlates, subjective experience and psychological burden of individuals with pedophilia.  She has previously researched opiate addiction, bipolar disorder, & obsessive compulsive disorder. She has also written on psychological assessment.  Dr. Cohen is an author on over 100 peer-reviewed journal articles and two books.  Her third book presenting an integrative model of the psychotherapy of personality disorders will be published in 2022. 

If you are experiencing thoughts of suicide please go to your local emergency room.  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, https://www.opencounseling.com/suicide-hotlines

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Jungian/Depth psychology provides a wonderful framework for exploring questions related to meaning and the self that can at time fall outside of boundaries of what is typically explored in cognitive behavioural therapy.  However, each perspective can offer tools and insights which may enrich the application of the other.  Dr. Sean Fitzpatrick, psychotherapist, author and executive director of The Jung Center in Houston, Texas joins us for a conversation in which we explore:  

• the origin story of Dr. Fitzpatrick's foray into Jungian/Depthy psychology as well as his experience/training with CBT during his graduate studies
• a brief overview of core principles of Jungian/Depth Psychology, including the pivotal role of the self vs. ego, meaning as well as unconscious psychological processes
• the role that imagery, fantasy and dreams may play with respect to helping to verbalize emergent ideas about the self
• how CBT clinicians can effectively leverage the use of imagery and fantasy in psychotherapy to explore the emergent self
• the definition of the "shadow" within the Jungian framework
• working with the "shadow" within psychotherapy to promote actualization of the self
• exploration Jung's notion of the midlife passage as a critical developmental process to the actualization of the self
• helping clients to develop flexibility in tolerating aspects of the self which are incongruent with that of the ego
• the role of symbolism within fantasy/imagery and how to operationalize within the reality of one's own life

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

Sean Fitzpatrick is a psychotherapist in private practice and the executive director of The Jung Center in Houston, Texas. His book The Ethical Imagination: Exploring Fantasy and Desire in Analytical Psychology was published by Routledge in August 2019. Sean holds masters degrees in religious studies from Rice University and in clinical psychology from the University of Houston — Clear Lake. He received his PhD in psychology, with a specialization in Jungian studies, from Saybrook University. He is a senior fellow of the American Leadership Forum. Sean serves on the board of the Network of Behavioral Health Providers in Houston. He teaches at The Jung Center in Houston and has presented lectures and workshops with a wide range of organizations.

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Following registration as an autonomous professional, a psychotherapist could potentially go decades providing service to clients in the privacy of their office without another professional ever directly evaluating their work. Clinical psychologist, researcher and consultant, Dr. Daryl Chow, joins us for an important discussion around clinician perceptions of competency and the promise of deliberate practice for not only improving clinical outcomes, but also clinician confidence and quality of worklife.  In this discussion we cover:  

• the accuracy of clinicians' perceptions of their own competency
• how perceptions of competency vary from early career, mid-career & late career
• how actual clinical effectiveness varies from early career, mid-career & late career
• the importance of selecting vs. training of clinicians 
• the factors that can contribute to clinicians having trouble accessing an accurate perception around one’s own competency
• the definition of deliberate practice 
• a conceptual framework for deliberate practice 
• structuring deliberate practice at early career, mid-career & late career (time commitment, logistics etc.)
• the most effective way to structure, frame and provide feedback to a clinician
• Dr. Chow's thoughts on the the value proposition associated with deliberate practice with respect to clinical outcomes, clinician quality of life, etc.  
• balancing deliberate practice with the demands of day-to-day clinical life through habit formation
• the usual modalities by which clinicians can undertake deliberate practice
• Dr. Chow's thoughts on why there is not more of a culture of ongoing deliberate practice within psychotherapy and why this may be changing

Feedback or comments?  Email the show at: [email protected]

Dr. Daryl Chow is a senior associate of the International Center for Clinical Excellence. He conducts research and workshops on the development of highly effective psychotherapists, and ways practitioners can accelerate learning. He was a featured keynote speaker at the Achieving Clinical Excellence (ACE) Conference, Sweden, 2018,  Daryl is a co-author of a new book, Better Results: Using Deliberate Practice to Improve Therapeutic Outcomes. He is also co-author of many articles and co-editor and contributing author of The Write to Recovery: Personal Stories & Lessons about Recovery from Mental Health Concerns,and the author of The First Kiss: Undoing the Intake Model and Igniting First Sessions in Psychotherapy. His work is also featured in two recently edited books in 2017. Daryl’s blog and podcast, Frontiers of Psychotherapist Development is aimed at inspiring and sustaining practitioner’s individualized professional development. Daryl maintains a private practice in Perth, Western Australia.

www.darylchow.com

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Chronic pain is emerging as one the most misunderstood aspects of the human experience.  Owing to this misunderstanding, there is often needless suffering as a function of many clients and clinicians not understanding the central role psychological processes can play in the experience of many types of chronic pain.  Clinical psychologist and researcher, Dr. Yoni Ashar, joins us for a fascinating discussion focused on understanding chronic pain from the lens of Pain Reprocessing Therapy (PRT).  In this discussion we cover:  

• the conceptualization of chronic pain within the Pain Reprocessing Therapy (PRT) model
• the personality traits that can predispose one to chronic pain
• helping clinicians to navigate the frequent perception by chronic pain patients that they are being told “it’s all in their heads".
• the importance of "buy-in" that the pain is not originating from tissue damage (when medical investigations confirm no clinically significant structural challenges, infection etc.).
• signs & patterns of symptom presentation that can indicate that pain is of a psychological origin rather than strictly physical origin
• brief consideration of the intensive short-term dynamic therapy model in the context of chronic pain 
• typical interventions within PRT
• the promise of PRT:  relief from pain vs. different relationship with pain
• how “standard” medical models of pain and even mindfulness-based approaches to pain differ from PRT 
• the evidence base for PRT
• the neurobiology of chronic pain from a PRT lens
• the contribution of trauma to the manifestation of chronic pain
• the role of medication, including antidepressants in the treatment of chronic pain from a PRT perspective
• application of this model to other physical/somatosensory challenges (dizziness, chronic itch, nausea, fibromyalgia etc.)

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

Dr. Ashar studies the brain, pain, and emotion. He is a postdoctoral associate at Weill Cornell Medical College, and he completed his doctorate in clinical psychology and neuroscience from the University of Colorado Boulder, under the mentorship of Drs. Sona Dimidjian and Tor Wager.  Dr. Ashar's current focus is on psychological treatments for chronic pain. Other research areas include brain mechanisms of placebo effects, meditation, and empathy, using functional MRI and machine learning. His research seeks to understand how our thoughts and behaviors influence our health and to create neuroimaging research products with clinical applications.

https://www.painpsychologycenter.com

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The interface between nutrition and mental health is a fascinating area of study that is of great interest to both mental health clinicians & clients alike; however, it can be at times difficult to find coherent messaging and/or data-driven information as it relates to the link between diet and psychological well-being.  Uma Naidoo, MD, a board-certified psychiatrist, professional chef, and nutrition specialist joins us for a wide-ranging discussion about themes explored in her new book This is Your Brain on Food including:  

• how  Dr. Naidoo combined her training as a psychiatrist, professional chef and nutritional specialist to write her book "This is Your Brain on Food"
• forming realistic expectations around the potential impact of nutrition and supplements on symptoms of mental disorders
• the special role that inflammation may play in the exacerbation and maintenance of mental health symptoms
• the enteric nervous system and the role the microbiome/gut flora might be playing with respect to mental health
• the pros/cons of supplements vs. real food
• the role that food & nutrition can play in the context of an overall treatment strategy
• the dangers of compulsive monitoring of food intake and the balance that must be achieved in this respect
• specific food-based strategies for anxiety
• considerations around caffeine and well-being, including guidance around recommended daily intake
• Dr. Naidoo's opinion with respect to elimination diets for assessing the relationship between nutritional factors and mental illness 
• the link between ADHD and sugar, as well as gluten and mental health challenges
• Dr. Naidoo's stance of being "diet agnostic" in the context of evaluating strategies such as "low carb", "carnivore", or ketogenic diet
• considerations around how medication interacts with nutrition
• Dr. Naidoo's overall diet recommendations
• Dr. Naidoo's favourite brain friendly recipe

Uma Naidoo, MD is a board-certified psychiatrist, professional chef, and nutrition specialist. She is currently the Director of Nutritional and Metabolic Psychiatry at Massachusetts General Hospital (MGH), where she consults on nutritional interventions for the psychiatrically and medically ill; Director of Nutritional Psychiatry at the Massachusetts General Hospital Academyand in private practice. She also teaches at The Cambridge School of Culinary Arts. She blogs for Harvard Health and Psychology Today and has just completed a unique video cooking series for the MGH Academy, which teaches nutritional psychiatry using culinary techniques in the kitchen.Dr. Uma has appeared as amental health and nutrition expert on Live withKelly & Ryan, Today Show, 700 Club, Impact Theory, and been featured in the Wall Street Journal, Shape, Parade, Boston Globe, mindbodygreen and more.

 https://umanaidoomd.com

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Owing to a rapidly changing world, many clinicians understandably feel it is increasingly difficult to keep track of (let alone integrate) considerations around systems level challenges (e.g., social media, political polarization, housing shortage, monetary policy etc.) that may be germane to their day-to-day work with clients.  In this conversation, Dr. Pete Kelly, C.Psych and Dr. Jeff Perron. C.Psych, MBA, share some of their thoughts on what they have been observing going on in the world based on their respective lens, as well as through the lens of clinical psychologists who are trying to help clients in an ever increasingly complex and distressing environment.  In this conversation (recorded January, 2022) they place a particular focus on how  current monetary policy could promote inequity and division in society as well as discuss how innovations like Bitcoin (perhaps surprisingly to many) could reflect a new way forward as per the issues raised in the discussion.  Topics covered include:

• reflections on noted shifts in macroeconomic patterns, political polarization and the "accelerant" influence of social media in this respect
• the potential benefits of mental health clinicians having awareness of systems level challenges faced by their clients 
• the challenge of science vs. advocacy driven narratives around important policy issues
• the role that current monetary policy could play in accelerating political polarization and economic disparity 
• the definition of "money" and types of money
• the challenges associated with fiat currencies related to inflation and how this drives division and inequity
• concerns around sustainability of current financial paradigms
• a very brief primer on Bitcoin and the role this emergent currency platform could play in addressing some of the challenges related to division and inequity of Fiat currency

IMPORTANT: Neither Drs. Kelly nor Perron are licensed investment advisors and none of the content in this podcast should be regarded as financial or investment advice.  The content of today's discussion is for general information only.  All opinions expressed are Dr. Kelly and Dr. Perron's alone.   

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

Dr. Jeff Perron, MBA, C.Psych is a Clinical Psychologist who works with adults. His work focuses primarily on helping clients who are experiencing anxiety, low mood, loss, burnout, life transitions, or general challenges in executing on goals that are important to them. He takes a CBT approach to helping clients identify their values and works with them to align their life more closely with those values.  He works to clarify client goals early on and adapt them as needed, while working to help make sure that the process consistently feels focused and aligned with client goals.  Dr. Perron completed his undergraduate training in Psychology at McMaster University and his PhD at the University of Ottawa, including a Residency at the Ottawa Institute of CBT.  Dr. Perron also has experience in business, economics, and human resources, holding an MBA from Wilfrid Laurier University.

Linked In: https://www.linkedin.com/in/perronjeff/
Twitter: @DrJeffPerron

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While a number of empirically supported, disorder-specific treatment protocols exist, it is frequently the experience of clinicians that clients present with co-morbid symptoms - that is, symptoms of a number of mental disorders at the same time.  This can present challenges around treating concurrent symptoms and/or what to prioritize in treatment.  Dr. Kristen Ellard, Clinical Psychologist, Professor & co-developer/co-author of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, a cognitive behavioral treatment designed to target emotion dysregulation across mood and anxiety disorders, joins us for a fascinating discussion in which we cover:   

• the origin story and philosophical underpinnings of the Unified Protocol
• how the Unified Protocol model proposes that normally adaptive emotional & behavioral processes are translated into psychopathology  
• the basic structure of Unified Protocol including core interventions
• the proposed mechanism of changes within the Unified Protocol's model
• whether commonly employed theoretical models in psychology (e.g., CBT, psychoanalytic, ACT, EFT etc) actually match the way in which the brain actually works  
• how to leverage knowledge of how the brain processes information to maximize the effective deployment of psychotherapy
• the critical role of somatic (interoceptive) sensations in the construction of emotional experiences
• how subcortical or “unconscious” areas of the brain might make calculations with respect to threat, attraction, preferences etc. 
• what we can learn about brain function and the importance of sense of self in the context of mental disorders from emergent data around the therapeutic benefits of psychedelics

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

Kristen Ellard, Ph.D. is Assistant Professor in Psychology at Harvard Medical School and Director of Dimensional Neuroimaging Research at the Massachusetts General Hospital Division of Neuropsychiatry. She completed her PhD in clinical psychology at Boston University under the mentorship of Dr. David Barlow, and completed her clinical internship and postdoctoral fellowship at Massachusetts General Hospital/Harvard Medical School. She was co-developer and co-author of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, a cognitive behavioral treatment designed to target emotion dysregulation across mood and anxiety disorders, which has now been translated into six languages. Dr. Ellard’s research uses transdiagnostic, dimension-based neuroscience and behavioral approaches to understand the roots of severe cognitive and affective dysregulation in neuropsychiatric disorders, and to find more efficient and effective means to address this dysregulation through combined behavioral and neuromodulatory approaches such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS). She has received several foundation awards and two NIH National Research Service Awards for her research program (F31/F32), including most recently a Fellowship Award through the MGH and Brown University Joint Training Program in Recovery and Restoration of CNS Health and Function (T32) and a Mentored Patient-Oriented Career Development Award (K23) from the NIMH.

https://dnn.mgh.harvard.edu/member/kristen-k-ellard-phd/