Retrain Your Brain Cognitive Behavioral Therapy In 7 Weeks - Seth J. Gillihan, PhD

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Here are a few key points about CBT from the introduction:

• CBT aims to help people suffer less and live more fully by replacing thoughts and behaviors that aren’t working well with new ones that work better.

• The author had an “aha” moment as a student when discovering CBT, realizing it could provide an effective way to help people through psychotherapy.

• CBT appealed to the author because it takes a practical, goal-oriented approach focused on problem-solving rather than just talking through problems.

• The introduction sets up CBT as an evidence-based, results-driven therapy that has been proven effective through research.

• The workbook is intended to be an accessible, interactive guide to help readers learn and apply CBT techniques on their own to address issues like depression and anxiety.

• The author draws on his clinical experience treating patients with CBT over many years to provide a straightforward yet beneficial introduction to the approach.

In summary, the introduction presents CBT positively as a solution-focused therapy that can help people make tangible improvements in their life by changing unhelpful thoughts and behaviors.

• CBT was developed as a more practical and evidence-based alternative to psychoanalysis. It focuses on identifying and changing unhelpful cognitive and behavioral patterns, rather than exploring unconscious influences from childhood.

• Behavioral therapies emerged in the mid-20th century based on principles of classical and operant conditioning from animal research. Pioneers like Wolpe and Lazarus applied behavioral techniques like systematic desensitization to treat anxiety disorders.

• CBT integrates behavioral and cognitive therapies. It is based on the cognitivism view that thoughts, interpretations and beliefs influence emotions and behavior. Unhelpful or inaccurate cognitive patterns can be identified and modified using cognitive techniques.

• CBT is collaborative, results-oriented, and time-limited compared to psychoanalysis. It helped address limitations of psychoanalysis by providing evidence-based treatments and a clear end-point for therapy.

• For Ted’s case of bridge phobia, CBT therapists would use techniques like exposure therapy and cognitive restructuring to help him change his learned fear associations and unhelpful thoughts about bridges.

• The passage describes cognitive behavioral therapy (CBT) for addressing a fear of bridges in someone named Ted.

• When Ted approaches a bridge, he panics due to uncomfortable feelings. His pattern is to avoid bridges to get relief from this feeling, but avoidance doesn’t help him actually cross bridges.

• The therapist proposes making a list of feared situations ranked by difficulty. They will then systematically face the easier fears to help diminish the overall fear over time as Ted’s brain learns bridges are not truly dangerous.

• The focus is on changing Ted’s behaviors that keep him stuck in avoidance, rather than exploring his past or unconscious conflicts. The goal is to directly modify his fearful behavior through graded exposure.

So in summary, the passage outlines a cognitive behavioral approach to helping Ted overcome his specific phobia of bridges by gradually facing his fears through systematic desensitization, rather than exploring underlying causes. The emphasis is on changing frightened behaviors in the present.

Here is a summary of the key points from the section:

• The section includes a link to guidelines for finding a CBT therapist to work with. CBT is intended to be an active collaborative process between the client and therapist.

• CBT is structured and focused on present issues, not just past events. Treatment involves clearly defined goals and a treatment plan to work towards those goals sequentially.

• Medication may be used in conjunction with CBT for some conditions like anxiety and depression. Studies show CBT has longer lasting effects in preventing relapse compared to medication alone.

• CBT is an active treatment that requires effort from both the client and therapist. It teaches coping skills and strategies to practice both during and after treatment ends. Regular practice of skills between sessions is emphasized.

• Research shows CBT is effective for many conditions when compared to control groups or other psychotherapies. Self-guided CBT using workbooks or websites can also provide benefits, though working with a therapist may enhance outcomes.

So in summary, it highlights the structured, present-focused, collaborative, and skills-building nature of CBT, as well as research supporting its effectiveness. Finding a qualified therapist to work with is recommended for best outcomes.

Here is a summary of the key points from the chapter:

• The chapter introduces Mel, who has a phobia of dogs due to being chased by one as a child. Her thoughts, feelings and behaviors related to dogs are explained using a CBT framework.

• Statistics on the prevalence of different types of anxiety disorders are provided, showing that specific phobias and social anxiety disorder are quite common.

• Anxiety is described as generally being adaptive and helpful, but becomes a disorder when it is excessive, persistent or significantly impacts one’s life.

• The main types of anxiety disorders according to the DSM-5 are explained: specific phobia, social anxiety disorder, panic disorder and agoraphobia. Characteristics and examples are given for each.

• Mel’s case of dog phobia is used to illustrate how CBT techniques like identifying thoughts, behavioral experiments and exposure can help overcome an anxiety disorder by breaking the vicious cycle of thoughts, feelings and behaviors.

So in summary, the chapter provides an introduction to different anxiety disorders and uses Mel’s experience to demonstrate how CBT works to treat phobias and anxiety.

• The “fight-or-flight” response activates the sympathetic nervous system to prepare the body for danger. This causes physical effects like increased heart rate, breathing, sweating, muscle tension, etc.

• It can also cause psychological effects like feeling lightheaded, derealization, depersonalization, nausea, exhaustion after the threat passes, and crying due to increased parasympathetic activity.

• Agoraphobia involves avoiding places where one fears having a panic attack, like public transportation, bridges, crowds, lines, or leaving home without support. It can become so severe that people do not leave home.

• Generalized anxiety disorder involves persistent and excessive worry about various things and inability to control the worry. Other symptoms include sleep issues, difficulty concentrating, and feeling tired. Worry is spread over multiple areas rather than focused on one cause.

• The checklist helps identify if one experiences symptoms of specific phobia, panic disorder, agoraphobia, social anxiety disorder, or generalized anxiety disorder.

• Depression is a leading cause of disability worldwide. Major depressive disorder is the most common type, involving feeling down or uninterested for at least two weeks plus other symptoms like sleep/appetite changes and low self-esteem.

• A major depression diagnosis can look different for different people in terms of symptoms and severity.

• Persistent depressive disorder involves feeling depressed most of the time for at least two years, as opposed to major depressive disorder which typically waxes and wanes within a year.

• Premenstrual dysphoric disorder (PMDD) is a controversial diagnosis added to the DSM-5 involving depression and mood changes linked to a woman’s menstrual cycle.

• Depression can manifest physically through changes in appetite, sleep, agitation or slowing down, slower healing, and greater risk of death from physical illness.

• Depressive disorders can be specified as single vs recurrent episode, mild/moderate/severe, with or without anxious distress, melancholic features, atypical features, peripartum onset, or seasonal pattern.

• Screening tools like the depression scale can help estimate the severity of depressive symptoms being experienced. Seeking professional help is recommended for anything beyond mild to moderate depression.

• Phil sees a psychologist named Dr. Whitman specializing in cognitive-behavioral therapy (CBT) for his seasonal pattern of low mood and anxiety in the fall and winter.

• In their first meeting, Dr. Whitman has Phil discuss what brought him in for treatment and does an assessment of Phil’s life, including his family relationships, work, friends, and more.

• When asked about his goals for treatment, Phil says he wants to “feel better this fall and winter.” Dr. Whitman works with Phil to specify what exactly “feeling better” would look like and come up with some concrete goals.

• Phil leaves the session feeling optimistic and discusses the session and his goals with his wife Michelle over dinner. As part of his homework, he and Michelle review his goals so she can provide input on making them more specific.

The summary highlights that Phil sees Dr. Whitman for seasonal depression and anxiety, they discuss what brought him in and assess his life situations, Phil identifies a general goal of feeling better which they make more specific, and Phil discusses the session and goals with his supportive wife Michelle.

Here are my thoughts on how anxiety and depression affect my professional and personal life:

Anxiety and depression have made it difficult to concentrate at work, which affects my performance and productivity. I worry excessively about deadlines and making mistakes. Public speaking or interactions that require a lot of confidence and energy are extremely stressful.

Financially, periods of poor mental health have led to times where I was unable to work. This caused money troubles and added additional stress. I sometimes choose career paths that I think will be less demanding or stressful, even if it means using less of my skills.

I find it hard to meaningfully connect with coworkers due to low energy and motivation. I isolate myself more. I often feel overextended trying to manage work responsibilities alongside family obligations. This constant feeling of not having enough time makes me feel burned out.

My hobbies and leisure activities are also impacted. Depression saps my enjoyment of activities I usually find relaxing. I spend free time mindlessly on screens instead of hobbies. Poor sleep affects my mood and ability to recharge. Exercise is the first thing to fall away when I’m struggling, even though I know it helps.

Finding purpose and meaning is difficult during episodes. Goals and passions seem unattainable. I miss feeling part of something larger. Overall mental health struggles really impact all domains of life, both professional and personal. It becomes a cycle that is difficult to break.

• Phil has been telling his wife Michelle that he will organize their messy garage for weeks but hasn’t gotten around to it yet. He feels bad about not taking care of this domestic responsibility.

• The passage discusses various domestic responsibilities people may have like cleaning, cooking, paying bills, yard work, taking out trash. It prompts the reader to reflect on any issues they have with handling responsibilities or dividing chores with partners/roommates.

• The reader is asked to review what they wrote about different areas of their life and underline anything that stands out as particularly important.

• They are then guided to develop 3-6 specific goals for how they want their life to be different in the coming weeks and beyond. Examples include feelings less anxious/depressed, exercising regularly, spending more time with friends.

• To prepare for the next session, the reader is instructed to complete a daily activities log tracking how they spend their time each day along with enjoyment, importance and mood ratings.

• The chapter check-in has the reader write any thoughts/concerns and outline an activity plan which includes reviewing goals, scheduling the next session, and completing the daily activities log.

In summary, the passage guides the reader through self-reflection on responsibilities and life areas, goal-setting, and preparatory activities like time logging to get them engaged in the cognitive behavioral therapy process.

Generally described as a treatment for depression, behavioral activation can lower anxiety as well. The core idea is that doing more meaningful activities and engaging in behavior consistent with one’s values can help improve mood. Rather than waiting to feel better before becoming more active, behavioral activation encourages taking action first by planning and completing enjoyable or important tasks. This approach aims to break the cycle of avoiding activities when depressed, which only serves to maintain and potentially worsen low mood over time. Clarifying one’s values across different life domains and then engaging in corresponding activities provides rewards that can lift depression and anxiety symptoms.

• Kat completed a values and activities form for the domain of physical health, listing specific activities she can do to support her physical health goals. Specific, measurable activities are better than vague goals.

• The story of Odysseus binding himself to the mast is used as a metaphor for proactively planning to overcome challenges to achieving goals and intentions.

• The reader is prompted to review their daily activities form from the past week to observe patterns and see if activities align with their values.

• The reader is guided to rate activities on their list as easy (1), moderate (2), or hard (3) and choose 3 easy activities from different life domains to start with this week.

• Tips are provided on how to increase the odds of completing planned activities, such as making each activity specific, enjoyable, important and protecting dedicated time for the activity.

• Benefits of exercise for anxiety and depression are summarized based on research findings.

• The chapter check-in prompts the reader to reflect on their learnings and outlook heading into the next week, which will focus on identifying thought patterns.

• The passage discusses identifying thoughts and thought patterns. It explains how our automatic thoughts influence our emotions, but these thoughts are often unconscious.

• It introduces Neil, a client struggling with unemployment who is starting cognitive therapy. His initial thoughts suggest he sees himself as “old” and unemployable.

• The passage reviews the cognitive model - that our thoughts mediate the relationship between events and our emotional response. By identifying thoughts, we can evaluate if they are valid interpretations.

• It provides guidance on how to identify thoughts, such as relaxing, imagining the situation, and noticing bodily sensations and thoughts that arise. Working with Neil, the therapist helps him identify the underlying thought fueling his negative emotions.

• Neil realized his thought was “Nobody would hire me,” suggesting he saw his age as an immutable barrier to employment. Identifying these thoughts is an important part of cognitive therapy to potentially change problematic thought patterns.

The key elements are introducing cognitive therapy and the process of identifying thoughts to make them conscious so they can be examined for accuracy and modified if necessary. Working with Neil as an example, it demonstrates how to uncover underlying thought patterns influencing emotions.

The passage discusses identifying thoughts related to anxiety and depression. It provides examples of common themes in different conditions:

• Specific phobia: Beliefs that the feared object is dangerous.

• Panic: Beliefs that a crisis is imminent and needs to be escaped or changed. Examples of panic-related thoughts are listed.

• Social anxiety: Fears of embarrassment and others negatively judging appearances or behaviors.

• Generalized anxiety: “What if” thoughts about potential negative future events that are hard to control. A tendency to believe worrying is useful for prevention or shows care.

It encourages reflecting on recent anxious situations to identify specific thoughts, and notes recurring themes often emerge. Identifying thoughts is a skill that can be practiced to better understand anxiety and depression.

Here is a summary of the key points from the passages provided:

• The person was experiencing distress from thoughts about fearing their own fear, and predictions of catastrophic outcomes from experiencing strong fear or anxiety. Specifically, they feared losing control, going crazy, or doing something embarrassing if their fear level became too high.

• When reviewing their experiences with fear and anxiety, they were asked to identify any thoughts they had about what might happen as a result of being terrified.

• Common cognitive themes in depression center around feelings of inadequacy (“I’m weak”, “I’m a loser”), hopelessness (“Why bother?”, “Nothing can help me”), and turning positive events or opportunities into negatives.

• The concept of a “core belief” is introduced, which is a central negative thought or image that drives more specific negative automatic thoughts. Tracing thoughts back to their common origins can help identify underlying core beliefs.

• The person was asked to monitor their thoughts during upsetting events or mood worsening in order to begin identifying patterns and unraveling their thought processes.

Some thoughts that potentially led to the person’s distress include predictions of loss of control, embarrassment, or going “crazy” if their fear became too intense. Feelings of inadequacy, hopelessness, and negative self-evaluation also seem to play a role based on the description of common depressive cognitions. Identifying automatic thoughts and core beliefs underlying the distress will help address it at a deeper level.

Here is a summary of the key points from the passages:

• Alex is struggling to balance the demands of a high-pressure job with raising two young children. Her days are very long and busy, with little time for rest or enjoyment.

• She is feeling burned out, irritable, and like she is failing as a mother. She had a troubling meeting with her supervisor who expected her to work more nights and weekends.

• In therapy, Alex began tracking her thoughts and noticed some may not be entirely accurate or helpful. She started making small changes like listening to music on her commute to relax.

• Unhelpful thoughts can be labeled as irrational, dysfunctional, biased or distorted. They don’t realistically reflect reality. Errors in thinking don’t serve us well emotionally.

• Alex had a stressful morning and felt like “a big disappointment to everyone.” Examining the evidence, some moments supported that thought but others contradicted it, like when her daughter said she was a “good Mommy.”

• By revising her thought to be more balanced and accurate based on all the evidence, Alex felt less like it was a crushing weight and more like a sadness she could handle. She realized she may not be failing miserably after all.

• The goal of cognitive therapy is to have accurate, not just positive, thoughts by examining evidence in a clear-eyed way to better match reality.

• The passage describes Alex telling the author about a time she felt horrible about herself for missing her daughter’s birthday party so she could see a friend.

• As they examined her negative thought (“I do nothing for my kids”), Alex realized the thought occurred while she was actively taking care of her daughter by comforting her before bed.

• This showed her mind’s ability to ignore positive evidence even when it’s right in front of us, and focus only on negative biases.

• When challenging thoughts, it’s important to consider all available information rather than just evidence supporting the negative view.

• The passage discusses how our minds can treat uncomfortable but not catastrophic situations as complete disasters. We may inflate how bad the outcomes of our fears would actually be.

• It notes that when examining our own thoughts, we should consider if our emotional reactions seem overblown given the thought.

• The example of Alex threatening to throw away her daughter’s stuffed animal to get her to dress shows how we are often harder on ourselves than others. We would not say the same harsh things to loved ones.

• Practicing talking to ourselves with compassion, like we would a loved one, can help combat self-critical thinking and feel more natural over time.

So in summary, the passage advocates considering all evidence rather than just negative biases, and adopting a kinder internal dialogue similar to how we’d speak to loved ones, to better align thinking with reality.

Alex was feeling busy and stressed, pulled in different directions by the demands of her work and family responsibilities. She realized that without using magic, there was no way she could meet all of these demands at once without sacrificing one for the other.

Rather than continuing to stress over not being perfect, Alex developed a more realistic thought: “This is a busy and demanding time in my life. I wish I had time to do everything perfectly, but that’s not the way the world works.”

The goal of questioning negative thoughts is not to convince ourselves we are not at fault, but to see ourselves more clearly - both our strengths and weaknesses. By seeing our imperfections as a normal part of who we are, we can take ourselves less seriously and value ourselves as complete human beings.

• Walter was struggling academically due to depression and poor time management. He would avoid and procrastinate on his schoolwork.

• CBT techniques like behavioral activation and challenging negative thoughts can help address avoidance and motivate task completion.

• Poor sleep can worsen time management issues, so CBT for insomnia principles like sticking to a schedule and limiting bedtime activities can help improve sleep.

• Depression and anxiety can interfere with motivation, concentration, problem-solving and exacerbating avoidance behaviors. This perpetuates a cycle of struggles completing tasks.

• Effective time management requires identifying strengths and challenges, prioritizing important tasks, and addressing unhelpful thoughts that contribute to procrastination. Making the most of our finite time each day is important.

The writing samples indicate Walter struggled with avoidance, negative thoughts about his academic abilities, and poor sleep, which compounded his time management issues related to depression. CBT techniques targeting cognition, behavior and sleep had potential to help Walter complete his coursework and get back on track academically.

The passage discusses principles for effective time and task management, suggesting breaking large tasks into smaller, more manageable parts or steps. The four key principles are:

1. Identify your tasks - Make a list of things that need to be done.

2. Prioritize tasks - Determine the order based on deadlines.

3. Plan when to complete tasks - Assign specific times to your calendar for each task or step.

4. Follow through - Actually do the work you scheduled.

It then provides an example of applying these principles to help a student named Walter manage his to-do list and incomplete coursework. His large tasks were broken down into smaller steps with deadlines, and specific times were scheduled on his calendar to complete each step. Planning specific times is emphasized as important for following through instead of a more flexible approach. Overall, the goal is to make overwhelming tasks feel more manageable by breaking them down and scheduling specific work times.

• Completing tasks according to a schedule is more likely when the tasks are broken down into small, manageable steps that feel achievable. This applies to large projects as well as everyday tasks.

• Being realistic about timelines is important to avoid feeling overwhelmed or rushed. Overestimating what can be done sets oneself up for disappointment.

• Setting clear reminders and alarms helps ensure tasks don’t slip through the cracks. Notifications on a calendar or phone provide accountability.

• Accountability to others, like professors or bosses, provides motivation even if contact has been avoided due to feeling behind. Reconnecting is generally better than further procrastinating.

• Starting a task, even without knowing all the steps, allows the process of working through it. Waiting until all aspects are planned can result in indefinite delay.

• Rewarding oneself for accomplishments, no matter how small, reinforces positive progress and motivation to continue with the schedule.

The key is breaking down tasks, being realistic, setting reminders, connecting with others, just getting started, and celebrating successes along the way to stay on track. Proper planning and structuring of tasks can help overcome obstacles from anxiety and depression.

• Setting small rewards for meeting goals can help motivate task completion. Walter rewarded himself with reading news articles after working for 45 minutes. Having something to look forward to right after work kept him motivated.

• Organizing one’s work space makes it easier to stay on task. Walter found he couldn’t concentrate in his dorm room and had to work in the library. Removing physical and mental distractions is important.

• Accepting discomfort and difficulty helps in sticking to plans. It’s normal for tasks to be hard, and resisting discomfort only makes things worse. When tempted to avoid, reminding oneself of why a task is important can encourage acceptance.

• Common barriers to completing tasks include procrastination, feeling overwhelmed, punctuality issues, and lack of motivation. Strategies from time management like breaking tasks into pieces, setting deadlines, and rewarding progress can help address these barriers. Understanding thinking patterns that fuel barriers also helps motivate improved strategies.

Here are the key points from the passage:

• Julie has struggled with social anxiety for most of her life, since 7th grade when it first emerged.

• She experiences fears and anxiety around social situations like speaking in front of groups, going on dates, or talking to new people where she worries others may think she’s stupid or awkward.

• Despite evidence she is intelligent and capable, these fears take over in anxiety-provoking social situations.

• At her job, a senior colleague recognizes Julie’s good work and innovative ideas, but encourages her to speak up more in meetings which paralyzes her with anxiety.

• The colleague wants to give Julie an exciting new project but is concerned about her ability to lead a group due to her fears around public speaking.

• Julie secretly feels relieved at not getting the leadership role as she has major anxieties about tasks like speaking in front of others.

• In summary, Julie struggles with longstanding social anxiety that interferes with opportunities at work due to fears of negative evaluation and perceptions from others in social situations.

• Julie struggles with social anxiety that holds her back professionally and personally. She wants to face her fears to advance her career and social life.

• Exposure therapy involves intentionally exposing oneself to fear-provoking situations to reduce anxiety over time. Facing fears directly is more effective than avoidance.

• Anxiety diminishes with repeated exposure because the feared outcome doesn’t occur, changing beliefs. The brain acquires new information that the situation is safe.

• Exposure works best when confronted incrementally from low to high anxiety situations without big jumps in difficulty.

• Progressing “from the ground up” like working up a tall building allows gradual acclimation to increasing heights.

• Choosing to face fears deliberately, not just when required, sends a stronger message that the situation may not be as dangerous as feared.

• One exposure is a good first step but is not therapy on its own. Repeated exposures are needed to fully experience reduced anxiety from the situation.

• It takes repetition of exposures over time to gradually dampen our fears and make us feel more comfortable in feared situations. One exposure is usually not enough.

• Exposures need to be relatively close together in time to be effective, such as flying multiple times within a short period rather than just once a year.

• As we continue working through our fear hierarchy, it’s important to stay in feared situations long enough to learn something new, rather than fleeing at the first signs of discomfort. Staying allows us to see that the discomfort passes and things may not turn out as badly as feared.

• Many “safety behaviors” people engage in are actually unnecessary and can be detrimental, preventing learning that the situation can be faced without those extra coping strategies. Dropping unnecessary safety behaviors is encouraged.

• When facing fears, it’s best to embrace the inevitable discomfort and uncertainty rather than resisting it. Having an attitude of accepting rather than fighting the negative feelings can reduce their power over us. Courage involves facing fears despite feeling afraid.

• The passage discusses techniques from cognitive behavioral therapy (CBT) to help manage social anxiety disorder and panic disorder.

• Exposures involve testing predictions about feared social situations to see if the feared consequences actually occur. This can help disprove irrational beliefs.

• Safety behaviors like excessive rehearsing and relying on substances are discouraged, as dropping them allows one to be more present and improve social skills.

• Turning attention outward toward the other person in a conversation, rather than inwardly monitoring oneself, reduces self-focus which increases anxiety and awkwardness.

• Interoceptive exposures involve approaching feared physical sensations like fast heartbeat or dizziness to reduce discomfort with bodily symptoms often linked to panic attacks.

• Approaching panic with willingness rather than avoidance, even mentally “bringing it on,” paradoxically makes panic less likely and lessens dread of it occurring.

• Relaxed breathing can help manage anxiety and focus attention during exposure exercises for both social anxiety and panic disorder.

Here are some key points about focusing inward versus outward during social interactions:

• When your attention is directed inward toward yourself and how you’re coming across, it can increase self-consciousness, anxiety, and worry about what others think of you. This takes attention away from the other person.

• Focusing outward on the other person, actively listening to them and participating in the conversation, can help reduce anxiety by shifting your focus from yourself to the interaction.

• Some effects of focusing inward include feeling more self-conscious, physically tense or flushed, difficulty thinking of responses, less ability to listen well or remember what was said, and less enjoyment of the interaction overall.

• During exposures for social anxiety, it can be helpful to practice focusing outward on the other person rather than inward on yourself and monitoring how you think you are doing. Actively listening and engaging can distract from anxious self-focus.

The key idea is that focusing inward tends to amplify social anxiety, while focusing outward on the other person can help reduce anxiety by redirecting attention to the purpose of the interaction - communicating with the other person. Practicing an outward focus during exposures can make them more effective for overcoming social fears.

Here are my thoughts and reflections after completing this chapter on facing fears:

Confronting fears takes courage, but also a systematic approach using guidelines from cognitive behavioral therapy. Gradually exposing oneself to feared situations or objects allows one to gain evidence that the fears are often exaggerated and can be managed. It’s important to start with easier, more manageable steps and build up gradually to more challenging exposure activities.

Monitoring thoughts and challenging unhelpful cognitions is crucial for gaining a more balanced perspective and reducing anxiety. Our thoughts often make fears seem bigger than they really are, so learning to question thought patterns is a core skill. While exposure activities may produce discomfort at first, staying engaged with the process and remembering the rationale helps one to learn over time that the feared outcomes usually do not come to pass.

Patience and commitment are important, as is celebrating even small wins. With practice, our fear response can reduce as we gather new, corrective experiences. Support from others can also help to motivate staying on track with the exposure tasks. Facing fears takes bravery, but yields rewards in gaining freedom from living limited by anxiety. I’m willing to work hard on my hierarchy to overcome unnecessary limitations in my life.

• John had been struggling with anxiety and worry, especially related to things going wrong at work and his family facing financial ruin.

• He started practicing CBT techniques like challenging anxious thoughts and facing his fears. He also started spending more time with friends and family.

• This helped adjust his thinking and remove obstacles to enjoyable activities. He realized he couldn’t live in constant worry.

• One impactful moment was connecting with his daughter when she came to his office. This made him realize the importance of showing love to his family.

• The most helpful parts of CBT for John were spending time with friends, loosening control at work, exercise, focusing on family, and managing his thoughts.

• He still struggled with falling back into worries, but felt better equipped to manage anxiety when it arose.

• Going forward, his plan was to focus on presence with family, exercise, social support, work-life balance, and challenging anxious thoughts.

• A potential challenge was a key employee leaving, but he now had tools like accepting uncertainty and focusing on what he can control.

• Mindfulness and accepting thoughts as thoughts, not truth, were presented as helpful ongoing practices for well-being.

A 2004 study by Ma and Teasdale found that mindfulness-based CBT significantly reduced relapse rates for people with recurrent depression compared to other therapies. Those who received mindfulness-based CBT saw relapse rates cut by more than 50%. While a full discussion of mindfulness is beyond the scope, the passage suggests considering whether mindfulness could help the reader, and provides resources on mindfulness to get started. Mindfulness appears to be a powerful tool for preventing relapse when used alongside CBT for recurrent depression.

Here are summaries of the two references provided:

Greenberger, Dennis, and Christine A. Padesky. Mind Over Mood: Change How You Feel by Changing the Way You Think, 2nd edition.

• This reference is for the second edition of the book “Mind Over Mood” by Dennis Greenberger and Christine A. Padesky. The book outlines cognitive behavioral therapy (CBT) techniques for changing negative thoughts and beliefs that contribute to depression and other mood issues.

Joiner, Thomas Jr., and Jeremy Pettit. The Interpersonal Solution to Depression: A Workbook for Changing How You Feel by Changing How You Relate.

• This reference is for the book “The Interpersonal Solution to Depression” by Thomas Joiner Jr. and Jeremy Pettit. The book provides a workbook for using CBT techniques focused on interpersonal relationships and social aspects. It aims to help people change how they feel by changing how they relate to and interact with others as a way to overcome depression.

Here are brief summaries of the key articles:

• Edna B., and Michael J. Kozak (1986) studied how exposure to corrective information can influence emotional processing of fear. They found that exposure to corrective information can reduce erroneous emotional processing associated with fear and anxiety.

• Francis & Dugas (2004) developed a structured interview to assess positive beliefs about worry and validated it, finding it has good reliability and validity.

• Freud (1949) provided an outline and overview of psychoanalysis, including its foundations, techniques, and applications.

• Gawrysiak et al. (2009) conducted a randomized controlled trial of behavioral activation for moderately depressed university students and found it was effective at reducing depressive symptoms.

• Gellatly et al. (2007) conducted a meta-analysis of self-help interventions for depression and identified components that made them more effective, such as providing structured materials and guidance.

• Several sources (Gillihan et al. 2012, 2015; Gillihan & Foa 2015) discussed behavioral therapy techniques like exposure therapy and identified best practices and common pitfalls in applying exposure-based therapies for anxiety disorders.

• Goldfried & Davison (1994) provided an overview of clinical behavioral therapy, including foundations, techniques, applications and empirical support.

• Haaga et al. (1991) conducted a meta-analytic review and found empirical support for the cognitive theory of depression.

• Hallion & Ruscio (2011) conducted a meta-analysis finding cognitive bias modification was effective for reducing anxiety and depression symptoms.

Here are the key points made in the papers:

• Rachman (1971) presents findings from his research on the effectiveness of different types of psychotherapy. He found that cognitive and behavioral techniques tend to be most effective.

• Öst (1989) found that one-session treatment using in vivo exposure can be effective for treating specific phobias.

• Moscovitch (2009) proposes a new model for case conceptualization and treatment of social phobia that identifies the core fear as negative evaluation by others.

• Several studies found CBT to be effective for treating insomnia, both as a stand-alone treatment and compared to other therapies (Mitchell et al. 2012; Okajima et al. 2011).

• Naragon-Gainey (2010) analyses the relationship between anxiety sensitivity and anxiety/depressive disorders through meta-analysis, finding it to be a vulnerability factor.

• Nolen-Hoeksema et al. (2008) examines Rumination and proposes it plays a role in the onset and recurrence of depressive episodes.

• Piet and Hougaard (2011) conducts a meta-analysis finding MBCT effective for preventing relapse of recurrent major depression.

• Several papers examine predictors and mechanisms of treatment outcome/response within CBT, such as compliance (Schmidt & Woolaway-Bickel 2000), expectancy (Westra et al. 2007), motivation (Sheldon & Elliot 1999).

Dr. Seth Gillihan is a clinical psychologist who specializes in cognitive behavioral therapy (CBT) and mindfulness-based interventions for conditions like anxiety, depression, and OCD. He has written and lectured nationally and internationally on the cognitive neuroscience of mood and emotion.

One of his publications was a co-authored book titled “Overcoming OCD: A Journey to Recovery” which described how CBT helped the son of his co-author Janet Singer recover from severe OCD.

Dr. Gillihan has a private clinical practice in Haverford, Pennsylvania. He lives in Ardmore, Pennsylvania with his wife and three children.

More information about Dr. Gillihan and additional resources can be found on his website at http://sethgillihan.com.

The foreword to the book was written by Lucy F. Faulconbridge, PhD, who is a clinical professor of psychology at the University of Pennsylvania specializing in eating disorders, depression and anxiety. She also maintains a private practice in Wayne, Pennsylvania.