What is process-based therapy?

What is process-based therapy?

Acceptance and Commitment Therapy (ACT) is a form of Cognitive Behavior Therapy (CBT). 

Cognitive Behavior Therapy traditionally has been focused on delivering specific treatment protocols for specific struggles; for instance, if you were dealing with fears of public speaking as we see in social anxiety, then there was a treatment protocol for you to get better or sometimes five different treatment protocols that you could choose from, based on the clinician you worked with If you were dealing with panic attacks, there was a specific treatment protocol for it. 

However, since 2000 Cognitive Behavior Therapy has moved from having a single protocol for a specific disorder – social anxiety, panic, etc- to have a unified protocol for multiple struggles because, in the case of anxiety, for example, it’s much more common to struggle with different types of fears than a single one.

So if you’re dealing with attacks it’s also possible that you’re dealing with chronic worry, or if you’re dealing with chronic worry it’s also possible that you’re struggling with fears of public speaking. Today I have a chance to speak with Dr. David Barlow, the developer of the Unified Protocol.

Key Takeaways

In this conversation, you will hear 

  • The basics of a Unified protocol in cognitive Behavior Therapy
  • What is avoidance and how it works
  • What’s negative affect and how it works
  • What’s neuroticism and how it works
  • Why is important to understand emotions
  • What are temperamental personality factors

You will also hear me asking Dr. Barlow for permission to be sassy and ask controversial questions.

  • What’s a process in behavior therapy?
  • Is process-based therapy different from the unified protocol?
  • What is a transdiagnostic process: is an intervention different than a process? Is a transdiagnostic process a way in which people cope with internal experiences?

Tune in, you don’t want to miss how cognitive behaviorists are thinking of therapy these days and how this informs your experience in therapy or coaching when dealing with fear-based struggles.

About Dr. David Barlow

Dr. Barlow received his Ph.D. from the University of Vermont and has published over 650 articles and chapters and over 90 books and clinical manuals, mostly in the areas of anxiety and related emotional disorders and clinical research methodology. He is formerly a Professor of Psychiatry at the University of Mississippi Medical Center and a Professor of Psychiatry and Psychology at Brown University.

Dr. Barlow was also a Distinguished Professor in the Department of Psychology at the University at Albany, State University of New York, and Director of the Phobia and Anxiety Disorders Clinic at the University at Albany, SUNY.

process-based therapy

Show notes with time-stamps

00:00 Introduction to ACT and the Evolution of CBT
02:35 A Deep Dive with Dr. David Barlow: The Unified Protocol
05:29 Exploring the Unified Protocol’s Foundations
11:43 Understanding Emotions and Their Impact
19:48 The Unified Protocol: Addressing Emotional Disorders
29:09 Concluding Thoughts on Emotion-Focused Therapy
 

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EBBTC Service Banner Perfectionism 1

Come back to the life you’re missing

Come back to the life you’re missing

Reading Time: 3 minutes

“How we spend our time is how we spend our days. How we spend our days is how our life goes. How our life goes determines whether we thought it was worth living.”

– Keith Yamashita

When you wake up, your mind starts its own journey. It’s like you’re getting into a car and your mind is the driver. Sometimes it takes you exactly to your destination. Sometimes it drives really fast. Sometimes, you can’t just get out of being lost in the streets of big houses, condominiums, and golf courses in the middle of the city. Sometimes, your mind takes you to the end of a cul-de-sac where you feel all those ruminations, worries, doubts, anticipations and many other acrobatic thinking patterns that occupy your time.

  • Thinking about doing things right and perfectly
  • Thinking about all the good reasons to postpone and delay stuff
  • Thinking about how much certainty you need to move forward
  • Thinking about the worst-case scenarios
  • Thinking about past negative outcomes or past mistakes
  • Thinking about not being good enough in some way
  • Thinking about the different ways to get out of a stressful situation
  • Thinking about how you’re the only responsible person for others’ wellbeing
  • Thinking about how thinking is fundamentally important

Overthinking patterns have this automatic quality, rushing you into feelings of stress, anxiety, loss, or dread. You may get so attached to them that they seem real and push you to do things that create much more pain, such as ejecting you from your present.

Dealing with overthinking partners is like every moment you’re confronted by a “haystack-sized pile of needles.”  Each one of those patterns pushes for your attention, makes you feel in a particular way, and claims to be legitimate. They are all interesting thoughts to have; for example, did I marry the right person? Can’t stop thinking about what happened before, I need to make sense of it; what if I don’t make the right decision? 

But the consequence of all of them is that they take you away from what’s happening in front of you, who is in front of you, and what the experience of that moment is for you.

Bring yourself back to the present

  • Acknowledge the cue to overthink
    Remember an important principle: The first thought on your mind, whatever you do afterward is on you.
    Do your best to notice that cue for overthinking (e.g. did I.. I need.. what-if…).
    Don’t fight it; don’t resist it; don’t respond to it. Just say to yourself “here it is.. “ and then …
  • Connect with your body
    Notice your body posture; notice the positions of your legs; notice your back posture; notice the ebb and flow of your breathing; you can also move your arms a bit to notice their movement.
  • Connect with what’s in front of you
    Notice your surroundings: what’s around you. What do you hear? What do you see? What do you smell?
    Notice who is in front of you: is there someone in front, next to, or behind you? How do they look? What colors are they wearing? What pieces of clothing do you see? How are they talking to you? Are they speaking fast or slow? Can you see the movement of their lips?

Final quote

I leave you with this last quote:

“How we spend our day is, of course, how we spend our lives.

– Annie Dillard

10 tricky ways you play-it-safe

10 tricky ways you play-it-safe

To be human is to be anxious. To be anxious is to plan our way out of an anxiety-provoking situation. I call those playing-it-safe. We all play-it-safe. Who doesn’t play-it-safe?

You might be playing it safe if you …

Your playing-it-safe moves might feel right at the time, but they can also keep you stuck in your head for hours and push you to make ineffective choices in your life.

In this podcast episode, I share with you in detail what’s a playing-it-safe move, how you can keep an eye on those playing-it-safe moves, and how you can check whether those playing-it-safe moves are working for you or against you.

Learn which playing-it-safe moves are working against you and how to change them.

Here is what you need to do:

  1. Listen to this episode from the beginning to the end.
  2. Then, take 7 minutes to complete the Playing-It-Safe Questionnaire
    https://www.thisisdoctorz.com/playing-it-safe-questionnaire/
  3. Figure out your Playing-it-safe profile

Knowing how you play-it-safe safe and how you rely on familiar thinking strategies that keep you stuck is crucial to make a difference in your life.

TEDx talk: Stop playing-it-safe and start living

Description:

Do you spend hours in your head thinking about something that happened, could have happened, or might happen? Have you ever thought of a situation, over and over, trying to come up with the best decision but didn’t take any action? How often do you over-prepare so you don’t make any mistakes? When was the last time you postponed a project because it wasn’t good-enough? Do you minimize your needs so you don’t rock the boat in a relationship? We all play-it-safe by thinking in a particular way or acting in a particular way; it’s cozy and familiar to do what your cautious mind pushes you to do. The challenge is when those playing-it-safe moves take a like on their own.

In this talk, Dr. Z describes why you play-it-safe, identifies the look, feel, and sound of the most common playing-it-safe moves, and teaches you micro-skills to check whether those playing-it-safe actions help you to be the person you want to be or not.

Show notes with time-stamps

01:08 Understanding Playing It Safe Moves
03:08 Discover Your Playing It Safe Profile
04:29 Diving Deep into the 10 Playing It Safe Moves
21:13 Recap and How to Use Playing It Safe Moves Positively
 

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Types of overthinking

Types of overthinking

Reading Time: 3 minutes

Like ice-cream, there are so many types of overthinking. 

Given the busyness of our minds and the unavoidable stream of thoughts we all have every moment we’re awake, it’s natural that each one of those thoughts could unfold into a thinking pattern.

You can have a thinking pattern about your morning routine, how to read a book, ask for a raise, and so on. Similarly, when facing an upsetting or anxiety provoking situation, of course, your mind is going to come up with a thinking pattern about how to manage, handle, and take care of what’s stressing you out.

The more that you rely on those thinking patterns, the more they get reinforced, get established, and get generalized to similar situations:

Here is the deal:

There are an alarming number of major life decisions we need to make: who we choose to marry, the school we go to, the house we want to buy, the next job you need to apply to, a relationship you need to get out from, the location where you want to retire, the amount of money you need to retire, and so on. Each one of those decisions requires careful thinking, for sure.

Simultaneously, there are day-to-day decisions, banal ones that we also get stuck on at times: the size of the TV you are going to buy, the coffee machine you need to get for your office, the model of the cell phone you’re going to get, how you spend your time, which task to focus on first given the laundry list of things you have to take care of,  the type of laptop you need for creating videos, the destination of your next vacation, the veterinarian for your pet, the book you’re going to read to your children. And so on.

Whether you’re making a major life decision or day-to-day one, all of them can be anxiety provoking. Naturally, as all humans do, you think of that particular situation as an attempt to solve it and with that, to solve your discomfort, struggle, uncertainty, and stress with it.

It’s all that thinking you do that evolves into overthinking patterns that, paradoxically, instead of moving you forward, it keeps you stuck in your head in the long run. It’s like overthinking is a safety move.

When completing my internship, with limited financial resources as a grad student, I decided to treat myself with a coffee machine. I love to drink a good cup of coffee! I looked at my budget and I could afford a coffee machine between $80 – 100.- max. The search began. Google recommend me to keep in mind these variables:

2021 11 18 17 10 32 1

My friend, a coffee snob like myself, encouraged me to consider “strength and flavor” as important qualities for this new acquisition.

In my relentless efforts to make the best decision for what a coffee machine represents to me, the amount of money, and all those variables that appear to be important, I spent 3 months dwelling on this decision. Until finally, fed up with this overthinking, I drove myself to a store and bought “a coffee machine.”

Overthinking is when thinking gets in your way of living your life.

Here are the types of overthinking patterns that you need to watch out for:

  1. Thinking about doing things right and perfectly
  2. Thinking about all the good reasons to postpone and delay stuff
  3. Thinking about how much certainty you need to move forward
  4. Thinking about the worst-case scenarios
  5. Thinking about past negative outcomes or past mistakes
  6. Thinking about not being good enough in some way
  7. Thinking about the different ways to get out of a stressful situation
  8. Thinking about how you’re the only responsible person for others’ wellbeing & important situations
  9. Thinking about how thinking is fundamentally important

While thinking carefully is an integral part of our lives, it also eject us from the present and rob us of fulfillment.

How playing-it-safe can be helpful or unhelpful in your life with Dr. Diana Hill, Ph.D.

How playing-it-safe can be helpful or unhelpful in your life with Dr. Diana Hill, Ph.D.

We all play it safe, that’s the norm and not the exception. Our playing-it-safe tendencies move in a continuum from being adaptive on one end to being unhelpful on the other. And one of the ways we play it safe is by pushing hard and working hard.

In this conversation, I interview Diana Hill, a clinical psychologist, co-author of the book ACT daily Journal and co-host of the psychology podcast Psychologists Off The Clock. Dr. Hill discussed how you can catch the cycle of striving.

Key Takeaways

Dr. Hill shares how to:

– Move from mental experiences into the real direct experiences

– How to start using an embodied approach to notice internal experiences

– How you can practice the exercise “one eye in and one eye out” as a starting point to step back from internal experiences.

Finally, at the end of the conversation, you will hear Dr. Hill’s recommendation on how to make the best of the ACT Daily Journal, if you just started working on it.

Screenshot 2024 03 30 at 4.14.44 PM

Resources

Show notes with time-stamps

01:10 Anticipating a Trip to Bolivia: Family, Friends, and Heat
03:14 A Deep Dive into Perfectionism with Dr. Diana Hill
05:17 Announcing New Classes and a Book on Perfectionism
12:10 Interview with Dr. Diana Hill: Acceptance, Commitment, and High Achieving Behaviors
27:35 The Act Daily Journal: Making ACT Accessible
 

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5 Easy Ways to Cultivate Self-Awareness

5 Easy Ways to Cultivate Self-Awareness

Life is a succession of present moments since we open our eyes to the moment we close them to fall asleep. There is so many fun, exciting, painful, joyful, pleasurable, and interesting moments we navigate throughout a given day, and there are also those unique and impactful moments that help us to grow, be better human beings and show up to those we love as we want to do so.

It’s in those moments that, if we pay close attention,  we become self-aware of what matters, what gets in our way of being who we want to be, what we could do differently, or what needs to change.

Self-awareness is not a drink, a pill, or a magical mushroom that you consume but a skill that can be fostered and nurtured.

And if you make it a habit, you can put it into action. Let’s dive into it!

What is self-awareness?

Self-awareness is the ability to:

  • Observe ourselves in a giving context: in which situations we get emotionally uncomfortable or struggle with worries, fears, anxieties, and rumination.
  • Acknowledge our personal history: how our past influences our behavior.
  • Notice our behavioral patterns, public and private ones: what are our go-to actions? 
  • Explore the impact of our actions in our day-to-day lives, relationships with others, and the relationship with ourselves: what happens when we do “x in a given context?”
  • Understand how our mind works and how we relate to our thoughts to make sense of the world within us and outside of us: how do we relate to thinking in general?

Self-awareness, in a nutshell, is observing before jumping to fix or solve anything

Now, we can be aware of our personal history and understand how our childhood, family experiences and socio-cultural environment have influenced us, that’s one form of self-awareness; and at a different level, there are all the painful, unbearable, and agonizing encounters that put us in contact with internal discomfort.

Like height, all of us have some of the self-awareness to start with, some people more than others, and yet, self-awareness is a skill that can be cultivated, we all can have it, and a skill that liberates us from living life as it happens to us and more like creating a life for us. 

For instance, I was talking to a friend recently about his playing-it-safe moves, we mapped the following:

When feeling lonely, my friend plays it safe by booking his schedule with different events and making sure there are no empty spots; going along with what his friends prefer to do, even though he doesn’t like those activities; makes an extra effort to be funny, goofy, even though he’s feeling tired and a bid down; texts multiple potential romantic partners in a dating app so he has always available options for dates. The bottom line is that, when feeling lonely, my friend plays-it-safe by minimizing his needs and avoiding feeling lonely.

The truth is that every time you experience some form of uncomfortable thoughts, feelings, sensations – you do something: you either try to solve that discomfort in your head – thinking and overthinking at times – or doing something; taking action. You play-it-safe.

Without self-awareness, we’ll be living in a random vacuum of things happening to us and we’ll be reactively responding to them with playing-it-safe moves. But it doesn’t have to be that way.

5 ways to cultivate self-awareness:

I’m almost sure you don’t want to live your life in pilot mode but in a meaningful way and make the best use of your time, energy, and passions. You can cultivate self-awareness anytime, and the more you try it, the more that it becomes second nature.

1. Notice when you’re in pain

This probably sounds pretty obvious, but all those moments in which you find yourself struggling with emotional distress, even when you cannot pinpoint exactly the source of it or the particular emotion you’re feeling, that’s a time to notice how those feelings are demanding you take action, are asking you to do something or to say something.

In those moments, you need to pay attention to how you’re attempting to handle that emotion: are you making room for it, or are you trying to get rid of it?

Question to ask yourself:

  • What is the emotion I’m running away from and need to make room for, learn from, and befriend?

2. Pay attention to your thinking patterns

Have you ever noticed when you spend hours and hours in your head to the point that instead of feeling clear-headed with your thinking process, you end up with a headache?

To cultivate awareness you need to pay attention to those moments in which you’re stuck in your head and check what your mind is doing and pushing you to think about. In those moments, take a deep breathe and check which one of these specific thinking patterns – playing-it-safe moves – your mind is engaging in:

  • Analyzing a situation because you’re searching for reassurance
  • Thinking quickly about gloom and doom scenarios 
  • Ruminating about past situations over and over
  • Telling yourself that your needs are not important
  • Exploring every what-if thought that comes into your mind
  • Assuming quick responsibility for others’ well-being as if you’re the only person responsible for those matters
  • Criticizing and negatively judging yourself for past situations or things you have said or done
  • Assuming that every thought your mind comes up with is important and you need to respond to it.

Question to ask yourself:

  • What is my mind trying to protect me from so hard using this [name of the playing-it-safe strategy]?

You can take the Playing-it-safe questionnaire to figure out those thinking patterns and actions that keep you stuck in your head.

3. Check your values and how you have been living them

When was the last time that you paused and asked yourself: Am I doing what matters? Am I living my values in my relationships, career, friendships, and spiritual life?

The reality is that most of us live life letting life happen to us and if we’re lucky, we figure out what’s truly important to us and what we want to stand for. So, another way to foster self-awareness is by pausing and making it a habit to check if what are your values, and whether your actions are congruent with them or not. 

You can set a monthly time in your schedule to check how you’re living your values.

Questions to ask yourself:

  • Am I living the life I want to live?
  • Then select four areas of your life (e.g. friendships, parenting, romantic relationships, spirituality, career, community) and ask yourself: Am I being the person I want to be in this [area]

If you want to do your own values-based mid-year review, here is a 21-page template you can use; it includes a description of 9 areas, a values thesaurus, a values dashboard, and reflective prompts for each area in your life.

[ Click here to download a 21-page template of a values-based annual review]

4. Check how you handle interpersonal conflict

Who doesn’t encounter conflict with others? Whether that’s in a friendship, romantic relationship, parenting, or work relationship, it’s quite likely that we’re going to experience some form of disagreement, misunderstanding, confusion, and disappointment. That’s just how relationships are; no relationship is exempt from it.  And yet, conflict doesn’t have to be a deal-breaker but an opportunity to grow, learn and foster emotional intimacy in some relationships.

And just to make it crystal clear, when thinking about conflict, I’m not thinking of people screaming at each other; I’m thinking of conflict as every time two or more people have a clash of opinions, wants, desires, and wishes.

Here are the most common conflict tactics people use and you need to watch for when dealing with interpersonal disagreements:

  • Demanding or making threats
    Going into hammer mode comes with making blunt threats, demands, or requests. Sometimes you may yell; other times, you may make a threat with a soft tone of voice.
  • Blaming or externalizing
    With this go-to tactic, you make others responsible for your stressful feelings, sensations, and even behaviors. I’m not saying the things others do aren’t wrong or inconsiderate, but blaming them distracts you from noticing your own hurt.
  • Reason-giving
    Using this go-to tactic is listing all the reasons, explanations, or justifications that your inner voice comes up with within the middle of a fight. What’s the outcome? You don’t hear the other person and your behavior may be unhelpful for achieving the relationship you want to have.I’m not saying you don’t have valid reasons to do what you do, say what you say, or feel what you feel; I’m just inviting you to notice whether holding on with white knuckles to those narratives is effective.
  • Character attacks
    At times your mind has a hard time separating a person from their behavior, and therefore the whole person’s character comes under attack rather than specific behavior. Have you ever been on the receiving end of someone attacking you with criticisms? Do you remember how it felt? A client said: “The last time I was in a situation in which a person I deeply love criticized me, I felt as if I were being psychologically stabbed; it didn’t make sense to me that because of a mistake I made, my whole person was being attacked.”
  • Placating
    Solving a conflict – using this go-to tactic – is focusing 100 percent on the other person’s needs, putting your needs, wants, and desires under the rug.
  • Disconnecting
    Going into ice-cube mode is going into an emotional and physical disconnection; it’s like you’re there, and you hear the other person, but you have shut down emotionally and nothing breaks your emotional walls. Like an ice cube, you come across as a cold person in those moments.

Questions to ask yourself:

  • What’s the cost of using those go-to conflict tactics in your relationship?
  • What do you need to do to remember that when dealing with interpersonal struggles, you’re hurting and the person in front of you is hurting too?

5. Do an inventory of painful experiences and what you learn from them

Life is not only flowers and butterflies, sweetness and delightfulness; our lives also come with hard moments, losses, disconnection, and tough things to go through. It’s like being alive comes with all those experiences, without exception. And that’s not necessarily a bad thing, but a reflection of the complexity of being alive.

Grab a piece of paper and jot down the different moments of struggle, pain, and hurt you have encountered over the years. Next, ask yourself the question below:

Question to ask yourself:

  • What did I learn about myself in each one of those experiences?
  • What do you need to do to remember that when dealing with interpersonal struggles, you’re hurting and the person in front of you is hurting too?

Summary

That’s it. Cultivating self-awareness will help you to be who you want to be, make the best of your decisions and pursue a purposeful and joyful life.

Last question for you

Here is my last question for you: What are the self-awareness moments you had this year?

As we finish 2021, I would like to take this opportunity to share with you those key moments of self-awareness that came my way.

Here are my ten moments of self-awareness in 2021:

  1. Humbleness has taken me very far in living my values.
  2. Learning to love and be loved comes with other uncomfortable feelings, all together
  3. Being honest with myself is liberating.
  4. There is no need for me to play-it-safe if it’s not working in my life.
  5. Walking with my eyes, mind, and heart open heart has made a difference in who I’m.
  6. Saying no, even to things that matter, has been crucial to living with purpose.
  7. Avoiding conflict is a recipe for disaster: I don’t know how to avoid conflict. I do look at conflict as an opportunity to grow and not as a deal-breaker.
  8. Openness to others and the truth about others is fundamental to my growth. 
  9. Radically accepting that I don’t have control of the outcome of situations and people’s experiences of me is hard, necessary, and important to be myself.
  10. When life sucks, being kind and gentle with myself is much more courageous than being tough.

I leave you with this quote:

“A more fruitful approach to the challenge of living more fully in the moment starts from noticing that you are, in fact, always already living in the moment anyway, whether you like it or not.”

– Burkeman, 2021



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