Monthly Archives: December 2011

December 28, 2011 · 10:09 AM

Bill Maher illustrates the ‘Bias Blindspot’

In the subtitle of his new book, provocative HBO commentator Bill Maher illustrates an interesting cognitive trap. Princeton University’s Emily Pronin, Daniel Lin and Lee Ross talked with their study subjects and explained cognitive biases such as the better-than-average effect, the halo effect, and the self-serving bias. Everybody got the idea quickly – everybody thought they were less prone to these biases than the average person. A tip of the hat to Mr. Maher, who at least seems aware of his bias blindspot.

Logging cognitions: Not “what” but “when”

In cognitive-behavioral therapy, it’s hard to get clients to write down their automatic thoughts. It’s easy to forget one’s pen and pad, and easier to feel self-conscious about jotting private thoughts in public. Even those who cope with those obstacles, still often wonder, “What am I supposed to write down?” It’s not that the therapist didn’t explain carefully, or that the client didn’t get the concept. Often, they hesitate because most automatic thoughts are about as profound as, “I wish this place had Wi-Fi.”

As David D. Burns, M.D.’s “downward arrow” exercise shows, thoughts that seem insignificant can grow from deeply-held beliefs. “I wish this place had Wi-Fi,” might imply a deeper fear of, “I can’t get what I need to do this report properly, which might imply, “My report isn’t going to be good enough for the presentation,” which might imply, “I’m going to be fired.” The chain could lead to a core cognition of, “I’m a total incompetent doomed to financial ruination and abandonment by my family and friends.” A wish for an internet link wouldn’t seem worth reframing, but the fear your life will be ruined certainly does.

Clients can feel more comfortable about noting automatic thoughts if they compare them to sea spume. These tiny bubbles are no more than a few seconds’ worth of salt water and air, but they are created by powerful ocean waves. Those waves are made by winds, which blow because of the atmosphere’s heating and cooling; and by the tides, which are created by the gravitational pull of the moon. Like automatic thoughts, sea spume is insubstantial froth that links directly back to massive forces.

Thoughts are usually emotionally loaded when they arise at a time of strong emotions. When client’s ask, “What should I write down?” it’s useful to say, “Don’t worry about ‘what’. Think about ‘when’.”

Sylvia Plath on Electroconvulsive Therapy, Pt. 1

A description of ECT poorly applied in the mid-1950s, from The Bell Jar, pg. 143: [i]

I tried to smile, but my skin had gone stiff, like parchment.

Doctor Gordon was fitting two metal plates on either side of my head. He buckled them into place with a strap that dented my forehead, and gave me a wire to bite.

I shut my eyes.

There was a brief silence, like an indrawn breath.

Then something bent down and took hold of me and shook me like the end of the world. Whee-ee-ee-ee-ee, it shrilled, through an air crackling with blue light, and with each flash a great jolt drubbed me till I thought my bones would break and the sap fly out of me like a split plant.

I wondered what terrible thing it was that I had done.

A note to clients: the use of ECT has really improved since then.

[i] Harper Perennial Modern Classics edition, ASIN B004N8X6LK

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Filed under The Client's Side

Tagged as ECT, Electroconvulsive Therapy, Electroshock, Sylvia Plath

December 12, 2011 · 8:15 PM

Why mindfulness works – The behavioral view

Photo @2005-2011 Juanita de Paola - http://www.juanita.it/

Experts have known since 500 BCE that mindfulness practice can lead to greater feelings of equanimity and contentment. Mindfulness- based therapies have been part of western psychology at least since 1979, when Jon Kabat-Zinn opened the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. Unlike many other “eastern” treatments, empirical studies have accumulated to support claims of effectiveness against depression[i] and anxiety disorders such as generalized anxiety disorder[ii], obsessive-compulsive disorder[iii], and even irritable bowel syndrome[iv].

What has been less well understood is how it works. Michael Treanor, of the University of Massachusetts published a meta-analysis[v] this February that suggests exposure is key. Since Joseph Wolpe’s time (and before), we’ve known if you expose yourself long enough to something that causes anxiety, your amygdala and sympathetic nervous system will (eventually) realize it’s not so dangerous. The difficulty has always been how to stay with the phobic object when every part of you wants to run. Treanor’s meta-analysis finds empirical support for the idea that mindfulness works as a conditioned inhibitor – meaning, in this case, it eases the urge to flee.

Treanor’s findings were anticipated in a 2005 article[vi] by Shapiro, Carlson et al. They defined mindfulness as choosing to focus one’s attention on the present moment, with an open, accepting attitude, and the intention of calming, exploring, or regulating oneself. Marsha Linehan made it part of Dialectical Behavioral Therapy because it helped her chronically suicidal clients stay present with their emotions long enough to recognize and tolerate them. For those overwhelmed by dysphoria, mindfulness can be like the difference between watching a football game from the 50-yard line, and being tackled and trampled by players on the field.

Exposure, naturally, is the key intervention in Edna Foa’s prolonged exposure therapy, which is the U.S. military’s treatment of choice for Post-Traumatic Stress Disorder. This article tells how Sgt. Richard Low, a veteran of 280 combat missions in Iraq, recovered from PTSD symptoms with help from Sudarshan Kriya yoga:

When he came back from the service, he didn’t think his experience affected him in any major way. He had nightmares, and he startled easily, but he chalked that up to just something veterans live with.

Then he enrolled in a study he initially wrote off as “just some hippie thing,” where he learned about yoga breathing and meditation. A year later, Low, 30, sums up his experience with two words: “It works.”

Heads-up to tough guys of the world: Mindfulness is not just a hippie thing. It’s also a Shaolin Monk thing.

[i] Hofmann SG, Sawyer AT, Witt AA, Oh D. The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. J Consult Clin Psychol. 2010 Apr;78(2):169-83.

[ii] Evans S, Ferrandoa S, Findlera M, Stowella C, Smart C, Haglina D. Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders, Volume 22, Issue 4, May 2008, Pages 716-721. (doi:10.1016/j.janxdis.2007.07.005)

[iii] Hanstede M, Gidron Y, Nyklíček, I. The Effects of a Mindfulness Intervention on Obsessive-Compulsive Symptoms in a Non-Clinical Student Population. Journal of Nervous & Mental Disease: October 2008 – Volume 196 – Issue 10 – pp 776-779 (doi: 10.1097/NMD.0b013e31818786b8)

[iv] Ljótsson B, Andréewitch S, Hedman E, Rück C, Andersson G, Lindefors N. Exposure and mindfulness based therapy for irritable bowel syndrome–an open pilot study. Journal of Behavior Therapy and Experimental Psychiatry. 2010 Sep;41 (3):185-90. Epub 2010 Jan 7.

[v] Treanor, M. The potential impact of mindfulness on exposure and extinction learning in anxiety disorders. Clinical Psychology Review, Volume 31, Issue 4, June 2011, Pages 617-625

[vi] Shapiro S, Carlson L, Astin J, Freedman B. Mechanisms of mindfulness. Journal of Clinical Psychology, March 2006, Volume 62, Issue 3, pages 373–386.