Latest / Why We Do What We Do / Cognitive Behavioral Therapy pt. 2

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Cognitive Behavioral Therapy pt. 2 · Why We Do What We Do

• 0:03
  Speaker 1: You're listening to Why we Do what we do? Welcome
• 0:16
  Speaker 1: to Why we Do what we Do? I am your
• 0:19
  Speaker 1: still talking through things, Host Abraham.
• 0:23
  Speaker 2: And I'm your still processing things Host Shame.
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  Speaker 1: We are a psychology podcast. We talk about the things
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  Speaker 1: that humans and non human animals do. And this is
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  Speaker 1: a part two. We are following up a previous discussion
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  Speaker 1: about cognitive behavioral therapy and concluding that discussion with where
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  Speaker 1: we left off. So we'll do a brief recap of
• 0:47
  Speaker 1: that discussion so you're all caught up. But I do
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  Speaker 1: want to also say that we covered a lot of
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  Speaker 1: foundational ground there, specifically so we could get to this
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  Speaker 1: part two. So if you haven't heard that part, I
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  Speaker 1: think your most complete and comprehensive experience will be to
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  Speaker 1: have listened to part one and then coming back for
• 1:08
  Speaker 1: part two. But if you don't want to do that,
• 1:09
  Speaker 1: that's obviously I can't stop you. So you know, do
• 1:12
  Speaker 1: whatever you're gonna do. We'll do our best to recap
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  Speaker 1: that so you can listen to part two. But this
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  Speaker 1: is the part I was the most excited to get to.
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  Speaker 2: Yeah, and we're gonna we're gonna deep dive on this.
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  Speaker 2: It's gonna be so much fun. So yes, I'm super
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  Speaker 2: Stuke too.
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  Speaker 1: Well. If you're joining us for the first time, then welcome.
• 1:27
  Speaker 1: I hope you enjoy this and that you don't have
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  Speaker 1: trouble following the logic from part one to this one.
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  Speaker 1: If you're a returning person, then welcome back. I hope
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  Speaker 1: that you heard the first part and you're here for
• 1:37
  Speaker 1: the second part, and maybe you've been here for a
• 1:39
  Speaker 1: very long time. And either a way, we appreciate both
• 1:42
  Speaker 1: of you. And if you would like to support us,
• 1:44
  Speaker 1: and you haven't already, you can like and subscribe, leave
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  Speaker 1: a review, leave us a rating, join us on Patreon,
• 1:52
  Speaker 1: tell a friend. I'll talk more about those things at
• 1:54
  Speaker 1: the end of this discussion. But this episode releases on
• 1:58
  Speaker 1: April twenty nine, So happy day of Remembrance for all
• 2:02
  Speaker 1: victims of chemical warfare.
• 2:05
  Speaker 2: Indeed, yeah, intense. It's also Denim Day. Less intense, less intense. Hey,
• 2:11
  Speaker 2: real quick, do you know what super Mario's overalls are
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  Speaker 2: made of?
• 2:15
  Speaker 1: Denim?
• 2:15
  Speaker 2: Denim, Denham, Denham.
• 2:18
  Speaker 1: Nice? It is welcome for that, thank you. Yeah. International
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  Speaker 1: Dance Day.
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  Speaker 2: Love that. It's also International Guide Dog Day.
• 2:27
  Speaker 1: Fantastic Do we ever do an episode on Guide Dogs?
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  Speaker 2: I feel like we've talked about guide dogs a lot,
• 2:33
  Speaker 2: but I don't know that we have had a conversation
• 2:35
  Speaker 2: about them on the show, like for a formal episode.
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  Speaker 1: There's a specific training that they do that they go
• 2:41
  Speaker 1: through and like a whole process. It might be interested
• 2:43
  Speaker 1: too interesting to dig in that on that at some point.
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  Speaker 2: But yeah, I agree.
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  Speaker 1: International Noise Awareness Day. Okay, such a thing as noise.
• 2:52
  Speaker 2: In case you didn't know. Yeah, it is Peace Rose Day.
• 2:56
  Speaker 1: Okay, sure not p I e ce and like of
• 3:00
  Speaker 1: a rose, but p e a ce a rose that
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  Speaker 1: brings peace.
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  Speaker 2: The thing our administration currently hates.
• 3:06
  Speaker 1: Yeah, we could use one of those.
• 3:08
  Speaker 2: Yeah.
• 3:08
  Speaker 1: It is Poem in your Pockets Day.
• 3:12
  Speaker 2: Is that a poem in your pocket? Are you just
• 3:14
  Speaker 2: happy to see me?
• 3:15
  Speaker 1: Yes?
• 3:18
  Speaker 2: It is a stop food waste day.
• 3:20
  Speaker 1: Oh, I can get on board with that.
• 3:22
  Speaker 2: Yeah.
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  Speaker 1: It is we jump the World's Day. I don't know
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  Speaker 1: that means, but okay, I think.
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  Speaker 2: It's we beat up, we beat up the Earth. It's
• 3:30
  Speaker 2: World Wish Day.
• 3:32
  Speaker 1: Okay, It's Zipper Day.
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  Speaker 2: It is. It's also go diaper free week.
• 3:39
  Speaker 1: Go dieper free Day. I think no, no, it's a
• 3:42
  Speaker 1: whole week.
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  Speaker 2: That's a type of all bids.
• 3:44
  Speaker 1: Okay, Oh, well, you know Trump's not listening to this,
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  Speaker 1: and that's for the best probably, But should he go
• 3:53
  Speaker 1: diaper free, I think we would all suffer just a
• 3:55
  Speaker 1: little bit more. Yeah.
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  Speaker 2: Yeah, he'd be mad at everybody else for him going
• 3:59
  Speaker 2: diaper free.
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  Speaker 1: Yeah, the leaking squish would be a lot more leaking
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  Speaker 1: and a lot more squish. International Mariachi Week it is.
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  Speaker 2: It is. That's so much better. It's National Auctioneer's.
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  Speaker 1: Week, also better, but relatedly, it is also National Scoop
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  Speaker 1: the Poop Week.
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  Speaker 2: Beautiful.
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  Speaker 1: Oh man, what a time to be alive, What a
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  Speaker 1: time to be alive. All right, well, let's do a
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  Speaker 1: quick recap of our previous episode so that we can
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  Speaker 1: prepare for the upcoming discussion we need to have. So
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  Speaker 1: last time, we largely started by situating this context around
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  Speaker 1: the story of a person. And we got this story
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  Speaker 1: from a website that was like stories about people who
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  Speaker 1: went through CBT. So this is about a character who
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  Speaker 1: I believe is a real person. It seems like all
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  Speaker 1: of this is based on her real experience, although the
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  Speaker 1: name may have been changed. This is Zara was wanting
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  Speaker 1: to get back to work. She had lost her job
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  Speaker 1: and had been out of work for several months and
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  Speaker 1: was trying to get back to work and had some
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  Speaker 1: fear around being ineligible and incompetence to perform some of
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  Speaker 1: the newer jobs because she had been at her previous
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  Speaker 1: job so long, and also because she was getting older
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  Speaker 1: and didn't have very much experience with some of the
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  Speaker 1: newer things. So a lot of the stories situated around
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  Speaker 1: the therapist helping her by addressing some of those concerns
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  Speaker 1: and thoughts, and so that's sort of just the story
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  Speaker 1: that we're building this discussion around.
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  Speaker 2: Right absolutely, And so we've been telling Zara story, and
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  Speaker 2: in the last episode we did talk about like the
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  Speaker 2: overall approach in the background of CBT, just as an example.
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  Speaker 2: Aaron Beck is the person who's responsible for kind of
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  Speaker 2: starting this back in the nineteen sixties, and it's really
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  Speaker 2: kind of evolved since then, but at the time that
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  Speaker 2: they were doing this, it was a little bit not
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  Speaker 2: necessarily structured or manualized, and so he's kind of responsible
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  Speaker 2: for taking this and making it a little bit more
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  Speaker 2: standardized across the board and really kind of building that
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  Speaker 2: as like a standardized, manualized process for treating the types
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  Speaker 2: of concerns that come up, which include problems with like
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  Speaker 2: specific behaviors, schizophrenia, anxiety, sleep, lots of different applications of
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  Speaker 2: this approach.
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  Speaker 1: Yeah, yeah, it evolved to be applied to a wide
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  Speaker 1: variety of things, including the ones that you cited. We
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  Speaker 1: sort of left the discussion by unpacking the parts of
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  Speaker 1: the approach. So it's cognitive behavioral therapy, and so there's
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  Speaker 1: the sort of cognitive piece and the behavioral piece, and
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  Speaker 1: the cognitive piece we worked. We talked through the fact
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  Speaker 1: that there are distorted thoughts, underlying beliefs, and automatic thoughts
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  Speaker 1: are sort of the three main components that they talk about,
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  Speaker 1: and that this all is about the relationship between cognition, emotions,
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  Speaker 1: and behavior as sort of the comprehensive picture of CBT.
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  Speaker 1: But in the cognitive part, automatic thoughts are just immediate
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  Speaker 1: reactions to things. Distorted thoughts are ways that we logic
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  Speaker 1: our way to problematic conclusions. And then the underlying beliefs
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  Speaker 1: are sort of rigid views that we have and assumptions
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  Speaker 1: about the world. And so in CBT, a portion of
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  Speaker 1: the therapy is designed to essentially identify those pieces of
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  Speaker 1: someone's sort of logic and approach and challenge it and
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  Speaker 1: sort of suggest, like, let's re examine this thought or
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  Speaker 1: those belief for this assumption and see if it holds
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  Speaker 1: weight under scrutiny.
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  Speaker 2: Right, So that brings us up to speed, and we
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  Speaker 2: are at the stage where we're going to talk about,
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  Speaker 2: let's say, the parts that work, or at least let's
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  Speaker 2: talk about the behavioral part of this. Right, this is
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  Speaker 2: where we're going to kick off part two and really
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  Speaker 2: get into the active ingredients of CBT in general. If
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  Speaker 2: you're feeling froggy.
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  Speaker 1: If you're feeling froggy, and we have some research to
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  Speaker 1: impact as well, yes we do, Yes we do.
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  Speaker 2: So let's go ahead and start with this idea. The
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  Speaker 2: behavioral component of CBT. Right, So the be is behavioral,
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  Speaker 2: and the behavioral part which is also like, there's a
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  Speaker 2: part of this called behavioral activation or like, so a
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  Speaker 2: huge component of this, and the behavioral activation component involves
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  Speaker 2: facing difficult or frightening situations instead of avoiding them, using
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  Speaker 2: role playing to practice those situations, and using calming strategies
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  Speaker 2: to reduce the reactivity to those circumstances.
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  Speaker 1: So during the role plane exercises the patient, the client,
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  Speaker 1: whatever they're going to practice the new behaviors during sort
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  Speaker 1: of a mock scenario. The idea here is that there
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  Speaker 1: are similar features which those behaviors among us would say,
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  Speaker 1: similar stimulus features and possibly stimulus functions as the real
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  Speaker 1: challenging scenario that the person might face. So if they
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  Speaker 1: have some problem about how an interaction might go, then
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  Speaker 1: they would set up that interact action or very specific
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  Speaker 1: scenario like just being on an elevator with coworkers. They
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  Speaker 1: might manufacture that scenario whatever it is. The point is
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  Speaker 1: that it sort of looks and feels like the scenario
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  Speaker 1: that's difficult, and then they practice how to navigate that
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  Speaker 1: situation in that sort of mock scenario, and they get
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  Speaker 1: feedback from the therapist to help shape and encourage their
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  Speaker 1: new response strategies so that they can start to learn
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  Speaker 1: to both attenuate the emotional reluctance and activation they might feel,
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  Speaker 1: as well as behave in a way that is more
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  Speaker 1: productive in that scenario.
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  Speaker 2: Yeah, this just made me picture a therapist working with
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  Speaker 2: somebody about the elevator scenario, and like I just pictured
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  Speaker 2: like sitting in an office and the therapist and the
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  Speaker 2: climber together and they both climb into like a small
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  Speaker 2: closet to practice.
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  Speaker 1: It and hopefully that's like hopefully it's not.
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  Speaker 2: What happens, but like I pictured that for a second
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  Speaker 2: as like you know, that's creative, I guess.
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  Speaker 1: And the therapist goes ding to simulate the door.
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  Speaker 2: Yeah, and like yeah, they have to. They have to
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  Speaker 2: play through all the scenarios, right, Like there's the person
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  Speaker 2: on the elevator who farts and you're like, oh, come on,
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  Speaker 2: or like the ding, or like the kid who like
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  Speaker 2: presses all the buttons and it's like, okay, what do
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  Speaker 2: you do? Like you know, all those all those fun
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  Speaker 2: scenarios that happen on elevators. Sure, now, the therapist will
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  Speaker 2: often assign homework and we say homework in quotes because
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  Speaker 2: the patient will practice using the active strategies that they
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  Speaker 2: learned in therapy. They're going to use them outside of
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  Speaker 2: therapy sessions. And this point in particular is critical. It
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  Speaker 2: is in the moments that they are likely to have,
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  Speaker 2: these specific moments that we're gonna do homework in that
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  Speaker 2: it's gonna likely evoke a problem, a problematic response that
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  Speaker 2: the patient practices and and and an alter and they're
• 10:44
  Speaker 2: gonna practice the alternative behavior in that situation. So what
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  Speaker 2: we mean by that is this, So if I am
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  Speaker 2: having to learn, let's go back to the elevator example,
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  Speaker 2: if I'm learning how to stand in an elevator with
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  Speaker 2: my coworkers, the homework would be, Okay, try to do
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  Speaker 2: this at least once during the week where you're gonna
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  Speaker 2: get in an elevator and you're gonna practice a skill
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  Speaker 2: in a real life situation. You can practice it and
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  Speaker 2: the therapist can get parameters. Right. Yeah, so you're already
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  Speaker 2: like nervous about this, So try to ride the elevator
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  Speaker 2: when it's low traffic time, so like you can have
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  Speaker 2: like not as many people where it's not as crowded
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  Speaker 2: in the elevator, so that you can practice the skill
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  Speaker 2: of riding the elevator with at least one other person
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  Speaker 2: in the elevator or whatever. Right, So let's practice that.
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  Speaker 2: Report back to me how you feel about it when
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  Speaker 2: you do it, Like think about these things during it,
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  Speaker 2: Like there's like some specific ideas and guidance around that
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  Speaker 2: particular activity, And yeah.
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  Speaker 1: Did the strategy work? What did you experience? Did it
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  Speaker 1: not work? Like were the parts that were like particularly
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  Speaker 1: stressful that we can now talk about where their ads.
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  Speaker 1: All right, we're back. I was listing things that might
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  Speaker 1: be part of the discussion about that, and they were
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  Speaker 1: real except for the adds part. So yeah, yeah, muddy
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  Speaker 1: the water. But yeah, So that is like, it is
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  Speaker 1: the assignment to actually go out and find an instance
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  Speaker 1: for where that scenario might take place, and then practice
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  Speaker 1: those responses in that situation for whatever that situation might be.
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  Speaker 1: In behavioral terms, we're thinking about unpacking this, there is
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  Speaker 1: a motivating operation which is sort of the setting context
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  Speaker 1: that they're in, which has a specific discriminative stimulus, which
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  Speaker 1: is to say, there are environmental triggers that have in
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  Speaker 1: the past provoked a certain type of response that probably
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  Speaker 1: left the person feeling angry, afraid, or some other form
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  Speaker 1: of distress. But having practiced a new response during role
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  Speaker 1: playing or having discussed it at least in that same
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  Speaker 1: situation in the future, the person actively does something different
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  Speaker 1: and as an outcome of that experiences ideally less frustration
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  Speaker 1: or anger or whatever us they would normally have experienced,
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  Speaker 1: and will likely even experience something more like calm or nonchalance.
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  Speaker 1: And that because the outcome of doing a different behavior
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  Speaker 1: in that same situation is a better outcome that is
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  Speaker 1: more likely to facilitate them making similar choices the next
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  Speaker 1: time that situation arises. If that all sort of makes sense,
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  Speaker 1: I kind of mixed my jargon and non jargon so
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  Speaker 1: much it might have gotten a little lost. But do
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  Speaker 1: you feel like, did I explain that clearly?
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  Speaker 2: Yeah? Yeah, yeah, yeah, I feel good about that. I
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  Speaker 2: feel that makes sense. So thinking about this and how
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  Speaker 2: this works. The therapist that the client is working with
• 13:36
  Speaker 2: or the patient's working with, they will work to help
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  Speaker 2: you gain a better understanding or the client have a
• 13:41
  Speaker 2: better understanding and appreciation for the behaviors and motivations of others,
• 13:44
  Speaker 2: practice problem solving strategies to use in those stressful situations,
• 13:47
  Speaker 2: and learn to develop confidence in their own abilities. So, like,
• 13:50
  Speaker 2: the idea is that you're going to contact some success
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  Speaker 2: by practicing THEEDS and these small increments and also do
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  Speaker 2: some mindfulness and thinking about like the scenarios and kind
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  Speaker 2: of like working through them. But the therapist is supposed
• 14:02
  Speaker 2: to be like kind of like a guide for that. Now,
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  Speaker 2: they're not going to give you. They're not going to
• 14:05
  Speaker 2: tell you to go do something like if you're like, hey,
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  Speaker 2: I need help, Like should I take this job? They're
• 14:09
  Speaker 2: not going to go take this job. They're gonna say,
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  Speaker 2: let's think about this, let's talk, let's talk about the situation,
• 14:13
  Speaker 2: let's talk about the ways it could go, and kind
• 14:15
  Speaker 2: of help you explore understand that circumstance more.
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  Speaker 1: Yeah, exactly, The point is not to push you in
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  Speaker 1: any one direction. It's just to ensure that you have
• 14:23
  Speaker 1: the enough skills in your toolbox that you get to
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  Speaker 1: make an intentional choice. Yeah, it's not driven by things
• 14:30
  Speaker 1: like fear, anxiety, distress, whatever, that you can sort of
• 14:34
  Speaker 1: let those set those things aside and make a choice
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  Speaker 1: that is more about what's important and valuable to you
• 14:40
  Speaker 1: in your life and right the kinds of things that
• 14:43
  Speaker 1: would make you feel sort of fulfilled and whatnot. But yeah,
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  Speaker 1: that's that's kind of honestly, the bulk of the behavioral piece.
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  Speaker 1: It's really about doing the actual behaviors and getting practice
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  Speaker 1: and feedback so that you can start to learn those
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  Speaker 1: as new skills. So it's just a lot of building
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  Speaker 1: and normally like for the most part, right, and then
• 15:02
  Speaker 1: going out and putting those into practice in those situations
• 15:06
  Speaker 1: so that you to put this in a lay term
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  Speaker 1: that is like technically incorrect, but it's correct enough that
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  Speaker 1: I think people who are not from our field would
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  Speaker 1: follow it. You're sort of rewriting the script in your
• 15:22
  Speaker 1: brain that has you be like, this is how I
• 15:25
  Speaker 1: respond in situations I don't like, right, and instead saying like, Okay,
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  Speaker 1: that's what you're used to doing. Now we're going to
• 15:32
  Speaker 1: start doing something different, and just by doing actually doing
• 15:35
  Speaker 1: the different thing, that has the effect of also changing
• 15:39
  Speaker 1: your thoughts about it, Like both of those things happen
• 15:42
  Speaker 1: at the same time, and that therefore changes your experience,
• 15:45
  Speaker 1: and there are going to be different consequences because your
• 15:47
  Speaker 1: behavior is different. There's going to be a different emotional
• 15:50
  Speaker 1: experience because your behavior is different. So the whole point
• 15:54
  Speaker 1: of this is just do the actual things in those
• 15:58
  Speaker 1: similar situations, and do the things that are more productive,
• 16:02
  Speaker 1: that facilitate the kind of experience that works better for
• 16:04
  Speaker 1: you in those situations, and sort of again get you
• 16:08
  Speaker 1: the opportunity to make an intentional choice. We spend all
• 16:12
  Speaker 1: this time in the last episode unpacking the cognitive portion
• 16:17
  Speaker 1: of CBT, and we've kind of already done the entire
• 16:20
  Speaker 1: behavioral portion, behavioral activation portion of CBT. And you might
• 16:24
  Speaker 1: think that that sounds simple, and that it plays a
• 16:27
  Speaker 1: lesser role in the process, but it actually is just
• 16:30
  Speaker 1: it's just about doing the actual thing. Like the cognitive
• 16:33
  Speaker 1: piece is a lot about taxonomizing different types of language
• 16:39
  Speaker 1: to categorize them as belonging to as being a proxy
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  Speaker 1: for belonging to different categories of thinking, which fine. But
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  Speaker 1: the behavioral pieces, as I said, just it's more about
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  Speaker 1: active engagement.
• 16:54
  Speaker 2: Yeah, yeah, for sure. So someone might be hearing all
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  Speaker 2: this and thinking the behavioral activation piece sounds well and good,
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  Speaker 2: but you're going to try. If you're going to try
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  Speaker 2: to change their response patterns, you also need to make
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  Speaker 2: sure that you've worked on their problematic thoughts in these situations,
• 17:09
  Speaker 2: like you might kind of that's normally what I think
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  Speaker 2: when I think that. Now, as we'll see in some
• 17:13
  Speaker 2: of the research, thoughts change when behavior changes, and thoughts
• 17:17
  Speaker 2: are behavior, so it makes sense that thoughts change when
• 17:21
  Speaker 2: behavior changes. So as a result, essentially what happens is
• 17:23
  Speaker 2: behavior changes, and then once we start kind of like
• 17:26
  Speaker 2: seeing the success or the variation and the behavior and
• 17:30
  Speaker 2: kind of like those those moments that are not nearly
• 17:32
  Speaker 2: as stressful or distressing, Like once we notice that, then
• 17:35
  Speaker 2: our thoughts start to change and our scripts start to
• 17:37
  Speaker 2: change around that we go from oh, this is a
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  Speaker 2: really I can't do this too, you know what, I
• 17:41
  Speaker 2: can do this even though it's hard to you know what,
• 17:44
  Speaker 2: I never thought i'd be able to do this, but
• 17:46
  Speaker 2: now I can. And that's successful. Like you can kind
• 17:48
  Speaker 2: of like move. You can see how somebody's thoughts will
• 17:50
  Speaker 2: change as they get more successive opportunities to engage in
• 17:53
  Speaker 2: those new behaviors.
• 17:54
  Speaker 1: And eventually make it all the way to the thought
• 17:57
  Speaker 1: like this is easy and I don't mind this.
• 17:59
  Speaker 2: Yeah, yeah, and.
• 18:01
  Speaker 1: Not even necessarily spending all that much time thinking about
• 18:04
  Speaker 1: it like that's it can it can eventually make its
• 18:06
  Speaker 1: way there. Not always, not for everything, and probably not
• 18:09
  Speaker 1: ideal when it is something that should be something that
• 18:12
  Speaker 1: you like, should have a strong reaction to because it's
• 18:15
  Speaker 1: helpful for you for whatever reason. But the point is
• 18:18
  Speaker 1: that like you could end up there, particularly for situations
• 18:21
  Speaker 1: where you don't really need to be activated all that intensely,
• 18:25
  Speaker 1: right exactly. I think that brings us to unpacking a
• 18:29
  Speaker 1: bunch of the research. As we said, this is a
• 18:31
  Speaker 1: heavily heavily researched subject, so there's there's a lot to
• 18:38
  Speaker 1: say here. But let's go ahead and get into the
• 18:40
  Speaker 1: research here, because there's some important things to understand and
• 18:45
  Speaker 1: unpack about this that we have discovered over time.
• 18:49
  Speaker 2: So of course, over time clinicians became interested in learning
• 18:52
  Speaker 2: which components of CBT were the most important and the
• 18:54
  Speaker 2: most effective. You see this a lot in treatment, I
• 18:57
  Speaker 2: think in general, where like especially if there's a lot
• 19:00
  Speaker 2: lots of parts or lots of pieces to the way
• 19:02
  Speaker 2: that we intervene, we want to go back and explore, like, well,
• 19:04
  Speaker 2: what part actually works like? Is it like? Is this
• 19:08
  Speaker 2: is it? This is it? This is a combination of
• 19:09
  Speaker 2: these things? What does this look like? And there are
• 19:12
  Speaker 2: several components involved at CBT we've kind of expressed, and
• 19:15
  Speaker 2: it would be the case that all of them together
• 19:17
  Speaker 2: are important for the process to work. Perhaps it needs
• 19:20
  Speaker 2: even more we could look at that, Or perhaps there
• 19:23
  Speaker 2: are some components that are more effective than others and
• 19:25
  Speaker 2: we should explore that too.
• 19:27
  Speaker 1: Yes, so there is a method in research to try
• 19:33
  Speaker 1: and understand the relevant components. Is often called a dismantling study,
• 19:39
  Speaker 1: which means that they will test just various components in
• 19:42
  Speaker 1: isolation from one another. Some people also maybe call it
• 19:46
  Speaker 1: a component study, but those are that's sort of the
• 19:49
  Speaker 1: thing that exists. So the first paper we're going to
• 19:53
  Speaker 1: discuss is one of the most seminal and widely cited
• 19:58
  Speaker 1: papers on this particular dismantling aspect. This is the nineteen
• 20:04
  Speaker 1: ninety six study by Jacobson at All in the Journal
• 20:07
  Speaker 1: of Consulting in Clinical Psychology. And as I said, this
• 20:12
  Speaker 1: is like, this is the paper people turn to. But
• 20:15
  Speaker 1: I mean, there's been a lot more since this, but
• 20:17
  Speaker 1: this is kind of the big one. They randomly assigned
• 20:20
  Speaker 1: one hundred and fifty patients to either a behavioral activation
• 20:23
  Speaker 1: component only without the cognitive component, or they expose the
• 20:29
  Speaker 1: patients to the full CBT model. So that was how
• 20:33
  Speaker 1: they were going to do their component's study here, is
• 20:36
  Speaker 1: to look at just the behavioral activation component or the
• 20:40
  Speaker 1: entire package and just see how how does it perform.
• 20:43
  Speaker 2: Yeah, and so the behavioral activation component included teaching skills
• 20:47
  Speaker 2: and addressing automatic thoughts, but did not address the core
• 20:50
  Speaker 2: schemas underlying beliefs, cognitive distortions, or any of the other
• 20:55
  Speaker 2: coditive components that were that are usually addressed or talked
• 20:59
  Speaker 2: about or or intervened on inside of CBT. So it
• 21:02
  Speaker 2: was just the behavioral activation piece with teaching skills, not
• 21:06
  Speaker 2: the underlying beliefs or the distortions.
• 21:08
  Speaker 1: So when they compared them, they found that both approaches
• 21:11
  Speaker 1: were equally as effective at changing behavior and changing dysfunctional
• 21:15
  Speaker 1: thoughts immediately following treatment. Both the behavioral only and the
• 21:22
  Speaker 1: CBT we're effective at both changing behavior and changing thoughts,
• 21:29
  Speaker 1: and also performed similarly at a six month follow up.
• 21:34
  Speaker 1: Remarkably when they also found the behavioral activation component also
• 21:38
  Speaker 1: better predicted explanatory assumptions of patients than the full CBT
• 21:45
  Speaker 1: model did. And the explanatory assumptions have to do with
• 21:49
  Speaker 1: these rigid what they sometimes referred to as subconscious beliefs.
• 21:54
  Speaker 1: It's the if then rules, If I fail, I'm worthless,
• 21:58
  Speaker 1: those kind of things, And it had better predictive utility
• 22:03
  Speaker 1: for those kinds of logic things than the full CBT
• 22:07
  Speaker 1: model even did.
• 22:08
  Speaker 2: Yeah, and here's the thing about this, and why are
• 22:11
  Speaker 2: we talking about this, Like when we are unpacking something
• 22:13
  Speaker 2: like this and we're we're looking at how like why
• 22:18
  Speaker 2: we would do a component analysis, like ultimately we're trying
• 22:21
  Speaker 2: to find out how we can save time and resources
• 22:25
  Speaker 2: and be the most effective. Right, So, in this situation,
• 22:28
  Speaker 2: where like, if all we've got to do is behavioral
• 22:30
  Speaker 2: activation and that works really well, that will save time
• 22:34
  Speaker 2: that a therapist might waste on an intervention that is
• 22:37
  Speaker 2: benign at best, right, Like, So thinking about it from
• 22:41
  Speaker 2: that perspective is like, this will make the services more
• 22:44
  Speaker 2: more effective, more efficient, and make it so that the
• 22:48
  Speaker 2: therapist is not having to spend so much time doing
• 22:50
  Speaker 2: things that are going to waste the patient's time in general.
• 22:52
  Speaker 1: Exactly like listening to ads. Okay, we're back, So Yeah. Interestingly,
• 23:07
  Speaker 1: the behavioral activation piece alone was not only as good
• 23:13
  Speaker 1: as the full model, but it was even better in
• 23:16
  Speaker 1: at least one way, suggesting that the cognitive part of
• 23:22
  Speaker 1: CBT is fluff, possibly even slightly unhelpful fluff. Again, just
• 23:31
  Speaker 1: relaying the research here, not making any qualitative definitive statements
• 23:37
  Speaker 1: on our end. Yeah, but I think what you could
• 23:40
  Speaker 1: take away from a study that shows that when you
• 23:42
  Speaker 1: strip out this one component it does just as well
• 23:45
  Speaker 1: as the entire package, and in some ways even better,
• 23:49
  Speaker 1: suggests that the other parts of that package are unnecessary.
• 23:54
  Speaker 2: Yeah yeah, but that was twenty years ago, right, So, Like,
• 23:58
  Speaker 2: you know, maybe maybe research is in its infancy. Maybe
• 24:02
  Speaker 2: there's some things that can unpack. I also want to
• 24:04
  Speaker 2: point out nineteen ninety six is pre pretty fly for
• 24:07
  Speaker 2: a white guy. So like when just if you needed
• 24:11
  Speaker 2: like a timeline, like a stamp on the timeline, this
• 24:13
  Speaker 2: is before. This is before pretty fly for a white guy.
• 24:16
  Speaker 2: So what happens in a post pretty fly for a
• 24:19
  Speaker 2: white guy era of research? You know, it's it's it's
• 24:29
  Speaker 2: for certain people. And that's what I've learned. So two
• 24:33
  Speaker 2: thousand and two study compared relaxation and desensitization to coditive
• 24:37
  Speaker 2: therapy or the two mixed together for people with generalized
• 24:40
  Speaker 2: anxiety disorder or god like we mentioned before. They found
• 24:43
  Speaker 2: that all three were equally effective with similar outcomes and
• 24:47
  Speaker 2: follow up data. So relaxation, desensitization by itself, caught it,
• 24:51
  Speaker 2: therapy by itself, or mixing the two together, and they
• 24:54
  Speaker 2: found that all three were useful.
• 24:56
  Speaker 1: Yes, yeah, so the behavioral component of that it was
• 25:01
  Speaker 1: part of it, wasn't there?
• 25:02
  Speaker 2: Yeah.
• 25:02
  Speaker 1: There was also a twenty twenty study in the Journal
• 25:05
  Speaker 1: of Clinical Child and Adolescent Psychology by Orror, Baker, Marchette,
• 25:09
  Speaker 1: and Stark, and they randomly assigned forty young girls with
• 25:13
  Speaker 1: depressive disorder into these groups. And they compared CBT to
• 25:17
  Speaker 1: the behavioral only portion of CBT, and they did this
• 25:21
  Speaker 1: in a study that looked at just pre post measurements
• 25:23
  Speaker 1: of their symptoms, so before they did the intervention, and
• 25:27
  Speaker 1: then after the intervention, and looked at the girls who
• 25:30
  Speaker 1: received just the behavioral component or those who received the
• 25:32
  Speaker 1: full CBT package, and found that the behavioral component produced
• 25:36
  Speaker 1: significant improvements in their depressive symptoms, while the cognitive component
• 25:40
  Speaker 1: actually marginally worsened treatment outcomes.
• 25:43
  Speaker 2: Wow.
• 25:44
  Speaker 1: They did find that the older the girls were, the
• 25:46
  Speaker 1: better they did with the cognitive component, so it was
• 25:50
  Speaker 1: age predicted how responsive they were to the whole thing,
• 25:54
  Speaker 1: But the behavioral component was the best across the board
• 25:58
  Speaker 1: for this one.
• 26:00
  Speaker 2: Interesting all right now. Similarly, a twenty twenty study in
• 26:04
  Speaker 2: cognitive behavior therapy seems like a reputable journal. Doesn't seem
• 26:08
  Speaker 2: like there's a bias there at all. They survey one
• 26:10
  Speaker 2: hundred and twenty CBT experts to gain consensus on the
• 26:14
  Speaker 2: most critical components of CBT, ranked across thirty five content
• 26:17
  Speaker 2: and process components of CBT. They reported the experts identified ensuring, understanding, developing,
• 26:23
  Speaker 2: and maintaining a good therapeutic alliance, explaining the rationale for
• 26:27
  Speaker 2: CBT eliciting feedback, identifying and challenging avoidant behavior, activity monitoring,
• 26:33
  Speaker 2: undertaking an initial assessment, relapse prevention methods, homework assignments. All
• 26:38
  Speaker 2: of those that we just mentioned, they were the most
• 26:40
  Speaker 2: important content components for CBT. So if you read those back,
• 26:46
  Speaker 2: they are almost entirely behavioral. Right. Ensuring understanding is just
• 26:50
  Speaker 2: verifying that somebody has the verbal behavior to repeat back
• 26:54
  Speaker 2: and understand what you've described. Right. Good therapeutic alliance is
• 26:57
  Speaker 2: the behavior of the therapist in relation to the pay,
• 27:00
  Speaker 2: making sure that that's good. Explaining the rationale. Getting feedback
• 27:03
  Speaker 2: is all verbal behavior. Identifying, avoidant and challenging. So we
• 27:06
  Speaker 2: identify and challenge the avoidant behavior. The behavioral part we
• 27:09
  Speaker 2: monitor it data, We do the assessment to figure out
• 27:12
  Speaker 2: what the concern is and maybe some possible motivations for that.
• 27:15
  Speaker 2: Relapse prevention methods meaning that we make sure that we
• 27:18
  Speaker 2: set up contingencies that the person is not likely to fail.
• 27:21
  Speaker 2: The homework assignments are like the actual practice of the skills.
• 27:24
  Speaker 2: Like there's so it's all behavioral. Every part of that
• 27:26
  Speaker 2: was behavioral.
• 27:27
  Speaker 1: Yeah, And I think they would argue that it is
• 27:30
  Speaker 1: a mix I think they weren't trying to land on anything.
• 27:33
  Speaker 1: And you could also maybe criticize, like, okay, but you
• 27:35
  Speaker 1: could survey a whole bunch of experts and have them
• 27:38
  Speaker 1: come to the wrong conclusion. Yeah, you know, and that
• 27:41
  Speaker 1: is definitely true because you're just getting people's opinions at
• 27:44
  Speaker 1: that point. But they are experts and they do have
• 27:45
  Speaker 1: a lot of experience, so it's still worth at least
• 27:48
  Speaker 1: considering that they have some valuable thing. And this was
• 27:51
  Speaker 1: the whole point was to gain consensus on this, so
• 27:54
  Speaker 1: you know, it was about multiple people sort of landing
• 27:57
  Speaker 1: in the same place. All Right, we'll do one more
• 28:01
  Speaker 1: for the purposes of this discussion, because there are dozens,
• 28:05
  Speaker 1: dozens at least of other studies in this vein alone.
• 28:09
  Speaker 1: I mean there's thousands of replication studies. There are thousands
• 28:13
  Speaker 1: of other like specific technique studies. There are at least dozens,
• 28:17
  Speaker 1: if not hundreds or thousands of dismantling studies as well,
• 28:21
  Speaker 1: So we're just doing we're sort of scratching the surface here.
• 28:24
  Speaker 1: A twenty twenty one meta analysis aggregated from seventy six
• 28:28
  Speaker 1: randomized control trials, which together included eleven thousand, seven hundred
• 28:33
  Speaker 1: and four patients, and they did this to all the
• 28:35
  Speaker 1: relative Yeah, that's just the many. That is a very
• 28:39
  Speaker 1: very large end size. For those of you concerned about
• 28:41
  Speaker 1: end sizes, once you get up to like the thousands range,
• 28:44
  Speaker 1: you are in the large end size. And this was
• 28:46
  Speaker 1: ten times more than that.
• 28:48
  Speaker 2: You know, it's wild because I, you know, I hear
• 28:50
  Speaker 2: from researchers that the end size doesn't really matter that much.
• 28:54
  Speaker 1: Depends on your methods.
• 28:55
  Speaker 2: Really, I guess it depends on your methods.
• 28:56
  Speaker 1: Yeah, and the question you're asking. But yeah, yeah, they.
• 29:01
  Speaker 2: So size does matter in research.
• 29:04
  Speaker 1: It's you know, it depends different strokes for different folks.
• 29:08
  Speaker 2: Yeah.
• 29:13
  Speaker 1: Uh. They identified So again, this is they wanted to
• 29:16
  Speaker 1: compare the relevant components of CBT across all of these studies,
• 29:20
  Speaker 1: and they identified that the behavioral activation was the most
• 29:23
  Speaker 1: effective component, and that the relaxation part was actually a
• 29:27
  Speaker 1: harmful component, making outcomes worse, but that in general all
• 29:31
  Speaker 1: forms of CBT had better outcomes than at least a
• 29:34
  Speaker 1: weightless control group. So it was like, if you did
• 29:37
  Speaker 1: any version of CBT compared to a weightless control the
• 29:43
  Speaker 1: behavioral component was the most effective. All of it would
• 29:47
  Speaker 1: improve outcomes except the relaxation stuff had some instances where
• 29:54
  Speaker 1: it marginally decreased outcomes for some of them, So for
• 29:59
  Speaker 1: what it's worth it, guess.
• 30:00
  Speaker 2: Yeah, yeah, I mean, like ultimately, kind of the major
• 30:03
  Speaker 2: finding in all of this is that at the end
• 30:05
  Speaker 2: of the day, the behavioral piece is really really crucial,
• 30:08
  Speaker 2: if not the most effective component, and arguably the thing
• 30:11
  Speaker 2: that's going to cause the least harm if it's done well. Right.
• 30:14
  Speaker 2: So I think if we go back to Zara's example,
• 30:17
  Speaker 2: let's talk about the technique that the therapist uses. They
• 30:19
  Speaker 2: use an ABC technique, where A is the activating agent. Yeah,
• 30:23
  Speaker 2: from my behavior analysts out there, you thought I was
• 30:25
  Speaker 2: going to say aneced and it's the activating agent, which
• 30:28
  Speaker 2: is the anecedent, But in this situation, it's the motivation
• 30:31
  Speaker 2: to get back to work, right, So A is the
• 30:32
  Speaker 2: activated it's I need to get back to work. B
• 30:35
  Speaker 2: is the beliefs that are causing the consequences. So you
• 30:39
  Speaker 2: have already decided that you will fail, so you don't
• 30:42
  Speaker 2: even try. You assume the others will judge you negatively,
• 30:45
  Speaker 2: but you have no evidence of that at all, and
• 30:47
  Speaker 2: in fact, you have a proven track record of success
• 30:49
  Speaker 2: at work. And you lost your previous job through no
• 30:51
  Speaker 2: fault of your own. So you've got this kind of
• 30:53
  Speaker 2: like these behaviors, these thoughts and beliefs that are kind
• 30:55
  Speaker 2: of that are creating some barriers in some situations. And
• 30:58
  Speaker 2: then see is the consequence, which is I avoid interviews
• 31:02
  Speaker 2: or Zara avoids interviews, They do not send applications, and
• 31:06
  Speaker 2: they're just generally avoiding the circumstances that are causing fear
• 31:09
  Speaker 2: and distress based on the distorted thoughts that are happening before.
• 31:13
  Speaker 1: So yeah, to help Zara, her therapists use some of
• 31:16
  Speaker 1: the following techniques. There was relaxation methods, including meditation and
• 31:20
  Speaker 1: progressive muscle relaxation also called PMR to relieve anxiety and
• 31:25
  Speaker 1: promote peace. They did, as we've discussed, role playing activities
• 31:29
  Speaker 1: to help Zara feel more comfortable in interview situations. So
• 31:32
  Speaker 1: they did mock interviews and then worked on identifying and
• 31:36
  Speaker 1: reframing thoughts. So sort of like what if the thought
• 31:39
  Speaker 1: so if what if they hate they all hate me
• 31:41
  Speaker 1: and I got sacked, instead became I have the ability
• 31:45
  Speaker 1: to make a great first impression and I have a
• 31:47
  Speaker 1: skill set that will impress my new boss. So just
• 31:50
  Speaker 1: trying to restructure those and then keeping a diary of
• 31:55
  Speaker 1: distorted thoughts, and each session Zara presented them and was
• 31:58
  Speaker 1: eventually able to discuss why each one was not true.
• 32:03
  Speaker 1: So she's doing her own challenging of those thoughts.
• 32:07
  Speaker 2: Yeah. They also worked on highlighting the gaps between her
• 32:09
  Speaker 2: anxieties and her actual experience of being in the workplace,
• 32:12
  Speaker 2: that idea of like kind of like grounding and like
• 32:15
  Speaker 2: thinking about like, well, you're anxious about this, but what
• 32:17
  Speaker 2: is the reality of this. The therapist then set a small
• 32:20
  Speaker 2: task for Zara to work through That started with simply
• 32:24
  Speaker 2: logging onto job sites, to browsing jobs, to making an application,
• 32:28
  Speaker 2: to making several applications, to finally attending some interviews. So
• 32:31
  Speaker 2: it went from Okay, let's start with just like going
• 32:34
  Speaker 2: on some websites, like you don't have to do anything,
• 32:36
  Speaker 2: you don't have to apply, you don't have to select
• 32:38
  Speaker 2: a job, just like just log on, just like take
• 32:40
  Speaker 2: a look and see how it goes and get some
• 32:42
  Speaker 2: information and start kind of like fading in to doing
• 32:44
  Speaker 2: some of the more complex stuff. Yeah.
• 32:46
  Speaker 1: Basically a systematic desensitization, which I believe we've discussed many
• 32:49
  Speaker 1: times on the show. And is a behavioral intervention. And
• 32:55
  Speaker 1: so yeah, Zara was back at work within a year
• 32:57
  Speaker 1: of essentially losing her job and is thriving and continues
• 33:01
  Speaker 1: to use the techniques she learned during her CBT sessions
• 33:03
  Speaker 1: whenever she feels anxious or stressed. And again, just to
• 33:06
  Speaker 1: remind everyone, that was, aside from some of our own
• 33:11
  Speaker 1: adding context here and there, that was lifted exactly verbatim
• 33:14
  Speaker 1: from a website that was telling her story. It felt
• 33:16
  Speaker 1: like it was weird to like try and paraphrase her story.
• 33:20
  Speaker 1: So I was like, let's just say it exactly how
• 33:23
  Speaker 1: they say it, so that it comes across clear and
• 33:26
  Speaker 1: not modified by our own language about it. But yeah, yeah,
• 33:31
  Speaker 1: so that's you know, I think, just something to make
• 33:33
  Speaker 1: sure is really clear. And let's end that section by
• 33:37
  Speaker 1: playing an ad. Okay, we're back. We have just wrapped
• 33:47
  Speaker 1: up sort of Zara's story, and I think, you know,
• 33:50
  Speaker 1: there's some take on points, some things we'd like to
• 33:53
  Speaker 1: sort of conclude with and our takeaways from unpacking cognitive
• 33:57
  Speaker 1: behavioral therapy.
• 33:58
  Speaker 2: Yeah, Professor to Abraham want to add, so, the most
• 34:00
  Speaker 2: important role that the content part of CBT has is
• 34:04
  Speaker 2: in marketing the therapy people don't just don't buy it.
• 34:07
  Speaker 2: If you tell them that you're changing their behavior, they
• 34:09
  Speaker 2: need to believe that you're changing their thoughts, which are
• 34:12
  Speaker 2: in most people's mind different from behavior. So it just
• 34:15
  Speaker 2: kind of like it sounds like you're changing something else
• 34:18
  Speaker 2: besides just oh, I'm just going to teach you new skills.
• 34:21
  Speaker 1: Right, even if it's not the part that works, it's
• 34:24
  Speaker 1: the part that sells the package, right, it's the glossy
• 34:28
  Speaker 1: artwork on the front that gets them to open the
• 34:30
  Speaker 1: book in the first place, right where it's like technically
• 34:34
  Speaker 1: irrelevant to what you get out of this, But if
• 34:37
  Speaker 1: it's the thing that gets you in the door, then sure.
• 34:40
  Speaker 2: Yeah.
• 34:41
  Speaker 1: But CBT found a way to apply behavioral technology to
• 34:44
  Speaker 1: effectively support people with behavioral cognitive But because those are
• 34:51
  Speaker 1: one and the same behavioral struggles and have wide scale application,
• 34:55
  Speaker 1: very effectively like it, it really works. Unfortunately, the most
• 35:00
  Speaker 1: important aspect of it is the aspect that is the
• 35:03
  Speaker 1: most difficult to sell, and even including the entire package
• 35:07
  Speaker 1: can sometimes be somewhat counterproductive. Nevertheless, we do have at
• 35:13
  Speaker 1: least a technology that works. It does help a lot
• 35:15
  Speaker 1: of people, but those are sort of, you know, interesting
• 35:19
  Speaker 1: takeaways from this I think is thinking about how do
• 35:23
  Speaker 1: you get an effective technology out there, wrap it in
• 35:28
  Speaker 1: really good marketing and make sure that technology works. And yeah,
• 35:33
  Speaker 1: the cognitive part is the really good marketing. The behavioral
• 35:35
  Speaker 1: part is the thing that works well.
• 35:37
  Speaker 2: And I think it helps too that it, like compared
• 35:39
  Speaker 2: to other therapies, it's a little bit more manualized. Yes,
• 35:43
  Speaker 2: like that makes it easy for therapists to be able
• 35:45
  Speaker 2: to take and apply in really meaningful ways. So I
• 35:48
  Speaker 2: think that really helps compare to some other practices.
• 35:51
  Speaker 1: Let me further extend a little bit of an olive
• 35:53
  Speaker 1: branch here, I think to it's possibly offended from CBT
• 35:57
  Speaker 1: people in this discussion by describing it in this way,
• 35:59
  Speaker 1: because I think what I also want to say is
• 36:02
  Speaker 1: a lot of the ways that they do some shaping
• 36:06
  Speaker 1: and modifications and facilitating the development of new behaviors looks
• 36:11
  Speaker 1: very different than what you might see in someone who
• 36:13
  Speaker 1: is trained as a behavior analyst, and they talk about
• 36:17
  Speaker 1: it in a way that's very different from how someone
• 36:19
  Speaker 1: whose job is to shape behavior would otherwise talk about it.
• 36:22
  Speaker 1: So they do bring something unique to the table, like
• 36:26
  Speaker 1: what Aaron Beck did to assemble this technology to manualize
• 36:29
  Speaker 1: it to be able to assess it and take data.
• 36:32
  Speaker 1: Like was all very innovative, and it worked inside of
• 36:35
  Speaker 1: a space of complexity that behaviorists just weren't touching at
• 36:38
  Speaker 1: the time that he developed it, and in many ways
• 36:41
  Speaker 1: they still don't reliably do that. I mean, it has
• 36:45
  Speaker 1: extended to things like acceptance and commitment therapy and acceptance
• 36:48
  Speaker 1: of commitment training, and functional analytics psychotherapy. Like there are
• 36:51
  Speaker 1: a lot that has evolved from the behavioral piece of
• 36:54
  Speaker 1: this out into the world to become psychotherapies that are
• 36:57
  Speaker 1: even more firmly rooted in sort of the the technology
• 37:00
  Speaker 1: and science of behavior. But the point is that like
• 37:04
  Speaker 1: this is right now the most heavily evidence based intervention
• 37:09
  Speaker 1: in the world, and it is widely widely used with
• 37:13
  Speaker 1: a lot of success, and the way that they do
• 37:16
  Speaker 1: apply it is different than what you might find from
• 37:20
  Speaker 1: people who are trained from a sort of core behavioral perspective,
• 37:23
  Speaker 1: and so I do want to point out like it
• 37:25
  Speaker 1: is working in a way that is bringing its own
• 37:28
  Speaker 1: sort of flavor to the table, if you will, about
• 37:31
  Speaker 1: how it approaches these things. I also wanted to say
• 37:34
  Speaker 1: really quick that there were a lot of dismantling studies
• 37:38
  Speaker 1: that unpacked this where it was not trying to separate
• 37:42
  Speaker 1: the cognitive portion from the behavioral portion, and so I
• 37:45
  Speaker 1: didn't include those in the review here. I mean, there
• 37:48
  Speaker 1: were quite a few more of those as well, but
• 37:50
  Speaker 1: like they ask questions like what's the like how important
• 37:55
  Speaker 1: is the session length or like how many sessions does
• 37:57
  Speaker 1: it have to be? Or is it important if we
• 38:00
  Speaker 1: include this specific talking point. So they were more about
• 38:06
  Speaker 1: unpacking like elements of the cognitive piece and many of them,
• 38:10
  Speaker 1: and less concerned about a comparison between whether it was
• 38:14
  Speaker 1: necessary at all. And that's sometime. I mean, I understand
• 38:19
  Speaker 1: why they would do that, because again they're sort of
• 38:20
  Speaker 1: operating under the belief that like that is an important
• 38:22
  Speaker 1: part to include, and they obviously people like it. The
• 38:25
  Speaker 1: therapist like it, people like it. Doesn't necessarily change their
• 38:29
  Speaker 1: behavior or the thoughts, but they like it, so it's there. Yeah,
• 38:32
  Speaker 1: I don't know, I guess I just wanted to say that, like,
• 38:33
  Speaker 1: going back to my original point, this is its sort
• 38:37
  Speaker 1: of own application of it. Like, I'm not sure that
• 38:39
  Speaker 1: we would have ever landed quite exactly on how they
• 38:42
  Speaker 1: set up, deliver, explain, and practice the behavioral components, because
• 38:47
  Speaker 1: we just don't do things quite that way, and that
• 38:50
  Speaker 1: part is the part that works. So like, you know,
• 38:52
  Speaker 1: they are doing something very right there.
• 38:54
  Speaker 2: Right percent. I think that I would implore behavior unless
• 38:58
  Speaker 2: who are listening to this to remember that evident space
• 39:00
  Speaker 2: practice does not mean behavior analytic practice alone, right, Like,
• 39:04
  Speaker 2: there are other evidence based practices out there that exist
• 39:07
  Speaker 2: and that work, and I think it's I think it's
• 39:10
  Speaker 2: valuable to like just understand that. Like it's they approach
• 39:13
  Speaker 2: it a different way with a different philosophical assumption in
• 39:15
  Speaker 2: many situations, but at the end of the day, like
• 39:18
  Speaker 2: we are working towards the same goal. And I think
• 39:21
  Speaker 2: that the behavioral piece is just something that we have
• 39:24
  Speaker 2: some overlap on that Ven diagram, but not a perfect
• 39:27
  Speaker 2: overlap because there's just different ways to approach it.
• 39:30
  Speaker 1: And I mean you should I think it's worth considering
• 39:32
  Speaker 1: that if you are if you have a technology that
• 39:35
  Speaker 1: people aren't going to use, what good is that technology?
• 39:38
  Speaker 1: And so like, if all you need to do is
• 39:40
  Speaker 1: present it in a different way and then that has
• 39:43
  Speaker 1: people feel more willing to accept that form of help,
• 39:45
  Speaker 1: then I'm like, well, presented in that way then, right, So,
• 39:49
  Speaker 1: I you know, they definitely have do a great job
• 39:53
  Speaker 1: preparing their audience or their their their consumers, their recipients
• 39:58
  Speaker 1: to be able to be receptive to that kind of
• 40:00
  Speaker 1: coaching and feedback. And so in that way it's very important.
• 40:04
  Speaker 1: It's a very important component of what they do, just
• 40:06
  Speaker 1: maybe for slightly different reasons than people coming into this
• 40:09
  Speaker 1: might think that it is right anyway. That's I think
• 40:13
  Speaker 1: where I would land on all this sort of stuff.
• 40:15
  Speaker 1: And again being in a somewhat I don't want to
• 40:19
  Speaker 1: say it's it's not competitive, it's just it's just a
• 40:21
  Speaker 1: different coming from a different approach you might expect or
• 40:24
  Speaker 1: feel like we're trying to take down And although we
• 40:27
  Speaker 1: were somewhat critical of this or really not, like there
• 40:29
  Speaker 1: is the research to back up everything that we're saying, right,
• 40:32
  Speaker 1: and if it says something different, we would say something different.
• 40:34
  Speaker 1: But you know, it's what's available and what has happened.
• 40:37
  Speaker 1: But like I said, I actually think we should be
• 40:40
  Speaker 1: remembering Aaron Beck's name. I think we should be acknowledging
• 40:43
  Speaker 1: the contribution that this has made to the world and
• 40:46
  Speaker 1: how much better of a place it is that this
• 40:49
  Speaker 1: is the predominant approach to psychotherapy as opposed to something
• 40:52
  Speaker 1: like really alienate some people now, but something like psychoanalysis
• 40:57
  Speaker 1: which does not have the most evidence based track record,
• 41:01
  Speaker 1: So I everyone am quite glad that this is the
• 41:04
  Speaker 1: thing that has that has become so popular and recognized
• 41:09
  Speaker 1: and well supported.
• 41:10
  Speaker 2: Yeah, I agree, I completely agree on that.
• 41:13
  Speaker 1: All Right, well, I've probably done enough sticky my foot
• 41:16
  Speaker 1: in my mouth for one episode. I feel like we're
• 41:19
  Speaker 1: good to wrap this one up. You have any more
• 41:21
  Speaker 1: take home points or thoughts or reflections, No, I feel
• 41:25
  Speaker 1: good to wrap this one up, beautiful. If you'd like
• 41:28
  Speaker 1: to tell us your thoughts on CBT, on anything that
• 41:31
  Speaker 1: we said in these two episodes, we would love to
• 41:33
  Speaker 1: hear from you. You can email us directly info at wwdwwdpodcast
• 41:37
  Speaker 1: dot com. You can also reach us directly on the
• 41:40
  Speaker 1: social media platforms. At the end of our discussions, we
• 41:44
  Speaker 1: do some recommendations. Sometimes we even do some listener mail,
• 41:46
  Speaker 1: which is what we're going to be doing today. But
• 41:49
  Speaker 1: if you're joining us for the first time, then stick
• 41:50
  Speaker 1: around because those parts I think are some of the
• 41:52
  Speaker 1: most fun parts of any discussion we get to do. Yes,
• 41:55
  Speaker 1: hopefully you will find as much join them as we do.
• 41:58
  Speaker 1: But first we'll do an.
• 41:59
  Speaker 2: Ad always with the ads.
• 42:09
  Speaker 1: All right, we're back. We have some credits and some
• 42:13
  Speaker 1: acknowledgments and then some listener mail and recommendation. So first
• 42:18
  Speaker 1: I would like to say thank you all for listening.
• 42:20
  Speaker 1: If you would like to support us, one way you
• 42:21
  Speaker 1: can do that is leaving us a rating and a review.
• 42:25
  Speaker 1: You can like, subscribe, tell a friend, tell a friend
• 42:28
  Speaker 1: to like and subscribe. Those are ways you can support
• 42:31
  Speaker 1: us non financially. Financially you can go over to Patreon
• 42:34
  Speaker 1: and if you do that then you will get access
• 42:36
  Speaker 1: to early episodes at free contents and bonus stuff, all
• 42:39
  Speaker 1: those kind of goodies. And in addition to that, the
• 42:41
  Speaker 1: thing that most people come over there for I think
• 42:44
  Speaker 1: is that we will read their name and our list
• 42:46
  Speaker 1: of supporters at the end of our discussion because we
• 42:49
  Speaker 1: so appreciate them continue to help us be a podcast.
• 42:52
  Speaker 1: So giant shout out and thank you to Mike, m Meghan,
• 42:55
  Speaker 1: Mike T, Justin, Kim Brad, Stephanie, Brian, Ashley, Kiara and Charlie.
• 43:00
  Speaker 1: You are the best and we really appreciate you.
• 43:03
  Speaker 2: You keep the lights on baby.
• 43:04
  Speaker 1: Indeed, also thank you to my team, without whom I
• 43:08
  Speaker 1: could not make this podcast. Writing in fact checking from
• 43:11
  Speaker 1: Shane and myself. Thank you for recording with me today.
• 43:14
  Speaker 2: Shane, hey anytime, thanks for having me.
• 43:16
  Speaker 1: Our social media coordinator is Emma Wilson. And our guy
• 43:19
  Speaker 1: in the chair who is everywhere and makes the sounds
• 43:23
  Speaker 1: in the air is Justin. Thank you for doing all
• 43:27
  Speaker 1: that you do, Justin. And it's been such a good
• 43:30
  Speaker 1: audio engineer.
• 43:31
  Speaker 2: Oh you're just the best and we love you. Emperor Justin.
• 43:35
  Speaker 1: That's right first of his name. I think that's what
• 43:38
  Speaker 1: I have to say about that part. Is there anything
• 43:39
  Speaker 1: I'm missing before we do our listener mail and recommendations?
• 43:44
  Speaker 2: No, I think that covers everything.
• 43:46
  Speaker 1: Here's a fun listener mail, all right, This is from
• 43:51
  Speaker 1: listener Sean. Sean has written in a little bit in
• 43:53
  Speaker 1: the past and has been a listener and so thanks
• 43:57
  Speaker 1: for right in. So this is in response to our
• 43:59
  Speaker 1: episode on Doctor Kevorkian, and Sean writes, quote, haven't written
• 44:04
  Speaker 1: in a good while, but this topic actually lands in
• 44:07
  Speaker 1: several ways. My grandma actually planned her death when I
• 44:10
  Speaker 1: was younger and informed the whole family. She had been
• 44:13
  Speaker 1: on oxygen as long as I could remember. Her partner
• 44:15
  Speaker 1: had passed years ago, and due to health concerns, they
• 44:18
  Speaker 1: wanted to amputate both her legs. Doctors basically told her
• 44:22
  Speaker 1: die later in pain or lose your legs. She was old,
• 44:25
  Speaker 1: pushing ninety, and didn't want to lose her last bit
• 44:27
  Speaker 1: of independence, so she reached out to the family and
• 44:30
  Speaker 1: said she would kill herself on X date, so come visit,
• 44:34
  Speaker 1: say goodbye, etc. The whole family supported her and visited her,
• 44:38
  Speaker 1: but suck, this had to be done by her own hand.
• 44:41
  Speaker 1: Many years later, my dad was diagnosed with the most
• 44:44
  Speaker 1: aggressive form of ALS. Less than a year and a
• 44:46
  Speaker 1: half after his diagnosis he passed. He would ask us
• 44:49
  Speaker 1: to kill him more and more often as he lost
• 44:52
  Speaker 1: the ability to control any part of his body. I
• 44:54
  Speaker 1: fully believe he hated his quote unquote life as it
• 44:58
  Speaker 1: got close to the end when he was unable to
• 44:59
  Speaker 1: eat communicate that desire. There's a little off topic, but
• 45:03
  Speaker 1: even insurance told us we needed to wait for any
• 45:05
  Speaker 1: sort of monetary assistance because quote unquote he may get
• 45:09
  Speaker 1: better from his incurable disease that has a mortality rate
• 45:12
  Speaker 1: of eighty percent for people within five years, and the
• 45:15
  Speaker 1: rest just live live just a little bit longer. Because
• 45:18
  Speaker 1: you know, insurance knows better than any medical professionals. He
• 45:22
  Speaker 1: was finally approved for a hospice nurse one week before
• 45:24
  Speaker 1: he died, and she arrived an hour after he actually
• 45:26
  Speaker 1: died for her first shift.
• 45:28
  Speaker 2: Wow.
• 45:28
  Speaker 1: Anyway, this is all to say that I fully support
• 45:30
  Speaker 1: assisted suicide and hate that people are forced into a
• 45:32
  Speaker 1: corner to either die in pain or do it themselves,
• 45:35
  Speaker 1: hoping they do it in a painless manner. I know
• 45:37
  Speaker 1: I'm a single anecdote data point, but those are my
• 45:39
  Speaker 1: thoughts end quote. Yeah, really powerful sentiments people have sort
• 45:44
  Speaker 1: of been through that personal journey. So thank you very
• 45:47
  Speaker 1: much for sharing and for vulnerability and for the story.
• 45:51
  Speaker 2: Yeah. Absolutely, Even though this is one anecdote, it is
• 45:55
  Speaker 2: still I think sufficient to describe the nuance of situations
• 45:59
  Speaker 2: like this, right, Like, I think that you have to
• 46:01
  Speaker 2: have those stories to be able to say, like, there's
• 46:04
  Speaker 2: a reason why this exists, there's a reason why we advocate.
• 46:06
  Speaker 2: And I think most of the time everybody's got a story.
• 46:09
  Speaker 2: But I think that that is so useful for understanding,
• 46:12
  Speaker 2: like it's not as easy as going yes or no.
• 46:15
  Speaker 1: Yeah, And you know, I came down in the episode
• 46:17
  Speaker 1: sort of landing on like I think that we should
• 46:19
  Speaker 1: try and give people the most quality of life as possible.
• 46:21
  Speaker 1: But I also think like it just can't be a
• 46:23
  Speaker 1: policy decision, that it's a black and white no, right,
• 46:26
  Speaker 1: you know, I think there's just there's got to be
• 46:27
  Speaker 1: more nuance and taken on sort of a case by
• 46:30
  Speaker 1: case basis, so that people can have the sort of
• 46:32
  Speaker 1: dignity and life and death that works best for them
• 46:36
  Speaker 1: and their family and their values and not necessarily have
• 46:39
  Speaker 1: the government be the thing that arbitrates those decisions when
• 46:44
  Speaker 1: they are in the power of the person who wants
• 46:46
  Speaker 1: to make those decisions. I do see the concern for
• 46:49
  Speaker 1: the opportunity for exploitation and abuse, and I do think
• 46:52
  Speaker 1: we should try and prevent that as much as possible.
• 46:54
  Speaker 1: But again, it's not a black and white no because
• 46:57
  Speaker 1: of risk. It should be a there's new here, like
• 47:00
  Speaker 1: we should take this on a case by case basis, right,
• 47:02
  Speaker 1: Like that's I think how we treat people with the
• 47:04
  Speaker 1: most dignity and the most respect and the most compassion
• 47:08
  Speaker 1: is to, you know, have those be choices when they
• 47:11
  Speaker 1: make sense for them to be choices, right, absolutely, so, Anyway,
• 47:14
  Speaker 1: I do appreciate that writing, and I hope that I
• 47:17
  Speaker 1: hope that that clarifies things for some people and that
• 47:19
  Speaker 1: they the examples are powerful, like those stories are powerful.
• 47:23
  Speaker 1: So I agree a single data point is not an
• 47:27
  Speaker 1: irrelevant one. Just you know, I think it further illustrates
• 47:31
  Speaker 1: the need for nuance and can consideration and discussions of
• 47:34
  Speaker 1: this nature.
• 47:35
  Speaker 2: Absolutely.
• 47:36
  Speaker 1: All right, Well that was that was a great listener mail.
• 47:39
  Speaker 1: If you'd like to write, and as I said, you can,
• 47:42
  Speaker 1: you can do that. We may read your listener mail
• 47:44
  Speaker 1: on air, so reis directly info WWDWWD podcast dot com,
• 47:48
  Speaker 1: or on social media platforms. But I think that brings
• 47:50
  Speaker 1: us to recommendations.
• 47:51
  Speaker 2: Yes it does. So I want to recommend a thing
• 48:04
  Speaker 2: that not everybody feels comfortable doing, but I think is
• 48:07
  Speaker 2: worth doing in general, and that is performing live in
• 48:11
  Speaker 2: some way like and when I say performing, I mean
• 48:13
  Speaker 2: performing an art, performing a skill, performing something in front
• 48:16
  Speaker 2: of a group of people. I have been very fortunate
• 48:20
  Speaker 2: to have been playing in bands and playing music for
• 48:23
  Speaker 2: most of my life, and at the time of this recording,
• 48:26
  Speaker 2: my band played a show last night and it was
• 48:30
  Speaker 2: just a great, a great time. There's something really interesting
• 48:33
  Speaker 2: about playing live music now in punk and hardcore. It's
• 48:36
  Speaker 2: very different than when I was coming up. It's more accepting,
• 48:39
  Speaker 2: like the groups are more diverse. People are just stoked
• 48:42
  Speaker 2: that there's live music. It's really cool. We played a
• 48:45
  Speaker 2: place last night. There was like a co op in DeLand, Florida.
• 48:49
  Speaker 2: It was a former church that had been renovated to
• 48:52
  Speaker 2: have multiple businesses and like art shops. So there was
• 48:54
  Speaker 2: a bakery, there was a coffee shop, there was a bar,
• 48:58
  Speaker 2: there was a Cuban sandwich restaurant, there was yoga classes,
• 49:01
  Speaker 2: there was a family friendly movie. They were playing the Goonies,
• 49:04
  Speaker 2: And we played in the cathedral and outside of the cathedral,
• 49:06
  Speaker 2: the former cathedral, there was a tattoo artist and there
• 49:10
  Speaker 2: were Airbnbs upstairs at this place too, So like this
• 49:13
  Speaker 2: place was like kind of this really interesting collection of
• 49:16
  Speaker 2: like art nerds and like locals that made this like
• 49:20
  Speaker 2: building that would have just sat there, made it into
• 49:23
  Speaker 2: something really special and really really cool for the community.
• 49:25
  Speaker 2: So performing live, performing in local places, getting to know
• 49:29
  Speaker 2: what's in your community, I think is really valuable. So
• 49:31
  Speaker 2: that's my recommendation.
• 49:32
  Speaker 1: And maybe also a little bit repurposing buildings.
• 49:35
  Speaker 2: And yes, and also repurposing buildings.
• 49:37
  Speaker 1: Yes, there's definitely some benefit to learning to perform in
• 49:41
  Speaker 1: front of people, and a lot of people that struggle
• 49:44
  Speaker 1: with like public speaking and being in front of an
• 49:48
  Speaker 1: audience and being sort of looked at, and then I'll
• 49:50
  Speaker 1: tell you what that is. Does. One way to help
• 49:52
  Speaker 1: get over that a little bit, yep, is to do
• 49:55
  Speaker 1: it and then do it a lot. I mean I
• 49:56
  Speaker 1: have now stood in front of and presented to or
• 50:00
  Speaker 1: formed for people, I mean hundreds of times, and I
• 50:04
  Speaker 1: think I have gotten fairly decent at it. Some might disagree,
• 50:08
  Speaker 1: but I think at least I'm at least not uncomfortable
• 50:12
  Speaker 1: doing it. Yeah, And so that's, you know, at the
• 50:15
  Speaker 1: very least, you can get over the discomfort by just
• 50:19
  Speaker 1: doing it a lot. And there's there's actually a lot
• 50:21
  Speaker 1: of benefits I think from being willing to put yourself
• 50:24
  Speaker 1: out there like that.
• 50:25
  Speaker 2: Yeah, for sure.
• 50:26
  Speaker 1: All right, I'm recommending a TV show. This is a
• 50:29
  Speaker 1: seft recommend because this is definitely not for everyone. This
• 50:33
  Speaker 1: is a new show. Maybe it's based off something, but
• 50:36
  Speaker 1: it's it's called The Miniature Wife. This is on Peacock,
• 50:41
  Speaker 1: the streaming service. I might be exclusively on Peacock, I'm
• 50:43
  Speaker 1: not entirely sure, but it is Elizabeth Banks, Matthew mcphaden,
• 50:49
  Speaker 1: some other people you know, other cast that audience will
• 50:52
  Speaker 1: recognize from other shows and whatnot. But essentially the premise
• 50:55
  Speaker 1: is this scientist guy develops technology to shrink things, and
• 51:01
  Speaker 1: through a series of events, his wife is shrunk down
• 51:05
  Speaker 1: to about six inches tall. They have kind of a
• 51:08
  Speaker 1: rocky relationship and this does not help sure and so
• 51:14
  Speaker 1: high jinks ensue. I can't imagine how this could possibly
• 51:18
  Speaker 1: get another season. So I'm thinking this is a one
• 51:19
  Speaker 1: and done type thing because they fully fully wrap this
• 51:23
  Speaker 1: up by the end. But who knows, you know, writers
• 51:27
  Speaker 1: come up with ways to extend these sorts of plots somehow.
• 51:31
  Speaker 1: But that is I will warn people first of all,
• 51:35
  Speaker 1: this is there's not really a nudity or sex. I
• 51:38
  Speaker 1: don't think like a little tiny bit like you see
• 51:41
  Speaker 1: a butt at some point, I think, but like, yeah,
• 51:43
  Speaker 1: there is quite a bit of swearing. There's some amount
• 51:46
  Speaker 1: of violence. It is most of the characters are just
• 51:51
  Speaker 1: the most unlikable people, Like everyone kind of sucks except
• 51:56
  Speaker 1: for like maybe two people in the whole thing, right,
• 51:59
  Speaker 1: But they all also have their arcs, Like everyone at
• 52:02
  Speaker 1: some point has a moment where they like do the
• 52:04
  Speaker 1: right thing and do the compassionate thing and support somebody else.
• 52:08
  Speaker 1: But for the most part. They're all just kind of jerks, Yeah,
• 52:12
  Speaker 1: throughout most of it, So like that might be a
• 52:13
  Speaker 1: little bit harder of a pillow swallow, but it is
• 52:15
  Speaker 1: a funny show. It's it's mostly a comedy. Well I
• 52:19
  Speaker 1: guess you sort of sort of shit gently in the
• 52:22
  Speaker 1: sci fi realm, but yeah, it's it's at least a
• 52:24
  Speaker 1: good time. I thought. So if you're if you're looking
• 52:26
  Speaker 1: for a series to watch, this is entertaining. I had
• 52:30
  Speaker 1: fun with it. Like I said, not for everybody, so
• 52:33
  Speaker 1: sort of a soft recommend but I did enjoy it.
• 52:36
  Speaker 2: Yeah. I mean Elizabeth Banks is great. She's a lot
• 52:38
  Speaker 2: of is so she.
• 52:40
  Speaker 1: Is just she seems I think she had a ton
• 52:43
  Speaker 1: of fun making this. She seemed like she's so animated
• 52:46
  Speaker 1: the whole time and just yeah, like really delivers everything
• 52:50
  Speaker 1: with the kind of Elizabeth Banks zest that you would
• 52:54
  Speaker 1: have come to.
• 52:54
  Speaker 2: Expect from her. Yeah, yeah, for sure.
• 52:57
  Speaker 1: Yeah, she's quite good. All right, So that is a
• 52:59
  Speaker 1: performing live for the Shane's recommendation and the Miniature Wife
• 53:02
  Speaker 1: TV series is mine. I think that's what we have
• 53:05
  Speaker 1: to say about cognitive behavior therapy, and so I think
• 53:08
  Speaker 1: we can wrap that one up. There is there aything
• 53:10
  Speaker 1: you like to add or that I forgot before we
• 53:11
  Speaker 1: say goodbyes.
• 53:13
  Speaker 2: Nope, not at the moment.
• 53:14
  Speaker 1: Cool. Then this is Abraham and this is Shane. We're out.
• 53:18
  Speaker 2: Se Yah. You've been listening to Why We Do What
• 53:21
  Speaker 2: We Do. You can learn more about this and other
• 53:23
  Speaker 2: episodes by going to wwdwwdpodcast dot com. Thanks for listening,
• 53:29
  Speaker 2: and we hope you have an awesome day.