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

Comments or feedback? Send us a text! Following registration as an autonomous professional, a psychotherapist could potentially go decades providing service to clients in the privacy of their office without another professional ever directly evaluating their work. Clinical psychologist, researcher and consultant, Dr. Daryl Chow, joins us for an important discussion around clinician perceptions of competency and the promise of deliberate practice for not only improving clinical outcomes, but also clinician confidence and quality of worklife.  In this discussion we cover:  the accuracy of clinicians' perceptions of their own competencyhow perceptions of competency vary from early career, mid-career & late careerhow actual clinical effectiveness varies from early career, mid-career & late careerthe importance of selecting vs. training of clinicians the factors that can contribute to clinicians having trouble accessing an accurate perception around one’s own competencythe definition of deliberate practice a conceptual framework for deliberate practice structuring deliberate practice at early career, mid-career & late career (time commitment, logistics etc.)the most effective way to structure, frame and provide feedback to a clinicianDr. Chow's thoughts on the the value proposition associated with deliberate practice with respect to clinical outcomes, clinician quality of life, etc.  balancing deliberate practice with the demands of day-to-day clinical life through habit formationthe usual modalities by which clinicians can undertake deliberate practiceDr. Chow's thoughts on why there is not more of a culture of ongoing deliberate practice within psychotherapy and why this may be changingFeedback or comments?  Email the show at: oicbtpodcast@gmail.comDr. Daryl Chow is a senior associate of the International Center for Clinical Excellence. He conducts research and workshops on the development of highly effective psychotherapists, and ways practitioners can accelerate learning. He was a featured keynote speaker at the Achieving Clinical Excellence (ACE) Conference, Sweden, 2018,  Daryl is a co-author of a new book, Better Results: Using Deliberate Practice to Improve Therapeutic Outcomes. He is also co-author of many articles and co-editor and contributing author of The Write to Recovery: Personal Stories & Lessons about Recovery from Mental Health Concerns,and the author of The First Kiss: Undoing the Intake Model and Igniting First Sessions in Psychotherapy. His work is also featured in two recently edited books in 2017. Daryl’s blog and podcast, Frontiers of Psychotherapist Development is aimed at inspiring and sustaining practitioner’s individualized professional development. Daryl maintains a private practice in Perth, Western Australia.www.darylchow.com

Comments or feedback? Send us a text! Chronic pain is emerging as one the most misunderstood aspects of the human experience.  Owing to this misunderstanding, there is often needless suffering as a function of many clients and clinicians not understanding the central role psychological processes can play in the experience of many types of chronic pain.  Clinical psychologist and researcher, Dr. Yoni Ashar, joins us for a fascinating discussion focused on understanding chronic pain from the lens of Pain Reprocessing Therapy (PRT).  In this discussion we cover:  the conceptualization of chronic pain within the Pain Reprocessing Therapy (PRT) modelthe personality traits that can predispose one to chronic painhelping clinicians to navigate the frequent perception by chronic pain patients that they are being told “it’s all in their heads".the importance of "buy-in" that the pain is not originating from tissue damage (when medical investigations confirm no clinically significant structural challenges, infection etc.).signs & patterns of symptom presentation that can indicate that pain is of a psychological origin rather than strictly physical originbrief consideration of the intensive short-term dynamic therapy model in the context of chronic pain typical interventions within PRTthe promise of PRT:  relief from pain vs. different relationship with painhow “standard” medical models of pain and even mindfulness-based approaches to pain differ from PRT the evidence base for PRTthe neurobiology of chronic pain from a PRT lensthe contribution of trauma to the manifestation of chronic painthe role of medication, including antidepressants in the treatment of chronic pain from a PRT perspectiveapplication of this model to other physical/somatosensory challenges (dizziness, chronic itch, nausea, fibromyalgia etc.)Have comments or feedback?  Email the show: oicbtpodcast@gmail.comDr. Ashar studies the brain, pain, and emotion. He is a postdoctoral associate at Weill Cornell Medical College, and he completed his doctorate in clinical psychology and neuroscience from the University of Colorado Boulder, under the mentorship of Drs. Sona Dimidjian and Tor Wager.  Dr. Ashar's current focus is on psychological treatments for chronic pain. Other research areas include brain mechanisms of placebo effects, meditation, and empathy, using functional MRI and machine learning. His research seeks to understand how our thoughts and behaviors influence our health and to create neuroimaging research products with clinical applications.https://www.painpsychologycenter.com

Comments or feedback? Send us a text! The interface between nutrition and mental health is a fascinating area of study that is of great interest to both mental health clinicians & clients alike; however, it can be at times difficult to find coherent messaging and/or data-driven information as it relates to the link between diet and psychological well-being.  Uma Naidoo, MD, a board-certified psychiatrist, professional chef, and nutrition specialist joins us for a wide-ranging discussion about themes explored in her new book This is Your Brain on Food including:  how  Dr. Naidoo combined her training as a psychiatrist, professional chef and nutritional specialist to write her book "This is Your Brain on Food"forming realistic expectations around the potential impact of nutrition and supplements on symptoms of mental disordersthe special role that inflammation may play in the exacerbation and maintenance of mental health symptomsthe enteric nervous system and the role the microbiome/gut flora might be playing with respect to mental healththe pros/cons of supplements vs. real foodthe role that food & nutrition can play in the context of an overall treatment strategythe dangers of compulsive monitoring of food intake and the balance that must be achieved in this respectspecific food-based strategies for anxietyconsiderations around caffeine and well-being, including guidance around recommended daily intakeDr. Naidoo's opinion with respect to elimination diets for assessing the relationship between nutritional factors and mental illness the link between ADHD and sugar, as well as gluten and mental health challengesDr. Naidoo's stance of being "diet agnostic" in the context of evaluating strategies such as "low carb", "carnivore", or ketogenic dietconsiderations around how medication interacts with nutritionDr. Naidoo's overall diet recommendationsDr. Naidoo's favourite brain friendly recipeUma Naidoo, MD is a board-certified psychiatrist, professional chef, and nutrition specialist. She is currently the Director of Nutritional and Metabolic Psychiatry at Massachusetts General Hospital (MGH), where she consults on nutritional interventions for the psychiatrically and medically ill; Director of Nutritional Psychiatry at the Massachusetts General Hospital Academyand in private practice. She also teaches at The Cambridge School of Culinary Arts. She blogs for Harvard Health and Psychology Today and has just completed a unique video cooking series for the MGH Academy, which teaches nutritional psychiatry using culinary techniques in the kitchen.Dr. Uma has appeared as amental health and nutrition expert on Live withKelly & Ryan, Today Show, 700 Club, Impact Theory, and been featured in the Wall Street Journal, Shape, Parade, Boston Globe, mindbodygreen and more. https://umanaidoomd.com

Comments or feedback? Send us a text! Owing to a rapidly changing world, many clinicians understandably feel it is increasingly difficult to keep track of (let alone integrate) considerations around systems level challenges (e.g., social media, political polarization, housing shortage, monetary policy etc.) that may be germane to their day-to-day work with clients.  In this conversation, Dr. Pete Kelly, C.Psych and Dr. Jeff Perron. C.Psych, MBA, share some of their thoughts on what they have been observing going on in the world based on their respective lens, as well as through the lens of clinical psychologists who are trying to help clients in an ever increasingly complex and distressing environment.  In this conversation (recorded January, 2022) they place a particular focus on how  current monetary policy could promote inequity and division in society as well as discuss how innovations like Bitcoin (perhaps surprisingly to many) could reflect a new way forward as per the issues raised in the discussion.  Topics covered include:reflections on noted shifts in macroeconomic patterns, political polarization and the "accelerant" influence of social media in this respectthe potential benefits of mental health clinicians having awareness of systems level challenges faced by their clients the challenge of science vs. advocacy driven narratives around important policy issuesthe role that current monetary policy could play in accelerating political polarization and economic disparity the definition of "money" and types of moneythe challenges associated with fiat currencies related to inflation and how this drives division and inequityconcerns around sustainability of current financial paradigmsa very brief primer on Bitcoin and the role this emergent currency platform could play in addressing some of the challenges related to division and inequity of Fiat currencyIMPORTANT: Neither Drs. Kelly nor Perron are licensed investment advisors and none of the content in this podcast should be regarded as financial or investment advice.  The content of today's discussion is for general information only.  All opinions expressed are Dr. Kelly and Dr. Perron's alone.   Feedback or comments?  Email the show: oicbtpodcast@gmail.comDr. Jeff Perron, MBA, C.Psych is a Clinical Psychologist who works with adults. His work focuses primarily on helping clients who are experiencing anxiety, low mood, loss, burnout, life transitions, or general challenges in executing on goals that are important to them. He takes a CBT approach to helping clients identify their values and works with them to align their life more closely with those values.  He works to clarify client goals early on and adapt them as needed, while working to help make sure that the process consistently feels focused and aligned with client goals.  Dr. Perron completed his undergraduate training in Psychology at McMaster University and his PhD at the University of Ottawa, including a Residency at the Ottawa Institute of CBT.  Dr. Perron also has experience in business, economics, and human resources, holding an MBA from Wilfrid Laurier University. Linked In: https://www.linkedin.com/in/perronjeff/Twitter: @DrJeffPerron

Comments or feedback? Send us a text! While a number of empirically supported, disorder-specific treatment protocols exist, it is frequently the experience of clinicians that clients present with co-morbid symptoms - that is, symptoms of a number of mental disorders at the same time.  This can present challenges around treating concurrent symptoms and/or what to prioritize in treatment.  Dr. Kristen Ellard, Clinical Psychologist, Professor & co-developer/co-author of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, a cognitive behavioral treatment designed to target emotion dysregulation across mood and anxiety disorders, joins us for a fascinating discussion in which we cover:   the origin story and philosophical underpinnings of the Unified Protocolhow the Unified Protocol model proposes that normally adaptive emotional & behavioral processes are translated into psychopathology  the basic structure of Unified Protocol including core interventionsthe proposed mechanism of changes within the Unified Protocol's modelwhether commonly employed theoretical models in psychology (e.g., CBT, psychoanalytic, ACT, EFT etc) actually match the way in which the brain actually works  how to leverage knowledge of how the brain processes information to maximize the effective deployment of psychotherapythe critical role of somatic (interoceptive) sensations in the construction of emotional experienceshow subcortical or “unconscious” areas of the brain might make calculations with respect to threat, attraction, preferences etc. what we can learn about brain function and the importance of sense of self in the context of mental disorders from emergent data around the therapeutic benefits of psychedelicsComments or Feedback?  Email the podcast: oicbtpodcast@gmail.comKristen Ellard, Ph.D. is Assistant Professor in Psychology at Harvard Medical School and Director of Dimensional Neuroimaging Research at the Massachusetts General Hospital Division of Neuropsychiatry. She completed her PhD in clinical psychology at Boston University under the mentorship of Dr. David Barlow, and completed her clinical internship and postdoctoral fellowship at Massachusetts General Hospital/Harvard Medical School. She was co-developer and co-author of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, a cognitive behavioral treatment designed to target emotion dysregulation across mood and anxiety disorders, which has now been translated into six languages. Dr. Ellard’s research uses transdiagnostic, dimension-based neuroscience and behavioral approaches to understand the roots of severe cognitive and affective dysregulation in neuropsychiatric disorders, and to find more efficient and effective means to address this dysregulation through combined behavioral and neuromodulatory approaches such as transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS). She has received several foundation awards and two NIH National Research Service Awards for her research program (F31/F32), including most recently a Fellowship Award through the MGH and Brown University Joint Training Program in Recovery and Restoration of CNS Health and Function (T32) and a Mentored Patient-Oriented Career Development Award (K23) from the NIMH.https://dnn.mgh.harvard.edu/member/kristen-k-ellard-phd/

Comments or feedback? Send us a text! Rumination in the context of OCD, anxiety & depression is often conceptualized as an automatic & intrusive psychological experience for which there is little relief beyond distraction, mindfulness etc.  Dr. Michael Greenberg, clinical psychologist and Director of OCD Associates, has re-framed rumination as a compulsion which is amenable to treatment via a number of specific techniques.  In this conversation we cover:how Dr. Greenberg's conceptualization of OCD differs from traditional conceptualizations of OCDthe unique contribution and value that psychodynamic models can bring to the conceptualization and treatment of OCDthe concept of the "core-fear" in OCDwhy rumination is so often thought of as an intrusive thought and the case for re-conceptualizing rumination as a compulsionthe importance of differentiating between awareness and attention with respect to mental eventsa brief summary of Dr. Greenberg's critiques of Acceptance & Commitment Therapy (ACT), particularly in the context of OCDthe form and function of rumination for most clients and the principles that need to be taught to clients in order to teach them to stop ruminatingdifferentiating between constant intrusive, automatic thoughts & ruminationa consideration of whether rumination in OCD is functionally or qualitatively different than in depression, generalized anxiety disorder etc. reflective pondering vs. brooding in the context of effective problem solvingexamples of response prevention in the context of rumination and Dr. Greenberg's conceptualization of ERP more generally integration of core belief work/psychodynamic principles for examining stuck points in OCD therapy.Comments or Feedback?  Email the show: oicbtpodcast@gmail.comHost note: We will be offering a 6 week essentials of CBT workshop that I will be facilitating beginning March 24, 2023.  For more information and registration, please visit: https://www.ottawacbt.ca/news.  Dr. Michael Greenberg is a licensed clinical psychologist and the director of OCD Associates, a national telehealth practice specializing in Rumination-Focused ERP.  He holds a PhD in clinical psychology from Fairleigh Dickinson University, where he trained in both Cognitive-Behavioral Therapy (CBT) and psychodynamic psychotherapy. He completed specialized training in CBT for anxiety disorders and OCD at Mount Sinai Hospital, and in the treatment of personality disorders and serious mental illness at Nassau University Medical Center. He completed post-doctoral training at Terrap, one of the oldest and best established CBT centers on Long Island. He is licensed in New York, California, and Virginia.https://drmichaeljgreenberg.com/ocdassociates/

Comments or feedback? Send us a text! While low mood & sadness are very frequently adaptive responses to life's challenges, there are times where this normally adaptive mechanism is applied for too long, at the wrong time, or at the wrong intensity in the form of major depressive disorder.  In our 2nd annual Fireside Chat geared for mental health clinicians and consumers alike, host of Thoughts on Record, Dr. Pete Kelly, C.Psych provides an in-depth overview of depression from a variety of perspectives including:  the cognitive, behavioral, physiological & emotional symptoms of depressionhow depression is diagnoseddepressive episode specifiers/subtypesrisk factors and warnings signs related to suicidea brief description of bipolar disorderthe evolutionary & functional significance of symptoms of depressionwhen and how depression goes from being adaptive to a problem of clinical significancethe critical role of loss in depressionrisk factors and vulnerability factors for depressionthe central relationship between anxiety & depressionconceptualizing the mechanics of depression from a CBT perspective (e.g., mood loops, cognitive distortions, TRAP-TRAC model, rumination, values, core beliefs, perfectionism, pain vs. suffering, etc)evidence based psychotherapy for depressiona brief overview of CBT interventions for depression (e.g., behavioural activation, cognitive restructuring, behavioural experiments)the case for proactive treatment of depressionsome thoughts on selecting a psychotherapistgeneral thoughts on integrating medication into treatment for depressionrecommended self-help resourcesComments or feedback?  Email us at oicbtpodcast@gmail.comIf you are experiencing thoughts of self-harm or suicide please go to your local emergency room.  In addition, the following resources are available:  Canada Suicide Prevention Service: 1-833-456-4566 (24/7)National Suicide Prevention Lifeline (United States): 1-800-273-8255For a list of International Crisis Lines please visit: https://www.opencounseling.com/suicide-hotlines

Comments or feedback? Send us a text! Clinical presentations characterized by "overcontrol" of emotions (e.g., OCPD, chronic depression, eating disorders) can present a very unique set of challenges & opportunities within the therapeutic setting.  Psychotherapist, supervisor and trainer, Hope Arnold, LCSW, MA, joins us for a discussion of the promise of Radically Open Dialetcial Behavior Therapy (RO DBT) for assisting these clients.  In this discussion we cover:a overview of RO DBT & how Hope became interested in this therapeutic modalityhow RO DBT differs from traditional DBT a brief review of core tenants of RO DBTthe typical format & delivery of RO DBTan overview of "overcontrol"the typical clinical presentations associated with overcontrol with a special emphasis on OCPDconceptualizing overcontrol including contributions of developmental history, temperament & personality structurewhy traditional therapies may not be poised to provide benefit to clients affected by overcontroltypical presentation of clients affected by over overcontrol in sessionhow clinicians can build empathy for clients with overcontrol even though it may be difficult to access a client's actual internal experiencetips for building awareness of one's own proclivity for overcontrol and deactivating the threat system to foster social connectednessHope Arnold, LCSW, MA is a Supervisor and Trainer in Radically Open DBT (RO DBT). She began her RO DBT training with Dr. Tom Lynch, treatment developer, in 2016. Hope continues to attend intensive trainings throughout the country and receives regular supervision from Dr. Lynch.  Hope is a co-creator of the RO DBT App for electronic diary cards and skills.  ​In her clinical work, Hope is the founder of RO DBT Denver in Denver, Colorado, a center dedicated to evidence-based care and treating disorders of overcontrol. She specializes in personality disorders (Obsessive Compulsive PD, Paranoid PD, Dependent PD, Avoidant PD), eating disorders, autism spectrum disorders (special interest in female autism), and treatment-resistant disorders (depression and anxiety).  ​Prior to opening RO DBT Denver, Hope was in private practice at the DBT Center of Houston and was the RO DBT Lead Clinician.  She led a team of six clinicians intensively trained in RO DBT and supervised the team member’s skill development. Hope completed her Intensive Training in DBT and Prolonged Exposure Therapy through Behavioral Tech.  Hope is also trained in Jungian Therapy, Cognitive Behavioral Therapy, and Cognitive Processing Therapy  ​Hope graduated Summa Cum Laude from Loyola University in New Orleans with a BBA in marketing. She worked for two of the largest private financial and consulting firms in the world before transitioning to being a clinician.  She has master’s degrees in social work from the University of Houston and psychology from Saybrook University with a concentration in Jungian studies.  ​Hope has presented at the local, national, and international level on topics related to DBT, RO DBT, and Jungian Theory. www.radicallyopen.net - International RO DBT organization & trainingwww.rodbtdenver.com - Free Loving-Kindness Meditation download on Client resources pagehttps://apps.apple.com/us/app/ro-dbt/id1526204265 - RO DBT Diary Card and Skills App Comments or feedback?  Email the show: oicbtpodcast@gmail.com

Comments or feedback? Send us a text! Clients with both an intellectual disability and mental health diagnosis are among the most vulnerable members of our society; however, these clients often face significant barriers with respect to accessing services for a number of complex reasons.  Dr. Philip Grandia, C. Psych joins us for an in-depth discussion of working with clients with an intellectual disability in a mental health context.  In this episode we cover:  a general overview and description of intellectual disability (ID) including diagnostic criteriaimportant considerations around differential diagnosis in the context of IDmental illness in the context of ID including frequently observed patterns of comorbiditythe very special concern of trauma & exploitation of clients with IDhow anxiety and depression presents in clients with IDthe role and caveats around the use of medication in clients with IDassessing one's own competency to deliver psychotherapy to clients with IDaddressing issues of capacity and consent when initiating treatmentassessing safety effectively in clients with IDclinician perceptions of clients with ID that reflect a barrier to accessing servicesthe types of CBT interventions that can be effective and helpful in clients with IDrewarding aspects of working with this populationDr. Philip Grandia is a Clinical Psychologist at The Royal Ottawa Mental Health Centre. Following his first career as an infantry officer in the Canadian Armed Forces, Philip underwent his PhD in Clinical Psychology at the University of Ottawa. He completed his residency and supervised practice at The Royal and subsequently joined the hospital as staff. In addition to his clinical work, Philip is actively engaged in program evaluation initiatives and Psychology training. He currently works on The Royal’s three dual diagnosis teams in the Community Mental Health Program.Have feedback or comments? Email the show: oicbtpodcast@gmail.comPlease note that while all emails are read, we are not able to reply to all messages that are sent. Emailing Thoughts on Record does not establish a clinician-patient relationship with the Ottawa Institute of Cognitive Behavioral Therapy (OICBT).  Moreover, we are not able to provide any comment or advice with respect to either general or specific clinical or personal situations. If you live in Ontario, Canada and wish to seek clinical services from the OICBT please visit www.ottawacbt.ca. If you are experiencing a mental health emergency, please contact your health care provider and/or proceed to the nearest emergency department.  The following resources are also available:  Canada Suicide Prevention Service: 1-833-456-4566 (24/7)National Suicide Prevention Lifeline (United States): 1-800-273-8255For a list of International Crisis Lines please visit: https://www.opencounseling.com/suicide-hotlines

Comments or feedback? Send us a text! Conversations around the conceptualization, development & implementation of diagnostic frameworks around mental illness often generate more questions than answers, but are endlessly fascinating in their ability to pull on a number of diverse & interesting threads of inquiry.  Clinical psychologist, professor & former president of the Canadian Association for Cognitive & Behavioural Therapies (CACBT), Dr. Andrea Ashbaugh, C.Psych returns to Thoughts on Record for a discussion of diagnostic frameworks for mental illness.  In this conversation we cover:thoughts on the conceptualization of mental illnessthe functional utility/evolutionary significance of mental health "symptoms" - even when frequent and/or intensecultural expectations around the experience of psychological pain advantages and challenges of current diagnostic symptoms (e.g., DSM 5, ICD-11)mental health consumer expecations around receiving a diagnosispotential benefits and harm that can come with a diagnosisthe emergence of potential dimensional models of diagnosis (e.g., The Hierarchical Taxonomy of Psychopathology (HiTOP))  transdiagnostic treatment of psychopathology, with a special focus on managing comorbidityconsideration of some common diagnostic conundrums e.g., severe symptoms in high functioning clientsAndrea Ashbaugh is an associate professor in the School of Psychology at the University of Ottawa, Director of the Centre for Psychological Services and Research, and is a licensed clinical psychologist in the province of Ontario, Canada. She obtained her master's and Ph.D. in Clinical Psychology from Concordia University in Montreal, Quebec, Canada and completed a post-doctoral fellowship in the Department of Psychiatry at McGill University and the Douglas Mental Health University Institute, in Montreal, Quebec, Canada.She is director of the Cognition and Anxiety Studies Laboratory (CASL) and the Sex and Anxiety Research Group (SAX-RG). Her research interests as part of CASL centre around understanding the causes and developing treatments for anxiety and fear-related problems. She has recently started a program of research to understand the causes and psychological effects of experiencing traumatic and non-traumatic events that transgress one’s moral beliefs (Moral Injury) in military personnel and veterans. Her research in the context of the SAX-RG centres around the impact of beliefs about arousal sensations and context on the interpretation of arousal, and its impact on sexual interest and functioning. She has received funding for her research broadly including from Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council of Canada.Dr. Ashbaugh regularly supervises CBT training and teaches courses on psychopathology and clinical psychology at both the graduate and undergraduate level. She has served on the Editorial Boards of Psychological Assessment. She is currently an Associate Editor for the Journal of Behavior Therapy and Experimental Psychiatry and editorial board member for Behaviour Research and Therapy. She is a former president of the Canadian Association for Cognitive and Behavioural Therapies (CACBT) and was seminal in the development of national CBT training guidelines that were released by CACBT in May 2019.