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In this podcast, Marni Amsellem, PhD, psychologist, talks about her work treating clients with cognitive behavioral therapy tools and techniques.
Dr. Amsellem works with many clients, helping them to develop tools to manage their anxiety, depression, health-related challenges and life changes. Dr. Amsellem talks about her areas of focus in cognitive behavioral therapy (CBT). She discusses insomnia, and explains how anxiety is sometimes the reason for poor sleep. CBT, she states, can help with underlying anxiety.
Continuing, Dr. Amsellem discusses the triggers that can bring on anxiety in some people. There are multiple factors that can impact us negatively, and Dr. Amsellem discusses the many statements and thoughts that we communicate to ourselves, sometimes far below our conscious level even.
Dr. Amsellem provides an overview of various themes she hears from her clients regularly, such as concerns over failure, concerns over rejection, to feelings of worthlessness, and others. She breaks down some of the techniques she utilizes and explains how cognitive behavioral therapy can assist with those negative thoughts we sometimes have by helping us reframe them and overcome them.
She talks about the importance of increasing our awareness of thoughts and triggers, and the patterns we gravitate toward. Wrapping up, Dr. Amsellem explains CBT in detail, and how it can be applied to real world situations and problems and help us create changes in our lives, for the better.
Richard Jacobs: Hello, this is Richard Jacobs with the Finding Genius podcast, health, medicine and bio-science edition. It’s my job, my self-appointed job to find the geniuses, the best people in their fields. I have interviewed over 2000 people, scientists, researchers, clinicians, etc. So today I have Dr. Marni Amsellem. She’s a psychologist and an author. We’re going to talk about cognitive behavioral therapy and we go into the specifics and how she helps people. So Marni, thanks for coming.
Marni Amsellem: Thank you so much for inviting me.
Richard Jacobs: Yeah. So I know there’s CBT or cognitive behavioral therapy for insomnia, for anxiety, for all kinds of stuff. What’s your focus there?
Marni Amsellem: Okay, so generally speaking, cognitive behavioral therapy has wide range of applications and I apply CBT to many problems either based rooted in anxiety, depression. And one application that I’ve been using it increasingly is for insomnia.
Richard Jacobs: Okay. Are you focused more on insomnia or anxiety?
Marni Amsellem: All of them and often insomnia has roots in both anxiety and depression as well. Particularly when the thoughts that people have that keep them from sleeping are related to beliefs that are a bit blown out of proportion about the meaning of the sleep. So if their sleep is disrupted, what that might mean for their functioning the next day. So there is a lot of anxiety that underlies that. So and that respect there’s some getting it, some of the underlying anxiety and, or depressive thinking when one is using CBT applied to insomnia. There are more specific aspects of CBT directed for insomnia than some of the other applications. But every issue that can be treated by CBT has nuances depending on the issue, but the idea is that it’s treating the underlying thoughts as well as the related behaviors that are associated with whatever the issue is.
Richard Jacobs: So it’s probably a self reinforcing thing, but like what starts the cycle of anxiety, insomnia, rumination, et cetera. And how does it stress?
Marni Amsellem: Exactly. So how the things begin. Ultimately it could be an event that triggers a thought or some sort of reaction in us. And what happens when something happens that we don’t know why it happens, we want to try to understand it. So we basically try to form our best guess of what is happening. So in that respect we are always trying to make sense of our environment. And sometimes we come up with some reasoning that might make sense to us but isn’t really serving us in some way. And then we might be jumping to conclusions a bit. We might be ignoring all of the nuances or the shades of gray that might be involved. So something when we first develop patterns, thinking that are not useful to us, it can be some sort of leap that isn’t really there, that isn’t really validated by the evidence of objectively. And sometimes it’s related to underlying deep beliefs that we have. Maybe related to our worst as an individual getting pretty deep, really. So sometimes they’re pretty deep rooted, but generally they are general statements that we make to ourselves. We might not even be aware of it. So often they’re below our consciousness some of the time. And consequently we’ll feel pretty bad or will feel pretty anxious depending on what the thought is.
Richard Jacobs: When clients come to you, are there particular stories that you hear over and over and over again?
Marni Amsellem: Pretty well. Everybody has their own stories. So I definitely will hear every individual’s perspective of what is driving them and what is contributing to whatever their discomfort is when they come in. But some of the themes that I hear over and over again relate to feeling like they are in some way falling short of something. Some theme of failure or fear of failure perhaps some sense of rejection can be an underlying theme. But some of the other things that really take a thought from being not useful to really impacting how somebody feels about themselves is when a thought becomes pretty global. So they’re taking, I got a C on this test, I guess I could have studied harder to I’m worthless. Like, what is the point? I’m not good at this. I’m good at nothing. So those types of things tend to really you know, they repeat themselves and individuals and it’s a way of making sense of an ambiguous situation. So they become a bit habitual.
Richard Jacobs: How do you post someone back from, you know, I’m worthless and I can’t do anything right type of thing to a more reasonable interpretation that, I’m good at some stuff, that didn’t work. Oh, well let’s move on.
Marni Amsellem: Yeah. Well that’s actually the power of what cognitive behavioral therapy can do because it really is just an examination of that belief system of that belief and breaking down each thoughts. So something happened. So there’s some sort of precipitating event or it could be receiving an email that’s trigger something in you or just even having a you know, whatever it is, right. There’s some sort of precipitating event and we might in our minds jump to some sort of conclusion that is not based in objective reality. And so what CBT does is it increases awareness of what that thought is that this kind of pops into one’s head. As well as any of the triggers that brought that into your head and what it felt like to have when you were experiencing that, what the emotions were and so it gets you to examine and identify what that specific thought was and also start to learn what patterns. Everyone tends to come up with their own shortcuts and they’re thinking what patterns we tend to gravitate toward and then start to challenge them by replacing them, reframing them with some sort of thought that is more adaptive. And so that’s really the magic, you are being a bit of an observer of yourself recognizing the specific instance and then thinking a little bit more, objectively challenging it, rationally challenging it. Any number of ways in which we can possibly look at a situation a little bit differently, reframe it and not lie to ourselves about it and not say everything’s great, but to really look at it a little bit differently. Allow yourself to see it a little bit differently. You know, while I did get a C on this test, I know that I can continue to work hard and try harder next time.
Richard Jacobs: What are some ways in which you could help clients get perspective even outside of the session? Are there like exercises for them to do or meditate? What they can do?
Marni Amsellem: Yeah. CBT is very much rooted in experiential learning. So the session is really just an opportunity for clients to start to learn the skills, but the real work happens outside of the session when you’re applying the tools that you’re learning in the session to your real life. So when you are having some sort of thought that’s not useful in real life, right? Again, when there’s the real trigger in your life and it’s not really like an academic exercise, you can then start to say, okay, I’m seeing this pattern repeating itself. Here’s what I can do. And then start to challenge it, say something that is more encouraging to yourself in that moment and then start to repeat it to yourself and notice the difference in how you feel. So CBT is definitely an approach that relies a lot on applying it, you know, find what you’re doing in the session to your real life. And really kind of treating it like homework.
Richard Jacobs: What happens if you say something to yourself positive, but you just don’t feel different? Does that mean that you haven’t gotten to the root of the problem, for instance?
Marni Amsellem: No, not at all. So it takes, and just like any skill, it may not happen overnight. It takes a lot of practice and it might actually take thing, a different message to yourself for one to stick. So again, instead of, something negative happens and you say it’s okay, everything’s perfect, right? There’s a lot of stuff to break down in that statement, but it’s finding a different reframed message that resonates with you, that seems authentic to you appropriate for the situation. So there’s that aspect of it. Try a different thought and keep practicing. So you get better at identifying that thought was, that automatic thought that was not useful to you to begin with. And it can be really challenging for some people, you know, clicks right away, other people it can take a lot longer and it could take breaking down some very well built up resistance to it. But then again, just like any therapy, I’ll say this and it is not a one size all approach. So every time I utilize CBT, which is regularly, I can tell you to buy it a lot. It is a tailored to every individual how they approach situations, what their individual challenges are. And for people for whom this is not something that resonates with the most, like there are a lot of other well validated approaches out there as well. Although CBT is considered to be the best validated, empirically validated approach.
Richard Jacobs: What kind of a resistance do people put up? How does it manifest?
Marni Amsellem: As far as CBT not being effective for them?
Richard Jacobs: No, I mean they’re not allowing you, they’re resisting you or how does that benefit, how does it come across?
Marni Amsellem: Yeah, I know. I think it’s more for themselves if so, if they’re really trying to break down something, if there’s a really well rooted belief that they have that something is true when it is just really their experience of how something feels rather than it’s objectively true. Breaking through that resistance in them can be hard. But generally speaking people will kind of indicate pretty early on whether this is something that they’re willing to try and this approach. And if they are I don’t generally see a lot of resistance to trying.
Richard Jacobs: What about expectation of results to people feeling one session and that’s good or do they come to sessions and then they feel afraid to stop? Like what have you noticed?
Marni Amsellem: Yeah. I mean just like a lot of therapy, sometimes a hardest thing is just making the appointment getting in the door. So there is some benefit even just regardless of the therapeutic approach, there can be some initial benefit of just recognizing, acknowledging to themselves that there is something that is making them uncomfortable and that they can seek help for it. That said CBT is again, one of the most well investigated therapeutic approaches. And because of that, we know that it can be effective in short term settings. And it’s because it’s been tested that way. But every individual is different. Again, some people will see benefits in just a few sessions related to the CBT, not just the walking in the door effect where they’re really starting to learn the skills and make changes to their thinking as well as to their actions. That’s another big component of CBT that we haven’t spoken about, the behavior aspect of CBT. But other people it takes a lot of more regular learning and reinforcement and continued booster sessions over time. But I’ve definitely seen real benefits from learning the skills in as little as three or four sessions.
Richard Jacobs: What are some of the skills that you try to impart to people?
Marni Amsellem: To become more aware of their thinking as it’s happening. Recognize some of the thinking patterns that are not useful for them. Those automatic patterns that I was referring to. So building awareness as a scale learning how to challenge them and uneffective way where they’re able to say, okay that thinking pattern is not useful for me. I’m feeling anxious after having these types of thoughts or I’m feeling down on myself in some way. So I learned that I can challenge it this way. I can go to, some this type of statement to say to myself in advance while this time was a challenge or while this is the case, or I don’t know for sure that I’m going to fail, right? It’s possible I might succeed instead of that belief or I’m going to fail. I’m going to go up there and make a big fool of myself standing up in front of that crowd. Do you know that? It’s possible you might not. So those are skills of learning how to automatically challenge themselves and I’m in these situations and some of the other skills are really like the more behavioral ones, putting themselves in situations. So often when we’re fearful of something, the instinct might be to avoid the situation. So in the case of fear, phobias of any sort of situation, we don’t want to be in really taking those steps, getting up there and giving that speech if you need to do that. That is one kind of like exposure, you know, get putting yourself in those situations. If we’re feeling down and we’re not having the internal drive to go do something, we’re kind of not feeling motivated. One of the most effective ways to break through it is to do exactly that, just to break through it. Put those shoes on and walk out the door. And then, because what happens is we make inferences of our own behavior and subconsciously we say, huh, I just went outside maybe I’m not so depressed after all versus like the opposite of, Oh look at me. I didn’t even get dressed today. I’m such a loser. So those types of inferences that we might make
Richard Jacobs: In specifically as it goes towards the Insomnia, how do you help people clear their minds so they can sleep? Because if you say go to sleep, go to sleep, go to sleep, and you try to, I need to go to sleep. It’s hard to, so what do you do?
Marni Amsellem: Yeah. So that is exactly why CBT has been applied to this issue of insomnia and insomnia is actually sort of, again speaking behavioral language, a bit of a conditioned response to the problem of not sleeping. So as humans we all have had nights where we’ve had trouble sleeping. And it might be situation, I’ll relate it to, there was a car alarm going all night last night. Or it could be related to being sick or related to stressful situation going on. When insomnia becomes a more chronic problem is when it gets reinforced from things that we’re doing. And some of those things that we’re doing might be just that of worry and having that sensation, or the thinking before bed of, Ugh, its bedtime. I’m not going to sleep tonight. It’s going to be another failure and I’m going to have to cancel my plans for tomorrow. I’m not be able to focus. And thinking really projecting into the future, but anticipating the worst feeling, having a lot of anxiety around the fear of the consequences of what a night of poor sleep might mean or less than optimal sleep. So from the prospective what we were just talking about, breaking down those thoughts examining the reality of them, right? The reality is we know that it is possible to make it through the day if we’ve had suboptimal night of sleep the night before. So, challenging that some of those deep beliefs, but CBT, I actually does a lot more than just examines the thoughts.
That’s one important component of it. It’s really also focused on a lot of the behavioral reinforcements, asleep. Things like creating a routine and some sleep hygiene habits, but also regulating the wake time. You’re getting really focused on that and breaking through kind of taking an individual approach. But if an individual has challenges with waking in the middle of the night, the goal would be to improve the quality of sleep and the efficiency. So setting awake time in the morning is a very behavioral approach at the six week time. So those are all some other components.
Richard Jacobs: What about friends, family, spouse, et cetera? What kind of things do they say that hurts the therapy versus helps the therapy? There are common phrases like, Oh, you’re fine, don’t worry about it. Or why do you worry so much? Just stop worrying.
Marni Amsellem: When we’re thinking about, well, both anxiety and depression. And by the way, there are a lot of applications for CBT beyond anxiety and depression, but those are very, very common ones. But yeah, the messages that we hear from people, the people in our lives are important and they can affect us. So both the supportive and encouraging messages as well as things that might seem insensitive or just inappropriate. So telling chronically anxious person to just calm down can sometimes really be the least useful thing that person can hear, particularly when they’re feeling kind of in a spiral at that moment. They know they would like to calm down, but that’s not what is going to really be useful for them in that moment. Same thing with somebody who’s pretty actively depressed, hearing somebody say, just smile or just be happy, right? That’s not going to really resonate with them in that moment. It’s a lot more than that. It’s really kind of like a dark cloud of a lot of things, biochemical things as well as some of the thinking patterns that are pretty global, pretty personal related to themselves.
Richard Jacobs: Okay. Well, I asked because I’m sure I’ve been insensitive and I try not to be. So that’s why I figured it’d be helpful for people listening maybe we can instruct the people around them, like, Hey, that’s not helpful. Maybe try telling me this, that or something else’s thing.
Marni Amsellem: You know what, I think that’s a really good question because at some point or another we all know someone who is going through a depressive episode is kind of somebody who’s regularly dealing with anxiety and that could be us. So that could be the person who’s listening to it right now as well. So they’re very common experiences and when you’re not in it, it is really hard to really personally and to kind of shut down their irrational thinking of why isn’t this person just doing this? Right. They should know that this is what they need to do because there’s a lot of things that are standing in their way and it really is a challenge. Like putting on those shoes to step outside could be the biggest challenge that day. But you know, as they’re getting better, that’s not a challenge anymore.
Richard Jacobs: Well, very good. So what’s the best way for people to find out more about CBT in general and then to come see you? I’m not sure where you serve people, but let me know.
Marni Amsellem: Yeah, I’m licensed in two States. So if anyone is in the New York area or Connecticut I would be able to work with them. But fortunately there are a lot of cognitive behavioral therapists. Therapists out there, a lot of providers and whether they’re a psychologist or other types of psychotherapists out there, social workers or some psychiatrists also do some CBT. You can search on different therapist’s search engines for local providers to you if you are preferring a in person experience. There are also a lot of tools online that people can use if you’re looking to find out more about the effectiveness of the therapy and efficacy and things like that.
There’s a lot of research. It’s a very well researched therapy. But if you’re looking for tools that you can use on your own, this is one type of therapy where there are a lot of great resources for you to use on your own, including some books that have been around a long time, some workbooks. And you can read some reviews online if you’re curious about how certain things will might work for you. As well as some apps too. So, we kind of live in a an age where there’s a lot of these tools that are available to us, but it can be really useful to work through this with somebody who’s trained to guide you through.
Richard Jacobs: Okay. Well, very good. Well, Marnie, thanks for coming on the podcast and sharing your wisdom. I appreciate it.
Marni Amsellem: Welcome. This was fun. It’s a great approach and it was fun to talk about this.
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