Therapy Show

Dr. Deborah Korn is a clinical psychologist in private practice in Cambridge, Massachusetts, and an adjunct training faculty member at the Trauma Research Foundation in Boston. Dr. Korn is a senior faculty member at the EMDR Institute where she has been on staff for the past 28 years. She is an EMDRIA Approved Consultant and serves on the editorial board of the Journal of EMDR Practice and Research. EMDRIA is the organization focused on promoting, fostering, and preserving the highest standards of excellence and integrity in EMDR research, treatment, and education both in United States and internationally. Dr. Korn has authored, or coauthored numerous articles and chapters focused on EMDR therapy, including comprehensive reviews of EMDR applications with Complex PTSD. Her most recent book chapter, written with the developer of EMDR, Dr. Francine Shapiro, is included in the second edition of Treating Complex Traumatic Stress Disorders in Adults, which was published in 2020. I encourage everyone to check out her new book Every Memory Deserves Respect: EMDR, the Proven Trauma Therapy with the Power to Heal, co-written with Michael Baldwin, a trauma survivor and EMDR client (not her own).   EMDR, a memory-focused psychotherapy developed by Dr. Francine Shapiro in the late 1980's, is now recognized in the treatment guidelines of organizations around the world as a top-tier, evidence-based treatment for PTSD.  The theory or model that guides EMDR therapy is the Adaptive Information Processing Model (AIP Model).  It proposes that psychological problems are due to a failure to adequately process traumatic experiences to a point of “adaptive resolution”. During EMDR sessions, the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on some form of external stimulation. Therapist-directed lateral eye movements are the most frequently used external stimulus but a variety of other stimuli, including hand-tapping and audio stimulation, are also used.  Research also supports EMDR's effectiveness with other problems not obviously trauma-related—depression, anxiety, psychosis, pain, obsessive compulsive disorder, substance abuse.  It can be used to treat people dealing with single traumatic events as well as those dealing with a history of prolonged, repeated exposure to trauma in childhood or as an adult.  It is used with people of all ages and can be administered, individually or in groups, immediately after an acute traumatic episode.  A recent meta-analysis found that EMDR was not only clinically effective but also the most cost-effective of the eleven trauma therapies evaluated in the treatment of adults with PTSD (Mavranezouli et al., 2020). TherapyShow.com/EMDR-Therapy Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Nicole Stadnick is a Psychologist, Assistant Professor in the Department of Psychiatry at the University of California San Diego, Director of Dissemination and Evaluation of the Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center and investigator in the Child and Adolescent Services Research Center. A primary area of Dr. Stadnick’s research aims to promote equitable access to evidence-based practices and mental health services for children with Autism Spectrum Disorder and co-occurring mental health needs through tailored service delivery models. She currently leads several implementation projects supported by the National Institutes of Health focused on community-engaged, cross-system health services and implementation research for individuals with complex clinical presentations including publicly funded mental health services and HIV AIDS care programs. Autism spectrum disorder (ASD) is a construct that describes a constellation of social communication difficulties and restricted, repetitive patterns of behaviors or interests that have strong genetic underpinnings and appear early in life. People on the autism spectrum often have difficulties with social, emotional, and communication skills. They might also repeat certain behaviors or have a hard time changing routines or daily activities. Signs of ASD emerge during early childhood and typically last throughout a person’s life (American Psychiatric Association, 2013). To address the documented disparities in access and receipt of evidence-based care for autistic individuals, service models are increasingly focused on ways to promote equity in access and reach. Primary care is well-positioned to reach those who may be at most risk of facing health disparities. Examples in primary care include the Extension for Community Healthcare Outcomes (ECHO) program and the Access to Tailored Autism Integrated Care model, both which are accumulating evidence for feasibility, acceptability, and adoption (Stadnick et al., 2019; Stadnick et al., 2021). TherapyShow.com/Austism-Spectrum-Disorder Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Elizabeth Nielson is a co-founder of Fluence and a psychologist with a focus on developing psychedelic medicines as empirically supported treatments for PTSD, substance use problems, and mood disorders. Dr. Nielson is a Site Co-Principal Investigator and therapist for an FDA approved Phase 3 clinical trial of MDMA-assisted Psychotherapy for Post-Traumatic Stress Disorder and has served as a therapist on FDA approved clinical trials of Psilocybin-Assisted treatment of Alcohol Use Disorder, psilocybin-assisted treatment of treatment resistant depression, and earlier phase 2 and 3 trials of MDMA-assisted psychotherapy. Through Fluence, she provides continuing education and training programs for therapists who wish to engage in integration of psychedelic experiences in clinical settings. Having completed an NIH postdoctoral fellowship at NYU, she has published and presented on topics of psychedelic therapist training, therapists’ personal experience with psychedelics, and including psychedelic integration in group and individual psychotherapy. Psychedelic-Assisted Psychotherapy is a technique that involves the use of drugs that produce a psychedelic effect in order to assist in the psychotherapy process. The U.S. Food and Drug Administration (FDA) named psilocybin-assisted therapy as a “breakthrough therapy.” Over the last two decades, researchers have received approval from governmental authorities to conduct trials on the use of the psychedelic substances to treat various conditions. What researchers have found is that psychedelic substances can have beneficial therapeutic effects. According to the research, there are a number of potential applications for psychedelic therapy such as anxiety, depression, substance use, alcohol use, and PTSD. At present, there are multiple clinical trials on psychedelic assisted therapy, some in phase II and III. While psychedelics have the potential to help treat a number of mental health conditions, it is important to remember that these are powerful substances that can produce profound mind-altering effects. While psychedelic assisted psychotherapy is generally considered safe, there are potential risks such as negative psychological reactions, danger in self-treatment, and personality changes. TherapyShow.com/Psychedelic-Assisted-Psychotherapy Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice Twitter @Fluencetraining Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. William R. Miller is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico, with over forty years of experience in teaching. Dr. Miller is a researcher and developer of the therapeutic model Motivational Interviewing. His many books include Motivational Interviewing: Helping People Change and Quantum Change: When Epiphanies and Sudden Insights Transform Ordinary Lives. Dr. Miller's latest book, Listening Well: The Art of Empathic Understanding, was released in January 2019. Motivational Interviewing is a collaborative conversation that strengthens a person's own motivation for and commitment to change. It is a client-centered therapy that addresses the common problem of uncertainty around change. It focuses on exploring and working through ambivalence and centers on motivational processes within the individual that help to process the change. This method differs from more externally-driven methods for motivating change as it does not impose change. Rather, Motivational Interviewing supports change in a way that is congruent with the personal own values and concerns. Having conflicted feeling about behavior change is considered a normal part of the change process. Motivational Interviewing is an interpersonal style, not at all restricted to formal counseling settings. It is a subtle balance of directive and client-centered components shaped by a guiding philosophy and understanding of what triggers change. Rereleased from Therapy Show Podcast Episode #12 TherapyShow.com/Motivational-Interviewing Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Stefan Hofmann is a professor in the clinical program at Boston University and the Director of the Psychotherapy and Emotion Research Laboratory at the Center for Anxiety and Related Disorders. Some of Dr. Hofmann’s research questions include: Why are psychological treatments, such as cognitive-behavioral therapy, effective for anxiety disorders? What is the mechanism of treatment change, and what are the active ingredients? How can these treatments be improved further? Dr. Hofmann is the Editor in Chief of Cognitive Therapy and Research and is Associate Editor of Clinical Psychological Science.  Dr. Hofmann is the co-author of Abnormal Psychology: An Integrative Approach,Essentials of Abnormal Psychology, and Process-Based CBT: The Science and Core Clinical Competencies of Cognitive Behavioral Therapy. I encourage everyone to check out Dr. Hofmann’s new book, the Anxiety Skills Workbook, which was recently published in April, 2020. Anxiety Disorders are different from normal feelings of fear or worry because they are excessive and can impede functioning. People suffering from anxiety disorders have a more chronic and extreme form of anxiety and develop behaviors that help avert anxious feelings. The type of anxiety disorder that a person experiences can be identified by the type of objects or situations that cause anxiety or avoidance behaviors. Generalized Anxiety Disorder is when a person worries excessively most days of the week for at least six months about many situations and finds it challenging to stop worrying. Some of the symptoms experienced include difficulty concentrating, becoming tired, restless, irritable, sleep problems, and muscle tension. Anxiety disorders can affect school and work performance and hinder personal relationships and social environment. TherapyShow.com/Anxiety-Disorders Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Ingmar Gorman is a co-founder of Fluence, a psychedelic education company training mental health providers in psychedelic treatments. As a psychologist, he shares his expertise in empirically supported psychedelic treatments with his clients and trainees alike. Dr. Gorman received his clinical training in New York City at the New School for Social Research, Mount Sinai Beth Israel Hospital, Columbia University, and Bellevue Hospital. He completed his NIH postdoctoral fellowship at New York University. He simultaneously served as site co-principal investigator on an FDA approved Phase 3 clinical trial of MDMA-assisted Psychotherapy for Post-Traumatic Stress Disorder and is currently a study therapist on the same study, as well as another FDA approved clinical trial of psilocybin for treatment resistant depression. Dr. Gorman has published on the topics of classic psychedelics, ketamine, MDMA, and Psychedelic Harm Reduction and Integration. Psychedelic-Assisted Psychotherapy is a technique that involves the use of drugs that produce a psychedelic effect in order to assist in the psychotherapy process. The U.S. Food and Drug Administration (FDA) named psilocybin-assisted therapy as a “breakthrough therapy.” Over the last two decades, researchers have received approval from governmental authorities to conduct trials on the use of the psychedelic substances to treat various conditions. What researchers have found is that psychedelic substances can have beneficial therapeutic effects. According to the research, there are a number of potential applications for psychedelic therapy such as anxiety, depression, substance use, alcohol use, and PTSD. At present, there are multiple clinical trials on psychedelic assisted therapy, some in phase II and III. TherapyShow.com/Psychedelic-Assisted-Psychotherapy Psychedelic Harm Reduction and Integration: A Transtheoretical Model for Clinical Practice Twitter @Fluencetraining Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Steven Hayes is Nevada Foundation Professor at the Department of Psychology at the University of Nevada and the developer of a new approach to human thought called Relational Frame Theory. He has guided ACT’s extension to Acceptance and Commitment Therapy (ACT) a popular evidence-based form of psychotherapy that is now practiced by tens of thousands of clinicians all around the world. Dr. Hayes was listed by the Institute of Scientific Information as the 30th “highest impact” psychologist in the world. Dr. Hayes is the author of many seminal books includin Acceptance and Commitment Therapy and my favorite Acceptance & Mindfulness Treatments for Children & Adolescents: A Practioner’s Guide. Whether you are a client or therapist, I encourage you to read his new book A Liberated Mind: How to Pivot Toward What Matters. ACT uses mindfulness and acceptance skills to help individuals respond to uncontrollable experiences with behavior that is more consistent with their personal values and goals. A therapy model where clients learn to accept their inner thoughts, emotions and sensations and begin to practice psychological flexibility which is demonstrated by more adaptive behaviors. ACT teaches individuals to deal with their emotional and mental struggles through a balance of acceptance of their problems and encouraging them to move toward more adaptive change. In contrast to most Western psychotherapy which is based on a medical model, ACT does not have symptom reduction as a primary goal. This is based on the belief that the attempt to get rid of symptoms can actually cause a clinical disorder. As soon as individual’s experience is labeled a symptom, they begin to fight against that symptom in order to eradicate it. In ACT therapy, a person would look to have a new relationship with their difficult thoughts and feelings, change their perspective on them as harmless, albeit uncomfortable, transient psychological experiences. It is through this process that clients utilizing an ACT modality actually achieves a reduction in their psychiatric symptoms. Re-released from Therapy Show Episode 9 TherapyShow.com/ACT Dr. Steven Hayes on Twitter: @StevenCHayes Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Elaine Walker is the Charles Howard Candler Professor of Psychology and Neuroscience at Emory College’s Department of Psychology and her research focuses on the precursors and neurodevelopmental aspects of psychopathology of schizophrenia. Schizophrenia and other psychotic disorders are major mental illnesses that involve an abnormality in central nervous system functioning. Dr. Walker’s research program is concerned with shedding light on the nature and origins of this abnormality, its interaction with neuromaturational processes and the role of environmental stressors in triggering psychotic episodes. Her team is studying the prodromal period of adult-onset psychosis in order to identify manifestations of dysfunction and the predictors of conversion to clinical psychosis. The focus is on exploring the relations among clinical symptoms, neuromaturational processes, neuropsychological functions, and Central Nervous System development. She is leading the Mental Health and Development Research Program supported by the National Institute of Mental Health. Dr. Walker is the co-author of Abnormal Psychology (2001) and co-editor of Adolescent Psychopathology and the Developing Brain: Integrating Brain and Prevention Science (2007) as well as co-editor of Schizophrenia: A Life-Course Developmental Perspective (1991). Schizophrenia is a serious illness that affects thinking, emotions, behavior and psychosocial functioning. Psychotic symptoms can include hallucinations, delusions, and disorganized thinking and are prominent symptoms in Schizophrenia.  Individuals suffering with Schizophrenia may seem internally preoccupied or may be observed responding to internal stimuli. The more psychotic aspects of Schizophrenia generally emerge between the late teens and mid-30s, although prodromal symptoms (slow and gradual development of signs and symptoms of the disorder) are usually apparent sooner and may manifest in social withdrawal, stranger habits, or a decline in academic performance. The severity of Schizophrenia can range from significant cognitive and emotional disability to somewhat milder social and occupational limitations. Individuals with milder forms of Schizophrenia may complete school, hold jobs, and start a family.  TherapyShow.com/Schizophrenia Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Frederic Reamer is a Professor in the School of Social Work at Rhode Island College for over 30 years.  He received his PhD from the University of Chicago and has served as a social worker in correctional and mental health settings. Dr. Reamer chaired the national task force that wrote the National Association of Social Workers Code of Ethics adopted in 1996 and recently participated in drafting new technology standards added to the code in 2017.  Dr. Reamer lectures both nationally and internationally on the subjects of professional ethics and professional malpractice and liability. He has conducted extensive research on professional ethics and has been involved in several national research projects sponsored by The Hastings Center, Carnegie Corporation, Haas Foundation, and Center for Bioethics of the University of Pennsylvania. Dr. Reamer is the author of many books, including: Boundary Issues and Dual Relationships in the Human Services; Risk Management in Social Work: Preventing Professional Malpractice, Liability, and Disciplinary Action; The Social Work Ethics Audit: A Risk Management Tool and On the Parole Board: Reflections on Crime, Punishment, Redemption, and Justice; Ethics and Risk Management in Online and Distance Social Work; and his latest, Moral Distress and Injury in Human Services, among others. Dr. Reamer’s journal article Ethical Standards for Social Workers' Use of Technology: Emerging Consensus is the most comprehensive discussion of recently adopted regulatory, ethics, and practice standards to date. Dual Relationships and Boundary Crossings: Social workers often encounter circumstances that pose actual or potential boundary issues where they may face conflicts of interest in the form of dual relationships. Dual relationships occur when social workers engage with clients or colleagues in more than one relationship outside of their professional relationship such as participating in business, sexual, social or religious activities. Some dual relationships are unethical (for example, when social workers exploit clients), and some are not (unintended encounters outside therapy). Further, some dual relationships are avoidable, and some are not (for example, when social workers and clients live in small or rural communities).  TherapyShow.com/Ethics-Social-Work-Practice Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Elizabeth Dexter-Mazza is licensed psychologist, a certified DBT therapist and co-author of the DBT STEPS-A social emotional learning curriculum for middle and high school students. Dr. Dexter-Mazza completed her postdoctoral fellowship under the direction of Dr. Marsha Linehan at the Behavioral Research and Therapy Clinics (BRTC) at the University of Washington. While at the BRTC, she was the Clinical Director and a research therapist for Dr. Linehan’s research studies, which provided both individual DBT and DBT group skills training. Dr. Dexter-Mazza is the co-author of DBT Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A). She has published several book chapters and peer reviewed articles on DBT, Borderline Personality Disorder (BPD), and graduate school training in how to manage suicidal clients. Dr. Dexter-Mazza is considered an expert in training mental health professionals around the world in DBT. She also provides consultation on the implementation of DBT and DBT STEPS-A to clinicians and schools. Dr. James J. Mazza has a Ph.D. in school psychology and the co-author of the DBT STEPS-A social emotional learning curriculum for middle and high school students. Dr. Mazza is a professor at the University of Washington – Seattle where he has been for the past 20 years teaching and conducting research in the field of adolescent mental health.  Dr. Dexter-Mazza is the co-author of DBT Skills in Schools: Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A). Dr. Mazza’s research interests focus particularly on adolescent internalizing disorders such as depression, anxiety, posttraumatic stress disorder, exposure to violence and especially suicidal behavior. He examines the complex relationships of how mental health issues impact adolescent social emotional abilities and academic skills through a multitiered system of supports.   Dr. Mazza’s focuses on school-based settings and has written extensively through peer-reviewed articles and book chapters on how to identify youth who are at-risk for suicidal behavior as well as developing social emotional learning (SEL) curricula to help all students learn emotion regulation skills.   DBT in Schools has developed the DBT Steps-A skills training and social-emotional problem-solving curriculum for adolescents. The curriculum was developed to be implemented in middle and high schools in order to teach all adolescents effective emotion regulation, decision making, and problem-solving skills. The DBT STEPS-A curriculum includes 30 lesson plans that are designed to fit within a general education curriculum. Each lesson is 50 minutes long. The curriculum was adapted from the skills training program in Dialectical Behavior Therapy developed by Dr. Marsha Linehan, Professor at the University of Washington (Behavioral Tech, n.d.).  The 30 lessons cover skills from each of the DBT skills modules including: Orientation & Goal Setting Dialectical Thinking Core Mindfulness Skills Distress Tolerance Skills Emotion Regulation Skills Interpersonal Effectiveness Skills DBT STEPS-A has been being used in several middle and high school programs around the country. TherapyShow.com/DBT in Schools Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Patricia Resick is a Professor of Psychiatry and Behavioral Sciences at Duke University Medical Center. Dr. Resick’s specialty is in understanding and treating the effects of traumatic events, particularly Post-Traumatic Stress Disorder. In 1988, she developed Cognitive Processing Therapy for PTSD, a brief evidence-based treatment and has overseen multiple clinical trials. CPT is considered a first line therapy for PTSD. The treatment manual for CPT has been translated into 12 languages and has been disseminated throughout the Department of Veterans Affairs in the US, Canada, Australia, and currently the Democratic Republic of Congo. Dr. Resick has written extensively on PTSD and is a co-author of the primary text in the field Cognitive Processing Therapy: A Comprehensive Manual. Cognitive Processing Therapy, which is also referred to as CPT, is a cognitive-behavioral therapy (treatment that focuses on thoughts and feelings) for Posttraumatic Stress Disorder, or PTSD, and related conditions. PTSD can develop when an individual experiences a traumatic event such as physical and sexual abuse or assault, accidents, threats, military combat, or being a witness to violence or death. CPT focuses on the connections between thoughts, feelings, behavior and bodily sensations. CPT is an evidenced-based therapy which means that it has been proven to be effective through rigorous scientific research. CPT provides a way to understand why recovery from traumatic events is difficult and how symptoms of PTSD affect daily life. The focus is on identifying how traumatic experiences change thoughts and beliefs, and how thoughts influence current feelings and behaviors. An important part of the treatment is addressing ways of thinking that might keep individuals “stuck” and get in the way of recovery from symptoms of PTSD and other problems. Twitter @PatriciaResick For more information, click on CPTforPTSD.com. TherapyShow.com/Podcasts Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Molyn Leszcz is a Professor in the Department of Psychiatry at the University of Toronto. Dr Leszcz served as Psychiatrist-in-Chief at Sinai Health System from 2006-2017 and as Vice Chair, Clinical for Department of Psychiatry, University of Toronto, from 2010-2017, his academic and clinical work has focused on improving integration in psychiatric care and broadening the application of psychotherapy within psychiatry. HIs research has focused on group psychotherapy for individuals with cancer, and genetic or familial predisposition to cancer; group psychotherapy for patients with schizophrenia; evidence-based approaches to group therapy and modified interpersonal group psychotherapy for patients with substance abuse; and the application of psychological interventions to improve health care workers' wellness. Dr. Leszcz co-authored with Irvin Yalom, Theory and Practice of Group Psychotherapy, the 6th edition was recently released in 2020. He also co-authored the book in the Psychotherapy Essentials to Go series, Achieving Psychotherapy Effectiveness, was published in 2015.  Dr. Leszcz was awarded the Anne Alonso Award for Outstanding Contributions to Psychodynamic Group Therapy and also was awarded Distinguished Fellowship in the American Group Psychotherapy Association, has been the recipient of a number of teaching awards at the University of Toronto and is a  Fellow of The Canadian Group Psychotherapy Association. Dr. Leszcz is the President of the American Group Psychotherapy Association and is a member of the International Board for Certification of Group Psychotherapists as well as the Editorial Committee of the International Journal of Group Psychotherapy. Group Therapy is a form of psychotherapy that involves one or more therapists working with several clients at the same time When facilitated with evidenced-based theory, Group Therapy can help individuals make profound and lasting changes in their lives. Group Therapy is often the main type of modality used in intensive outpatient programs, partial hospitalization programs, inpatient psychiatric units and residential treatment centers, and is commonly integrated into a comprehensive treatment plan that also includes individual therapy and medication. Groups can be as small as three or four people; however, group therapy sessions typically involve around seven to twelve individuals. The precise manner in which the session is conducted depends largely on the goals of the group and the style of the therapist. Some therapists might encourage a more free-form style of dialogue, where each member participates as he or she sees fit. Other therapists instead have a specific plan for each session that might include having clients practice new skills with other members of the group. TherapyShow.com/Group-Therapy AGPA on Twitter: @agpa01 Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. John Norcross is Distinguished Professor of Psychology at the University of Scranton and author of the acclaimed self-help book Changeology. He has authored over 400 publications and written many books on the field of psychotherapy, including the APA Handbook of Clinical Psychology and the Systems of Psychotherapy which currently in its 9th edition. Dr. Norcross has received many awards, including Pennsylvania Professor of the Year from the Carnegie Foundation, the Distinguished Contributions to Education & Training Award from APA, Fellow status in multiple associations, and election to National Academies of Practice. Individual Therapy refers to psychotherapy with an individual client. Often, a person enters individual therapy with the goal of reducing psychiatric symptoms and improving functioning. Additionally, they may also want to address situational stressors, family relations, life span issues or substance use disorders. It is important to keep in mind that engaging in individual therapy may bring to the surface painful emotions, traumatic memories, and latent parts of oneself. However, with a skilled and attuned therapist, individual therapy has the potential to help overcome obstacles to wellbeing, increase positive feelings, learn new skills for coping with difficult situations, improve decision making, and help reach goals of symptom reduction and improved functioning. Interestingly, some individuals go to therapy simply for continued self-growth, even after their acute symptoms have subsided. Dr. John Norcross on Twitter: @JohnCNorcross Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Judith Beck is President of Beck Institute for Cognitive Behavior Therapy, a nonprofit organization which provides training and certification in CBT to health and mental health professionals around the world. Dr. Beck divides her time between teaching, clinical work, program development, research, and writing. Dr. Beck is also Clinical Professor of Psychology in Psychiatry at the University of Pennsylvania. She is the author of the primary text in the field, Cognitive Behavior Therapy: Basics and Beyond, which is now in its third edition and has been translated into 20 languages. Dr. Beck’s other books include Cognitive Therapy for Challenging Problems, Cognitive Therapy for Personality Disorders, the Oxford Textbook of Psychotherapy, and The Diet Trap Solution. The online CBT courses she has developed at the Beck Institute have been taken by people in 130 countries. Cognitive Behavior Therapy is a cognitive therapy focused on identifying and modifying thoughts, feelings and behavior. Based on the cognitive model, CBT is a psychotherapy approach that recognizes that an individual’s reactions, either emotionally or behaviorally, are a result of how they perceive a given situation. One important part of CBT therapy is helping clients notice their automatic thoughts in order to change their unhelpful thinking and behavior. Once clients become aware of their automatic thoughts and how those thoughts lead to negative emotions and behavior, they can begin to experience lasting improvements in their mood and functioning. TherapyShow.com/Podcasts Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Patrick Corrigan is a Distinguished Professor of Psychology at the Illinois Institute of Technology and a leading expert on the topic of Stigma. Dr. Corrigan has written more than 400 peer-reviewed journal articles, is Editor Emeritus of the American Journal of Psychiatric Rehabilitation, and Editor of Stigma and Health, a new journal published by the American Psychological Association. Dr. Corrigan is the author of many books, including The Stigma Effect: Unintended Consequences of Mental Health Campaigns, The Stigma of Disease and Disability: Understanding Causes and Overcoming Injustices, and is part of the team that developed the Honest, Open, Proud series which aims to reduce the stigma of mental illness. The lives of people with mental illness are worsened by stigma, thus leading to public prejudice, loss of self-worth, and negative implications for mental health and well-being. Stigma and discrimination can also worsen someone's mental health problems, and delay or impede their getting help which can impact their recovery. Social isolation, poor housing, unemployment and poverty are all linked to mental illness. Therefore, stigma and discrimination can exacerbate the cycle of mental illness. The National Consortium on Stigma and Empowerment (NCSE) is a research group meant to promote recovery by understanding stigma and promoting empowerment.  The Consortium is located at the Illinois Institute of Technology with a collection of researchers at Yale University, the University of Pennsylvania, Rutgers University, Temple University, the University of Wisconsin, Illinois State University, and the University of Chicago. TherapyShow.com/Podcasts Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Lawrence Shulman is Professor Emeritus and former Dean of the University at Buffalo’s School of Social Work.  As a social work practitioner-educator for more than 40 years, Dr. Shulman has done extensive research on the core helping skills that are used in social work practice, child welfare, school violence and supervision best practices. Dr. Shulman is the co-founder and co-chair of the International and Interdisciplinary Conference on Clinical Supervision sponsored by the National Institutes of Health and the Haworth Press. Recognized for his dedication to excellence in scholarship and research, pedagogy and curriculum development, and organizational leadership, Dr. Shulman is a recipient of the 2014 Significant Lifetime Achievement in Social Work Education Award, conferred on him by the Council on Social Work Education. Dr. Shulman has published numerous journal articles on the topic of direct practice and is the author of many books including the Enhanced Eighth Edition of the Empowerment Series: The Skills of Helping Individuals, Families, Groups, and Communities, the Dynamics and Skills of Group Counseling and the fourth edition of the seminal book Interactional Supervision. Parallel Process makes clear that the role of the supervisor and the purpose of supervision are quite different from counseling and therapy. However, there are striking parallels in the dynamics and skills. The core dynamics and skills of the supervisor-practitioner working relationship which include rapport, trust, and caring are similar to those skills used to develop a working alliance in psychotherapy. There are also four phases in the supervisory relationship which include the preliminary, beginning, middle and ending/transition phase, which shape the supervisory relationship over time. The use of certain communication, relationship and problem-solving skills by the supervisor can influence the development of a positive working relationship with the supervisee, and that this working relationship is the medium through which the supervisor influences the practitioner. Dr. Shulman puts emphasis on the word “influence” because a central assumption of this approach is that both supervision and direct practice are interactional in nature and that the supervisor and the supervisee each play a part in the process. The outcome of supervision is the result of how well each contributes to the process. Dr. Shulman’s suggests that “more is caught than taught” and that our supervisees watch their supervisors very closely. Whether we like it or not, whether we are aware of it or not, our supervisees learn more about practice from the way we work with them than from what we say about their actual practice. Supervision is not therapy, and, in fact, Dr. Shulman believes that supervisors who are seduced into a therapeutic relationship with their supervisees actually model poor practice, since they lose sight of the true purpose of clinical supervision and their role in the process. TherapyShow.com/Supervision-Best-Practices Disclaimer: The information shared in this podcast is not a substitute for getting help from a mental health professional.

Dr. Vibh Forsythe Cox is a consultant and trainer for Behavioral Tech, the training company founded by DBT treatment developer Dr. Marsha Linehan. Dr. Forsythe Cox is a Licensed Clinical Psychologist in Washington State, and a DBT-Linehan board of certification certified clinician.  She is the Training and Content Development Specialist at Behavioral Tech and was a primary content developer for Behavioral Tech’s Comprehensive Online Training which is an online training resource for therapists interested in being trained in Dialectical Behavioral Therapy. DBT aims to teach people how to live in the moment, cope healthily with stress, regulate emotions, and improve relationships with others. DBT provides individuals with new skills to process painful emotions and reduce conflict in their relationships. The term “dialectical” comes from the idea that bringing together two opposites in therapy—acceptance and change—can produce more positive results than either of these concepts alone. Clients can reach their goals when they work with a therapist to synthesize these two opposites. What is the “D” in DBT? The “D” means “dialectical.” A dialectic is a synthesis or integration of opposites. In DBT, dialectical strategies help both the therapist and the client get unstuck from extreme positions. In this video, learn how dialectical strategies keep the therapy in balance and help clients reach their ultimate goals as quickly as possible. What is the “B” in DBT? The “B” stands for “behavioral.” DBT requires a behavioral approach. This means that we assess the situations and target behaviors that are relevant to our clients’ goals in order to figure out how to solve the problems in their lives. Learn how DBT provides you a path to get the change that your clients so desperately need to see (BehavioralTech.org). therapyshow.com/Dialectical-Behavioral-Therapy  

Dr. Gary Sachs is Clinical Vice President at Signant Health and the founder of Massachusetts General Hospital's Bipolar Clinic and Research Program. He is also an Associate Clinical Professor in Psychiatry at Harvard Medical School and was the Principal Investigator of the National Institute of Mental Health’s Systematic Treatment Enhancement Program for Bipolar disorder. Dr. Sachs is a Distinguished Fellow of the American Psychiatric Association. He chairs the Scientific Advisory Committee of the Depression and Bipolar Support Alliance (DBSA) also serves on DBSA board of directors. In March of 2020, he became president elect of the International Society for CNS Clinical Trial Methodology (ISCTM)  Dr. Sachs has authored over 200 peer reviewed articles and is a contributor to the seminal book Managing Bipolar Disorder: A Cognitive Behavior Treatment Program Therapist Guide (Treatments That Work) which addresses the management of bipolar disorder. In March of 2020, he became President Elect of the International Society for CNS Clinical Trial Methodology. Dr Sachs is an award-winning teacher and is recognized as a “Top Doctor” by US News and World Report, and by Reuters as among the world’s 100 most influential Psychiatrists, Neurologists and Neuroscientists.   Bipolar disorders are mood episodes that affect a person’s ability to function, and where a person experiences an intrusive mood episode such as mania, hypomania, or depression. These changes in mood can appear as intense highs and lows and can last for days at a time or longer. They are generally well demarcated changes in mood that interrupt previous functioning, which is to be distinguished from volatile behavior that is better explained by poor characterological temperament or the psychological effects of substance abuse. TherapyShow.com/bipolar-disorders

Interpersonal Psychotherapy focuses on social roles and relationships and is a time-limited course of treatment for depression and other mental disorders, which strengthens relationships and social supports in order to improve an individual’s mood and functioning. IPT generally lasts 12–16 weeks, with the timeframe agreed upon by therapist and client at the beginning of the treatment. IPT addresses swiftly the following problem areas in order to reduce symptoms: interpersonal disputes, role transitions, grief and loss, and interpersonal sensitivities (or deficits). Dr. Myrna Weissman is a Professor of Epidemiology and Psychiatry, Vagelos College of Physicians and Surgeons and the Mailman School of Public Health at Columbia University and Chief of the Division of Translational Epidemiology at New York State Psychiatric Institute. Dr. Weissman, along with her late husband Dr. Gerald Klerman, founded the therapeutic model of Interpersonal Psychotherapy. She is the author or a co-author of over 600 scientific articles and chapters and 12 books. Her most recent book is The Guide to Interpersonal Psychotherapy, which was published with her late husband Gerald Klerman, as well as John Markowitz. Interpersonal Psychotherapy on Twitter: @ipt_is

Sean Cullen is a Licensed Professional Counselor and was one of my first interviews last year before I graduated with my doctorate from Rutgers School of Social Work. So, if the sound is less than perfect, please forgive those imperfections. I wanted to release this podcast because Sean discusses how to effectively work with law enforcement in dealing with mobile psychiatric crisis situations in the community. This requires extensive training, but when done right, it can be an extremely beneficial and life-saving service. Sean is extensively trained and has over 19 years of experience working in emergency community settings as a Mobile Crisis Screener in Morris County, New Jersey. Sean is also a Medical and Psychiatric Clinician at one New Jersey’s best hospital systems, and actually took over for me when I left this hospital to pursue my doctoral work. Mobile Crisis is the provision of emergency mental health services in the home. If you are concerned about yourself, a family member, or a friend who is experiencing a psychiatric crisis, you can request a Mobile Crisis team to provide mental health intervention and support in the home to help overcome resistance to treatment (Goldman, 2015). Mobile crisis teams can provide mental health engagement, intervention and follow-up support to help overcome resistance to treatment. Depending on what a person is willing to accept, the teams may offer a range of services, including: Assessment, Crisis intervention, Supportive counseling, Information and referrals, including to community-based mental health services, and Transport to Psychiatric Emergency Room. If a mobile crisis team determines that a person in crisis needs further psychiatric or medical assessment, they can transport that person to a hospital psychiatric emergency room. Mobile crisis teams may direct police to take a person to an emergency room against their will only if they have a mental illness (or the appearance of mental illness) and are a danger to themselves or others. TherapyShow.com/MobileCrisis

Dr. Richard Schwartz earned his Ph.D. in Marriage and Family Therapy from Purdue University and is the founder of the therapeutic modality Internal Family Systems. Dr. Schwartz is also the founder of The Center for Self Leadership where professionals and the general public can attend workshops and trainings. Dr. Schwartz is the author of Family Therapy: Concepts and Methods, the most widely used family therapy text in the US. Dr. Schwartz is also the author of Introduction to the Internal Family Systems Model. Dr. Schwartz has also released a new audiobook, Greater Than the Sum of Our Parts: Discovering Your True Self Through Internal Family Systems Therapy.  IFS model of psychotherapy offers a clear, non-pathologizing, and empowering method of understanding human problems. IFS uses family systems theory—the idea that individuals cannot be fully understood in isolation from the family unit—to develop techniques and strategies to effectively address issues within a person’s internal family. This evidence-based approach assumes that each individual possesses a variety of sub-personalities or parts, with each part serving a particular role. Often, these internal parts are produced by the individual psyche in response to traumatic experience. These parts attempt to control and protect from the pain of the wounded parts and are often in conflict with each other and with one’s core Self. This undamaged core Self is the essence of the Self and represents the seat of consciousness with many positive qualities such as calmness, compassion, consecutiveness, confidence and leadership. For example, in alcoholic families, children often take on protective roles because of the dysfunction in the family. Some children may also take on maladaptive roles, such as the mascot, lost child, or scapegoat. In all of these cases, these roles are not the true nature of the children. These children are adapting to the chaos and upheaval that is common in the alcoholic family. A similar process occurs with internal families, where internal parts take on extreme roles caused by traumatic experiences. IFS can help transform these parts into positive internal family members. There are three distinct types of parts in the IFS model: Managers are responsible for warding off painful experiences and emotions in order to function in everyday life.  Exiles are often in a state of pain or trauma, which result from childhood experiences. Managers and firefighters exile these parts and prevent them from reaching the conscious level. Firefighters distract the mind when exiles can no longer be suppressed. In order to protect from feeling the pain of the exiles, firefighters make a person act impulsively and engage in behaviors such as addictive, abusive or self-harming such as alcohol, drugs, sex, or even work. Managers and Firefighters play the Protectors role, while Exiles are the parts needing protection. Re-released from 2019 Dr. Richard Schwartz on Twitter: @DickSchwartzCSL

Dr. DuWayne Battle is an Associate Professor of Teaching, Director of the Baccalaureate Program, and Course Coordinator of the Diversity & Oppression courses for the Rutgers School of Social Work graduate and undergraduate programs. Under his leadership the undergraduate social work program has more than quadrupled, making it one of the largest and most diverse in New Jersey. Ranked number 2 and 3 of the best US undergraduate social work programs by College Factual and U. S. Today respectively. Dr. Battle is the past president of the Association of Baccalaureate Program Social Work Directors, the National Association of Social Workers – NJ Chapter, and the Southwestern Social Work Association. Currently, he is the campus coordinator of the Baccalaureate Child Welfare Education Program (BCWEP), a consortium of all of New Jersey’s schools and departments of social work. He is also a member of the New Jersey Baccalaureate Social Work Educators Association (NJBSWEA), member of the NASW-NJ Continuing Education Program Committee, and serves on several other boards and committees. His most recent work has been related to COVID-19 and racial justice.  “COVID-19 and the death of Black Clergy,” “I can’t breathe,” and “How do we keep the homeless safe during this crisis?”  He had a BBC interview on “The disproportionate impact of the Coronavirus on the African American community,” and he has an article in press entitled, “Examining the Social Justice Implications of Physical Distancing and the Economic Stimulus Plans.” His co-authored article, entitled, Measuring student learning in social justice courses: The Diversity and Oppression Scale, provides an important instrument to evaluate courses on diversity, oppression, and social justice in schools of social work. Dr. Battle has been an advocate for open and affordable textbooks, increasing accessibility for people with disabilities, and he has led an effort to raise awareness about domestic violence and more than $200k for the Krystal Skinner Memorial Scholarship Endowment Fund and the Phi Alpha National Honor Society Scholarship Endowment Fund. A look into the diversity and oppression course at Rutgers School of Social Work which explores a range of diverse populations by race, ethnicity, gender, sexual orientation, and physical differences. Additionally, students examine the role, function, and effects of oppression in society as it relates to social, economic, and environmental justice. Students investigate the many assumptions that underlie theory and research methodologies from which basic constructs of human behavior are drawn. Students also seek to understand how power and other dynamics work together to sustain oppression at the individual and institutional levels. Also, of interest in this course is how oppression affects social work practice service delivery at micro and macro levels, with particular emphasis on social policies and strategic planning which drive the shape of services. This course, required of all MSW students as part of the Professional Foundation Year, introduces those concepts about diversity and oppression considered essential foundation knowledge for social work, and provides the basis of subsequent and more extensive exploration of related issues in other classes and the field practicum. The Code of Ethics of the National Association of Social Workers (2017, standard 1.05,(c)   mandates that “social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical ability.” As a result of this course, students are expected to begin a career-long process of learning and incorporating an understanding of culture and oppression into their practice. The Code of Ethics of the National Association of Social Workers (1999, standard 1.05, p.9) mandates that social workers pursue knowledge about effective micro and macro practice with diverse and oppressed clients and the social systems with which they interact. As a result of this course, students are expected to begin a career-long process of learning and incorporating an understanding of culture and oppression into their practice. TherapyShow.com/DiversityandSocialJustice

Dr. Sue Johnson is a clinical psychologist, researcher, professor, and a leading innovator in the field of couple’s therapy and adult attachment. Dr. Johnson is the founder of Emotionally Focused Couples and Family Therapy, which is backed by over 30 years of peer-reviewed clinical research. Dr. Johnson is founding Director of the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) and Distinguished Research Professor at Alliant University in San Diego, California, as well as Professor Emeritus, Clinical Psychology, at the University of Ottawa, Canada. Dr. Johnson is the author of many books, including Hold Me Tight, Love Sense, and Created for Connection. Emotionally Focused Therapy builds on the idea that adult relationships are complex, and it gives therapists a guide to help their clients in couples therapy. EFT seeks to help the couple bond and become a secure base for each other. EFT is a short-term and structured therapeutic approach, which teaches couples how to change negative communication patterns so they can feel closer and more connected to each other. The emerging research on neuroscience validates the importance of healthy attachments. When there is a breakdown in our relationships, our brains interpret this as danger, which leads to a fight-or-flight response. EFT seeks to help a couple bond and become a secure base for each other. Rebroadcasted from August, 2019. EFT on TherapyShow.com

Dr. Anna Lembke is an associate professor in the department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine. She is Medical Director of Stanford Addiction Medicine, Program Director for the Stanford Addiction Medicine Fellowship, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. Dr. Lembke was one of the first in the medical community to sound the alarm regarding opioid overprescribing and the opioid epidemic. In 2016, she published her best-selling book on the prescription drug epidemic, Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop. Her book was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic. Substance Use Disorder is a syndrome where a person compulsively uses substances despite many negative experiences and harmful consequences. Individuals who experience severe substance use disorder symptoms have an intense desire to use certain substances like alcohol or drugs, regardless of the problems that come about by consuming them. Gambling Disorder is new to the DSM-5 and is characterized by repeated gambling despite extremely negative consequences affecting the whole family.

Dr. Linda Carpenter is a Professor of Psychiatry in the Alpert Medical School of Brown University and Director of the Transcranial Magnetic Stimulation (TMS) at Butler Hospital. Dr. Carpenter completed her undergraduate degree at the University of Michigan, her M.D. from the University of Pennsylvania, and internship in internal medicine, a residency program in psychiatry, and a clinical neuroscience research fellowship at Yale University. She joined the faculty at Brown in 1997 and has continued her path as a physician-scientist investigating the neurobiology of, and new treatments for, major depression and other mood and anxiety disorders. Dr. Carpenter has conducted a number of randomized clinical trials sponsored by industry and the National Institute of Health, including Deep Brain Stimulation (DBS), Transcranial Magnetic Stimulation (TMS) and transcranial Direct Current Stimulation (tDCS). She is the founding Director of the Butler Hospital TMS Clinic and Neuromodulation Research Facility where she treats patients with pharmacoresistant depression and works with a variety of Brown-based research faculty who incorporate noninvasive brain stimulation techniques into their clinical research. Dr. Carpenter’s current research projects involve using imaging and EEG biomarkers to optimize and individually customize TMS therapy for depression. Transcranial Magnetic Stimulation (TMS) is a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain in order to improve symptoms of neuropsychiatric disorders.  It is currently FDA approved for Major Depressive Disorder and Obsessive-Compulsive Disorder. TMS is typically used when other treatments have been ineffective. TMS is a technique that applies magnetic pulses to the brain delivered by a coil which is placed on the patient’s head. The pulsed magnetic field induces an electrical current in the brain and causes activity in brain cells called neurons. Different coil types are used to induce different magnetic field patterns and how fast the pulses are delivered can determine how the brain changes in response. Stimulation pulses are typically applied at an intensity level that is customized for each individual patient.

Dr. Walter Kaye is a Professor in the Department of Psychiatry and the Founder & Executive Director of the Eating Disorders Program at the Eating Disorders Center for Treatment and Research at UC San Diego. Dr Kay is a leading expert in Eating Disorders and is a co-editor in the Clinical Handbook of Complex and Atypical Eating Disorders and the Behavioral Neurobiology of Eating Disorders. Dr. Kaye’s current research is focused on exploring the relationship between brain and behavior using brain imaging and genetics and developing and applying new treatments for anorexia and bulimia nervosa. Eating Disorders are severe disturbances in eating behaviors, thoughts and emotions. Many who suffer with eating disorders are preoccupied with both food and their weight. They can have severe body image dissatisfaction and a need for perfection. Even though eating disorders are grouped together in the DSM-5, they are distinct illnesses. Anorexia Nervosa symptoms include a distorted body image and a belief in being overweight despite being dangerously underweight. There are two types of anorexia nervosa, one restrictive and one binge-purge type. Bulimia Nervosa is characterized by eating excessive amounts of food in short period of time, and then purging the food using compensatory behaviors like vomiting and laxatives. Binge Eating Disorder is engaging in episodes of excessive eating, but unlike bulimia, there is not purging of the food or calories. Eating disorders affect people from all racial and ethnic backgrounds on many psychosocial levels. They can cause serious medical problems, and a multidisciplinary approach to care is needed.   Transcript Dr. Bridget Nash (2s): Hello, my name is Dr. Bridget Nash and I'd like to welcome you to the Therapy Show, a podcast series that seeks to demystify mental health treatment. Today I am honored to welcome Dr. Walter Kaye who is a Professor in the Department of Psychiatry and the founder and Executive Director of the Eating Disorders Program at the Eating Disorders Center for Treatment and Research at UC San Diego. Dr Kaye is a co-editor of the Clinical Handbook of Complex and Atypical Eating Disorders and Behavioral Neurobiology of Eating Disorders. He is a leading expert in eating disorders, and it's here to discuss some of the new research in the field of Treatment. Dr. Kaye welcome to the Therapy Show! Dr. Walter Kaye (42s): Oh, thank you very much. Dr. Bridget Nash (45s): Can you start by telling us a little bit about your personal background and professional development that led to your research in the field of eating disorders? Dr. Walter Kaye (53s): Yeah, certainly. I first trained as a neurologist and then trained in Psychiatry a number of years ago, and I've always been interested in doing research. I didn't particularly have an interest in eating disorders, but I got a fellowship at the National Institute of Mental Health, and when I went there I was asked to take over a study on Anorexia, and actually in my training I had never met anybody with Anorexia and at the time, I was particularly interested in trying to understand how behavior was encoded in the brain. Dr. Walter Kaye (1m 24s): And so, I was thinking about studying some disorders like Parkinson's that have certain changes in behavior, and we know that that's due to the neurologic disturbances in treating people with Anorexia. I was really struggling how, what we call it a stereotypic their behavior is, that it is people with Anorexia resemble each other much more so than probably any other psychiatric disorders in terms of people resembling each other. For example, if you have schizophrenia, people have all kinds of different symptoms. But people with Anorexia tend to have the same, relatively the same symptoms, and you know, that it can make you think that there is something in the brain that's causing this a, so that is actually been what got me interested in in studying brain and biology and Anorexia. I was at NIMH for about seven years, and then I went to the University of Pittsburg for 20 years, and now I'm here at a University of California, San Diego, where I do research and also, I oversee the treatment program for Anorexia and Bulimia.  Dr. Bridget Nash (2m 27s): So how would you briefly explain Eating disorders to a non-professional? Dr. Walter Kaye (2m 31s): This is a number of ways to explain it to it. I think that's what's really confuses people because people with the Anorexia often, but not all the time, they see themselves as being too fat and they go on a relentless pursuit of the thinness. And initially the other disorder that we treated very often is Bulimia Nervosa, which is where people are kind of alternate between restricted eating, overeating and then sometimes purging and people also have a body image distortion, but these are disorders that are often also associated with things like anxiety in obsessionality. Dr. Walter Kaye (3m 5s): And people have a certain time pattern of temperament traits. These tend to be perfectionistic, sometimes obsessive, anxious people. And so this has been very, very puzzling because the eating disorders, you know, tend to start mostly in females around early teenage or mid teenage years and so the prevailing notion is that this is a disorder of this caused by culture or society and people are dieting to achieve some kind of desired look. Dr. Walter Kaye (3m 39s): But the reality is that people with Anorexia diet to a weight that, they can be 50, 60 pounds, and and nobody would consider that to be fashionably slim. In fact, people with Anorexia, when they get to that weight, they still see themselves often as being too fat, and they want to pursue a lower weight. And the other thing that's really noticeable about Anorexia is that, it's very hard for people to diet or lose weight. The recidivism rate in obesity is very high and to be able to eat a few hundred calories a day, every day for years at a time is not something that most people can’t do. Dr. Walter Kaye (4m 21s): We've really been very interested in the question of whether it is really an underlying biology that explains a lot of these puzzling symptoms that you see in the Anorexia and Bulimia. Dr. Bridget Nash (4m 31s): Can you talk about what's happening in the brain and the body when a person has an eating disorder? Dr. Walter Kaye (4m 36s): Well, there's two levels of it. One is the question of whether there is some underlying biology that causes an eating disorder. And then the second part is, “gee what happens when you starve yourself and what effects does that have on their brain and the body.” Let's talk mostly about Anorexia cause that's really where I do most of my research. People with Anorexia go on this, this is kind of relentless diet and they may be 12, 14 and 15 years old when they start it. Dr. Walter Kaye (5m 7s): But if you ask somebody with Anorexia what they were like is a child before they ever developed the eating disorder, what most of the time they'll tell you is they have a certain pattern of temperament and personality traits. These tend to be as children they're very achievement oriented, or they want to get all A's. They tend to be often kind of perfectionistic. They may be anxious and worried about what might happen, concerned about risk, inhibited, sometimes very obsessional, and organized, sometimes kind of inflexible, but these are, for the most part, this isn't the problem for them. Dr. Walter Kaye (5m 44s): Their parents there pretty compliant kids. They do well in school. They are, but something happens when they start to get into these teenage years and often, they have exaggerated anxiety. And what they'll often tell you is, there something about food, or wanting to eat food that makes them very anxious, and something about not eating that either makes ... doesn't increase the anxiety or it actually feels kind of empowering. And so, they get into this, because food is so uncomfortable for them, that they get into this escalating downwards spiral where the more weight they lose, the more weight they want to lose, and they can literally starve themselves to death. Dr. Walter Kaye (6m 25s): In fact, this disorder has the highest death rate of any behavioral disorder. It's thought that somewhere between five or ten percent, maybe even more, people with Anorexia will die from the Anorexia. And so once you start to starve yourself and lose weight like this, there is a whole host of secondary changes that occur in the body as your body is trying to a conserve energy and live with very few calories and it effects nearly every organ system in the body as you lose weight. Dr. Walter Kaye (6m 56s): So, it's been very hard to tease apart what's the cause and what's the consequence of Anorexia. Now, over the course of this disorder, what we find is that a group of people recover and somewhere probably around about 50% of the people eventually recover and may do very well in life. But it's not unusual that people may be ill with Anorexia for two or five or even ten years before they get better. And about maybe about 30% or so have a partial recovery, and then you have a group of people that have very chronic disorder or die from it. Dr. Walter Kaye (7m 34s): And the thing that's really the most concerning thing to recognize is we don't really have very powerful treatments for Anorexia. There's no medication that's been proven to work. We have some treatments that seem to work more effectively in adolescents and children with the Anorexia, it's a, it's called Family Based Treatment or Maudsley, we can go back and talk a little bit more about that. But even with that treatment, it's very hard to change this anxious behavior that happens when people eat. Dr. Walter Kaye (8m 6s): And so it's very important to really understand the biology and the mechanisms underlying this behavior in order to come up with more effective kinds of therapy both to keep people from being ill for many, many years before they get better or to prevent them from becoming chronically ill or dying from this illness Dr. Bridget Nash (8m 28s): For Bulimia, can you talk a little bit about the body image symptoms? And also, is there a secondary gain that somebody might experience from binging and purging? Dr. Walter Kaye (8m 37s): Human behavior is complicated and, as similar as people with Anorexia are to each other, everybody's an individual, and there's probably always a mixture of different kinds of environmental and biologic factors that contribute to anybody developing a disorder like this. People was Bulimia -- why do people binge and purge --well people with Bulimia often tell you that when they're stressed or upset or anxious, have a fight with their mother or something like that, there is something about bingeing and purging behavior that actually is kind of comforting and may make the uncomfortable feelings go away, at least temporarily, even though in the long run they return and they may feel worse. So, they're, just like with Anorexia, there there's some beneficial response to extremes of food intake or extremes of not eating food, and now that we're beginning to understand more about the brain, some of the biology about this, begins to make sense. And with some people with Bulimia, because people with Bulimia often stay around the more normal weight, the body image issues that may be part of what's is also driving their desire to, to lose weight and to, to remain at a certain, what they consider ideal body weight. Dr. Walter Kaye (9m 58s): So, it's complicated, but again, most people with Bulimia don't get to the extremes of weight loss that you see with Anorexia. Then, of course, there's actually a third disorder here, which are people that have both a mixture of Anorexia and Bulimia and they lose a lot of weight, but they also binge and purge. Dr. Bridget Nash (10m 18s): Eating disorder behaviors are very secretive. Are there any signs or symptoms that a family can look for in the early stages of illness that can help them? Dr. Walter Kaye (10m 27s): You see two different kinds of patterns here. In people with Bulimia that don't lose an extreme amount of weight, they often tell you they're ashamed and a distressed about binging and purging. And they tend to be the most secretive. They're the people that nobody in the family will know that they're bingeing and purging, they're doing this at night, or they're hiding, or they're any number of things that people do to keep it a secret from their family. This may go on for years and sometimes it’s very hard to discover and the family begins to notice that there's large amounts of foods missing or that is a toilet has gotten clogged up by vomitus. Dr. Walter Kaye (10m 59s): You know one of the things that happens when people binge or purge to an extreme, it may affect their menstrual periods then they stop having a menstrual period or they may be very irregular. We see in a very different pattern in Anorexia and people with Anorexia don't usually try and hide it, they have more of a, a denial so that they don't see themselves as well being too thin. And in fact, even though they may lose 30, 40 pounds, they'll look at it their arm, you know, hold their arm out to say... Dr. Walter Kaye (11m 30s): "Can't you see how fat I am." And they're not really very motivated to get into treatment and there's a lot of denial and a lot of resistance to being in therapy and sometimes frank hostility to try to get them into treatment. And that's of course, one of the problems with Anorexia because it says it can be a life threatening illness. Yet this is a group of people that don't feel that they're at any risk. Dr. Bridget Nash (11m 56s): Why is the early intervention critical for people suffering with eating disorders? Dr. Walter Kaye (12m 0s): This goes back to a couple of different reasons. 1) There is there is some evidence that the earlier you get somebody into treatment, the better they might do. So, the most effective treatment we have, particularly for Anorexia, is called Family Based Treatment or Maudsley. And because this can be a very chronic disorder, and people get into treatment or are forced into treatment and forced to gain weight, but they leave treatment and they lose that weight all over again. Dr. Walter Kaye (12m 30s): And they may go through repeated cycles. So, because most families are unable to keep their child in a treatment program for a long period of time, and because this is a chronic disorder, this therapy has been effective because it makes parents an ally. Instead of saying to parents, you are bad people, you've caused this. There is really no evidence that families cause eating disorders or that bad parenting causes eating disorders. You want to bring them in as an ally and try to explain to them reasons why your child is acting this way, and more importantly make the parents part of the treatment team so once your child goes home, the parents have strategies and knows how to most effectively get them to eat and maintain their weight. And that treatment has really been a game changer in that there's a number of studies that have shown that is a more effective treatments for many people, especially if they’re younger than older treatments as usual. But say that there's a large proportion of people that don't really respond very well to Family Based Treatment and go on to have a chronic disorder. Dr. Walter Kaye (13m 33s): And so that's one of the reasons we need to learn more about the biology so that we come up with more effective approaches here. But what happens to people when they get malnourished? Well, there are certain systems in the body that growth during the teenage years is a very important, and so one of those is bone strength. And actually, your bones continue to develop and get stronger during your teenage years and your bone growth becomes peak in your late teens, early twenties, and then its, then you slowly lose strength as you get older. Dr. Walter Kaye (14m 11s): If you miss that are critical period of bone growth, you're gonna, your likely to have weak bones all your life. You cannot make up for it later with better nutrition when you're in their twenties and thirties. And it is not unusual that we see people who have had a period of Anorexia and now are fully recovered, but they suffer, they're very susceptible to fractures as they get into their thirties and forties that other people might not have just because their bones are so weak. And they're certain other patterns, similar kind of patterns of growth that occur in parts of the brain during your teenage years as you're are getting into your twenties. Dr. Walter Kaye (14m 48s): And now we're beginning to wonder whether there may be permanent changes to some parts of the brain if people remain malnourished for many years. There are long term consequences that can happen. And even people that have Bulimia Nervosa that don't lose a lot of weight can also show some of these more chronic permanent changes. Dr. Bridget Nash (15m 10s): I liked the way you talk about the family as part of the treatment team. And I think that a multidisciplinary approach is key to treating someone with an eating disorder, even including like when we think about it, the medical, the dental, the psychiatric in the psychotherapy piece, I think they're all critical don't you think? Dr. Walter Kaye (15m 30s): It takes the team to treat somebody with Anorexia. A dietician, a various kind of therapy, sometimes medication. Family is just maybe the most critical element of that whole team. Dr. Bridget Nash (15m 43s): What are some of the most common obstacles that prevent people from achieving a full recovery? Dr. Walter Kaye (15m 49s): I don't think we really know that. And that's where you start to get into biology. One of the questions that we've really struggle with, and typically are doing research on his, this question about eating behavior. Let me ask you, how, how do you feel when you go without eating for a day or two? Dr. Bridget Nash (16m 7s): Angry! Dr. Walter Kaye (16m 7s): Yeah. Most people will say there's something unpleasant about it. It's irritable. It's uncomfortable. It just doesn't feel good and what people will find, if you go without eating for a day or two, you you get hungry, that first bite of food really is more pleasurable. It will still be pleasurable. But when you are really hungry, food tastes better doesn't it? Dr. Bridget Nash (16m 28s): Yes. Dr. Walter Kaye (16m 30s): Okay. So, if you ask somebody with Anorexia, what do they feel like when they have to eat or they think about food, you know, what they almost always tell you is there's something about that that makes them anxious and uncomfortable. And when they don't eat, they feel the anxiety isn't increased, or sometimes they feel even better, empowered. So, just from that standpoint, it makes you think that there's something that is wired very differently in people's brain with Anorexia because the primary job of animals is to find food and feed themselves every day. Dr. Walter Kaye (17m 4s): And we know from animals’ studies there is very powerful systems that are built into the brain to do that. So, what happens is, when animals go without eating for a while, their body says to sense that they need energy stores, their energy stores are diminished, their gas tank is less full. And that, there's a number of different pathways from the brain that send the messages signals to the, to the brain that say "Gosh, you need more energy." And what that does is that really, you know, in humans that is interpreted as an uncomfortable feeling like: “Hey, there's something wrong, you got to go out and eat.” And in animals, what that particularly does is that works on a part of the brain that is very important for reward and motivation, and it actually sends a signal to that part of their brain that motivates you to go out and search for food. So, we know a lot about that part of their brain. It's very deep in the brain and is shared with animals. It's actually below our consciousness. It's a part of the brain that sits on top of the brainstem, but under the cortex and is called the striatum or the basal ganglia. Dr. Walter Kaye (18m 9s): And it’s very important for motivating all kinds of behavior, whether it's food or drugs or sex or anything that people or animals are motivated to do. And you can do brain imaging studies now that, at least, ask the question of – “What happens in that part of the brain, there's the activity in that part of the brain, that's important for motivation get turned on when you are hungry.” And so, we did a study in, and this is just published a couple of months ago in the American Journal of Psychiatry, where we had people with Anorexia come into a laboratory that we have on campus, building a setting. Dr. Walter Kaye (18m 45s): And they lived there for three days. One day we had them go without eating for 16 hours. On the other day we had to meet normally. And what we wanted to do is measure the activity in this motivational part of the brain. And so, we had them come in. Then after that the, they came into an imaging center and we imaged to their brain and we had them, we put a little plastic tube in their mouth we had them taste, repeat a taste of sugar water, which we know kind of turns on this system. And what we found is that, in the control women, the women that didn't have Anorexia, we found exactly what others have found. Dr. Walter Kaye (19m 20s): On the day that they were hungry, there was much more activity in this motivational center of the brain then there was on the day they were full. No surprise. And we did the same thing in people with anorexia, you know, what we found is that, on the day that if they were fed, they look just like the controls. On the day they were hungry, it was decreased activity in the motivation center. So. this makes perfect sense. It what is really saying is that people with Anorexia, the reason they can starve themselves is that they're just not getting a signal that's compelling them to go out and eat food. Dr. Walter Kaye (19m 59s): Does that kind of makes sense? Dr. Bridget Nash (20m 2s): It does. Now are they motivated to do anything else? Like to do other things like compulsive behaviors? Dr. Walter Kaye (20m 6s): We have looked at other kinds of motivation, which is things like response to money, and they had the same diminished signal in that part of the brain. So, you know, people with Anorexia like to save money, they don't spend money. And so, they are not really motivated to for any kind of reward, and that actually we think as part of the problem with treatment is that they really have a hard time sensing the reward of it. You know, parents try to motivate their kid's all the time to eat and maintain their weight by a promising "I'll buy you a new Porsche." Dr. Walter Kaye (20m 39s): Because treatment is so expensive, it's probably cheaper to buy them a Porsche and it doesn't work because the people with Anorexia tend to be very insensitive to reward. But the converse side of it is there over-sensitive to things going wrong, to what we call punishment or some kind of aversive risk state. In fact, it, the other thing that we found in this study is that the more anxious than people with... Anorexia were, the more activity they showed in this part of their brain that's very sensitive to things going wrong and inhibit behavior. Dr. Walter Kaye (21m 15s): And actually what we think is going on is that if you're an animal out there in the wild, you're a rabbit, your living out there in their field, you are living here in your little hole on the ground, is relatively safe, you start to get hungry, that hunger is going to motivate you to go out and look for food, right? But animals have to have a system built into their brain that inhibits that behavior if there's something dangerous going on like a predator that might eat it. And so even though that rabbit is very hungry, that rabbit has to inhibit that hunger and motivation to eat and run away if there's some kind of risk going on, some kind of danger. Dr. Walter Kaye (21m 54s): And what I think is going on with the people with Anorexia is they are getting kind of a biased signal here. They're over sensitive to things going wrong, danger, anxiety, adversity, change, uncertainty. All those things that give you a signal there's some kind of risk, and they're actually getting a signal in their brain. They're somehow miscoding food and their miscoding food is being dangerous and risky. And that doesn't exist for the rest of us because nobody is wired that way, but there's something very different about the brain that people with Anorexia. Dr. Walter Kaye (22m 28s): Does that kind of make sense. Dr. Bridget Nash (22m 31s): It makes a lot of sense. I just wonder what the cause is. Do you have any theories of the cause of where that began? Dr. Walter Kaye (22m 38s): Well, now that we're beginning to understand what system is involved in the brain, we think that there's something wrong in this mechanism that balances reward and punishment, and people with Anorexia tend to be very sensitive to punishment and risk and things like that. So, then what exactly is it a chemical mechanism of that is still a mystery, but I think we've started to understand were to look now. Dr. Bridget Nash (22m 60s): That's really hopeful and promising. So, is there anything that improves treatment outcomes? Dr. Walter Kaye (23m 6s): We're finding that some people, and there have been some articles now in the literature, part of this system, it relies on a chemical called dopamine, which actually, people think of it as a reward chemical, but it’s actually a very important for this balance between reward and punishment. And that there's some studies suggesting at at least some people with Anorexia, may respond to some drugs that work on the dopamine system. It was a paper on American Journal last year is showing that Zyprexa also called Olanzapine showed improved weight gain to some extent in people with Anorexia. Dr. Walter Kaye (23m 42s): And there's been several other studies showing that a drug called Abilify which kind of has a similar mechanism or Aripiprazole also might work on some people, it doesn't work in everybody, it's not a magic bullet, but it may be helpful to some people. We really need to do now more controlled studies of that. But at least it’s starting to open the door to ask questions about mechanisms, Oh, by the way, I wanted to mention one other thing. The thing that's really important about this study I just told you about is we studied people who had recovered from Anorexia and not people that were ill. Dr. Walter Kaye (24m 16s): And the reason that we did that is this problem with teasing apart cause and effect. If you study people are ill or malnourished with Anorexia, it wouldn't be surprising you'd get altered signals in his system, and we wanted to look at people that are normal weight, not on a medication, normal menstrual function, doing really well in life and we found that they still had a disturbance in this system and suggesting that this may be the trait that leads to Anorexia in the first place. Dr. Bridget Nash (24m 48s): Are there other mental disorders that often co-occur with eating disorders? Dr. Walter Kaye (24m 52s): Sure. One of the, it seems to be the most common is anxiety or Obsessive Compulsive Disorder, but people also have depression and they may have a number of other disorders too. Dr. Bridget Nash (25m 5s): So, do people with eating disorders have a higher rate of suicide? Dr. Walter Kaye (25m 8s): Unfortunately, they do. I mean that's part of the increase death rate and mortality rate in Anorexia is some people starve themselves to death, but some people commit suicide and another reason why we need more effective treatments. Dr. Bridget Nash (25m 24s): Why is it important that clinicians who are treating people with eating disorders are trained in the most up-to-date research and treatments? Dr. Walter Kaye (25m 32s): Just because of the difficulty of treating this disorder and the difficulty of even getting people to participate and engaged in treatment. The more we learned about the Anorexia and the symptoms that people have, I think the better we can speak peoples, the language in the way, you know, understand the way people are thinking and reach out to them and get them to be motivated and engage in treatment, and I think one of the problems that we've had with Anorexia and often psychiatric disorders, is that, do you try, and there's theories about behavior... Dr. Walter Kaye (26m 7s): and maybe they make a lot of sense, but maybe they don't, and if you try and use a theory, that really has no particular, it doesn't fit or explain why somebody has a disorder, it is less likely to result in any kind of effective therapy. So, for example, now that we understand this altered balance between reward and punishment, we can work with families on that strategy, and we explain this to families and say: "Look, rewarding your child isn't going to be that effective." But there are these are kids that worry about consequences and don't want to do things wrong or make mistakes or... Dr. Walter Kaye (26m 44s): and we can help families develop strategies to use consequences. Now we're not trying to punish their kids, it's just that, ya know, sometimes they pay much more attention to that and to realize that, if they don't eat and maintain their weight, there is going to be consequences they consider even worse, then it becomes very individualized cause you want to figure out what consequences bother that child the most. What we are finding that can be somewhat a more successful kind of strategy. Dr. Bridget Nash (27m 13s): That's incredible. So, to use consequences to get the attention and to sort of start the conversation with the young person or whoever you're treating, that's excellent. Dr. Walter Kaye (27m 23s): For example, kids with Anorexia, you know, they really don't want to go back into treatment, they don't want to go into the hospital, they don't want to go into, you know, a residential program and sometimes that's the only leverage that you have. Not great, but you have to work with what you got it. Dr. Bridget Nash (27m 38s): And I think if you're not trained in understanding eating disorders, I want to ask you to explain to our audience, eating disorders are different. They're almost like distinct disorders, like Bulimia is a distinct disorder and Anorexia nervosa are distinct disorders, I mean we call them all feeding disorders, but their complex and they're different. Dr. Walter Kaye (27m 57s): They're both very different and they actually, sometimes have some similarities and one of the puzzling things is that both the Anorexia and Bulimia run in families, so one person can have Anorexia and another can have Bulimia you know, I don't think we really, you understand this. Dr. Bridget Nash (28m 14s): And if you're a clinician who's working in the field, who's been certified and I think you also understand that some people need multiple treatment, multiple treatment center or multiple residential treatment... Dr. Walter Kaye (28m 25s): Yeah. Dr. Bridget Nash (28m 26s): ... to get better. Whereas the person who's not experienced might see that as they're failing or they're not getting it the first time. Can you speak to that a little bit? Dr. Walter Kaye (28m 35s): Yeah. Well, you know, one of the things that's very important is that when people get malnourished, they actually, their symptoms tend to get worse and they spiral out of control and they have difficulty. The brain gets starved. They have difficulty learning things or using therapy, and, and so for both mental as well as physical reasons, they need to get back to a healthy body weight and that can really be an enormous challenge for people with Anorexia, and so being an a, you know, they often end up a higher level of care because it’s just so, if you don't get them until a more healthy nutritional state, they may die from their Anorexia. Dr. Walter Kaye (29m 13s): And also, the other thing that's going on here is that some people with Anorexia get very energy inefficient. And by that, I mean there's been studies showing, for example, people with obesity, have a hard time losing weight and they seem to have an easy time gaining the weight back after they lose weight. The opposite tends to seem to occur with a lot of people with Anorexia. They lose weight very easily, and it's hard for them to gain weight. Dr. Walter Kaye (29m 43s): And sometimes they need thousands of calories a day to gain that weight back. And if you're somebody with Anorexia and you want to eat 500 calories a day and you need three or four thousand to gain weight, you know, two, three pounds a week, food is making you anxious, what's the chance they're going to be able to do that at home? Not great. And they may have to eat that amount of food for two, three, four months to get back to a healthy body weight. Dr. Walter Kaye (30m 13s): So sometimes higher levels of care are just so critical to save their life. Dr. Bridget Nash (30m 19s): Exactly. Now aren't people with Anorexia nervosa interested in food? I mean, I think there's a misconception that they're not interested in food, but do you think that they might have a preoccupation with food perhaps? Dr. Walter Kaye (30m 32s): Absolutely. I mean, they collect calories. They cook for others. They window shop for food. They work in food industries. And I think this has been one of the puzzling parts. So, this network, you can have a brain circuit that is very important for recognizing you're hungry and driving the motivation to eat. And there's a series of kind of steps along the way that do that. And it's possible that you could have a blockage in one part of that which is... Dr. Walter Kaye (31m 2s): So, people with Anorexia seem to recognize that they're hungry, they're getting the signal, they can't turn that signal into motivation to eat, to initiate eating. But they're still, their part of their brain is still recognizing they're hungry. And this is a strange signal that nobody else has, and I suspect that really explains why they're obsessed with food and they cook for others, yet they can't eat. Dr. Bridget Nash (31m 31s): And can you speak a little bit about Binge Eating Disorder. It's a new disorder in the DSM-5, but I think it's one that has a lot of medical consequences. Dr. Walter Kaye (31m 39s): Yeah. Binge Eating Disorder tends to occur more frequently in males. It's a somewhat later age of onset and people have, they tend to often have mood and anxiety disturbances and respond somewhat differently to treatment and other treatments compared to Anorexia, but ideologically they're really not the same disorder whereas you see, Bulimia nervosa and Anorexia nervosa kind of run together in families, you don't really see that; Binge Eating Disorder has a separate kind of family and inheritance structure. Dr. Walter Kaye (32m 13s): There's one other disorder that we've recognized now that it's ARFID, or Avoided Restricted Food Eating Disorder, which is very extreme, picky. It tends to occur in children, that's something that we treat a lot also. And these are kids, there is a whole host of different symptoms they have. Some have pain in their stomach and can't eat because it causes pain and some are very anxious, some have obsession, they only can eat four different white foods, some disturbed by certain textures and tastes of food. Dr. Walter Kaye (32m 43s): So, it's not just one symptom complex - it's something that we've more recently kind of recognized, and some of these children really have a hard time eating and lose a lot of weight and so it's one of the disorders that we treat. And there's some from these children who end up developing Anorexia and some just have an ARFID disorder, so it's things that we're learning about, but it's also a disorder where Family Based Treatment is often very useful. Dr. Bridget Nash (33m 10s): And early intervention as well. Dr. Walter Kaye (33m 12s): Yeah. Yeah, exactly. Yeah. Dr. Bridget Nash (33m 14s): What are you most excited about mental health treatment today? Dr. Walter Kaye (33m 18s): Well, you know, I think we're finally becoming a science. The progress that's been made in the last 10, 20 years has just been enormous. And of course, the reason was that the brain is encased in your skull there, as opposed to having diabetes or heart disease where you can measure things. We haven't been able to measure what's going on in the brain and it's only been the last decade or so we've had powerful brain imaging and genetics kinds of studies that are allowing us to really look inside the brain and begin to understand brain circuits and pathways and mechanisms of behavior and how behavior is encoded in the brain... Dr. Walter Kaye (33m 54s): that have just made a difference. I am just kind of astounded how far we've gotten in my professional career, where you can begin to look at these behaviors and go like "Oh, well I think this part of the brain is involved and now I understand the mechanism, and I can predict what we are going to find and we can replicate those kinds of findings." And that's starting to lead to more effective treatments as we begin to translate that science into therapy. Dr. Bridget Nash (34m 18s): Effective and targeted treatments as well. Dr. Walter Kaye (34m 24s): Yeah. And that's one of the things that we do here. I like to look at our program not only as a, a treatment program, but also a laboratory for developing treatments. So we've very interested in this whole question of temperament in people with Anorexia and you know, these temperaments don't go away, but people with Anorexia when they recover, tend to do really well in life and they learn to use some of these temperaments in really kind of advantageous ways. This is a group of people who were very achievement oriented. Dr. Walter Kaye (34m 53s): They self-discipline, they pay attention to detail. They work hard. They wanted to do the right thing and they often have not just great but have actually spectacular careers. And so, this actually turns out to be a benefit to having some of these traits once people learn to use them in advantageous constructive ways. So, we think that that may be actually an important insight into developing more effective treatment approaches. Dr. Bridget Nash (35m 25s): That is very exciting. If you had a magic wand and could improve one thing about mental health treatment today, what would it be? Dr. Walter Kaye (35m 31s): Being able to understand each person's unique vulnerabilities and mechanisms because when you really come down to it, people are pretty complicated and everybody has probably in some ways unique mechanisms that are causing, and environmental influences and so that starts to explain why, whatever treatment we have works for some people, but not others. And so, if we could better understand, you know, it's called precision medicine. If you can better understand each person's unique with a series of factors, you could really more precisely prescribe treatment. Dr. Walter Kaye (36m 6s): We're not there yet. It's going to be a while. Yeah. We'll probably get there. Dr. Bridget Nash (36m 12s): No, we're going to get there because people are going to be asking for it now. Like when we hear from you and hear all of these exciting targeted treatments, it's going to kind of create a demand. Do you think? Dr. Walter Kaye (36m 25s): Yeah, yeah, absolutely. Dr. Bridget Nash (36m 28s): Dr. Kaye on behalf of myself, my listeners, and all of the people that you've helped through your work. I want to thank you for your contributions to mental health treatment and for taking the time out of your busy schedule to help me and my audience better understand the field of eating disorders. And to my listeners, be sure to check out my website TherapyShow.com, which has many resources about mental health. There, you will also find how to submit questions, stories, or insights that you have about the mental health system or suggestions about who else I interview can and how I can improve the show. Dr. Bridget Nash (37m 1s): I'd like to close by reminding our listeners to please subscribe, share, and review this podcast. So you, someone you love, and people around the world can gain more benefit for therapy. There is no need to suffer in silence. Get the help that you need to create the life that you want.

Dr. John Oldham is the Distinguished Emeritus Professor of Psychiatry in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. Dr. Oldham specializes in the field of personality disorders and is recognized internationally as a leader in psychiatric medicine receiving numerous awards and honors. Nationally, he has served psychiatric organizations in many capacities during his career, including as past president of the American Psychiatric Association and past president of the American College of Psychiatrists. A prolific writer and educator, Dr. Oldham is the author of The New Personality Self-Portrait: Why You Think, Work, Love and Act the Way You Do. He is also the Senior Editor of the second edition Textbook of Personality Disorders, the editor of the Journal of Personality Disorders and joint editor-in-chief of Borderline Personality Disorder and Emotion Dysregulation. Personality Disorders are an enduring way of feeling, thinking and acting that is different from those around them. Individuals suffering with Personality Disorders experience significant disruptions in their relationships, work and school. They are grouped together in clusters, based on their common characteristics. Personality Disorders are believed to have both genetic and environmental cause. There are no specific medications for Personality Disorders, however, some mediations are prescribed depending on symptoms. 

Dr. Arthur Becker-Weidman is the Director of the Center for Family Development with offices in Western New York and New York City.  He is an internationally acclaimed speaker and workshop leader and consults with therapists and organizations throughout the US and internationally about the evaluation and treatment of disorders of attachment, attachment-focused treatment, and prenatal exposure to alcohol. He has achieved Diplomate Status in Child Psychology and Forensic Psychology from the American Board of Psychological Specialties, and is a Certified Therapist, Consultant, and Trainer by the Attachment-Focused Treatment Institute and by the Dyadic Developmental Psychotherapy Institute. Dr. Becker-Weidman was Vice President on the Board of Directors of the Association for the Treatment and Training in the Attachment of Children and was the founder and first president of the Board of the Dyadic Developmental Psychotherapy Institute. He is an adjunct Clinical Professor at the State University of New York at Buffalo and The Academy for Human Development in Singapore, and Medellie College.  Dr. Becker-Weidman has published many papers and research reports in peer-reviewed professional journals.  He is the author and co-editor of seven books including Attachment Parenting: Developing Connections and Healing Children and The Attachment Therapy Companion: Key Practices for Treating Children & Families, as well as four training DVD’s and many articles in professional peer-reviewed journals. Attachment-Focused Treatment is grounded in attachment theory and the neurobiology of interpersonal experience. This therapy approach uses methods and principles from Dyadic Developmental Psychotherapy (DDP) in order to effectively treat children and adults. DDP is an evidence-based, effective, and empirically validated treatment that is grounded in current thinking and research on the etiology and treatment of Complex Trauma or Developmental Trauma Disorder and disorders of attachment. It is now recognized as a general approach to treatment.  TherapyShow.com/Attachment-Focused Therapy

Husseini Manji, M.D., FRCPC is the Global Therapeutic Head of Neuroscience at Janssen Research and Development, LLC, one of the Johnson & Johnson pharmaceutical companies. Dr. Manji is also a Visiting Professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine. Dr. Manji was previously Chief of the Laboratory of Molecular Pathophysiology & Experimental Therapeutics at the National Institutes of Health (NIH) and Director of the NIH Mood and Anxiety Disorders Program, the largest program of its kind in the world. Dr. Manji has received a number of prestigious awards, including the National Institute of Mental Health Director's Career Award for Significant Scientific Achievement, the Depression and Bipolar Support Alliance Klerman Senior Distinguished Researcher Award, the PhRMA’s Research & Hope Award for Excellence in Biopharmaceutical Research and has been recognized as one of 14 inaugural “Health Heroes” by Oprah magazine. Dr. Manji has published extensively on the molecular and cellular neurobiology of severe neuropsychiatric disorders and the development of novel therapeutics, with over 300 publications in peer-reviewed journals, and is the author of Bipolar Depression, Molecular Neurobiology, Clinical Diagnosis, and Pharmacotherapy which is currently in its second edition. Major Depressive Disorder includes depressed mood or loss of interest in activities that used to bring pleasure. In addition to feelings like dread or apathy, anger or remorse, many people suffering with depression also experience physical symptoms such as problems with eating, sleeping, mustering energy, and concentrating. Some medical conditions can also cause depressive symptoms, so considering possible underlying medical problems is important. Depression is a very common disorder, as many as one in six people experience depressive symptoms in their lifetime. Depression is differentiated from sadness and grief by the severity and duration of depressive symptoms. It is important for anyone experiencing a Depressive Disorder to seek help from a licensed clinician to be evaluated for safety. Depressive Disorders on TherapyShow.com TherapyShow.com/Podcasts

Thomas R. lnsel, M.D. is a psychiatrist and neuroscientist and a national leader in mental health research, policy, and technology.  From 2002-2015, Dr. Insel served as Director of the National Institute of Mental Health (NIMH), the component of the National Institutes of Health (NIH) committed to research on mental disorders. Prior to serving as NIMH Director, Dr. lnsel was Professor of Psychiatry at Emory University where he was founding director of the Center for Behavioral Neuroscience in Atlanta.  More recently (2015 – 2017), he led the Mental Health Team at Verily (formerly Google Life Sciences) in South San Francisco, CA.  In 2017 he co-founded Mindstrong Health, a Silicon Valley start-up building tools for people with serious mental illness.  In 2020, he co-founded NEST Health, a global therapeutic online community for recovery.  Since May of 2019, he has been a special advisor to California Governor Gavin Newsom and Chair of the Board of the Steinberg Institute in Sacramento, California. Dr. Insel is a member of the National Academy of Medicine and has received numerous national and international awards including honorary degrees in the United States and Europe. ​Lara Gregorio is a Licensed Clinical Social Worker and co-founder and CEO of NEST Health. With 20+ years in the behavioral health space, in settings ranging from inpatient to community mental health and private practice, Lara has a commitment to empowering consumers, scaling compassion, and providing care when, how, and where it is needed. Innovating and designing programs in the digital mental health space since 2013, she has built telehealth programs and designed online therapy and mental health community platforms. NEST Health is online community where people can access stepped care from peer support to individual psychotherapy. NEST Health on TherapyShow.com TherapyShow.com/Podcasts

Dr. George Koob is an internationally recognized expert on alcohol, stress, and the neurobiology of alcohol and drug addiction. He is the Director of the National Institute on Alcohol Abuse and Alcoholism, where he provides leadership in the national effort to reduce the public health burden associated with alcohol misuse. As NIAAA Director, Dr. Koob oversees a broad portfolio of alcohol research ranging from basic science to epidemiology, diagnostics, prevention, and treatment. Dr. Koob earned his doctorate in Behavioral Physiology from Johns Hopkins University in 1972. Prior to taking the helm at NIAAA, he served as Professor and Chair of the Scripps’ Committee on the Neurobiology of Addictive Disorders and Director of the Alcohol Research Center at the Scripps Research Institute.  Dr. Koob is the recipient of many prestigious honors and awards for his research, mentorship, and international scientific collaboration.  Dr. Koob has authored more than 650 peer-reviewed scientific papers and is a co-author of The Neurobiology of Addiction, a comprehensive textbook reviewing the most critical neurobiology of addiction research conducted over the past 50 years. Neurobiology of Addiction refers to the of changes in the brain circuits of an individual after repeated use. In the most severe cases, there are changes in the reward system, decision making, and self-control become impaired. The specific changes in the brain will depend upon what addictive substance is used: alcohol, opioids, cocaine. These agents induce an increase in dopamine in the part of the brain called the basil ganglia which in turn produces an intense feeling of pleasure. The other part of the brain referred to as the prefrontal cortex becomes impaired after repeated substance use, which makes stopping more difficult. After repeated use, tolerance develops, and the brain needs more of the substance to create that experience of pleasure. This can make life without the substance feel less enjoyable. When a person experiences the pain of withdrawal symptoms, they will seek to use substances in order to reduce those distressing feelings associated with withdrawal. TherapyShow.com/Podcasts

Dr. John Krystal is the Robert L. McNeil, Jr. Professor of Translational Research, Psychiatry and Neuroscience at Yale School of Medicine, the Chair in the Department of Psychiatry at Yale-New Haven Hospital and the Director of the Clinical Neuroscience Division at the Department of Veterans Affairs’ National Center for PTSD.  He is a leading expert in the areas of alcoholism, schizophrenia, depression and the Neurobiology of Post-Traumatic Stress Disorder which is the topic we will discuss today. Dr. Krystal’s work is interdisciplinary and links psychopharmacology, neuroimaging, molecular genetics, and computational neuroscience to study the neurobiology and treatment of these disorders. He is best known for leading the discovery of the rapid antidepressant effects of ketamine in depressed patients. Neurobiology of PTSD refers to changes in their brain and body that develop, as a protective response, after a frightening or dangerous event. Other symptoms include intrusive or negative thoughts, avoidance behaviors, becoming easily startled or irritable, feeling like one’s surroundings or oneself is unreal, and problems with sleep. Most people who experience a trauma naturally recover. Those who experience prolonged psychological and physiological symptoms may require treatment. TherapyShow.com/Podcasts

Dr. Judith McCoyd is an Associate Professor at Rutgers School of Social Work and co-author of Grief and Loss Across the Lifespan, a book that seeks to educate mental health clinicians about how to address the needs of someone experiencing grief and loss. She is also a co-author of Social Work in Health Settings, a comprehensive and insightful casebook of social work practice in health care. In this podcast, Dr. McCoyd returns to specifically discuss grief and loss within the context of the COVID-19 pandemic. Many individuals are grieving the loss of loved ones and lifestyle due to COVID-19 and the personal and economic changes it has instigated.  Dr. McCoyd discusses the theory of Disenfranchised Grief as a framework for understanding many of the losses experienced during this time. She provides suggestions for how we can process grief and loss during these uncertain times, as well as during more typical times of grieving. TherapyShow.com/Podcasts

Kelly Smyth-Dent, LCSW, along with Dr. Ignacio Nacho Jarero, created the Acute Stress Syndrome Stabilization Procedure and the ASSYST-Remote for Telebehavioral Health. Having access to remote therapy during the Covid-19 pandemic is important, especially during this time of social distancing when therapists are looking for creative ways to help their clients. Kelly is the CEO of Scaling Up a company dedicated to inform the masses about the benefits of EMDR therapy and AIP-informed procedures and to make EMDR-based individual and group intervention trainings and services more accessible and affordable to therapists, clients and organizations. Through these networks, training opportunities and services, we aspire to global healing through rapidly scalable and effective mental health interventions. ASSYST-R is a mental health procedure that can be performed remotely. TherapyShow.com/Podcasts

Deb Dana is a Licensed Clinical Social Worker and a leading expert in the field of using polyvagal theory in therapy. Ms. Dana is a consultant for the Traumatic Stress Research Consortium in the Kinsey Institute which is focused on using the lens of Polyvagal Theory to understand and resolve the impact of trauma. She is the author of the book The Polyvagal Theory in Therapy, co-edited with Stephen Porges Clinical Applications of The Polyvagal Theory, and I encourage everyone to read her new book Polyvagal Exercises for Safety and Connection which will be released in April 2020 and can be pre-ordered on Amazon.com. Polyvagal Theory, developed by Dr. Stephen Porges and translated into a therapy framework by Deb Dana, LCSW, identifies a biological order of human response that is active in all human experience. We come into the world wired to connect and with our first breath we embark on a quest to feel safe in our bodies, in our environments, and in our relationships with others. The autonomic nervous system, working below awareness and far away from our conscious control, is our personal surveillance system, always on guard, asking the question “Is this safe?” Its goal is to protect us by sensing safety and risk, listening moment by moment to what is happening in and around our bodies and in the connections we have to others.   Dr. Porges, understanding that this is not awareness that comes with perception, coined the term neuroception to describe the way our autonomic nervous system scans for cues of safety, danger, and life-threat without involving the thinking parts of our brain. Because we humans are meaning-making beings, what begins as the wordless experiencing of neuroception drives the creation of a story that shapes our daily living. The autonomic nervous system is made up of two main branches, the sympathetic and the parasympathetic, and responds to signals and sensations via three pathways, each with a characteristic pattern of response. Through each of these pathways, we react “in service of survival.” The sympathetic branch is found in the middle part of the spinal cord and represents the pathway that prepares us for action. It responds to cues of danger and triggers the release of adrenaline, which fuels the fight-or-flight response. In the parasympathetic branch, the remaining two pathways are found in a nerve called the vagus. Vagus, meaning “wanderer,” is aptly named. From the brain stem at the base of the skull, the vagus travels in two directions: downward through the lungs, heart, diaphragm, and stomach and upward to connect with nerves in the neck, throat, eyes, and ears. Dr. Porges identified a hierarchy of response built into our autonomic nervous system and anchored in the evolutionary development of our species. The origin of the dorsal vagal pathway of the parasympathetic branch and its immobilization response lies with our ancient vertebrate ancestors and is the oldest pathway. The sympathetic branch and its pattern of mobilization was next to develop. The most recent addition, the ventral vagal pathway of the parasympathetic branch brings patterns of social engagement that are unique to mammals. When we are firmly grounded in our ventral vagal pathway, we feel safe and connected, calm and social. A sense (neuroception) of danger can trigger us out of this state and backwards on the evolutionary timeline into the sympathetic branch. Here we are mobilized to respond and take action. Taking action can help us return to the safe and social state. It is when we feel as though we are trapped and can’t escape the danger that the dorsal vagal pathway pulls us all the way back to our evolutionary beginnings. In this state we are immobilized. We shut down to survive. From here, it is a long way back to feeling safe and social and a painful path to follow. Polyvagal Therapy on TherapyShow.com TherapyShow.com/Podcasts

Dr. Michael LaSala is the Director of the DSW program and an Associate Professor at the School of Social Work at Rutgers University. His research and clinical interests are the couple and family relationships of gay men and lesbians. Dr. LaSala has published extensively in peer-reviewed professional journals, and his current work examines the role of gay and lesbian family relationships in coping with stigma, ethical practice with LGBTQ populations, as well as the parental influence on gay youth's safe sex behaviors. He is the author of Coming out, coming home: Helping families adjust to a gay or lesbian child which describes the findings and practice implications of a National Institute of Mental Health-funded qualitative study of 65 gay and lesbian youth and their families. Dr. LaSala has been practicing social work for over 30 years at the direct practice, supervisory, and administrative levels and continues to practice part-time as a licensed clinical social worker at the Institute for Personal Growth in Highland Park, New Jersey Therapy for Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) focuses on mental health issues related to an individual’s sexual or gender identity and treats mental distress caused by the oppression, marginalization, and discrimination that may occur when coming out to family members, adjusting to a person’s authentic identity, and dealing with family pressures and expectations. According to the research, youth who identify as LGBTQ have an increased risk of self-harm and suicidal ideation, especially when they are faced with discrimination. In school, students who identify as LGBTQ are bullied, victimized, and rejected by their peers, which can lead to mental distress. LGBTQ adults may also experience similar persecution at their workplace, schools, and housing. These stressors may be the catalyst for LGBTQ individuals to seek mental health treatment, and an LGBTQ informed therapist can help reduce symptoms of depression, anxiety, and substance use in their clients (Almeida, et al., 2009; Yarbrough, 2018). Family Therapy for those who are Gay, Lesbian and Transgender targets the relationships between the individual and their family members. We have repeated findings that strongly suggest that supportive relationships between LGBTQ+ and their family members can be protective, reducing their risk for suicide, anxiety, depression, substance abuse, and risky sexual behaviors. Family therapy can thus help the family harness this protective power. When a child comes out to a parent, the child is looking for support and acceptance while the parents is possibly experiencing shock, guilt, sadness and worry. Family therapy techniques targeting this population involve education, enactments, or getting family members to talk to each other in productive, non-reactive ways, and reframing difficult conversations (LaSala, 2010; Nealy, 2017; Stone Fish, 2007). TherapyShow.com/Therapy for LGBTQ

Dr. Arnold Pallay received his medical degree from Boston University School of Medicine and has been in private and academic practice for more than 30 years. He practices family medicine and genetics in Montville, New Jersey and is affiliated with multiple hospitals in the Northeast. Dr. Pallay is the Founder and currently is Associate Medical Director of the Genomics Program at Atlantic Health System, has advanced training in genetics and genomics and is a frequent lecturer locally and nationally to both physicians and the lay public. Dr. Pallay is an appointed member of the Commission on Education of the American Academy of Family Physicians and is a teaching clinical faculty member at a number of New Jersey, New York and Pennsylvania medical schools including Rutgers, Seton Hall, Thomas Jefferson and Tauro Medical Schools. His practice participates in genetic research, including serving in a 13-site national genetics consortium studying children with genetic disorders that was sponsored by the American Academy of Pediatrics. He has been involved in research protocols to determine if precise genetics testing can alter the care received by medical and mental health patients by choosing to use or avoid certain medications in larger population cohorts.    The vast majority of Pharmacogenetic Testing is performed and implemented with antidepressants. Many individuals who are prescribed antidepressants do not respond to their first choice of medication, and this may lead to impediments to recover. It is often the case that a trial-and-error process takes place before a person responds to psychiatric medications. This can be problematic because of the time that elapses before recovery, as well as exposing a person to potential adverse side effects from psychiatric medications that have no benefit to them. Some patients do not respond to treatment, and genetic researchers believe that there may be a genetic reason for their non-response. Often if an antidepressant is tolerated and improves symptoms for a family member, it will have a higher chance of success on a patient. Since each person has a unique way that they metabolize psychotropic drugs, exploring a pharmacogenetic approach to narrowing down which antidepressant is the better choice to begin treatment.

Dr. Helen Blair Simpson is a Professor of Psychiatry at Columbia University Medical Center and Director of the Center for Obsessive-Compulsive and Related Disorders. Dr. Simpson is also the Director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute.  Her research program focuses on how to improve treatments for people with obsessive-compulsive disorder so that they can live productive lives. Dr. Simpson’s research is interdisciplinary and includes treatment development studies, clinical trials examining the effects of medication and cognitive-behavioral therapy, brain imaging studies exploring the brain mechanisms of Obsessive-Compulsive Disorder, and animal studies in collaboration with basic scientists. Her work has been funded by the National Institute of Mental Health, and private foundations like the Obsessive-Compulsive Foundation and the Brain and Behavior Research Foundation. Dr. Simpson was a member of the workgroup that developed the first Practice Guidelines for the Treatment of Patients with Obsessive-Compulsive Disorder for the American Psychiatric Association. She is an advisor to the World Health Organization for Obsessive-Compulsive Disorder and related disorders.  Obsessive-Compulsive Disorders (OCD) are persistent intrusive obsessive thoughts accompanied by repetitive behaviors and involves persistent and intrusive thoughts about any number of topics accompanied by repetitive behaviors often performed to alleviate anxiety. A person suffering with OCD can have recurrent unwanted thoughts that are very difficult to ignore or at times feel compelled to perform a compulsion (repeated behaviors like checking, washing, and ordering) which are experienced as distressing and affect functioning. These behaviors are time consuming and interfere with daily functioning. Some people suffering with obsessive-compulsive disorders have a suspicion that their obsessions are untrue, and others believe their obsessions have a chance of being true. However, even if they believe their obsessions may be untrue, someone with obsessive compulsive disorder still finds it difficult to stop their obsessions and compulsions.

Dr. Jesse Wright is the Kolb Endowed Chair of Outpatient Psychiatry and Director of the Depression Center at the University of Louisville, the Founding President of the Academy of Cognitive Therapy and the President of the Kentucky Psychiatric Association. He is a Fellow of the American College of Psychiatrists and his research interests include the development and testing of computer-aided psychotherapy programs and the interaction between pharmacotherapy and psychotherapy.  Dr. Wright created a popular software application that is used to help people learn cognitive-behavior therapy skills to reduce symptoms of depression and anxiety and his book, Learning Cognitive-Behavior Therapy: An Illustrated Guide, which includes a DVD with video demonstrations of key treatment methods, is being used in training programs throughout the world.  Dr. Wright’s book, Cognitive-Behavior Therapy for Severe Mental Illness, presents advanced strategies for treating challenging conditions. This volume was chosen as the “Mental Health Book of the Year” for 2009 by the British Medical Association. I highly recommend Dr. Wright’s first book written for the general public, Getting Your Life Back: The Complete Guide to Recovery from Depression, which was chosen by Self Magazine as one of the eight best self-help books. His most recent book, also written for the public, is titled Breaking Free from Depression: Pathways to Wellness and has also received rave reviews. Twitter @Jesswrightmd

Dr. Tayyab Rashid is a licensed clinical psychologist at the Health & Wellness Centre, University of Toronto Scarborough. For more than 15 years, Dr. Rashid has worked with individuals experiencing complex mental health issues including severe depression, debilitating anxiety, borderline personality disorder, and suicidal behavior. Dr. Rashid has also worked with individuals experiencing with severe trauma, including 9/11 families, survivors of Asian Tsunami of 2004 and Syrian refugee families. Dr. Rashid has recently won Outstanding Practitioner Award from the International Positive Psychology Association and Chancellor Award from the University of Toronto. Dr. Rashid’s work has been published in academic journals, included in textbooks of psychiatry and psychotherapy and has also been featured in the Wall Street Journal, Maclean's magazine, Canadian Broadcasting Cooperation and at TEDx. His book Positive Psychotherapy along with Martin Seligman, is considered the most comprehensive in the field and has been translated in five languages since its publication in late 2018. Positive Psychotherapy (PPT) encourages individuals to fully recognize what is good inside of them and use those strengths to become resilient in order to meet the challenges that come with mental distress. A PPT therapist does not view clients as broken. Rather uses a type of positive inception within the therapeutic interaction using optimism with the hope of building a foundation for a supportive and co-creative relationship. The human brain is hard-wired to react more strongly to negatives than to positives, and this can make some suffering with a mental illness less functional. A better therapeutic approach is to emphasize strengths and work toward reducing symptoms. It is important to note that PPT does not deny negative emotions nor encourage clients to see the world through rose-colored glasses. A PPT therapist does not offer empty platitudes, such as pointing out the positive opportunities that trauma, loss, or adversity may present for a person’s development and growth. PPT can help clients learn how to encounter negative experiences with a more positive mindset and reframe and label those experiences in ways that are helpful. As the quality of the client-practitioner relationship has always been a strong predictor of therapeutic outcomes, it stands to reason that the relationship should be a goal in and of itself. PPT strives to allow clients to experience a sense of wellbeing during sessions and throughout the client practitioner engagement, while the attitude of non-attachment and realistic expectation are practiced and instilled. PPT builds on strengths and positive emotions and equips clients to find meaning in their lives in the effort to undo psychopathology and promote wellbeing. TherapyShow.com

Dr. Lawrence Shulman is Professor Emeritus and former Dean of the University at Buffalo’s School of Social Work.  As a social work practitioner-educator for more than 40 years, Dr. Shulman has done extensive research on the core helping skills that are used in social work practice, child welfare, school violence and supervision best practices. Dr. Shulman is the co-founder and co-chair of the International and Interdisciplinary Conference on Clinical Supervision sponsored by the National Institutes of Health and the Haworth Press. Recognized for his dedication to excellence in scholarship and research, pedagogy and curriculum development, and organizational leadership, Dr. Shulman is a recipient of the 2014 Significant Lifetime Achievement in Social Work Education Award, conferred on him by the Council on Social Work Education. Dr. Shulman has published numerous journal articles on the topic of direct practice and is the author of many books including the Enhanced Eighth Edition of the Empowerment Series: The Skills of Helping Individuals, Families, Groups, and Communities, the Dynamics and Skills of Group Counseling and the fourth edition of the seminal book Interactional Supervision. According to the National Association of Social Workers (NASW), supervision is defined as: ​[T]he relationship between supervisor and supervisee in which the responsibility and accountability for the development of competence, demeanor, and ethical practice take place. The supervisor is responsible for providing direction to the supervisee, who applies social work theory, standardized knowledge, skills, competency, and applicable ethical content in the practice setting. The supervisor and the supervisee both share responsibility for carrying out their role in this collaborative process. (Best Practice Standards in Social Work Supervision, n.d.)​ National Association of Social Workers and the Association of Social Work Boards Best Practice Standards in Social Work Supervision are outlined as follows: Standard 1. Context in Supervision Standard 2. Conduct of Supervision Standard 3. Legal and Regulatory Issues Standard 4. Ethical Issues Standard 5. Technology Click here to review supervision standards.

Dr. Frederic Reamer is a Professor in the School of Social Work at Rhode Island College for over 30 years.  He received his PhD from the University of Chicago and has served as a social worker in correctional and mental health settings. Dr. Reamer chaired the national task force that wrote the National Association of Social Workers Code of Ethics adopted in 1996 and recently participated in drafting new technology standards added to the code in 2017.  Dr. Reamer lectures both nationally and internationally on the subjects of professional ethics and professional malpractice and liability. He has conducted extensive research on professional ethics and has been involved in several national research projects sponsored by The Hastings Center, Carnegie Corporation, Haas Foundation, and Center for Bioethics of the University of Pennsylvania. Dr. Reamer is the author of many books, including: Risk Management in Social Work: Preventing Professional Malpractice, Liability, and Disciplinary Action; Boundary Issues and Dual Relationships in the Human Services; The Social Work Ethics Audit: A Risk Management Tool and his latest, On the Parole Board: Reflections on Crime, Punishment, Redemption, and Justice. In a recent article in Social Work Today, Dr. Frederic Reamer discussed the recent developments of the New NASW  Code of Ethics Standards for the Digital Age (2017). In August 2017, the NASW Delegate Assembly formally approved significant updates to the profession's venerable Code of Ethics. The revisions focus explicitly on ethical challenges pertaining to social workers' and clients' increased use of technology. They reflect a broader shift in social work practice related to technology that has led to very recent and noteworthy changes in regulatory (licensing board) standards, practice standards, and ethical standards. Recognizing the profound impact that technology is having on social work practice, in 2013 the Association of Social Work Boards (ASWB) board of directors appointed an international task force to develop model regulatory standards for technology and social work practice. ASWB embarked on development of new technology standards in response to demand from regulatory bodies around the globe for guidance concerning social workers' evolving use of technology. The ASWB task force included representatives from prominent social work practice, regulation, and education organizations throughout the world. The task force sought to develop standards for social workers who use digital and other electronic technology to provide information to the public, deliver services to clients, communicate with and about clients, manage confidential information and case records, and store and access information about clients. The group developed model standards addressing the following key concepts: practitioner competence; informed consent; privacy and confidentiality; boundaries, dual relationships, and conflicts of interest; records and documentation; collegial relationships; and social work practice across jurisdictional boundaries. These model technology standards, formally adopted in 2015, are now influencing the development of licensing and regulatory laws around the world. Following this development, in 2017, with unprecedented collaboration among key social work organizations in the United States—NASW, Council on Social Work Education, ASWB, and Clinical Social Work Association—the profession formally adopted new comprehensive practice standards focused on social workers' and social work educators' use of technology. Approved by these respective organizations' boards of directors, these transformational comprehensive standards address a wide range of compelling issues related to social workers' use of technology to provide information to the public; design and deliver services; gather, manage, and store information; and educate social workers. These new standards constitute a sea change in social work practice, administration, and education. Most recently, social work has adopted an updated NASW Code of Ethics that incorporates 19 new (and some revised) technology-related standards. The process started in 2015, when NASW appointed a task force to determine whether changes were needed in its Code of Ethics to address concerns related to social workers’ and clients’ increased use of technology. The last major revision of the code was approved in 1996. Since 1996, there has been significant growth in the use of computers, smartphones, tablets, e-mail, texting, online social networking, monitoring devices, video technology, and other electronic technology in various aspects of social work practice. In fact, many of the technologies currently used by social workers and clients did not exist in 1996. In August, 2017, NASW adopted a revised code that now includes extensive technology-related additions pertaining to informed consent, competent practice, conflicts of interest, privacy and confidentiality, sexual relationships, sexual harassment, interruption of services, unethical conduct of colleagues, supervision and consultation, education and training, client records, and evaluation and research (Reamer, 2017; Reamer 2018).

Dr. Doug Behan is the Director of Continuing Education and an Assistant Professor of Professional Practice at Rutgers School of Social Work. Dr. Behan has been at Rutgers School of Social Work since 2007 where he enjoys leading the nation’s largest university-based continuing education program for social workers and teaching clinical courses to MSW students. Dr. Behan has over 30 years of experience in a variety of social work settings. He has worked extensively in the mental health field as a clinician, supervisor, and administrator. In his career, he has enjoyed developing many programs including the school’s continuing education program, professional conferences and certificate programs, international training programs in China and India, a domestic violence treatment program, a children's intensive outpatient program and an intensive outpatient detoxification program. Dr. Behan has a deep connection to Rutgers where he has earned his undergraduate, master’s, and doctoral degrees. What are the Common Factors of Effective Psychotherapy? Meta-analytic studies show that no major treatment approach (e.g. CBT, psychodynamic, family systems) has proven superior to other approaches in treating psychiatric disorders. After decades of devotion and refinement, why has no treatment approach emerged as superior to the others? The answer is that treatment models are effective, not primarily because of their unique qualities, but because of the therapeutic factors they all share. Known as the “common factors”, when these components of psychotherapy are present, positive outcomes are maximized. Learn more about the common factors by visiting Dr. Behan’s website, WhatWorksInTherapy.com, where you can find valuable information on what to look for when seeking psychotherapy.

Dr. Ursula Whiteside is a licensed clinical psychologist and a member of the Clinical Faculty at the University of Washington. Dr. Whiteside trained under Dr. Marsha Linehan, the creator of Dialectical Behavioral Therapy, and later served as a DBT-adherent research therapist on a clinical trial led by Dr. Linehan that was funded by the National Institute of Mental Health.  As a researcher, she has been awarded grants from the National Institute of Mental Health and the American Foundation for Suicide Prevention. Dr. Whiteside is the CEO of NowMattersNow.org which was conceived from her research study involving over 18,000 high-risk suicidal patients in four major health systems. This study includes a guided version of NowMattersNow.org which is a program she developed that includes skills for managing suicidal thoughts and is based on DBT and paired with Lived Experience stories. Dr. Whiteside is national faculty for the Zero Suicide Initiative, a practical approach to suicide prevention in healthcare and behavioral healthcare systems. Dr. Whiteside serves on the faculty of the National Action Alliance Zero Suicide Academy. She is also a founding board member of United Suicide Survivors International and a member of the Standards Trainings and Practices Committee for the National Suicide Prevention Lifeline. As a person with Lived Experience, she strives to decrease the gap between "us and them" and to ensure that the voices of those who have been there are included in all relevant conversations. Nothing about us without us. Suicidal Behavior Disorder is a proposed separate diagnosis in the Diagnostic and Statistical Manual, Fifth Edition. Firstly, in order to have this diagnosis, an individual has made a suicide attempt within the past two years. Secondly, the criterion for non-suicidal self-injurious behavior is not met during the aforementioned suicide attempts. Thirdly, the diagnosis is not applied to preparation for a suicide attempt, or suicidal ideation. Fourthly, the act was not attempted during an altered mental state, such as delirium or “ confusion.” Finally, the act was not ideologically motivated, i.e., religious or political (American Psychological Association, 2013). A prior history of suicidal behavior is a key predictor for future suicidal behavior. Other environmental factors such as unemployment, financial crisis, bullying, military combat, incarceration, or relationship disruptions are also associated with risk. Although suicidal behavior may co-occur with another psychiatric condition, this is not always the case. Many people who die by suicide have not been diagnosed with a mental disorder. Suicidal behavior is the cause of over a million deaths worldwide every year. Non-fatal suicidal behavior is estimated to be even more common. It is important to create strategies to identify those individuals at risk within the health care system. This is critical because, as mentioned above, many people who complete suicides have not interacted with a mental health worker but may have been seen by a medical professional such as a primary care physician. Defining suicidal behavior disorder as a separate diagnosis in the DSM-5 is important to standardize care in order to develop methods to identify suicidal behavior, document in medical records, and track patients at every level of care. The fact that suicidal ideation waxes and wanes over time can create perilous situation in which key information may be missed. Continuity of care is very important with patients with a risk of suicidal behavioral—some healthcare systems have more robust medical records systems than others. Even in cases when the past suicide attempt is identified, data about suicide risk is often lost during hand-offs and may not be included in discharge summaries (Orquendo & Baca-Garcia, 2014).   Twitter: @ursulawhiteside @NowMattersNow

Dr. Stephanie Carnes is the President of the International Institute for Trauma and Addiction Professionals, more commonly called ITAP, which is a training institute and professional organization for addiction professionals. Dr. Carnes is a Senior fellow at Meadows Behavioral Healthcare where she works with sexually addicted clients and their families. Her father, Dr. Patrick Carnes, is the founder of ITAP and is an internationally recognized expert in the field. He also created the assessment tool and the 30-task model treatment modality which is used by clinicians all over the world to help their patients recover from sexual addiction. Dr. Carnes’ credentials include being a certified sex addiction therapist, a clinical sexologist, a licensed marriage and family therapist and a supervisor specializing in therapy for couples and families struggling with sexual addiction. Dr. Carnes is the clinical architect for Willow House at The Meadows, a 45-day inpatient program designed specifically for women who are struggling love addiction, relationship issues, and intimacy disorders.  Dr. Carnes currently co-facilitates Module 2 in the Certified Sex Addiction Therapist Training as well as the Certified Partner Trauma Therapist Training.  She is the author of numerous publications including her books Mending a Shattered Heart: A Guide for Partners of Sex Addicts and Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Compulsive Sexual Behavior Disorder was added as a new mental diagnosis by the World Health Organization in the ICD-11. Compulsive Sexual Behavior Disorder is characterized by a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to negative consequences and impairment in a person’s functioning on many levels including family, work and social life. A defining feature of Compulsive Sexual Behavior Disorder is when a person makes unsuccessful efforts to stop or control the time they participate in sexual fantasies, urges or behavior in an attempt to cope with stress or mood states.

Dr. William Dodson is a board-certified psychiatrist and, since 1994, has specialized in attention deficit hyperactivity disorder which is more commonly called ADHD. He has written extensively on how the basic research on ADHD can be applied to everyday clinical practice. Dr. Dodson retired in April from active patient care and is currently spending his time completing the manuscript of a textbook on ADHD for clinicians on how to diagnose and treat ADHD from childhood to the elderly.  Incredulously, there is no such textbook, and this will be the first one available for clinicians once it is completed. Dr. Dodson is a former faculty member at Georgetown University and the University of Colorado Health Sciences Center, Dodson is a Life Fellow of the American Psychiatric Association and was the 2006 recipient of the Maxwell J. Schleifer Distinguished National Service Award for his work with people with disabilities. Attention-Deficit/Hyperactivity Disorder includes a persistent pattern of inattention, hyperactivity, or both. If present, ADHD symptoms of inattention or hyperactivity can make it difficult to perform in school, home, and social settings. Dr. Dodson’s work with ADHD has revealed the hallmark feature of ADHD to be the “inconsistent engagement,” inconsistent performance, inconsistent moods, etc. Activities that were done beautifully yesterday are terribly done today. Usually this is commonly viewed in a very judgmental way that the person with ADHD is “flighty, unreliable, unpredictable, or intentionally not trying.” It is only in the last few years as children with ADHD became articulate adults with ADHD that we have come to understand that there is a consistent pattern to the inconsistency. In a limited number of circumstances people with ADHD could “get in the Zone/get in the Flow” and not have any impairment at all. When an ADHD person is Interested, Challenged, or finds the task Novel or Urgent they snap into the Zone and can literally do anything they try to do. When they lose that sense of ICNU, they are back in La La land again. The conditions that engage, organize, and motivate the other 90% of human beings (Importance, Rewards, and Consequences) never ever work for people with ADHD. Individuals with an ADHD nervous systems ALWAYS use Interest, Challenge, Novelty, and Urgency and can NEVER use Importance rewards and consequences in daily life to get the tasks of their lives done. The second defining feature of ADHD is the special problems of how people regulate their emotional lives.  People who have an ADHD style nervous system tend to experience their own lives in an intense and passionate way that can be exhausting to themselves and their loved ones.  To make matters even more difficult, people with ADHD can also have episodes of overwhelming, almost unbearable emotional pain that are triggered by their perception that they have been rejected, criticized, or fallen short of their own expectations.  While no one likes being rejected or criticized, the experience of Rejection Sensitive Dysphoria (also called emotional dysregulation in Europe) is much, much more intensely painful and disruptive to their lives than similar events are to Neurotypical people without ADHD. The combination of the emotional component of Rejection Sensitive Dysphoria and the cognitive component of an Interest-Based Nervous System can explain virtually all of the manifestations of adolescent and adult ADHD. So, in the end the only person who sees the evidence of ADHD firsthand is you. In the end the only person who must completely be sure that you have an ADHD nervous system is you as well.

Dr. Stapleton is an Associate Professor in Psychology at Bond University in Australia and in 2019 she was named Psychologist of the Year by the Australian Allied Health Awards. Dr. Stapleton is the world’s leading researcher in Emotional Freedom Techniques which is commonly called EFT or Tapping and has established herself as one of Australia’s leading online Health Professionals. One of Dr. Stapleton’s most significant contributions to the field of mental health was to lead the world’s first randomized clinical trials investigating the effectiveness of EFT. I encourage you to read Dr. Stapleton’s new book The Science Behind EFT Tapping which was published in 2019. Emotional Freedom Techniques, commonly known as EFT or Tapping, are groundbreaking techniques that combine psychotherapy and acupressure, bringing together elements of exposure, cognitive therapy and somatic stimulation. EFT’s developers see it as being similar to acupuncture but without the needles, and it has been referred to as ‘psychological acupuncture’. As with acupuncture, EFT stimulates various pressure points on the face and body to relieve stress, which then alleviates many psychological-based concerns. EFT is a powerful self-applied, stress reduction method based on extensive research that demonstrates that emotional distress can contribute to illness. EFT can help a range of symptoms or conditions by simply focusing on the issue you would like to address and linking it to an acceptance statement using a simple two finger tapping technique. EFT is a surprisingly easy technique to use and works by stimulating pressure points on the body with this two finger tapping technique which result in a calming effect on the amygdala (the stress center of the brain), and the hippocampus (the brains memory center), both of which play a role in the decision making process to determine if something is, or isn’t, a threat, and in the fight or flight response. EFT also seems to have the same calming effect on cortisol – the stress hormone. High cortisol levels can be caused by a variety of things, including biological stressors, and mood disorders such as depression and anxiety and psychological stress. Clinical trials have shown that EFT is able to rapidly reduce the emotional impact of memories and incidents that trigger emotional distress. EFT has an immediate calming effect and can be used by children as young as 3-4 years old. Emotional Freedom Technique on Twitter: @PetaStapleton

Dr. Michael Kerr succeeded Dr. Murray Bowen as Director of the Georgetown Family Center and served in that role until 2010. Dr. Kerr co-authored with Dr. Bowen the seminal book Family Evaluation: An Approach Based on Bowen Theory. Dr. Kerr’s new book, Bowen Theory’s Secrets: Revealing the Hidden Life of Families, was released in February 2019. Dr. Kerr was also the founding editor of Family Systems: A Journal of Natural Systems Thinking in Psychiatry and the Sciences. Dr. Kerr is now the Director of the Bowen Theory Academy in Islesboro, Maine. Family System Therapy  uses systems theory to describe the family as a complex emotional unit where members are intricately and intensely interconnected. FST looks through the lens of system theory where each family member is emotionally and behaviorally connected through complex interactions. In FST, “Families so profoundly affect their members’ thoughts, feelings, and actions that it often seems as if people are living under the same ‘emotional skin.’” Family members react to one another in both behavior and emotions. If there is a change in one person, there will most likely be reciprocal changes in other family members. Family members who “absorb” the anxiety of others are vulnerable to depression, alcoholism, affairs, and physical illnesses. Family Systems Therapy on Twitter: @thebowencenter

Dr. Judith McCoyd is an Associate Professor at Rutgers School of Social Work and co-author of Grief and Loss Across the Lifespan, a book that seeks to educate mental health clinicians on how to address the needs of someone experiencing grief and loss.  Grief and loss experiences can affect a person’s feelings, behaviors, and thoughts. During a lifetime, we all experience multiple losses. Grief and loss therapy can help to offer support through the bereavement or transition process, regardless of whether or not an individual has a formal mental health diagnosis. There are many types of losses and talking to a therapist can allow one to process the meanings of these losses and the changes in identity that they can spur. Loss can include the loss of a job, home, functioning, and even the loss that occurs when there is a transition. One example of loss is when a child goes off to kindergarten or college, which may bring on grief as well as a longing for the past. Indeed, any change can be a form of loss of the way things once were. Cultural beliefs and traditions influence how people express grief. In some cultures, grief may be open and sociable. In other cultures, grief is experienced privately and quietly. Culture generally guides the time period in which family members are expected to grieve. In short, culture, the support of family and friends, and the adaptability to change all influence an individual’s ability to cope with loss. Having a therapist to accompany one through the process of change and reflection can be powerfully beneficial.

Dr. Michael Nichols currently serves as a Professor of Psychology at William & Mary and has been a leading teacher and practitioner of Family Therapy for over 40 years. He is the author of many revolutionary books, including Stop Arguing with Your Kids, The Lost Art of Listening, The Essentials of Family Therapy, which is currently in its sixth edition, and Family Therapy: Concepts and Methods, which is currently in its 11th edition. Family Therapy is a strength-based, outcome-oriented treatment that focuses on the interaction between the individual and his or her family.  According to Family Therapy, our behaviors are a function of our relations with others, and Family Therapy examines the interplay among family members, rather than focusing solely on individuals. The role of the family therapist is to discover each member’s underutilized strengths and to help him or her move past negative patterns of communication that interfere with the family’s health and functioning. After observing how your family interacts, the therapist will draw a chart, or map, of your family’s structure. Since there is an overall organization or structure that maintains a family's dysfunctional interactions, this chart helps identify the hierarchy, family subsystems, and boundaries (both rigid and flexible) within the family unit, such as the relationship between parents or between one parent and one particular child. Using this plan, the therapist can also see where changes are needed and what type of interventions will help restructure the family.

Dr. Marlene Maheu is a licensed psychologist and the founder of the Telebehavioral Health Institute. She is the originator of the Framework for Telebehavioral Health Competencies for Ethical Telebehavioral Health and Online Counseling. Dr. Maheu is the author of many books, including A Practioner’s Guide to Telemental Health: How to Conduct Legal, Ethical and Evidenced-Based Telepractice. Telebehavioral Health is a remote mental health service where the delivery of mental health care services uses technology, such as videoconferencing, computer programs, and mobile applications, led by mental health providers, such as psychiatrists, psychologists, social workers, counselors, and marriage and family therapists. Recently, there has been an increase in Telebehavioral Health services. Because physical contact with mental health clients is generally not necessary, it seems that this type of mental health service is a good fit for mental health practices. The use of large computer screens may actually enhance the level of communication between the client and the clinician. If a person is concerned about the stigma associated with going to the office of a mental health provider, they can meet with that provider remotely. Due to the shortage of mental health providers, having the opportunity to see individuals remotely may actually make it easier for clinicians to see more clients. Telebehavioral Health on Twitter: @telepsychology