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Cognitive Behavior Therapy: Optimizing Our Nature

Meeting Minutes for June 8, 2005; #187


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Announcements

We thank all who donated items for our first Garage Sale Fundraiser and those who participated in running it at the Freethought Commune and making it a fun and successful day. We made 310 dollars, which covers three meeting rentals plus change.

Our current calendar of events is as follows:

June 11 at 1PM: Freethought Potluck at the Van Oosterhout's house in Marne. Join us for games, music, recreational activities and a stroll in the surrounding woods if you wish. Bring a dish to pass, and any sports items and musical instruments are encouraged. For more information contact hosts Jan or Bill at jabivo@aol.com or call 616-677-5536.

June 15 is the next Freethought Movie Night, hosted by Jason Pittman at his home at 740 Lockwood, NE, GR. The featured film will be The Corporation. BYOB and a snack to pass. RSVP by email at jpittman@backpacker.com or telephone: 616-634-2471.

June 18 (Saturday) is the next Freethought Women's Group, at 10AM at Jennifer and Amanda's house; 734 Lockwood Street, NE, GR. They are currently reading, and have as the book for discussion: Don't Think of an Elephant; Know Your Values and Frame the Debate, by George Lakoff. Feel free to bring a snack to share. For more information, questions or directions, send email to musiqueforlife@yahoo.com (Jennifer Beahan) or call 616-706-2029.

Our next regular meeting is on June 22 with the topic: The Science & Politics of Energy. Greg White, Legislative Liaison, Michigan Public Service Commission, will be our presenter for this meeting.

July 6 is the next Freethought Movie Night. See above information. The featured film will be: O Brother Where Art Thou.

On July 9 (Saturday), from noon to 6PM, we are having our Annual Freethought Picnic. This year it will be at Millennium Park, at Open Shelter “A.” Our newly produced Freethought Association banner will be on display there. Bring a dish to pass, sports equipment, juggling props and musical instruments, and sunscreen. There is a man-made beach and small lake there and plenty of trails and fun things for all ages.

The first regular meeting of July is on the 13th with the topic: Organ Donation; The Gift of Life and will be presented by Jennifer Tislerics of the Michigan Gift of Life.

The second Freethought at Lake Michigan happening will be on July 23 at the (Bill & Jan) Van Oosterhout's Lake Michigan cottage. Request directions and details by emailing jabivo@aol.com or call 616-677-5536. Bring your own beverage, dish to pass, swimsuit, instruments, etc.

July 27 should prove to be an unforgettable meeting, with members: Matt Wylie, Jeremy Beahan and A.J. Koorstra presenting The Jesus Smorgasbord; Recreational Christianity in the Northern Bible Belt.

For our August 10 meeting Dr. Brian Mikula will present The Science of Chiropractic.

Rot on the Vine; The Many Dark faces of Religion, is the provocative topic title for our August 24 meeting. J. Stenish, Professor of Chemistry, Emeritus, Western Michigan University, and author of the book Rot on the Vine will be our presenter for this evening.

PLEASE NOTE that our September 14 meeting will be our last one at the Yankee Clipper Library location! The topic for this meeting will be Astronomy; The Origin of Religions, presented by Bob Baumbach, Professor of Astronomy at GRCC (retired) and FA member.

The September 28 event is one we are co-sponsoring with the Fountain Street Church: Our Environmental Destiny, presented by Robert F. Kennedy, Jr. He will be speaking at the Fountain Street Church in downtown Grand Rapids at 7:30PM, and the ticket cost will be 10.00. The progressive FSC has, like our own organization, had a shining roster of special guest speakers throughout its colorful history.

Our very first meeting at our new location, the Women's City Club in the downtown Grand Rapids area, will be on October 12, with the topic: Baubles of Blasphemy, presented by Edwin Kagan, Constitutional attorney and author of Baubles of Blasphemy, and the Founder of Camp Quest- a secular summer camp.

Some things change—others stay the same. Meetings at the Women's City Club will continue to be held on the second and fourth Wednesdays of each month, unless otherwise noted. The format will also remain the same: starting time will be at 7PM for our scheduled topic, with a question and answer period following the main presentation. We will also continue with our social time immediately following the meeting there at the WCC, then, all are welcome to join us at Vitale's Restaurant where we gather socially, with space always reserved for us. The Women's City Club offers us great seating, access to a living room in addition to the main meeting/lecture room, a good commitment for the future, parking is very accommodating and they throw in refreshments with the agreeable rental charge.

This year's annual Winter Solstice Party will be the Women's City Club, with a dinner and presentation, on December 14, at 6:30PM. We will have more information on this annual event and call fro RSVPs as the time draws closer.

The Women's City Club is located at 254 East Fulton, near Davenport College and across from the Masonic temple. The telephone number is 459-3321 and they can be reached by email at: womenscityclub@iserv.net.

We have scheduled meeting topics and presenters for the balance of the year and we will keep you posted on what is coming up. Or check our website for the full calendar and more information as well as links to a plethora of interesting things for freethinkers.

Member, James Courtney, had a tape available of the NPR radio program, This American Life, that recently featured the topic: Godless in America. Courtney has also authored a book that we look forward to learning more about.


Presentation

The topic for this meeting was Cognitive Behavioral Therapy; Optimizing Our Nature and was presented by FA member Robert W. Collins, PhD, PC. His doctorate is in psychology and he was a professor at Grand Valley State University before going into private practice and then focusing on his Internet business that treats toilet training issues using behavioral psychology, and with the memorable name: Soling Solutions ( www.soilingsolutions.com <http://www.soilingsolutions.com/> ).

Dr. Collins began by comparing/contrasting the grand scope of the evolutionary view, which encompasses the change and adaptation of species through geological time spans with that of what Cognitive Behavior Therapy (hereafter rendered as CBT) addresses. CBT deals with the individual, operating within the framework of a lifetime. He moved on to explaining that the root of cognitive is cognos, which means to think, to know. Descartes famously summed up the cognitive being in his line: Je pense donc je suis (I think, therefore I am). Another way of looking at it is: We think...we exist....we exist...we think. Our adaptive power within H. sapiens' history derives from our intelligence; our essence is in our ability to think and know.

We are pattern-seeking/seeing animals and this too is a power we hold, but it can also lead to misinterpretation of our physical reality. Depending on the pervasive cultural influences, we might see the Virgin Mary in a tortilla chip, knothole of a tree or grease stain on a garage window—or some other gestalt from other culture-specific memes. The powerful image-making and interpreting machines in our heads can hallucinate fantastic illusory realms and cast us deep into delusional thought processes.
CBT explicitly uses reason and education to correct non-psychotic disorders of thought and emotion, where the patient practices a prescribed course of action leading to mental hygiene. The techniques of CBT may be used for everyday challenges, such as an inability to speak in public, handling job interviews effectively, etc., as well as more major issues.

CBT is evidence- based and it minimizes the exploration of childhood, unlike psychoanalysis. Also, it regards a continuum where the past becomes the present rather than a long belabored exploration of the past itself. It explores daily issues, takes clients at their word, and deemphasizes motives and symbols. With CBT, clients learn to adapt and monitor their behavior, practice new approaches, and take control of their lives. The training clients receive during the course of their therapy, they then learn to apply directly in their real world lives. CBT is a very direct form of therapy and it can be used in combination with other therapeutic means of restoring normal cognitive functioning.

Two of the founders of CBT are Albert Ellis, PhD and Aaron Beck, MD. Dr. Collins turned to Ellis first. Dr. Ellis used the pedagogical device of ABCD in his teaching. A, for instance, stood for antecedents; B for Beliefs; C for consequences; D for disputing the irrational beliefs, and so on. A client may come to the CBT practitioner with a host of irrational beliefs (IrB's) such as that he or she is stupid, or must be loved by all for everything. The goal is for the client to get to the real issues as well as learn to perceive what triggers problem reactions to the environmental elements, how he or she behaves at these times, and to learn ways to adapt to these situations and change behavior at these times. When the client is frustrated by not being able to be everything he or she thinks s/he should be, the client may be encouraged to look at reordering his/her priorities, rather than thinking of him/herself as a failure. CBT seeks to mitigate catastrophizing life's challenges, but instead to look at them in a different way; one that makes life manageable and leads to a successful approach to handling the difficulties in it.

Dr. Ellis, who was trained in psychoanalysis- but went to the other end of the spectrum (daily life events in the present [as part of a continuum in life], not focusing on motives or the past primarily), was not interested in the concepts regarding bedwetting, as one example, as being about passive aggression on the part of the child toward his or her parents, but instead looked at the direct problem and how to go about modifying the target behavior. Dr. Ellis feels that people often make too much of shoulds and musts, setting themselves up for stress and problem behavior. He shoulded all over the place and he shoulded on himself—or referring to the fixation on musts as musterbation, are some of the examples of the earthy manner in which Dr. Ellis would convey his thoughts.

His approach not only broke up false links people created about themselves, but also addressed over-generalizing in the larger life scheme. Since his style, and that of CBT in general, was not to dwell on failure as a natural—a given—due to past events, Ellis had no time for victimization, which often serves as an impediment to therapeutic progress. The past is not all- important—one is served better by moving on, looking ahead, and dealing with the here and now problems in a rational manner.

Dr. Ellis' personal style was also, in contrast to Dr. Beck's, rather loud, confrontational and dramatic. A client complaining of suicidal thoughts would likely be met with the in-your-face demands of: How many ways can you do it!? Give me ten examples! Be specific!! This would serve as a risk assessment device as well as revealing the client's thought processes. He had a coarseness about him, often peppering his talks with foul language, and was very spontaneous- employing all means to get people to deviate from negative behaviors, while keeping the client on his or her toes, and demanding active participation in his/her own progress.

Dr. Aaron Beck, on the other hand, was a quieter, more systematic CBT practitioner. He compelled his clients to participate in homework assignments, such as keeping a good diary, charting, and collaborating in the rational treatment methodology to- in effect- become his/her own scientist. He would get his clients to become conscious of, and to identify, thoughts that were cognitive distortions, or CDs. These are reflexive, and manifested as habits, normally operating below the client's radar of self awareness. That which is over-learned can be adaptive or maladaptive—sabotaging or productive (a double edged sword, as Dr. Collins stated). A medical doctor, Beck saw maladaptive habits as viral—growing and spreading to more and more aspects of the client's life, creating ever more pathology in the client's life experiences and interactions.

Some of the Cognitive Distortions (CDs) Dr. Beck had addressed were the all or nothing one... where everything is black or white; over-generalization; jumping to conclusions, the shoulds and musts that we examined with Dr. Ellis' approach; personalization and scapegoating. Over personalization can introduce paranoia in the client, and mental filters that cause the client to perceive too much negative feedback in others can create an escalating negative feedback loop where real negativity is generated, exacerbating and adding real negativity to the distorted view.

A homework assignment for the client may involve examining core values and presenting positive ideas to focus on. The learning process for the new ideas may be sensory and will involve generating evidence that supports the new ideas and beliefs. The patient can then know that the positive statements are correct and verified and has a list of examples of his or her own competence, rather than focusing on inadequacies and how problems have always plagued him or her. This technique, in effect, re-programs the client while making him/her more involved directly in the treatment process. S/he learns skills that can then be used in other situations.

Dr. Collins talked about the thought record at this point. The patient learns to recognize where s/he was when certain thoughts were generated, who he or she was with, and the feelings accompanying the triggered event. The therapist may ask if the client was predisposed toward more likelihood of re-occurrence of the habit in particular situations; all with the goal of increasing self- awareness of negative habits and concepts in the patient. The hot thought—the immediately triggered reflexive ideas that arise from certain situations- are reflected upon from the journaling done by the patient-- in order to determine what evidence there is for its support or erosion. When the real core problem is addressed, then a valid target is found to work on.

If the person simply feels generally inadequate, then there is nothing to get a hand hold on to manage. In an actual thought record page Dr. Collins displayed, there were columns with the first one asking the type of questions indicated at the beginning of the previous paragraph; the next column asked for a description of the patient's mood and to measure the intensity of it; next he will describe what is going through his mind at that time, think about what that says about himself, speculate on his fears of what might happen, etc., then examining the hot thought—both what supports it and what does not. Then the patient will write balancing alternative thoughts, and then he is to rate to what degree he believes his alternative thoughts to be valid. He may then be asked to go back to the moods column and re-rate the intensity of each feeling, as well as any new records.

An example Dr. Collins provided of evidence or experiences a patient was able to produce, that ran counter to his previous feelings of inadequacy, listed truths such as that his children and wife loved him; his children turned out well as a result, in part, from his parenting; he has genuine friends; he believes he is doing well at his job at times, etc., including feedback he has gotten from others—employer, customer satisfaction, and so on. Part of the journaling process will involve evidence and experiences that support the new belief that are written as a narrative—such as a specific event that occurred involving personal interactions with significant others, and Dr. Collins showed us written examples of this as well.

Dr. Beck's approach may perhaps suffer from being too systematic with the treatment time being slowed down (and extended) as a result. The days are gone, Dr. Collins noted, when patients would be in therapy for years, as with psychoanalysis. Managed Care protocol looks for a very quick turn around time. One chart Dr. Collins showed us gave visual feedback to the patient regarding his or her depression levels over the weeks of therapy, with one of the axes plotting depression level and the other one showing weeks. It would be hard to imagine, now, a Managed Care approach extending over 36 weeks or more, as indicated on the graph.

Dr Collins, in discussing anxiety, mentioned the What If poem from the Shel Silverstein children's book, A Light in the Attic. It went as follows: Last night, while I lay thinking here/ Some Whatifs crawled into my ear/ And pranced and partied all night long/ And sang their same old Whatif song:/ Whatif I'm dumb in school?/ Whatif they've closed the swimming pool?/ Whatif I get beat up?/ Whatif there's poison in my cup?/ Whatif I start to cry?/ Whatif I get sick and die?/ Whatif I flunk the test?/ Whatif green hair grows on my chest?/ Whatif nobody likes me?/ Whatif a bolt of lightning strikes me?/ Whatif I don't grow taller?/ Whatif my head starts getting smaller?/ Whatif the fish don't bite?/ Whatif the wind tears up my kite?/ Whatif they start a war?/ Whatif my parents get divorced?/ Whatif the bus is late?/ Whatif my teeth don't grow straight?/ Whatif I tear my pants?/ Whatif I never learn to dance?/ Everything seems swell, and then/ The nighttime Whatifs strike again.

Because anxiety mimics nearly every physical problem, overuse of medical services occurs. Patients can sometimes become even more distressed when being seen by a psychiatrist, since they feel the problems they suffer from are all in their head, but if they are being seen by a physician, they are- conversely- more relaxed oftentimes, in feeling it is a physical problem only. Dr. Collins addressed at this point, some of the male/ female differences seen in how anxiety problems are dealt with by the different genders. He also talked about how group therapy sessions are good for anxiety problems but must have a good group leader, or else patients will sometimes tend to try to one-up each other with their personal stories.

Patients may be instructed to simply allow a panic attack happen-- to go with the flow. They will realize that they hadn't died and the worst effects of the attack are mitigated via passive response. This creates a new reality for them that helps reprogram them and allows them to trust their bodies again, and then, begin to recover. Dr. Collins also talked about hypnosis and how this works. It is often portrayed as an amazing phenomenon but is actually very ordinary and can occur any time the subject is in a suggestible state of mind.

People who journal have fewer physiological illnesses. Recording their experiences causes the patient to become exposed to what's going on and to examine it in a more rational way at a time when the hot thoughts are not overwhelming. Errant suppositions can then be disputed, based on evidence. They also learn to be aware of their own fear responses: heart palpitation, dizziness, etc. and to know what symptoms follow the initial reaction. People are often prone to overestimation errors, feeling things have to happen due to poor development of critical thinking skills. Books on fallacious thinking often mention the belief in the hot hand, and not understanding how fair coin tosses will run 50-50 (heads or tails) but that if one focuses on only an isolated run of one or the other within the series, it will seem otherwise.

Dr. Collins also mentioned role playing real situations as efficacious in reducing anxiety and gaining control over one's reactions to those situations when they occur. Other helpful approaches involve cognitive/behavioral rehearsals, use of metaphors and stories, biographies and testimonials. Our presenter gave us an amusing example of employing paradoxical psychological judo, where a compulsive liar was asked by her therapist to simply tell one additional lie each day! She said that she lied without thinking about it—out of unconscious habit. The result of her assignment was that having to plan the additional lie forced her to become more aware of her other lies, and then, to realize how silly her lying really was. Since she had to take control over her lying in order to plan telling more falsehoods, she realized that she had control over telling fewer prevarications too!

Such exercises as the example just given about the liar, shows how these assignments tend to lend a sense of empowerment to the individual. He or she can take active control over the target problem and recovery. The group leader, in the above example, took care to explain the reasons for trying this paradoxical intervention, what might be accomplished, and left it up to the client to decide if it was worth a try as an experiment. It was done with the client's informed consent and agreement.

In the Q&A portion of this evening's presentation, one audience member mentioned how his panic attacks were made manageable when he assimilated and accepted them. He became less panicked over the thought that he might have these attacks!

It was asked if the CBT approach, where the power of recovery is in the hands of the patient him/herself, is one that is agreeable for those who require an authority figure to take charge. Dr. Collins noted that even in this case, the patient may desire to please the therapist, who pushes him/her to try new things, and then the patient will take the skills learned in pleasing the therapist out into the wider world.

Religious issues were discussed. In most cases the religious orientation of the patient relative to the therapist is irrelevant but in those situations where it is a factor, the therapist simply can refer his/her patient to one more in line with the patient's worldview.

In reply to a question, Dr. Collins addressed the concepts behind neurolinguistic patterning but deemed it to be more in keeping with pop psychology. He talked about ADD and how those who have it experience a negative reaction from their environment—feeling harassed by it. They are often highly emotional, filled with negative thought processes and sometimes they can feel jealous of non-afflicted siblings. ADHD children do not usually readily respond to CBT, since they typically have trouble processing the word-based approach and some of the concepts involved. The ratio is 8:1 for boys compared to girls with ADHD. Boys, in general, are more doers than verbalizers.

In discussing genetic predispositions, Dr. Collins turned to his specialty of toilet training issues. The statistics he gave were that if one parent was a bedwetter then the offspring was 40% as likely to be one as well. If both parents were, then this rises to 80%! He is convinced of the power of the genetic component in behavior. The environment can potentiate nature.

The last issues discussed dealt with specific well-known individuals and to what extent certain behavioral problems can be discerned in them. We also examined how historical factors, different lifestyles and environments can correlate with increases or decreases in certain forms of mental illness. Some events or changes in how human societies operate now may fuel a sense of losing control. We are forced to adapt to lightning quick changes in our lives, equipped with the tools we developed in the our hunter-gatherer past. These skills and adaptations served us well for the overwhelming majority of humankind's existence but runs afoul of some of the most recent developments in our environment. We are of nature and it may loop back upon us.

Secretary: Charles LaRue.


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