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CBT Pioneers and Influencers
CBT is already a mature field, often being the approach someone seeking treatment specifically names, and a young enough field to still have many of the first influential thinkers, researchers, and practitioners among us. We are thus blessed with the ability to ask them about themselves and their approach to the problems that confront many of us. Imagine a world where we got to listen to Darwin outside the Royal Society or to the Wright brothers, and you’ll get a sense of the important of these sessions, and the treat they are to so many of us.
Meet our CBT Pioneers and Influencers!
Meet Russell Barkley, who has explored ADHD and its implications for half a century, looking at parental relationships, its effects on executive functioning as well as it long-term health and occupational outcomes. Lately, he’s been studying mortality rates and life expectancy as he has followed ADHD through adulthood, showing it is not only a mental health problem but a health concern as well.
David Barlow explores a new approach to therapy: Transdiagnostic Therapeutic Elements that would be applicable across a range of disorders. Watch as he tells us more.
Listen to Judy Beck as the teacher comes full circle, returning to her roots. It includes fascinating insights, especially a discussion of the principles and fidelity inherent in manuals and the need to conceptualize the patient’s individual needs.
David Burns explores his approach to a patient-focused approach to therapy.
Andrew recounts his interesting path from deep South chicken-farming family to Southern California researcher, therapist, and innovator. From “practice dating” and family systems, he’s moved to couples’ conflict and couples’ intervention, studying the push-pull patterns and the roles the partners take. With the late Neil Jacobson, he developed Integrated Couple Behavior Therapy that focuses on understanding broad patterns, causal analysis, and behavioral change and, especially, emotional acceptance.
Esther Deblinger shares her personal and professional journey choosing a career in clinical psychology and focusing her research on helping children and families overcome adversity. Her research in collaboration with colleagues not only led to highly effective evidence-based treatments that are utilized worldwide, but her academic pursuits deepened her understanding of the impact of childhood trauma on her own parents. Her training, research and service efforts continue to be inspired by the resilience she has seen in her parents as well as the many children and families with whom she has worked.
Keith S. Dobson, FCPA, FCAHS, FRSC, Professor of Clinical Psychology at the University of Calgary recounts his early days among some of the field’s greats: Brian Shaw, Tim Beck, Neil Jacobson, Steve Hollon, and Nik Kazantzis and talks about the challenges of bringing what we learn in practice back to the laboratory for further exploration, saying we should aim to improve its bidirectional pulse. He sees the recognition of transdiagnostic approach’s usefulness as a great opportunity for CBT. And he worries about both access to and funding for CBT and its practitioners. He quoted a recent WHO study that pegs mental health spending at 2.1% of an anemic pie; there just aren’t enough practitioners to support demand. Dobson tells a little about his past and volumes about the current and future state of CBT. Enjoy.
Perhaps most famous for Acceptance and Commitment Therapy, Hayes is equally passionate about social justice and societal concerns and his hope that psychology can leave the protocols behind and focus on the competencies.
When asked about dissemination, he said he hates the word and hates the very idea. We shouldn’t be telling, or showing, he says, but, instead, creating a safe space in which we welcome all to talk about their perspectives before talking about ours. At the same time, Hayes relishes the work of Ronan and Klepac’s Organizational Task Force and wishes we were banging the drums more loudly about their findings.
Stefan G. Hofmann
Stefan G. Hofmann
Stefan talked about what’s most important in CBT, asking, what are the core competencies and what allows us to properly target a problem. He noted that it is essential that approaches must not lead to tunnel vision, but, instead, we must always be prepared to tear the walls down, using what is demonstrated to work.
He noted that ABCT is incredibly rewarding, a community that is inclusive, both of people and approaches to treatment.
One of CBT’s recognized experts in depression, Steve Hollon looks at the landscape in clinical practice today, seeing a need for change. He wants us to use what we know works, not what we know best. He lauds those, like Vikram Patel, who is researching ways to increase access to mental health care in less developed countries, exploring new ways of task shifting.
Alan Kazdin recounts how he came to be a psychologist and discusses where his emphasis is now: studying models of treatment delivery with the idea of completely changing who, and how many, can access treatment. He notes that “most people in need of psychological help receive no treatment.” This is based on current delivery models. He’s hoping to find ways to make delivery scalable and accessible, overcoming the current inherent limits.
Art Nezu and Christine Maguth Nezu
Art and Chris have done outstanding work in developing problem solving approaches and specialty competencies in psychology, as well as promoting multiculturalism and diversity within the field. Listen as they discuss early days in art, theatre, and social activism through their fortune telling for the field.
Tom Ollendick talks pediatric anxiety treatments, and especially his early work with one-session treatments that had success rates as high as 75% and long-term success even at 4 years.
Jacqueline B. Persons
Jacqueline B. Persons
Jackie has been a tireless promoter of integrating clinical work and research. Case formulation and case conceptualization are virtually synonymous with her work. She studies change in outcomes.
Jackie recommends that clinicians collect data to inform treatment and treatment’s progress. She says that data, and those viewed changes, can be repurposed to help develop refinements to treatment approaches. Data helps the patient and informs the science. She notes that all her own work comes out of the clinical work she does, which is probably what led her to found the Research in Clinical Practice SIG at ABCT.
She noted that she was trained by Tim Beck and David Burns.
Patricia Resick looks to the future, discussing the potential of technology, not only in treatment where remote sessions are being shown to be as effective as in-camera ones, but also in helping train front-line providers, like the social workers who are often the ones administering most of the treatment that people will receive. She thinks courses in CBT, especially basics, diagnosis, and assessment, could supplement the two years in masters-level training that often doesn’t cover enough.
Steve Safren recounts his work on “Life Steps,” which promotes adherence to taking HIV medicine. In 1996, medicines were becoming available that changed HIV from a death sentence to something manageable, but the drugs were difficult to take, had huge side effects, and had complex dosages. Life Steps helped people break those complex dosages into manageable steps. He notes that this adherence intervention has since been adapted to other areas, include comorbid depression and other mental health problems. And, he says, it’s become the standard of care for Doctors without Borders in their fights against HIV/AIDS in South Africa. He thinks that what science shows isn’t always practiced. He notes how, when confronted with severe mental health problems, instead of sequencing various solutions, such as medicines and cognitive-behavioral therapy, which science shows is the most effective approach, practitioners might just throw everything at it at once. He is also looking forward to seeing more studies comparing new technologies to in person treatment, to see which has more success for which clients; and hoping to involve CBT in the medical system more effectively.
In a discussion in which he lays out various elements that we do, or can, use to help us better address our patients’ needs, Greg Siegle points to neuroscience, mindfulness, dissemination and implementation, as well as brain mechanisms, and manages to make it all visible, understandable, and come to life.
Talking about neuroscience’s role, he says negative emotions are visible, we can see them: he’s watched a 30-second response to a negative word, uttered in a nanosecond; by showing this to our patients, we show them they are not the sole cause of their negative emotions. Ultimately, we might be able to personalize medicine, finding those who are more likely to respond better to CBT or, even better, find ways to prepare those who might not so that they could better benefit. He hopes we can harmonize the language of psychology, as researchers, clinicians and patients, and industry each use different languages. We should aim to build dissemination and implementation into research so our findings can be used. Talking about ABCT, Siegle said the Association kept him touch with what clinicians care about.
One of the foremost experts in hoarding, Gail Steketee reflects on her past and psychology’s future. She thinks it essential to find out what works best, for whom, and under what conditions. She believes we need to take advantage of new information available now from our research findings in neuroscience and biology in order to better help people.
Gail thinks that it is important to distinguish when diagnostic categorizing works for us; when the “lumping and splitting we all do as humans is used to best advantage.”
CBT Pioneers Project
Interview with Dr. Richard Suinn
June 4, 2021
Interviewer: This interview for the CBT Pioneers project is with Dr. Richard Suinn, ABCT’s president during 1992-1993. Dr. Suinn agreed to participate in this interview under a unique situation: he is only recently recovering from a stroke which has affected his speech fluency.
We’re very glad that you’re here with us today, Dr. Suinn!
Is there anything that you’d like to say before we get started with the questions?
Dr. Suinn: No, I apologize if I am not as fluent as I would normally be, but we will do the best we can, and hopefully have a good interview.
Interviewer: Yes. Thank you for being here with us today. Okay, so Dr. Suinn, I’d love to know: Who are the most important influences on your career?
Dr. Suinn: Well, first of all, the one that stands out the most is Brendan Maher. He had been the Chair of the Department of Psychology at Harvard, and became President of [APA] Division 12, Division of Clinical. During his presidency, and when he was designing his convention, he called me and invited me to be part of a symposium panel.
I was a young, wet-nosed, assistant professor at the time, and this was my first convention. And eventually, it became one of many conventions that have been on. That was a starter, and that was very important to me.
He then became editor of the Journal of Clinical and Consulting Psychology. And again, he reached out to this young man, and asked me to be a member of his editorial board. And that was the start of my entry into the editorial activity. So, he gave me a real boost at the start of my career.
In addition to that, I feel that I have been influenced by the period of time that I was in graduate school. This was a period of time when behavioral therapy was being birthed. Joe Wolpe, Arnold Lazarus, Cyril Franks, and a number of other leaders were just pulling together this animal called behavioral therapy, which would become a world force.
The interesting thing was the availability and accessibility to these leaders. I visited Joe Wolpe, Cyril Franks, Arnold Lazarus on a trip once, and was very welcomed by them. It was strange to me to call these people who were leading this development of behavioral therapy by their first name. And in fact, I had a drink with Cyril Franks, something called a shandy.
One cannot help but believe that this personal kind of accessibility was important, and it was significant to my career.
Interviewer: And what else started your interest in cognitive behavioral treatments? I hear these influences from people who influenced you, what about other things that started your interest in cognitive-behavioral treatments?
Dr. Suinn: Sports psychology was important to my becoming interested in behavioral therapy. I was a faculty at a small liberal arts college, when a student basketball player came up to me and said, “I need help. Can you do something about anxiety? I am a good basketball player, but I have a problem when it comes to driving the ball towards the basket. Then, I freak out. I get so anxious that I no longer can perform very well. Can you help me get rid of this anxiety?”
While I was fully trained in the usual psychotherapeutic approaches in graduate school, this was a problem that I couldn’t deal with. And I wound up discussing the turning away [of this student]– he was one of the few people to whom I had to say, “No, I cannot help you.”
Then, I entered the realm of people working to develop this new field. Joe Wolpe was writing his book on reciprocal inhibition. Arnold Lazarus was doing his thing. Albert Bandura was laying the foundation in his “psychotherapy as a learning process” manuscript. And there were techniques being developed.
So, that’s what attracted me. Being able to apply [these techniques to] those concrete issues, such as those facing that young man. Next question.
Interviewer: And what are your most important contributions to research and practice in clinical psychology?
Dr. Suinn: I suppose that history will recognize two areas of importance. The first one is – again, you need to understand what the times were like. This was a period of time when there were no behavioral treatments for generalized anxiety disorder. We had the phobic disorders on one hand, but when you face someone with GAD, there were none at the time. So, putting together the relaxation methods and basic imagery with some exposure, but with the fact that with exposure, you are running the risk of increasing the discomfort. So, I was searching for a method using relaxation and imagery to control the anxiety at each level.
It became a useful tool – I named it Anxiety Management Training, and eventually published a book on how to use this method.
Later on, it dawned on me that there were some commonalities in emotional regulation, and then saw the application of AMT, as I called it, to anger management. And therein, we developed what was called, at the time, anger management training. So, there is that one development that I am learning to take credit for.
The other is that, eventually, through some clinical practice, I developed the idea that the imagery techniques we were using in behavioral therapy could be applied to fostering positive behaviors, healthy behaviors. And I worked with a ski team to see if the use of relaxation with imagery could improve their performance. We quickly found that this was indeed possible and a number of research articles came out. Mainly from physical educators, rather than psychologists. I named this methodology Visual-Motor Behavioral Rehearsal. This is a descriptive term that can be found in historical books on phys ed, a reference to VMBR if they adopted the technique in their study.
So, I have crossed over and become known as not only a clinical psychologist, but also a sports psychologist. I was, in fact, the first psychologist to be named as a sports psychologist for an Olympic Team. I served as a sports psychologist for 5 Olympic Teams. So, there you are.
Interviewer: Fascinating! How can we do a better job of disseminating CBT to clinicians?
Dr. Suinn: Well, I would do something drastic as an experiment sometime. That is, it seems to me that reading journal articles about CBT can be a drudgery because there is this long format. I think that the appeal of reading a journal is the findings. So, instead of having to plow through the history, introduction, methodology, and then you get to the results, why not try and put the results section in front of the introduction and methodology? You can always look into the later part of the article for that information. Maybe this will make the dissemination more attractive, or at least ensure reading a journal article is less difficult.
Interviewer: And what do you believe are the biggest challenges facing clinical science?
Dr. Suinn: Well, when you go these days to a workshop or a convention, or a conference, it’s amazing how many new findings there are in terms of interventions. I think that we have made great strides in developing these techniques, but the number of psychotherapeutic or cognitive behavioral therapy types of interventions has been going out of hand. A new one develops almost overnight, and then there is a brief series [of studies] to support the efficacy, and then it is dropped into the clinical realm for practice.
I think that the prolific number of ideas is a great boost in keeping the association active and viable, but I honestly believe that it’s gotten out of hand. Maybe we need a moratorium to stop and look at what we have now and study factors regarding our current interventions to see more of the fundamentals. But that’s just my opinion. Next question.
Interviewer: What changes would you want to see in graduate teaching and training in psychology?
Dr. Suinn: Oh, I have some radical ideas about that, too. Let’s start with high school. More and more so, you find students eligible to take advanced placement courses. These effectively are meant to be beyond the usual high school level. And in fact, are often offered as substitutes for the same type of course, same content course, when the student gets to college. If that is the case, if an advanced placement course replaces or can meet the credit requirement at the college level, then that says that the college and the AP course are equivalent.
So, why not make that in fact the case, and take out the intro courses that are offered in undergraduate schools and replace those courses with more advanced [classes], more practicum even? So, it would free up [space to take other courses]. If you give an advanced placement credit, you’re saying that you don’t need to take the intro course, and we don’t need the intro level course, we can replace the intro course with something else.
The other idea that I have is for the development of a new course called “Behavioral Change,” which would be focused on various interventions that come not simply from clinical or cognitive behavioral therapy, but social psychology, which has interventions in its own ways. Environmental social people have their own ideas about how to foster change. And I know industrial organizational majors learn another sequence. And even if we look at addiction counseling, they have their own ideas about what is necessary for change. It’s time to share and integrate these different approaches. Next question.
Interviewer: What areas or issues do you feel CBT needs to address more in the future?
Dr. Suinn: Well, my old war cry that I initiated during my presidential year is still an issue. Diversity, diversity, diversity. ABCT (that’s a tongue twister!) is now beginning again to focus on diversity. In my presidential year, we reached out and found a pool of people who had not been affiliated with CBT and who were interested. They still exist, they’re still reachable, and they’re still available. Greater activity needs to be adopted to deal with this deficit.
Interviewer: This is my last one for you: How has membership in ABCT impacted your career?
Dr. Suinn: Well, it provided a single focus for my activities. Almost all of my research was in the field of cognitive behavioral therapy. All of my professional and organizational activities centered on cognitive behavioral therapy affiliations. I think it was remarkable that my interests and focus and life was connected with this behavioral therapy.
I will also say, since we’re talking about the end of a career, that this might be my last interview. I am 87, no, I just made 88! I’m 88 years old, and I’ve been diagnosed with Parkinson’s disease/disorder, which is a progressive, terminal disease that I’m doing the darndest to delay the end state. I’ve already survived several years. And so, this may be in fact, my goodbye interview. I appreciate it – being recognized by the Association. But, I will not yet say goodbye, only “see you later.” That’s the end!
Interviewer: Dr. Suinn, thank you so much for being here today. We’re so thankful and honored that you took the time to have this interview with us!
Maureen Whittal, Accidental Psychologist
Dr Whittal thinks that early influences are among the strongest, and so, if one has a good early mentor, well, the world opens up. Jack Rachman was her first psychology mentor, and he made research fun. More than that, he approached teaching as a team sport, often seeing tough patients together so they could learn from one another, something they do to this day, 30 years later. She also credits Michael Otto (the best internship in the country) and Peter MacLean who stressed that theory is at least as important as the mechanism, permitting understanding of why things work, or don’t. Listen to the full interview to get your fill of spiders and snakes and learn about the world’s most downloaded app.