“BOLSTERING Resilience” with Dr Donald Meichenbaum (audio)

“BOLSTERING Resilience”   with Donald Meichenbaum is part 1 of a series on essential CBT skills for Building Resilience re-edited and re-published by Daniel Mirea on NeuroAffectiveCBT.com and Academia.edu with author’s permission for free use and specialist training – the content belongs exclusively to Dr Donald Meichenbaum (this material can also be found on the Melissa Institute website)

Dr Donald Meichenbaum is an American Psychologist, Distinguished Professor Emeritus of Waterloo University, Ontario and a Research Director of the Mellissa Insititute for Violence Prevention. But he is much more that, Dr Meichenbaum is one of the CBT founders alongside earlier pioneers such as Beck and Ellis; he is better known for his ‘Clock Conceptualisation’, SIT model (Stress Inoculation Training) and Cognitive Behaviour Modification approach. Credited for his contributions with the nickname “The Freud of CBT” he was voted by APA in 1982, as one of the most influential psychotherapists of the 20th Century. Some of his extensive research on violent trauma might have been overlooked here in UK where the focus is much more on brief, cost-effective methods that can be applied within an NHS/ IAPT department. My goal is to correct that by drawing attention to his incredibly detailed research on constructivism, resilience, the use of spirtituality, stories, metaphors and narration in CB therapies; such interventions can be applied anywhere and translate to any culture. His work is best expressed through his lecture notes and handouts which he graciously donated for free learning and study. I kept these notes intact and whilst editing for online publishing, I realised this material could comfortably amount to a whole new approach, which I would personally label ‘Narrative Constructive Psychotherapy’. But of course, Dr Meichenbaum in his characteristic style is far too modest to accredit himself with yet another therapy label. As such, I will do that for him and in doing so, I take the opportunity to honour and thank him for his contributions over the years and ensure his legacy by passing his ‘teachings’ on to generations of psychotherapy students. When you read these notes, there is a feeling that sometimes he speaks directly to you in one of his lectures. Perhaps you should imagine exactly that…. enjoy.

This is for you Don! Happy Birthday!       

These are authentic lecture notes and handouts written by Dr Meichenbaum, they were intentionally not edited, so that when you will explore the material you would get a sense of ‘here and now’ as if you are attending his lecture right now and he speaks directly to you.

Dr Meichenbaum talking about resilience and trauma with Daniel Mirea

TABLE OF CONTENTS

          Evidence of resilience

           Possible mediating mechanism

           The nature of resilience

          Implications for conducting psychotherapy

          Intervention strategies for bolstering resilience

          Characteristics of ” HYPE ” in the field of psychotherapy 

        

EVIDENCE OF RESILIENCE

Trauma is everywhere, but so is resilience, the good stuff is more important than the bad stuff “In spite of behaviors”

Resilience can on short be described as positive adaptation despite adversity. Here are a few facts about resilience.

  1. Individuals can be resilient at one time in their lives, but not at other times.
  1. Resilience is not an all or none phenomenon. Individuals can be resilient in one area of their lives, but not in other areas of their lives.
  1. Resilience (positive emotions) and trauma reactions (negative emotions) can coexist, side-by-side.
  1. Resilience does not come from rare, special or extraordinary qualities or processes. Resilience develops from the “everyday magic of ordinary resources.” Resilience is not a sign of exceptional strengths, but a fundamental feature of everyday coping skills (Masten, 2014).
  1. Resilience rests fundamentally on relationships. Attachment figures act as regulators of stress and provide a secure base. Bystanders provide “social capital”, nurture an adaptive capacity, and provide a sense of security. They foster mastery motivation and a sense of self-efficacy.
  1. Resilience-engendering behaviors and positive emotions such as optimism, gratitude, forgiveness, awe, and the like, can contribute to positive neurobiological changes (brain chemistry and structural alterations), and even impact gene expression.
  1. Resilience is more accessible and available to some people than for others, but everyone can strengthen their level of resilience and “islands of competence”.

POSSIBLE MEDIATING MECHANISMS

  • Exposure to multiple diverse traumatic victimizing experiences can alter brain architecture and function, derail developmental “wear and tear” on the body. (Allostatic Load)
  • Neurobiological changes resulting from exposure to Adverse Childhood Experiences (ACE’s) include alterations to the amygdala, hippocampus, anterior cingulate prefrontal cortex, nucleus accumbens, and at the neurochemical level alterations including dopamine, norepinephrine, epinephrine, cortisol, serotonin brain-derived neutrophic factor, endocannabinoids, glutamate and neuropeptides.
  • When a child experiences adversity early in life their monocytes and macrophages (types of white blood cells) become calibrated to respond to future threats with a heightened pain inflammatory response, and by influencing the hormonal system and dysregulation of cortisol levels.
  • Traumatic stress may alter the organization and “tuning” of multiple stress response systems, including the immune system, the autonomic system and the hypothalamic-pituitary-adrenal (HPA) axis and alter gene expression. For example, childhood maltreatment sensitizes the amygdala to over respond to threat.
  • Childhood adversity has been associated with shorter telomeres. Telomeres are receptive DNA sequences that cap and protect the ends of chromosomes from DNA damage and premature aging.
  • In terms of the developing brain, exposure to cumulative adverse events contributed to:
  1. Reduction in the volume and activity levels of major structures including the corpus callosum (connective fibers between the left and right side of the brain), limbic system (amygdala and hippocampus) that is involved in emotional regulation.
  • Cerebral lateralization differences or asynchrony. Abused children are seven times more likely to show evidence of left hemisphere deficits.
  • Impact the communication between the Prefrontal Cortex (PFC) (upper portion of the brain) and the Amygdala (lower portion of the brain). The “top-down” regulation of executive skills can be compromised by perceived threats and stressors.

The bottom-up emotional processes (amygdala) can “hijack” the PFC.

  • The earlier and the longer the exposure to cumulative ACE, the greater the neurological impact.

THE NATURE OF RESILIENCE

Such psychological processes as positive emotions, optimism, active coping, social supports and prosocial behaviors, meaning making, humor, and exercise can foster and support resilience and reduce the intensity and duration of stress responsivity. Such positive activities are associated with reduced HPA axis reactivity. The impact of positive emotions is cumulative; repeated positive emotional experiences over time prime the system for optimal response to negative stimuli by expanding physical, psychological, intellectual and social resources (Fredrickson, 2001). There is a protective capacity of positivity. The presence of Oxytocin that accompanies engaging in resilience -engendering behaviors can counteract the impact of stress-engendering processes.

NEURO-PSYCHOLOGICAL MECHANISMS THAT NURTURE RESILIENCE

  1. Reframing/Reappraisals is the ability to frame events in a relatively positive light. Functional MRI studies have shown increased activation in the lateral and medial prefrontal cortex regions and decreased amygdala activation during reappraisal. The increased activation in the lateral prefrontal cortex (the “executive” center) helps modulate the intensity of emotional responses and keeps the amygdala in check. Resilient individuals are better able to extinguish and contextualize traumatic emotional memories and can more readily retrieve positive memories.
  1. Use of Humor is a way to engage in cognitive reappraisal and emotion regulation. A network of subcortical regions that constitute core elements of the dopaminergic reward system are activated during humor.
  1. Exercise, Meditation, Mindfulness and Acceptance type activities have both neurological and psycho-social benefits, and bolster resilience.
  1. Optimism is the inclination to adapt the most hopeful interpretation of the events which influences emotion regulation, contributes to life satisfaction, and increases psychological and physical health. An optimistic future-oriented outlook has been associated with increased activity in the amygdala and anterior cingulated cortex. For instance, optimists have lower rates of dying after cardiovascular disease over 15 years, compared to pessimists.

As Southwick and Charney (2012, p. 25) observe, “optimism serves as the fuel that ignites resilience and provides energy to power the other resilience factors”. But it is realistic optimism that works best, whereby individuals pay close attention to negative information, and not blind optimism that does not work.

  1. Active goal-directed problem focused coping of taking direct actions when stressful life events are potentially changeable can increase neurotransmission in the mesolimbic dopaminergic pathways that increase pleasurable feelings and that stimulate reward centers such as the ventral striatum. Dopamine release in the brain leads to “openness to experience”, exploratory behaviors, and to the search for alternatives. A form of active coping is to engage in Behavioral Activation (physical exercise) which has positive effects on mood such as depression and that promotes resilience and neurogenesis. Exercise increases the level of serotonin, norepinephrine, dopamine and by stimulating the reward circuits in the brain. Exercise has also been shown to increase the size of the hippocampus and serum levels and increase brain volume (prefrontal cortex), especially among the elderly.

In some instances, when stressful events are not changeable, the use of emotional-palliative coping strategies such as acceptance, distraction, spirituality are the best ways to cope.

  1. Prosocial behaviors and social supports and social competence, altruistic behaviors, helping others, and empathetic capacity facilitate resilience. The neuropeptides oxytocin, and vasopressin have been found to increase trust, compassion and enhance the reward value of social stimuli. Cortical “mirror neurons” have also been implicated in the regulation of positive emotions and can reshape the circuitry responsible for resilience. They play a role in facilitating social interactions by promoting shared understanding and empathy.

For example, compassion contributes to an increase in the level of endorphins, endogenous cannabinoids, endogenous morphine, dopamine, vasopressin, nitric acid, and oxytocin. In addition, the stimulation of the Autonomic Nervous System (ANS) engenders compassion, as compared to negative emotional distress. Compassion also triggers an orientation response and accompanying heart rate deceleration tied to respiratory sinus arrhythmia, heart rate variability and reduced startle responses and skin conductance (vagus nerve response), as well as triggering “mirror neurons”. Resilient individuals are better able to bond with others and attract social support.

Low levels of social support have been linked to increased rates of depression, anxiety and PTSD. In a 9-year prospective study, individuals with no or few social supports had 1.9 to 3 times the risk of dying from a variety of illnesses, including cancer, cerebrovascular and cardiovascular diseases, as compared with those who had optimal social supports. Among the elderly, loneliness is a strong predictor of early morbidity and has the same predictive power of smoking and lack of exercise.

Helping individuals increase their social supports and engaging in caregiving activities trigger the immune system to respond positively and stimulate the reward circuits along the medial forebrain bundle and engages dopaminergic neurons. Various hormones and neuropeptides like oxytocin and vasopressin facilitate social engagement and increase adaptation to stress by increasing empathy, eye contact, social cognition and problem-solving skills. Such positive attachment relationships buffer physiological stress responses.

  1. Meaning-making is another strategy that can buffer against negative feelings and is associated with resilience. Having a role model who provides a “guiding light” and developing and following a personal “moral compass”, holding spiritual beliefs, and engaging in religious faith-based practices bolster resilience and facilitate recovery. For example, consider the experiences of Jerry White (2008), who lost limbs to landmine explosions and who founded Landmine Survivors Network, which later became the Survivor’s Corp. It is designed to foster a mindset of “Survivorship”, which he defines as “choosing to live positively and dynamically in the face of death, disaster and disability; a form of meaning making. His approach is designed to combat the development of a “victim mentality” where individuals tend to pity themselves, resent their circumstances, live in the past and blame others. White believes that a victim-minded person is generally inflexible, stuck in his or her grievances, and is seemingly unable to let go, find hope, or move forward. Over time, a victim’s intense focus is on their own personal suffering which can interfere with his or her ability to take positive action, relate to others in a healthy manner, or participate more fully in daily life.

White proposes five steps to help trauma survivors to tap their innate resilience and grow stronger.

  1. Face facts: acknowledge and accept what has happened, the suffering and loss. Find a way to live with it and piece together a “personal story”.
  • Choose life: live for the future, not in the past.
  • Reach out: connect to others who have “been there”. Reach out to peers, friends and family.
  • Get moving: set goals and take action for a healthy recovery. Develop an individual action plan and identify your life priorities. Each step engenders hope and builds self-confidence. Regularly evaluate your progress and when needed re-evaluate and change one’s objectives. Such individual action plans are a contract of sorts with oneself and with others.
  • Give back: be thankful for what you do have. Contribute to others and to your community. Express gratitude – – thanking people who have helped. Express generosity – – giving back more than taking. Move from being a beneficiary to a benefactor.
  1. Hamby has highlighted three areas of resilience-engendering activities:

  a) Emotional regulation of both negative and positive emotions— emotional

            awareness, distress tolerance, a positive Mindset, feelings of 

            self -efficacy, and the ability to cheer oneself up after bad things

            have happened.

b)  Interpersonal supports– family support, able to share feelings, problems 

           and family rituals/parent monitoring and investment in academic competence/ 

      sense of belonging “mattering”/ support from prosocial peers/ at least two adults 

      outside of the immediate family who have connected with the child/ teacher

     engagement and school connectedness/ feeling safe in school and in the

     community/community supports.

  • Meaning-making activities– religion and spirituality/ dedicated to a cause,

           sense of purpose / belief in a better future / commitment to a specific role

(student, worker, father, mother)/ adhere to code of honor or possess a “moral   compass”.  As Viktor Frankl observed, “Anyone who has a WHY in their life can  learn to handle any HOW.”

In summary, the experience of positive-balanced emotions such as optimism, joy, pride, contentment, compassion, love, forgiveness, gratitude, humor have been associated with distinct neurobiological and psychological changes that provide a protective capacity. The positive emotion of awe, which reflects positive feelings of being in the presence of something vast that transcends our understanding of the world contributes to altruistic behaviors and to a sense of community. Awe helps shift one’s focus from a narrow self-interest to the interests and well-being of a group to which individuals belong. Sights and sounds of nature, collective rituals, artistic events of music and dance elicit positive emotions that have behavioral and physiological sequelae. These neurobiological responses include:

Increase of neurotransmitters like cortisol levels that facilitate pathway communication between Prefrontal Cortex (PFC) and subcortical systems like the amygdala. For instance, GABA (gamma amino butyric acid) which is an inhibiting neuropeptide made in the orbitomedium PFC (OBPFC) when released “turns down” the alarm system of the amygdala. The left PFC, a site associated with positive emotions such as happiness, is more activated during Compassion Meditation.

These positive emotions reduce physiological arousal and broaden and build an individual’s focus of attention, allowing more creative inclusive, flexible, integrative perspective taking, engenders positive reappraisal of difficult situations, fosters problem-focused coping, and facilitates the infusion of ordinary events with meaning. Fredrickson, in her Broaden-and-Build Theory, highlights that the impact of positive emotions is cumulative. Repeated positive emotional responses to negative events expands and builds psychological and behavioral resources.

IMPLICATIONS FOR CONDUCTING PSYCHOTHERAPY

The research on neurobiology of resilience underscores the value of conducting psychoeducation on neuroplasticity (the power of the human brain to change and repair itself) and the potential recovery from experiencing traumatic and victimizing experiences. The therapist can help clients learn a variety of skills and engage in activities that bolster positive emotions and improve resilience and health. When discussing with clients the lingering impact of traumatic and victimizing experiences, the therapist can convey examples of how the body “keeps score” and the enduring impact on the clients brain and behavior. The good news, however, is that the brain is a remarkable resilient organ and clients have the potential ability to reverse this process. Clients can learn to capitalize and build upon what is called neuroplasticity, and moreover, even begin to “turn on” and “turn off” the genes in their body (neurogenesis).

The therapist can say: “Let us begin by having you better appreciate the possible impact that traumatic and victimizing experiences may have on your brain and behavior. Traumatic events and losses can lead the lower part of your brain that is the emotional center to:

… hijack; overwhelm; flood; overshoot; ramp up; exceed; trigger action pathways;  over activate and have a spiraling, cascading snowball effect; prime or kindle;  shorten your fuse; and undermine and shut down the upper part of your brain, the  frontal lobe executive control center.”

            When conducting this type of psycho-education, the therapist should choose one or two of these illustrative verbs to describe the impact of traumatic and victimizing experiences and accompanying losses. Do not overwhelm the client. The therapist should then solicit personal examples from the client that reflects that activity.

            “Can you give me an example of how you did X?” (Choose one of the following):

“Magnified your fears; time slide back to your old ways of coping that once

worked for you; went into a kind of autopilot mode of survival; engaged in

safety behaviors; were hypervigilant and constantly on the lookout for possible

threats; repeatedly conducted a kind of after-action analysis in the form of

ruminating; had difficulty sleeping; sought an adrenaline-rush by engaging

in high-risk behaviors, used booze or drugs to self-medicate?”

            The therapist can convey to the client that he/she noticed, and wondered if the client also noticed, these behavioral patterns and “What is the impact, toll and price that resulted?” After discussing such consequences and how they may interfere with achieving the treatment goals, the therapist can convey that the therapy can help the client learn how to: (Choose one)

     “Regulate, modulate, control, strengthen, regain, restore, reprogram, reshape,

re-right myself, re-establish, re-define, mobilize, adapt, calibrate, blunt, improve

their error detection skills; soothe, down-regulate, label and tame emotions,

surmount your fears, orchestrate, get accustomed, accepted, organize your

traumatic memories into a narrative account, develop coherent redemptive

stories that have a beginning, middle and ending, note what you have done to

survive, contextualize and put the landmark traumatic events into a larger

autobiographical account.”

            The therapist can highlight that attention and increased awareness are the key first steps in the ability of the brain to repair itself. The client can learn how to “talk back” to the amygdala or the lower part of the brain and take charge once again. For instance, clients can learn emotion-regulation skills and they can come to tell themselves and others:

 “I can rewire my brain.”

 “I can talk to my amygdala (the alarm center) and train my emotional brain.”

 “Not allow my amygdala to hijack my frontal lobes.”

 “I can use the upstairs part of my brain to calm down the downstairs part of my brain.”

  “My positive emotions can Re-shape my brain.”

 “Positive relationships that I have can switch on and off different gene contributions  and leave a positive chemical signature on my genes that affect my brain development.”

“By being kind I can raise my level of oxytocin which curbs stress-induced rises in  heart rate and blood pressure and that reduces feelings of depression. Being kind  protects my heart.”

“I can reduce my heart rate by 6 to 10 beats per minute by taking slow deep  (diaphragmatic) breaths.”

“I remind myself that my brain is not fixed, nor static. It is highly plastic and flexible.

It can repair itself, with my help.”

“As with other parts of my body, I need to use my brain or lose it.”

“If I don’t stimulate my brain, my brain cells will die and be pruned away.”

“I have the capacity to bend, but not break.”

“I can see the big picture and find the silver lining and develop a new normal.”

“I can get myself to do what I do not feel like doing and get myself out of my comfort  zone.”

INTERVENTION STRATEGIES THAT BOLSTER RESILIENCE

(See Meichenbaum’s Roadmap to Resilience book for examples)

Use Physical exercise – – Behavioral Activation and use Active Coping Strategies.

Use Emotional Regulation and Distress Tolerance Skills and Increase the Protective Capacity of Positivity that Buffers Negative Feelings.

Focus and savor positive emotions and past reminiscence and anticipate positive emotions (anticipating). Engage in goal setting and affective forecasting in the form of positive future-oriented imagery that nurtures hope. Avoid “dampening” or minimizing positive events, I don’t deserve this”… “This won’t last”.

Engage in Mindfulness Exercises – – pay attention in a particular way, on purpose in the present moment, and nonjudgmentally.

Engage in Loving-kindness Meditation and engage in Acts of Kindness.

Engage in gratitude exercises “Give back and pay forward”.

Engage in Forgiveness exercises Toward others and Toward Oneself – – Compassion is the awareness of the suffering of others and oneself, coupled with the wish and effort to alleviate it.

Engage in Meaning-making Activities and Cognitively Reappraisal (“Healing through meaning”)

Use Spiritual-related Activities – – Use of One’s Faith and engage in communal religious activities (See Meichenbaum “Trauma, spirituality and recovery” )

Increase Social Supports – – keep interpersonally fit by participating in positive activities; selectively choosing and altering situations, improving self-presentation (smiling, dressing up), improving communication skills and accessing social networks.

Use humor, Have fun and build-and-broaden Positive Emotions (“Bucket List Activities”)

Each of these Activities will help bolster resilience by increasing the accompanying neurobiological processes. There is increasing data that a course of psychotherapy- even without medication- had measurable physical consequences in the brain.

CHARACTERISTICS OF “HYPE” IN THE FIELD OF PSYCHOTHERTAPY

Your attendance at this conference reflects your interest in increasing your knowledge and your clinical strategies and skills to help your patients achieve better treatment outcomes. Such concerns are timely given the research findings in the field of psychotherapy on the marked variability in effectiveness across psychotherapists. The most effective psychotherapists average 50% better outcomes and 50% fewer dropouts than psychotherapists in general (Wampold, 2017).  One of the characteristics of more “expert” psychotherapists is their penchant for maintaining a critical attitude apropos of Paul Meehl’s (1973), admonition of “Why he does not attend case conferences,” and the presence of “SELF-DOUBT.”  Research indicates that psychotherapists self-reported self-doubt predicted treatment outcomes- more doubt about their skill in helping patients (e.g., “Lacking confidence that you might have about a beneficial effect on a patient.” and “Unsure about how best to deal effectively with a patient.”), had better treatment outcomes, particularly if they also had a positive sense of self. Consistent with the article by Nissen-Lie et al. (2015) entitled  “Love yourself as a person, doubt yourself as a therapist ” , the present Psychotherapy Consumer Checklist is designed to plant the seed of self-doubt and nurture a healthy sense of  “HUMILITY “,  and hopefully improve treatment outcomes. What follows is a Checklist of “Psychotherapy Beware Signals.”

 1. Advocates for a therapeutic approach state that their treatment is “revolutionary” and offer outlandish unsubstantiated claims for its superiority (Over 90% improvement rates). “Simple, but powerful” treatment approach. “A breakthrough treatment.”

2. Make claims that you can learn from a “master”, “leading expert” or “guru” and use marketing terms like “powerful”, “transformative”, “unique and ultimate training,” “life-changing benefits”, “deep psychological healing”, and moreover, assure that your “complete satisfaction is guaranteed.”

3. Advocates use Acronyms (Acronym Therapies) and “psycho-babble” to sell their treatment approach.

4. Claim that the treatment approach could be applied successfully with patients who have a wide variety of psychiatric and physical conditions, and across multiple age groups without any clinical trial demonstrations.  Advocates often imply that their treatment approach “fits all” (“One size fits all”).

5. Claims that treatment approach is “evidence-based”, scientifically proven, because it has met the criteria of two randomized controlled trials, but they do not report Effect Sizes, nor provide details about the exclusionary criteria of the patients. “Cherry-pick” the patients. Also, does not report on the attrition and drop-out rates, follow-up data. Advocates often broadly and subjectively define “evidence” (e.g., “I saw it work with my clients, and that is my evidence”.)

6. Advocates state that “Over X number of studies have consistently demonstrated efficacy and superiority”, without citing or critiquing these studies.

7. Compare proposed treatment to “weak” comparison groups. Does not compare treatment to “bona-fide” comparison groups that are intended to be effective (See Wampold et al., 1997).

8.  Compares the proposed treatment versus a reduced, or weaker version of the comparative treatment. For example, see Foa et al. (1999) comparison of Prolong Exposure versus Stress inoculation training (SIT), where the third application phase of SIT was omitted.

9. Do not report on possible “allegiance effects” of who conducted the controlled outcome studies.  Moreover, the cited supportive studies that were initially conducted yielded more effective results than later conducted studies. (“Strike while the iron is hot”, and when the enthusiasm for the new therapeutic approach is highest.) See the provocative informative article by Lehrer (2010) of the “decline effect” in research attempts to replicate clinical trials. For example, the efficacy of antidepressant medication has gone down as much as threefold in recent decades.  Effect Sizes from studies from treatment studies drop off.  He observes that the researcher’s belief can act as a kind of blindness. 

10. Do not independently determine if the treatment rationale offered to the alternative treatment and control groups is judged as being as credible and believable as for the advocated treatment. This can lead to differences in expectancy effects across groups.

11.  Do not highlight the role of non-specific treatment factors, such as therapeutic alliance, expectancy effects, and other placebo considerations. For example, does not include any measures of the ongoing quality of the therapeutic alliance, such as the Therapeutic Alliance Scales, or the Quality of Relationship Measures, or the session-by-session treatment-informed feedback (Prescott et al., 2017).

12. Does not include a critical account of the scientific validity, or theoretical basis, for the effectiveness of the proposed treatment. Offers little scientific basis for the proposed change mechanisms for the treatment. See controversy over so-called “energy –based” treatments such as Tapping, Eye Movements, Magnetic fields, Meridian band techniques and the like. The intervention may work, but it has little to do with the proposed treatment model. The proposed treatment may do better than no treatment, or weak control and comparison groups because of non-specific factors, such as placebo effects.

13. Advocates use “neuro-babble” and “neuro-networks” and reductionism (often with colored versions of the brain) to explain the treatment approach. They resort to a dubious neurological basis for the explanation of their treatment approach.

14. Advocates fail to discuss criticisms of their treatment approach. They fail to mention the results of dismantling studies that question the basis of their treatment approach.

15. Advocates tell their patients that “If this treatment does not help you, then nothing else will.” They convey an expectancy that reinforces treatment outcomes.

16. Advocates promote advance training, sell paraphernalia, tapes that go along with their treatment approaches. They require that trainees sign statements that they will not share treatment protocols with others. “Commercialism is rampant.”

17. Advocates are very defensive and “thin-skinned” about their approach. They often question the motives and background of those who have questioned the efficacy, theoretical basis of their treatment approach. They fail to question what they are proposing and readily dismiss skeptics. They may disregard “inconvenient truths” and offer “alternative facts”, thus, holding onto debunked theories.

18. The advocates of their treatment approach rely on the endorsements of a leaders in the field. For example, some therapists in the trauma field cite Bessel van der Kolk as an advocate and endorser of their treatment approach.

19. Advocates establish a coterie of trainers and an International organization to promote the treatment. Advocates use public media (television, blogs, print) and they over sell their treatment approach. Advocates are “slick salespersons,” setting up clinics, training settings, and conferences.

20. The advocates will provide a Certificate that you have taken the training and can call yourself an X therapist. Offers to put you on a referral list of Certified X practitioners.

HOW MANY OF THESE 20 ITEMS DOES YOUR TREATMENT APPROACH INCORPORATE?

For online training with Dr Meichenbaum please follow the UKCHH link below.

https://www.ukhypnosis.com/cpd-workshops/

The UK College of Hypno-CBT, led by principle Mark Davis is a respectable and ethical organisation commited to evidence-based CBT, Mindfulness and innovative Hypnotic approaches that improve resilience, symptomatic independence and self-efficacy.

REFERENCES

Frankl, V E (2004). Man’s search for meaning. Waterstones

Frederickson, B (2004). Broaden and build theory of positive emotions.  Philos Trans R Soc Lond B Biol Sci. 2004 Sep 29; 359(1449): 1367-1378.  doi: 10.1098/rstb.2004.1512 PMCID: PMC1693418 PMID: 15347528

Masten, A. (2015). Ordinary magic. New York.

Southwick, S. & Chaney, D.  (2012).  Resilience: The science of making life’s great challenges. New York: Columbia University press. 

Meichenbaum D. Roadmap to resilience. WordPress

For more resources from Dr Meichenbaum please click on the Melissa Institute link right here !

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