Motivation Revolution / Burns

Transcription

1 The Motivation Revolution (Lunch Presentation) David D. Burns, M.D. Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences, Stanford Medical School 1 Cognitive vs. Motivational Revolution The Cognitive Revolution You FEEL the way you THINK The Motivation Revolution Motivation and resistance play at least as great a role in how we think, feel, and behave Integrating these can often produce amazing results 2 New Research on Depression Self-Help Inventory Listed 45 coping behaviors Frequency How often do you do this when you re depressed? Helpfulness How helpful do you think it would be? Willingness How willing would you be to give it a try, if suggested by a therapist or trusted friend? 3 M.D. Page 1

2 Results All three scales (Behavioral, Cognitive, and Motivational) were correlated with depression More depressed individuals Used fewer coping behaviors All lower expectations that coping would help Were less willing to try new coping behaviors 4 Results (cont d) Only the Willingness scale predicted changes in depression Strong antidepressant effect Appears to be mediated by psychotherapy homework (HW) Consistent with clinical experience 5 Results (cont d) Replicated in five different samples Inpatients and outpatients First variable in the world literature that has been show to have robust and consistent causal effects on depression Burns, D. Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression, Cognitive Therapy and Research DOI /s Published online 22 April M.D. Page 2

3 Willingness and Changes in Depression 100 Severe 90 Moderate Mild Initial BDC Final BDC Minimal High Will Low Will Willingness to Change Instructions. Below you'll find a list of things people Not at all willing 1 - Somewhat willing 2 - Moderately willing 3 - Very willing 4 - Extremely willing 1. Try new ways of relating to other people 2. Get started on a task I've been avoiding or putting off 3. Make a plan for solving the problems in my life 4. Face a problem I've been avoiding 5. Confront my fears, even if it makes me very anxious Total Score 11 British CoBalT Trial 469 chronically depressed patients randomly assigned to Usual care (antidepressants) Usual care plus CBT Improvement defined as 50% reduction in BDI scores 9 M.D. Page 3

4 Six-Month Evaluation Percent achieving improvement 22% of usual care patients 46% of usual care plus CBT CBT improved outcomes Results in both groups were unimpressive Lancet, doi: /S (12) Epub 2012 Dec 7 10 What is TEAM Therapy? T = Testing E = Empathy A = (Paradoxical) Agenda Setting M = Methods 11 A = (Paradoxical) Agenda Setting The Most Important Key to Therapeutic Success or Failure 12 M.D. Page 4

5 Goals of Agenda Setting Bring resistance to conscious awareness Melt away the resistance and make the patient accountable before trying to help the patient The failure to do this is BY FAR the most common cause of therapeutic failure 13 Two Types of Resistance Outcome Resistance Concept of Magic Button Process Resistance There is no Magic Button 14 Outcome and Process Resistance Will be different for Depression Anxiety Relationship problems Habits and addictions Eight completely different types of resistance 15 M.D. Page 5

6 Depression Resistance in a Nutshell Outcome Resistance You ll have to accept something about yourself that you don t want to accept Process Resistance You ll have to do psychotherapy homework 16 Outcome Resistance Example Depression The woman who thought she d murdered her baby 17 Outcome Resistance Exercise Severely depressed, suicidal heroin dealer / addict with Explosive Personality Disorder I m a hopeless case, and there s NOTHING you can do about it! 18 M.D. Page 6

7 Downward Arrow Technique Acceptance Paradox Experimental Technique Empathy 2 Agenda Setting Externalization of Voices Let s Define Terms Double-Standard Technique I m a hopeless case. 100% Straightforward CBA Identify the Distortions Straightforward Technique Paradoxical CBA Cost-Benefit Analysis I m a hopeless case! Advantages Disadvantages Advantages of Paradoxical Agenda Setting Extremely high-speed change now possible for many patients Far deeper and more authentic understanding of the complexities of the patient s concerns Transforms the patient s problems into assets Creates collaboration and trust 21 M.D. Page 7

8 Disadvantages of Paradoxical Agenda Setting Difficult to learn Conceptually challenging / anti-intuitive Technically challenging Emotional challenging for the therapist Codependency Narcissism Conflict Phobia Conflicts of interest 22 Unlimited Free Psychotherapy Training Six weekly evening TEAM Therapy training groups in Northern California, including two at Stanford Personal work and new psychotherapy training techniques Please visit us when you are in the Bay Area 23 Additional Resources TEAM Therapy TeamTherapyTraining.com Interactive T.E.A.M. training videos based on actual therapy sessions Will show an excerpt in afternoon workshop Tools, Not Schools, of Therapy Dr. Burns interactive psychotherapy e-textbook david@feelinggood.com 24 M.D. Page 8

9 Additional Resources TEAM Therapy Therapist s Toolkit State of the art assessment and treatment tools david@feelinggood.com for more information 25 Additional Resources TEAM Therapy Dr. Burns workshops, including intensives Listed at FeelingGoodInstitute.com Mentoring / training for therapists Intensive treatment in SF Bay Area 26 M.D. Page 9