Show notes
Episode 438 The TEAM Approach to Habits and Addictions Powerful New, Radically Different Approaches that Can Help! Today, Dr. Jill Levitt joins David and Rhonda to discuss and illustrate the TEAM CBT approach to habits and addictions and give a little promo for their upcoming online workshop on Habits and Addictions on March 28, 2025. You can sign up for the workshop here: cbt-workshop.com Although the workshop is for mental health professionals, participants will have the chance to work on their own habits and addictions during the workshop in order to gain a more in-depth understanding of the new treatment methods for: Overeating / binging / restricting Drugs Alcohol Procrastination Doomscrolling Excessive cell phone use Internet addiction Excessive use of social media Shop-a-Holic Biting fingernails Video games Gambling And more David emphasized that nearly all current treatment methods frequently fall short because they focus on control of symptoms using behavior modification rather than the cause. He describes a research study at the Stanford inpatient unit that indicated that 50 common DSM Diagnoses (such as mood disorders, anxiety disorders, personality disorders, and more) were not significantly correlated with any of the DSM addictive / misuse disorders including drugs, alcohol, eating disorders, and gambling, which was not really consistent with the beliefs of many that emotional factors play a central causal role in addictions. In fact, the only significant correlation he noted was between depression and overeating, but the correlation was in the negative direction—in other words, higher levels of depression were associated with weight loss, not weight gain. And, in addition, the magnitude of the correlation was extremely small, indicating that other factors play a far more important role. So, what is the explanation for this puzzling and anti-intuitive finding? David described a 5-item survey he developed which asks about temptations in use or give in to your habit / addiction in the past week. This tool, in contrast to all of the DSM diagnoses, was very strongly correlated with all the addictions. This suggests that we give in to our habits and addictions for one simple reason--they make us feel great! At least in the short term! 150 years ago, they didn’t have an epidemic of obesity in America. Why not? Life was likely just as stressful as it is now, maybe even more so! But what they didn’t have was all the fast food restaurants and all the gooey, tasty foods that are abundantly available today, and they didn’t have the resources to purchase them, either. This doesn’t mean that behavioral models or diets or other tools have no value. But the TEAM CBT model focuses first on assessing the patient’s motivation for and resistance to treatment using a variety of powerful and innovative new techniques, including: The Triple Paradox The Ten Positive Distortions The Habits and Addictions Log (HAL) The Devil’s Advocate Technique The Five-Minute Rule The “I Stubbornly Refused” Technique The Anti-Procrastination Sheet Relapse Prevention Techniques utilizing The Externalization of Voices The Acceptance Paradox Stimulus Control And more They emphasized that these are methods, but not in the ordinary sense, because they rely heavily on the use of paradox, which is unfamiliar to many therapists, and require a great deal of skill. Jill and David first discussed the nature of tempting thoughts and how positive distortions work. Then, they illustrated the Devil’s Advocate Technique with Rhonda who volunteered to work on her temptation to overeat chocolate, and especially chocolate chip cookies with peanut butter, and listed several of her tempting thoughts, including: 1. A little chocolate chip cookie can’t hurt. 2. I have to keep them in the house because my husband loves them. 3. Just one cookie. It will taste SOOOO Gooood! 4. I can always work out a little more. 5. That cookie smells Sooo Good! I just CAN’T resist. Jill and David played the tempting part of Rhonda’s brain, and she played the part that resisted the temptations. She started strong, but her conviction seemed to weaken on the third thought, and she didn’t win “huge.” Instead of doing a role reversal to “help” or “save” her, David said that perhaps that wasn’t really something she was willing to give up, and perhaps we could work on something else instead. She INSTANTLY did a complete turnaround and won “huge” when they gave her another chance to defeat the tempting voice. David and Jill emphasized that paradox nearly always wins, and “helping” nearly always fails. But this is why these methods are so challenging—because the therapist’s well-intentioned attempts to help nearly always backfire, and yet are extremely difficult to resist. Jill and David emphasize that prior to doing this type of role-playing method, it is crucial to find out if this is something the patient really wants help with, and Jill emphasized that we rarely or never impose an agenda on any patient. We do not have any belief that there is a “correct” way for people to be. Rhonda—or any patient--will first have to convince us that this is something she really wants help with. And that will be one of the many take home messages for the therapists who attend on March 28th. Thanks for listening today, and be sure to tune in again next week! Jill, Rhonda, and David