Richard Jacobs: This is Richard Jacobs with the Finding Genius Podcast now part of the Finding Genius Foundation. Today I have Seth Gillihan, he’s a Clinical Psychologist. He’s also a bestselling author and a podcast host. He’s the creator of the Think Act Be online school. We’re going to talk about Cognitive Behavioral Therapy for kids and teens.
Tell me a bit about your background. Why are you interested in CBT, and working with teens and kids? How did you get where you are?
Seth J. Gillihan: I started out in psychology because I wanted to work directly with people and try to make a positive difference in people’s lives. I found early in my training that the cognitive behavioral approach really appealed to me because I came from a science background. I didn’t have a Psychology background at all in college. I studied Biology and also French. The research basis for CBT really appealed to me and the idea that it could be really effective in just a few sessions using some pretty straightforward tools that were pretty intuitive, they made sense to me as a new trainee.
It really resonate with people just on a basic level, things like, by examining the stories that our minds are telling us, we can discover a lot of the falsehoods that were living by, such as these assumptions that we make, like I’m going to fail or nobody’s going to like me. So just by figuring out what we’re thinking and thinking more helpful thoughts, we can really feel better. We can be more willing to take risks when we’re not so sure that we’re going to fail. So that’s really what drew me to CBT. To be honest, I work some with teens and have worked with kids, but primarily my focus is in working with adults and I had developed a kind of on the go CBT resource called The CBT Deck that was intended for adults. There was such a need during the in general, but even more so with the pandemic.
I worked with my publisher on a plan to adapt The CBT Deck for kids and teens. The best part about it for me was I got to collaborate on it with my 10 year old daughter, Ada. It was really meaningful because she was big help. She helped me to get the language right and saying things like, “Dad, we don’t really use that word or that’s not really how we would say that.” She helped me with the illustrations and finding the things that really appealed on a visual level, but she had gone through an intense bout of anxiety herself. Coincidentally, around that time, the original CBT Deck had come out. So I’d gotten my author proofs to go through and check for spelling errors and things like that. She asked me, “If she could borrow it?” I didn’t know, for a while, she was using one of the cards each day. She told me looking back that it was extremely helpful, which of course brought tears to my eyes and really convinced me. I thought of it before, it’d be need to collaborate with one of my kids on this deck and she was excited to do it.
Richard Jacobs: What is this deck? Does it helps people? What are the cards in the deck? What’s on them?
Seth J. Gillihan: In this particular deck, there are 58 cards with one practice or one skill per card. They’re divided into three categories. The three pillars of CBT are Cognitive techniques, Behavioral techniques, planning actions that help move us toward our goals and then mindfulness. So being in the present in an open and accepting way. I abbreviate those, Think for Cognitive, Act for Behavioral and Be for mindfulness, “Think Act Be”. So there are Think cards, Act cards and Be cards.
Generally I recommend, just shuffle the cards and draw one at random. There’s one card that’s about standing up for one’s self and noticing what our thoughts are, they are really critical and being kinder to ourselves.
Richard Jacobs: Saying bad stuff to yourself or about someone else?
Seth J. Gillihan: About Yourself.
Richard Jacobs: Like when you’re saying, “I’m a fool, why did I do that? It was so stupid.
Seth J. Gillihan: Yes, exactly like, “Oh My God, I’m so stupid. I’m never going to get this right.” There are ones about helping us to helping kids to practice a growth mindset. So if we fail at something, instead of saying, “I can never do this.” Say things like, “All right, I’m still growing or I’m still learning.” It’s in our nature to grow and develop over time. There’s one about facing the fear of school, which is common and using the behavioral technique of taking things one step at a time and breaking down challenging tasks. I’m really trying to present solid research practices, but in a way that’s really user friendly for younger people.
Richard Jacobs: Is this deck part of your normal practice? Do you have a clinical practice where you see patients? How did you come up with this deck? In what context do you use it?
Seth J. Gillihan: I don’t use it directly in my practice. I don’t actually use the deck. It’s actually not a bad idea, but I think part of it just feels kind of self-promoting. My goal more and more as a therapist and all my therapy these days for the past year and a half or so, has been through video to help people bring these practices into their daily life. Not just for us to talk about them and plan for them in our sessions, but really to have them when they need them, when things come up. What I loved about the cards is that they’re so portable and they’re really bite-sized.
Richard Jacobs: What’s an example on a couple of the cards, like what are some cool ones that people really like?
Seth J. Gillihan: Let me actually pull one up, so I can tell you word for word. I’ll read you a card from the CBT Deck for anxiety, rumination and worry. This was a follow up to the original one because so many people are dealing with anxiety and worry. Here’s an example, this is from a think card. So dealing with our thoughts, the title is “See Yourself Coping.” This is one of my favorites. One of fear’s greatest lies is that you won’t be able to handle potential problems. When you’re worried about something that could happen, start to see yourself coping skillfully with it, recall the strength you’ve shown countless times as you’ve risen to the occasion to face challenges, and expect yourself to bring the same resourcefulness and determination to the problems of today.
What I love about that idea is that, first of all, framing it as a single practice for the day, a person can take this card with them. It can come back as a reminder because for me, it’s easy to say, “Oh, I’m going to practice that today,” then 10 minutes later, I’m like what was that thing I was going to do? So it’s a good reminder. This one in particular, I like because we can get into these arguments like, “What if this thing happens? It is better if it not happens or there’s a problem at work.” So we’re focusing on “What if this happens?” There’s a kind of background to assumption that if it happens, I’m not going to be able to deal with it or if it happens, it’s going to be terrible rather than it’s going to be another ongoing series of problems that I’ve had to deal with. Life in a way, it just a continual unfolding of problem after problem that we deal with. So I like to focus on what am I going to do if that happens? We don’t have to obsess about whether or not it’s actually going to happen.
Richard Jacobs: How did you write these cards up? Are these just good ideas you had or are you drawing on a body of work that you just translated into cards form?
Seth J. Gillihan: Some of them were existing techniques, things that I had probably picked up over the years. Some were things that I had come to just in working with patients individually and wanted to capture in this kind of more formal way. A lot of them were just either things that I had found helpful myself. Honestly, all of these are things that at times I find useful and rely on. My process really was to decide about how many cards I wanted and then just start to sketch out ideas, literally on pen and paper because I tend do better creative thinking that way versus with a blank page and a cursor on a computer. From those very rough sketch, I then starting to flush them out and organize them to see, “If I need more here about facing fears, breaking down big tasks to make them more manageable, or some about confronting low mood and moving through that when we just want to withdraw. In fact, we need to do something rewarding. I have a great publisher, he’s a fantastic editor who helped me really to polish them and get them ready to present to the public.
Richard Jacobs: Do you have just one deck or is it deck divided into three sections, The Think Act Be?
Seth J. Gillihan: I have three decks and each deck is divided into “Think Act Be”. So each deck has the full Cognitive, Behavioral and Mindfulness suite of practices. There’s the original CBT deck, which is fairly broad a lot of anxiety, depression, and self-confidence types of cards, then there’s the one that focuses on anxiety that I read from. The most recent one is the one for kids and teens.
Richard Jacobs: You said you’re not using these in your normal practice. So how are you using them?
Seth J. Gillihan: Well, other people are using them, I’ve sort of offered them to the world.
Richard Jacobs: How do people come across them and in what context? What kind of feedback do you get?
Seth J. Gillihan: Thankfully, the feedback has been super positive, which led to the subsequent decks. A lot of therapists are using them, both those who are maybe new to CBT or are not experts in CBT themselves, but they want to offer some of the practices. I even hear from experienced CBT Therapists, who just like them as a supplement to their in session work. I think that’s a lot of it. I honestly don’t know exactly how people find them other than searching for probably resources on Amazon or something, but a lot of individuals are using them with or without a therapist just to use the card today and deal with whatever they’re dealing with.
Richard Jacobs: What kind of feedback do you get on them? What kind of people give you feedback? What are some interesting things they said that exploded your head or you thought was really cool?
Seth J. Gillihan: I haven’t kept many of those in my head, but the feedback I get from people that I’ve never met is often some of the most meaningful. It means a lot when someone I know like, my daughter obviously tells me it was helpful, but it’s really moving to put these things out into the world. You have no idea how they’re going to be received, and then when someone, you never met maybe in a different country or different state is saying, “I find this so helpful.”
Richard Jacobs: It’ll be cool if you made an app that it randomly pops up one of these every day, so you can practice them and go through stuff, or it could take you to choose a track like, “I’m very anxious and ruminate, so I want to go on that specific track” and it shows you cards that are relevant to that.
Seth J. Gillihan: I think that’s great. I actually just sign an agreement with an audio book company. It’s going to do something maybe fairly close to that. You won’t match it to what a person is looking for, but because of the format there will be that option of randomly selecting one and pulling it up. I’ve definitely thought about, but without really taking any step toward it, but thought about amplifying this because it does seem to lend itself really well to that kind of presentation. This is a review from someone named Ms. Sanchez, “This excellent self-help CBT resource. I bought a lot of self-help cards, but these CBT are by far the best for my needs. I like this. I like that this set is based upon helping me learn and to build positive emotions by redirecting my thoughts. It also has an extra element by giving me an exercise to practice and build skills each day. I just randomly pull one out and work on it that day, or look for a specific card when I’m feeling emotionally triggered and need to redirect reinterpret or reframe my thoughts.” Yes, it’s touching and people are finding these things useful.
Richard Jacobs: What are the elements of CBT that you’ve found are helpful for people? What kind of mental problems does CBT seem to work best for? Which ones is it not so good for?
Seth J. Gillihan: It’s been shown to be helpful for pretty much everything it’s been applied to. It’s because the approach is so broad. It’s kind of bit of an exaggeration, but sort of like water. Water is good for pretty much everything, health wise. It’s really getting at kind of the underlying architecture of our minds and actions. So thinking more helpful thoughts is useful for depression. Some of the earliest studies on CBT showed that it was really effective for treating depression. There are medications that can be as effective as CBT, but in the long run CBT does better. Once you’re done with the treatment, you take it with you. It doesn’t really stop once the treatment is over because you’ve incorporated or internalize these skills.
There are tons of studies showing it’s effective for Anxiety Obsessive Compulsive Disorder, Posttraumatic Stress Disorder, and Insomnia. Insomnia is a big one, for insomnia CBT is really the go to frontline treatment, superior to sleep medications in many ways and certainly not habit forming in the same way, and smoking cessation and alcohol dependence relationships. It’s kind of like mindfulness in that way.
Mindfulness as a standalone approach is pretty much good for anything that you throw it at. Sleep is a good comparison. Pretty much every outcome that we care about gets better when our sleep improves and in a similar way when we’re tending to our thoughts and we’re living our lives in a way that’s aligned with our goals and we’re letting go of resistance things we can’t control through mindful presence, then the things just tend to be better.
Richard Jacobs: Why don’t you use this in your practice when you’re doing your talk therapy over zoom and stuff like that? Is it too much of an artificial prop or a crutch, or do you not know how to integrate it? What’s your thought?
Seth J. Gillihan: The cards, at least from my approach, they’re super helpful for someone who doesn’t necessarily have access to a therapist. They work really well in conjunction with therapy as a supplement to it. Maybe I’m just self-conscious seeming like I’m trying to promote my own work.
Richard Jacobs: You do a session with someone, you talk about X, Y, Z, and you say, “Hey, I created these cards. Usually I sell them, but of course I’m not going to sell them to you because you’re my patient you’re paying.” A good homework for you to do maybe to like pick two cards and think about them during this week. Maybe that would be helpful?
Seth J. Gillihan: We end up doing that without the cards by just offering them the same types of practices. An advantage of therapy is that I can tailor exactly what we do. Whereas the cards, there are lots of lot them, they’re 108 in one, 101 in another and 58 in the kid’s one. So there are many options, but I can really make sure that what the person is looking for is exactly what I’m asking them to work on. A lot of people actually that I’m know, they think more about where we are at this point. A lot of the people that I’m working with are not necessarily addressing those types. Maybe we’re working on broader types of issues like, family of origin or kind of longer term, just the way practice goes. Sometimes you end up working with people for longer term than short term focused CBT work. You may have the skills, but really what they’re looking for is more about processing things from their past or dealing with broader issues that maybe don’t fit quite as innately into to a kind of card based approach.
Richard Jacobs: How does CBT help people in your experience? What is it about that seems to work to help people feel better?
Seth J. Gillihan: The simplicity of it is really appealing to people and helpful because it’s something you can do on your own. You can learn it with a therapist, but it doesn’t depend on having another person there like, other types of therapy. If you’re depending on someone for their insights into your internal dynamics that really is a two person process. My goal really is for a person not to need me anymore for the CBT skills.
These very basic processes that it gets at, like our thoughts or if we pay attention, our minds are always telling us things and we often assume that they’re true and we take them for granted. We don’t often think about it, for example, I’m worried that today something bad is going to happen today or maybe I’m worried that I’m going to give report at work and it’s going to go badly. I can have thoughts that things are going to go badly today and I might be anxious and nervous about that, then I can recognize like, “All right, that’s just a story that my mind is telling me,” but we can go a level deeper than that. This is the level that we often don’t get to, but the mindfulness element of CBT really helps us to do that.
We can rather than getting locked into, “Am I going to have a good day or a bad day?” We can ask ourselves, “Why does my ultimate wellbeing depend on what happens during this talk at work today?” Maybe there’s a level of contentment that transcends these ups and downs of our moment to moment lives. There are these little kind of tricks and hacks for our nervous system, but what we’re getting at is understanding the optimal way to live and for our mind to function. The law of that is letting go of the struggle with whether things are going to be for me or against me, and opening instead to more of what life brings us.
Richard Jacobs: Are you saying that don’t see it as a life’s against me type thing, instead just see it as like you’re here living amongst all these other people and life’s not directed against you necessarily?
Seth J. Gillihan: Yes, The life is life. Bad things are going to happen. The ultimate point of life is not to avoid pain at all costs, but to really have a fuller experience of what it means to be alive. I know for myself, I get stuck in these. I get really focus on wanting things to work out the way I want them to. We can really end up contorting ourselves in unhelpful ways and making our happiness so contingent on things that are outside of our control. Our ultimate it’s a bit of a cliché, but our ultimate superpower is to take back the responsibility for our wellbeing. I say this in one of the cards, “Not to outsource our happy, but to remind ourselves that our decision to be content is really an inside job.”
Richard Jacobs: What’s an example of outsourcing your happiness? What do you mean?
Seth J. Gillihan: If someone cuts you off in traffic and then you’re off for the rest of the day. There’s an underlying assumption, like that person ruined my day or ruined my morning. But what they did is they did something inconvenient, and possibly rude and self-serving that lasted for a moment. I’m not at all saying that I’m a master of this or it’s easy, but we have some choice in how much we hang onto that versus if someone tailgates us and I find that really irritating. I can make that a problem that has to be fixed and I have to do something about it. I have to punish that person for being such a blanket-blank or I can just let it go.
For a lot of us, there’s this built in assumption that if they offend me and I don’t do something about it, then they won and I lost. What losing really is, it’s allowing it to get us to bend ourselves out of shape more than we need to. Whereas, winning is moving on.
Richard Jacobs: Sometimes, something will happen in a day. It’ll make me mad and I try not to let it color the rest of the day, but sometimes it’s very hard. Those kinds of things, it’s like an internal struggle to do that.
Seth J. Gillihan: Yes, it’s super hard. But if we can practice, even you preemptively telling ourselves that I’m going to be in charge of my happiness just for today. I’m not saying that I’m not going to react to other people. I think that’s normal, but I’m going to remind myself as much as I can that I have a choice. I can hold on to things or I can let them go. Also I can question that automatic assumption that I have to get back at people.
Richard Jacobs: What have you noticed over the past year and a half? If it’s not obvious, what all the COVID garbage done to people’s brains. It seems like it’s scrambled them and affected them in bad ways, myself included. What are you observing in your practice? What it’s doing to people?
Seth J. Gillihan: It’s been really tough in a lot of ways as people know, with the uncertainty around the disease and so much loss of jobs and social contact. It really revealing for us in ways, we hadn’t been so acutely aware, just all the little things we take for granted, such as daily contact with people, the little incidental run-ins that we have at the gym saying, “Hi,” to someone, and those encounters that are giving us little boosts throughout the day. We’re maybe not consciously aware that we’re missing those, but when as we start to get them back, “We’re like, its feels so good.” You have this unexpected deeply human exchange with the checkout person at the grocery store, like it’s so nice to be back.
At the same time, when we broaden our perspective, we can see there’s a lot of good has come from this time. I think a lot of people have found a clarity in what’s important. Being forced to pause has, at least allowed us to examine a lot of the assumptions that our lives were based on about: How busy we had to be? What we had to do? How much we had to spend? So that’s what I’ve heard from pretty much everyone that I’ve talked to about this. This is not at all to deny the enormous suffering and desperation that a lot of people have experienced through this time, but at the same time not to ignore what’s really a richer picture than that. I’m starting to say pretty much everyone has said somewhat guiltily. But actually, there have been a lot of positives from this time. I think people are reluctant to say it because the pain for so many people is so much more obvious. Many of us are realizing that we’ve been required to grow in ways that we wouldn’t have been, if this not had happened.
Richard Jacobs: You’re seeing with your population that people are actually, okay. They’re not worse off, but they’re in some ways better?
Seth J. Gillihan: Well, it’s a complicated picture. Some are certainly worse off in some ways. Someone said to me, “They hadn’t been hugged in months” and that’s someone who lived alone. It such a painful statement, but at the same time that same person might say, “There’ve also been positives from this time.” Our brains are really good at honing in on what’s wrong because that’s how we stayed alive, evolutionarily by noticing and fixing problems. I also think it takes deliberate attention to ask ourselves, what might be right about this time or what an unexpected good thing is. Sometimes even our problems reveal good things. So this is one of the practices is on the cards. Most of the time, if there’s something wrong, there’s something right behind us. The examples would be;
Richard Jacobs: It’s a good idea. It would make things more positive if you’re able to do it.
Seth J. Gillihan: Yes, but I hope it’s clear. I’m not talking about this is just like power positive thinking or happy thoughts. It’s about being realistic. So if we’ve gone through a trauma, it’s not asking like, what was the good thing about my trauma? Certainly not trying to force other people to come to that kind of an awareness prematurely, like what were some of the good things that happened from your assault? It’s like get out of here, I got a lot there. Most of us, even with dramatic events and myself having lived through multiple traumas, as you look back, you recognize that you are the person because of the things that you’ve been through and why you wouldn’t have chosen those things. You see with very clear eyes. I’m not talking about let’s just think happy thoughts in a kind of Norman Vincent Peale peel type of way, but let’s be honest about our lives and take a broader view.
Richard Jacobs: What’s the best way for people to interact with you? What if they want therapy from you or to get your cards? Can you restate the name and where they available?
Seth J. Gillihan: The cards, there’re different versions of The CBT Deck, so that’s the title of the original one. There’s “The CBT Deck for Anxiety, Rumination and Worry” then there’s “The CBT Deck for Kids and Teens.” Those are available pretty much wherever books are sold. They’re certainly available online. If you can just do internet search for those, you’ll find them. People can also go to my website, my first and last name, www.sethgillihan.com. They can find links there to all my books, online courses, and podcasts etcetera.
Richard Jacobs: With the new loosening of laws on telemedicine, are you able to work with people in many states or where can you help people?
Seth J. Gillihan: There are some people I can work with out of state but I’m not to accept new patients for the foreseeable future.
