Part 2 The History of Exposure Therapy Albert Bandura and Guided Mastery

As I contemplated what to write next in the series on the History of Exposure and Response Prevention Therapy(ERP), I decided to pick the first article in the pile of ones I had found, and came up with Swimming against the mainstream: the early years from chilly tributary to transformative mainstream, by Albert Bandura, Behavior and Research Therapy, 42(2004): 613-30.

I know Bandura's name from being a teaching assistant for a Health Behavior class(an ironic position for a woman with Health Anxiety), and the professor's discussion of Bandura's concept of Self Efficacy: the belief in our own capabilities to get things done. For myself, I had little belief that I could do anything to change my compulsive behaviors or deal with the obsessive thoughts, and this is truly disheartening.

ERP is a form of Behavior Therapy(BT), and Bandura traces his involvement in the history of BT, starting in the 1950's. The dominant form of treatment for psychological problems was Psychodynamic--the descendants of Freud, the heavy dependence on the therapist interpreting what the patient says in terms of things simmering in the unconscious, and searching for underlying meaning.

To directly deal with a behavior that causes suffering was considered superficial, inadequate, but Bandura noticed how people who modified their behavior(ie. stopping drinking) in one way, had changes throughout other aspects of their lives. He published an article in 1963 on psychotherapy as a learning process, and it generated huge interest--including from Victor Meyer, featured in my last post. The response from more traditional psychotherapists was resolutely negative--BT was dangerous! It would lead to "symptom substitutions" and all that unconscious stuff stewing would burst out.

In meeting others with OCD in support groups or at the IOCDF conference, and reading the OCD-Support List, and comments from readers of this blog, I am taken aback by how, in mainstream treatment of OCD by therapists of a general psychodynamic bent, they still want to find the underlying cause of the obsessions and compulsions, to the exclusion of actually addressing the behavior itself. This can lead to OCD hell--especially for those of us with existential OCD questioning of everything we do anyway. And Cognitive Therapy can also fall into the same hell, with analyzing our thought distortions ad infinitum.

This is not to say that the content of our minds was not important: there were those who were also interested in thoughts and beliefs, within the context of BT, and argued that people are self-examiners of their own functioning, that they as self-aware beings, we can influence our own environment, hence adding the "C" to "CBT"--Cognitive Behavioral Therapy.

He worked with people who had phobias, and I recognized the core truth in what he says, "When people avoid what they dread, they lose touch with the reality of what they shun." If a person with agoraphobia can test their dread by leaving the house and surviving, then they can get better, but Bandura understood the reality that

Intractable phobics, of course, are not about to do what they dread.

Yeah. I see myself in this. Bandura endeavored to create an environment where people could move toward that experience of getting back in touch with the reality that they shun. Bandura developed a treatment he called Guided Mastery, which strikes me as having elements of ERP:

• Modeling of the behavior by the therapist or other support person
• Following a graduated set of subtasks from easiest to most difficult
• Joint performance with the therapist of the feared task
• Performing the feared activity for only a short time, and gradually extending the time
• Increasingly challenging oneself in order to reclaim life
  

And then we come back to self-efficacy, which I learned about so many years ago.

Unless people believe they can produce desired effects by their actions they have little incentive to act or to persevere in the face of difficulties. Whatever other factors serve as motivators, they are rooted in the core belief that one has the power to effect changes by ones actions.

He argues that a good therapist arranges things for others in such a way that allows for success and "avoids placing them prematurely in situations where they are likely to fail," and emphasizes that if one can learn to see failure as informative rather than demoralizing, one can become resilient.

What can you do to encourage your own successes?

Starting to Move Again Part 2 A Progress Report

by Nina

Daffodil by Melina Meza

As some of you may remember, during this last winter, Baxter and I became concerned about people we were hearing about who were afraid of leaving the house because they were worried about falling on the winter ice. Even worse, we heard about a couple of people who had fallen and who had then lost all their confidence in their physical abilities. The real problem here is that loss of confidence can lead to inactivity, and that inactivity in turn leads to stiffness, weakness, loss of balance and/or loss of agility. But we knew that yoga could help these people so we got started blogging!

First, Baxter wrote a general post about how you can use yoga to cultivate balance specifically for dealing with icy conditions (see Winter Ice, Fear of Falling and Yoga).

But I decided that I wanted to help a specific individual, a women who had left a comment on my post Regaining Stability for Free. Here is the original comment:

“Omgosh. I ....this took my breath away. This is exactly what happened to me! I was this vibrant, moving being....then a stupid, nasty fall (via a piece of gravel on the sidewalk) ended all that. And my subsequent life mirrors your friend's. Thank you SO much for giving us hope!”

So I followed up with this reader to find out more about her particular issues, and with Baxter’s help I came up with three short yoga sequences for her to practice as a way to regain both her physical abilities and her confidence (see Starting to Move Again ). The three sequences were:

1. Baxter’s classic Low Back Care Practice. Because our reader was having back problems in addition to fear of falling, I hoped this sequence would help relieve back pain and restore a feeling of physical wellbeing.

2. Baxter’s classic Mini Restorative Practice . Because our reader was feeling anxious, I hoped this sequence would help relieve stress. And because she was stiff from lack of exercise, this sequence would allow her to gently and passively regain flexibility.

3. My Gentle All-Around Practice. Because the standing poses in this sequence build strength in the lower body and improve balance and stability, I felt this sequence would be helpful for our reader as well as for anyone who is afraid of falling.

My hope was that practicing these sequences on a regular basis would, over time, restore our reader’s flexibility, balance, and feelings of self confidence, and allow her to be a “vibrant, moving being” once again.

Now that it’s spring, I decided to check back in with her to see how the program had worked for her. The news was so good, I decided I had to share it with you. Here’s what she said:

“The moment I started practicing, I knew that I had the tools to positively effect a change, and that translated, almost immediately, into regaining my confidence. And once I got my flexibility back, it was as if there was a mind-body reconnection as well. Although I sometimes backslide, when I do attend to the poses and sync my mind with my body, I feel pretty much invincible!”

I’m partly sharing this with you simply because it makes me so happy! But there is also an important takeaway: having a home practice, however basic, is empowering.

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Menu Part 2 Second List of Publications for Potential Posting

Advances in the Treatment of Glaucoma; Optistock Industry Overview, Fall 2001.

This article was published by Optistock.com as part of an Industry Overview. (The editors added an addendum on treatments for AMD.) My piece, on glaucoma, was a comprehensive overview of the then current thoughts on treatment of this significant disease.

Spotlight: Laser Phaco – An Overview; Optistock, Fall 2002.

I wrote this right after the first laser (the Dodick Laser Phacolysis System) was approved. I felt then, and still do, that laser phaco will never amount to a significant market presence.


Over the years, I have written several pieces on potential treatments for Age-Related Macular Degeneration (AMD) that were published in Ocular Surgery News. Three of these are shown below:

Photodynamic Therapy for Macular Degeneration; Ocular Surgery News, December 15, 1994.

My first look at PDT therapy for AMD.

Laser Treatments for AMD Show Promise; Ocular Surgery News, January 15, 2000.

A look at the status of both PDT and other potential laser treatments for AMD.

Visudyne Looks Promising for Treating Wet AMD; Ocular Surgery News, January 15, 2001.

In this column, I questioned whether the use of Visudyne might break the Medicare bank.

Avastin: A New Hope for Treating AMD

This, as yet unpublished report, will be a contemporary look at the brand new potential drug treatment for AMD, based on the latest clinical results – and reports from analysts that follow the field.

In addition, I have also written about a new laser treatment for glaucoma:

SLT: New Treatment for Glaucoma Becomes Available; Ocular Surgery News, May 15, 2001.

In this column, I interviewed the inventor of the new laser treatment for glaucoma, selective laser trabecloplasty, and wrote about its application compared to argon laser trabeculoplasty, the then standard of care.

Friday Q A Trauma Resurfacing Crying in Class Part 2

Morning Glories by Melina Meza

Last week when Baxter and I wrote our post Friday Q&A: Trauma Resurfacing, Crying in Class, we felt a bit like we were going out on a limb. Finding the right way to talk about trauma resurfacing during yoga practice was a delicate process, especially because neither of us has had the experience ourselves. And we also wanted to be as diplomatic as possible in discussing the role yoga teachers should play (and not play) when a student cries during classes. So we were very pleased to receive some positive comments about our post. In fact, Baxter found the comments on the blog site so insightful that he asked me to share them with you, our readers. Of course, some of you may read the comments sections of our posts and will have already seen one or both of these comments. But for those who read the original post early or those of you who don’t read the comments, I'm including them below. We are so grateful that these readers took the time to contribute their own thoughts about this important topic. Thank you, Kate and Mary!

—Nina

"Thank you for this post; I think lots of teachers will benefit as I've seen little written about it. This line of Baxter's really resonated with how I feel on the topic: "I try not to pacify or console, or imply that I know what they are going through, but continue to cultivate a safe environment for them to experience their full practice." Creating a safe space for the more intense moments of the practice to be digested is key, and I believe is often what enables them to come up for people in class in the first place. I find it useful to let students know that when practicing yoga over a series of years almost every emotion available will be experienced to some degree and that crying from sadness or any other emotion can be a healthy and useful way to process those emotions or experiences that arise. I wonder if saying even that much goes outside scope of practice, but nonetheless it's been beneficial for students who have cried in class to hear and understand so they don't feel there is something wrong with their practice or something that needs fixing. 
Nina, thank you for the resources for better supporting those working with a history of trauma. The front body protected poses are excellent reminders." —Kate

"Thank you for this important post. I think we will be seeing much more about the benefits of a yoga practice for trauma survivors. I can highly recommend the book by Emerson and Hopper, and the training through the Trauma Center at JRI. As an adjunct to talk therapy, I believe yoga is a powerful ally in the treatment of trauma, and hope that more people will become aware of its benefits. In those cases, making sure that the student is already actively in therapy is vital, so that what comes up in yoga class can be processed safely with a trusted professional. In my experience so far, your advice about child's pose (and front body protecting positions) is spot on – although, naturally any pose could trigger emotions and memories, as each individual's experience is unique. As the original commenter stated, I agree that there are likely many more trauma survivors in our classes than we realize, and although there is no way of knowing the reason for the spontaneous tears in class, I think it's a gift for any practitioner to be in an environment where experiencing and expressing emotions is welcomed and not judged – something that all yoga teachers can strive to provide." —Mary

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The Power of Svadhyaya Self Study Part 2

by Nina

Anatomical Body
India, Gujarat, 18th century

While preparing to write this post, I discovered that I had, uh, completely forgotten about some of the things I’ve written for the blog. (Hey, I’ve been writing at least one post a week—and sometimes two or three—for almost three years.) Yes, I was quite surprised to find a post about how we could use the wisdom of the Bhagavad Gita to heal from an election so divisive that even Big Bird wasn’t being nice (see Yoga Philosophy of the Day, Part 2), another about how I was using yoga philosophy to prepare for a trip to Germany that I was feeling uneasy about (see Yoga Philosophy of the Day), and a third about how we can use wisdom of yoga to change our behavior patterns (see Thinking About the Wisdom of Yoga). But it’s no surprise at all to me that I find yoga philosophy extremely valuable in my every day life. And I’ve written about that in a general overview—which I have not forgotten about—called Why You Should Study Yoga Philosophy.  

As I mentioned in my post Svadhyaya (Self-Study), Part 1, there are two different interpretations of the meaning of niyama svadhyaya (self-study). In his book The Yoga Sutras of Patajanli, Edwin Bryant says:

Svadhyaya literally means self-study, but it more commonly refers to the study of sacred texts (in a sense the two meanings overlap, since sacred texts typically teach about the self).

So while one meaning of svadhyaya is to cultivate your inner witness to study your own self as I wrote about my first post earlier this week, another is to study the yoga scriptures, such as the Bhagavad Gita and Yoga Sutras, and—if you’re feeling brave—the Vedas and Upanishads. And this type of study complements your self-study because as you read these texts, you can reflect how to use the knowledge they contain. I consulted with Ram before writing my posts on svadhyaya’s two different meanings, and he recommended asking yourself these questions about the scriptures:

• How do you use the knowledge for self-empowerment? 
• How do you use the knowledge for the betterment of society? 
• How do you grow in body and mind after reading those scriptures? 

This kind of self-study can also include more than reading just the original scriptures themselves. As Ram said:

S(s)vadhyaya =education, study, or knowledge improvement that is gained from studying not just scriptures but any book or any experience that provides deep meaning or interpretation of life (that is, thought provoking).

So svadhyaya includes any books about yoga, whether books that interpret the scriptures, such as the Edwin Bryant book I mentioned above (which I frequently turn to), books about the history of yoga, such as Georg Feuerstein’s The Yoga Tradition about ancient yoga and Yoga Body: The Origins of Modern Posture Practice by Mark Singleton about modern yoga, or modern books about yoga (plus, our blog, of course). Obviously, texts from the religions of the world will also provide you with food for thought, but you should also consider psychology books and books about human behavior. Two of the non-fiction books that have influenced me greatly include Full Catastrophe Living by Jon Kabat-Zinn and A General Theory of Love by Thomas Lewis, Fari Amini, and Richard Lannon. Even fiction that explores the human condition can contribute to your self-study (I read an interesting New York Times article For Better Social Skills, Scientists Recommend a Little Chekhov that explained how literary fiction can help you develop empathy and improve your understanding of human behavior).

It makes a lot of sense that in our studies of the self, we should turn to the wisdom of others. After all, yogis and people of other cultures worldwide have been engaged in self-study for centuries, so we can learn a tremendous amount from their experiences. As a matter of fact, the single piece of yogic wisdom that I keep returning to in my everyday life is over two thousand years old:

The wise man lets go of all

results, whether good or bad,

and is focused on the action alone.

Yoga is skill in actions.

—Bhagavad Gita

Brad and I have been talking about that quote a lot lately because he has been taking on some big challenges at work and he finds that taking this yogic approach has helped him maintain some peace of mind. (And, yes, I do remember that I include that quote that in my posts all the time!)

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This is our new Web 2 0 website

Welcome to the fourth iteration of our website as we are now well into our 4th year of existence. Previously, we had a separate website and discussion forum. We were having such a horrible problem with spam on the discussion forum, that it really detracted from the quality of the content, and I (Dr. Johnson) had to spend an unacceptable amount of time trying o clean it up. We are now using the open source WordPress as the basic backbone of the website. Overall, the appearance should be cleaner and easier to read. More important is that is will be both an informational web site with static informational pages, but it will also include blog-styles posts as well as comments and stories from treated patients and those still exploring their options for treatment. I’m new to WordPress, so this is a work I progress and, I hope, a better opportunity for interaction and access for those seeking a legitimate opportunity to improve the quality of vision and quality of life. Cheers, Dr. Johnson

View the original article here

Video of the Week Dynamic Warrior 2 with Crazy Arms

This creative version of Dynamic Warrior 2 changes up the classic arm position to build additional strength in your upper body through variety of movement, as well as to challenge your memory by offering you a new movement pattern.

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