Dr. John on The Doctors: Explaining The Third Wave of Psychotherapy

This is the clip I’ve traditionally used to introduce myself and my practice. When I was in LA, I specialized in social anxiety and phobias, including a fear of flying. And being in LA, at some point I was featured on a day-time talk-show called “The Doctors,” which focused on medical information and featured doctors demonstrating their techniques and methods. So I’ll use portions of that show to explain my take on therapy, as well as psychedelic therapy and what I think the future will be.

The best way to explain the progression here is to think of psychotherapy as waves. When they do phones, it’s generation, G2, G3, G6. For Psychotherapy, it’s waves. Like phones, you can use the therapies of prior waves, though it’s a bit outdated.

The first wave for psychotherapy was your basic behavioral therapy. So as you’ll see in the clip in my office I used to have airline seats and virtual reality. If you have a fear of flying and you put on the headset and sit on those chairs, you’ll get nervous, you really will. But go through some relaxation techniques and you’ll start to relax. All of a sudden the beeps and the turbulence don’t seem as scary. That is the first wave.

Simple behavioral therapy. Paring relaxation to something that elicits anxiety, leading the anxiety to extinction. And for many of my clients, that’s all they needed. Happy to provide that. Yet it was always missing something, a cognitive component.

You have thoughts and beliefs that themselves can lead to anxiety. Questioning those beliefs, challenging those beliefs can really accelerate the therapy.

So having the client question their anxiety: “Just because I feel nervous, doesn’t mean I’m in any danger.” Or “the Flight attendant isn’t panicking or worried; maybe I shouldn’t either.” Very similar to behavioral therapy, but adding thoughts, cognitions. That brings us to the 2nd wave: cognitive-behavioral therapy.

The third wave, is more mindfully based. That’s what you’ll see in the clips today.

Rather than questioning the thoughts, you’re accepting them, along with the feelings.

Allowing the feelings to be there as you move towards purposeful, value-driven behavior. And studies are now showing that adding this mindful component seems to increase the efficacy of the therapy, compared to just the traditional CBT.

Okay, so enough of the preview. Let’s get to the clips to show you this all in action. To introduce you to the television show, here is their introduction where they discuss the topic of fear and phobias.

Introduction

The first person they wanted to have on their show was someone who had a fear of flying.  During that time, I was the fear of flying guy in Los Angeles, so I was asked to demonstrate my techniques with someone who had such a fear. Now, I should note that this individual was not an actual client and that this was a demonstration due to this being a televised show. So let’s meet the participant:

Karen's symptoms and the consequences

For many people, stress, anxiety, and depression can really impact not just their well-being but their goals and aspirations.

Here, Karen wanted to fly, she didn’t want to have to drive across country just to visit her son but her anxiety was preventing her from flying. 

So here, I’m going to demonstrate some of the techniques I use for anxiety in general and phobias in particular. Now, keep in mind that this was taped in 2012, so I looked a bit younger than I do now. Anyway, here’s where I come in.

 Applied Relaxation

So what you’re seeing is the behavioral component, applied relaxation techniques. The major goal here is to not make anxiety go away completely. Rather it’s to develop in the people I work with an increased tolerance for anxiety. Our goal is to reduce the anxiety about anxiety. This, paired with an increased ability to relax oneself can really make the difference in helping people feel better and reach their goals.

In this next clip, we move into a demonstration of exposure therapy, with virtual reality. Now, in this clip I’m using virtual reality equipment from, well, the turn of the century. Works pretty well, but it’s all a bit dated. 

Virtual Exposure Therapy

Here what we’re doing is allowing Karen to feel some of the anxiety while also questioning it. Allowing her to observe the anxiety without being consumed by it. Even though the anxiety is there, she’s in no danger. It’s something that she’s able to observe and feel and let go. Karen here is learning to tolerate the anxiety.

To understand that the anxiety might not go away completely, but that it’s nothing that she can’t tolerate.

She can allow the anxiety to be there and it doesn’t have to limit her. That’s where the mindfulness comes in. Gives you some distance from the anxiety. Allowing it to be there, knowing it will pass in time. We practiced that a bit more in the demonstration. 

And then, she was off to take her flight at the Santa Monica Airport. Here’s a quick recap of the show, where we see Karen as she arrives at the airport

Meeting Jillian

For the show, they had her fly with Jillian Michaels, a fitness and wellness coach. I think she does a good job, but my one critique is that one line, that fear is something we can choose to educate ourselves out of.

A major component of these third wave therapies is that there’s always going to be fear and anxiety.

Although helpful, education about how safe flying is by itself isn’t going to take away nervousness, fear, or anxiety. The key is to make room for the anxiety, breathe into it, let it be there. That although you’re feeling fear, it’s a natural emotion; it doesn’t mean you’re in any danger, and that it’s something that you can be willing to tolerate for the goals in life.

What she does right

This is the part is where I really agree with Jillian. That once you learn to manage and build your tolerance for anxiety, you can start to learn from it. It can help you become a stronger person. Additionally, the focus on values can go a long way in helping people reach goals and overcome adversity. Okay, onto the landing.

The Landing

So as we see here it wasn’t that her anxiety disappeared. Rather she developed the skills to better tolerate the anxiety. Breathe through it. The anxiety will reduce but never go away completely. And that’s okay.

Giving room for the anxiety takes away its power and builds confidence.

This makes it much easier to work through anxiety or whatever emotion tends to hold you back. And that is the mindset that I apply to my current practice and Pentabelt™. We’re developing skills to mindfully accept and tolerate feelings so that you can live a healthier and happier life.

So that represents the base of what I do. That is the third wave of psychotherapy. Adding onto that is psychedelic therapy, which will be the 4th wave. After that, and this is a few years away, is the 5th wave, using psychedelic therapy in a community setting to build resilience in young adulthood.

And so, in the next section, we’ll explore how psychedelic therapy represents the next generation, the next wave of psychotherapy.

On to Section 3