My dear readers, this month, our guest at #EpicTalk series of authentic conversations is one of the most famous CBT psychotherapists in the entire world. He had the chance to learn from Aaron T. Beck (the father of CBT) and he developed the therapy of emotional schemes. He is a well-known book author, and his books were published around the world. Ladies and gentlemen, let’s welcome dr. Robert Leahy – Director of the American Institute of Cognitive Therapy and Professor of Clinical Psychology at Weill-Cornell University Medical School.
Gáspár: Dr. Robert Leahy, it is a great honor for us to have you invited here, in our #EpicTalk series of memorable conversation, on the most important psychology platform in Romania. Many years ago (precisely, in 2011), I had the pleasure to listen to you live, at The International Congress of Cognitive Psychotherapy, in Istanbul. I sincerely admit – together with Paul Gilbert and Frank Dattilo – you are the most influential cognitive-behavioral psychotherapists. You changed my vision about psychotherapy and therapeutic relationships.
So, I would begin this conversation asking you, above all… How did you confront this difficult spring, especially that (as much as I know) you live in New York – one of the most affected cities in USA by COVID-19? In these months of collective anxiety and vulnerability, I continuously watched your posts in social media and I was very glad to feel your thoughtfulness for the community.
Robert Leahy: Thank you for inviting me to discuss these things. This pandemic is worldwide and it is hard to imagine anyone not affected in some way. It is especially challenging for those working in hospitals, but also difficult for those people living in crowded housing or people who need to go to work to support their families. Minority groups in the United States have suffered disproportionately. In addition, elderly people – especially those living in nursing homes – have very high death rates.
Having said this, I am fortunate that we have been able to leave NYC in late March to move our weekend home in a very rural area 110 miles from New York. We are seeing patients via telehealth – and it seems to be working fairly well. Yet, throughout April and May I heard on a weekly basis about people dying from COVID. Not only elderly people, but people of a wide range of ages. Indeed, this pandemic has more of an effect on Americans on a day to day basis on the lives of people than the Second World War. After all, if you were not involved in combat in the War, your day to day life was not as dramatically affected.
Like many people I have felt the emotional impact of this pandemic. I have had to use all of my cognitive behavioral skills to cope. One way that I cope is to try to help other people through reaching out, writing blogs and articles, seeing patients, and showing compassion. The pandemic presents the “perfect storm” for depression and anxiety. We have isolation, threat, uncertainty, bad news all the time, unemployment, lack of control, and disconnection from the structure of daily life. For some people the “shelter in place” or “stay at home” feels like defeat or “house arrest”.
So, what can we do to cope better with the pandemic? Let’s look at several issues. First, we have what I call rational fear. This means that there is a good reason to fear a threat. COVID is a killer. We currently have over 110,000 people in America who have died. The way I view rational fear is that it protects us from unnecessary risks. Following the guidelines of health authorities is the way to cope with rational fear. We practice social distancing, wearing a mask when around other people, increased hand hygiene, and cleaning surfaces. These are ways of manifesting control. Second, we have the issue of isolation. Fortunately, my wife is an excellent companion and source of support. But we can reach out to people immediately and easily. Contacting friends, family and colleagues has been quite rewarding. Social distancing does not mean social disconnection. Third, many people focus on what they cannot do, but we can shift our focus to what we can do. Many people feel helpless. But helplessness depends on the tasks that you focus on. I may not be able to go to restaurants in New York, but I can exercise daily, see patients on-line, read, write, have conversations, work on tasks at home, watch videos, learn, and look for the silver lining. Fourth, there is considerable uncertainty and people who are prone to anxiety equate uncertainty with a bad outcome. But uncertainty is simply that—we don’t know. For example, we don’t know when there will be effective treatments or a vaccine. But that does not mean we will not have these medicines. Indeed, we are witnessing the most ambitious commitment on the part of public and private enterprises to develop these medicines. I personally feel cautiously optimistic—but I also do not know and I do not know when this will happen.
Gáspár: In time, the cognitive-behavioral therapy saw many changes and significant adaptations. And you had a major contribution in the development of emotional patterns. In the last months, the whole world had to confront a lot of negative emotions, I would like to know… What are these emotional patterns and how they impact our perception on life and on the manner we interpret difficult situation – like this pandemic?
Robert Leahy: This is an excellent question—and thank you for bringing this up. Yes, we have a wide range of emotions: frustration, anxiety, depression, hopelessness, anger. Each emotion makes sense, so we need to validate those emotions in ourselves and in others. Who would not have some anxiety during this troubling time? But my emotional schema model has been helpful to me and my patients. One thing that we can realize is that emotions are not fixed and permanent. For example, your anxiety may come and go during the day – depending on what you are doing and what you are thinking. We can normalize that anxiety might be a universal feeling, but also realize that we do have some control over anxiety. For example, I can reduce my anxiety by realizing that there is a very low probability that I will die from COVID. I can recognize that just because I feel anxious, this does not mean that I am in danger (emotional reasoning). I can expand the emotions that I have today by searching for ways to find compassion for others, appreciation for what I have, show gratitude toward people in my life currently and in the past, enhance my curiosity about something. I like to think about emotions as a collection of experiences that I can move to and from. Each day is a journey across the landscape of feelings. The key thing is not to get stuck on one emotion.
Gáspár: Browsing on the The American Institute for Cognitive Therapy website, I saw (hoping that I counted carefully) you have published by now 28 books. And I happily observed that some of them were translated in Romanian language. Starting from your books, I wonder what you believe… How evolved the cognitive therapy lately, and what directions do you see for changing in the future?
Robert Leahy: Yes, I have written and edited many books and it keeps me busy finding challenges. I think that one of the motivations I have in writing is to find something that interests me. For example, my book on jealousy was motivated by my curiosity about this powerful emotion. So I began researching this topic and tried to integrate evolutionary theory, cultural factors, sex differences, cognitive therapy, emotional schema therapy, acceptance and mindfulness.
I think that CBT has two directions. One direction is for people to identify with a specific model – such as Beckian therapy, DBT, Behavior Therapy, or ACT. In my experience, each approach has value, so I use all of them, depending on the patient. The second approach is exactly that: the willingness and openness to integrating approaches. I see this in the work by Steve Hayes and Stefan Hofmann on common processes – which I applaud.
But I also think that CBT has not fully used a lot of the work in other fields – especially cognitive psychology, behavioral economics, decision making, and other areas. For example, I am currently working on a popular audience book on regret. This is a significant problem for many people who have difficulty making decisions and difficulty living with the outcomes. I am drawing on the work in cognitive psychology, judgment theory, and behavioral economics. This includes “rules of thumb” that people use (heuristics) and how some people approach life as “maximizers” (wanting the perfect solution) while others are more accepting or “satisfiers”. So, this book will be a challenge. But I like a challenge.
Gáspár: From my point of view, integrating mindfulness in majority of psychotherapeutic approaches represents the most spectacular adjustment in psychology of the 20th century. How do a cognitivist relate to mindfulness and how often practice it in daily life?
Robert Leahy: I think that mindfulness is a valuable technique and in fact it is an intrinsic part of cognitive psychology and emotional schema therapy. But mindfulness does not enrich our conceptualization of the emotions that I find interesting. For example, I am interested in jealousy, envy, ambivalence, regret, the desire for revenge and boredom. Yes, we can say, “Stand back, observe, do not judge”. That is very helpful. But it does not help us understand these emotions, why they have evolved, how they can sometime be useful, and how to find the balance of an adaptive strategy. Our emotional lives are far too complicated to be equated with one approach. We need all of the approaches, including (but not limited to) mindfulness.
Gáspár: You are one of the most appreciated clinicians and psychotherapist in the world. In all the years you worked with the human mind… What surprised you most? What it that psychological revelation which determined you to rethink the way you look people, relationships and life?
Robert Leahy: I was initially trained by Beck and later by David Burns in supervision. These were invaluable experiences. But what I realized is that validation, acceptance of “negative” emotions, living with unresolved issues, and having flexible expectations were important.
Gáspár: I know in 2017 you visited Romania (I do not know if that was your first time) and you participated in The International Congress of Cognitive Psychotherapy in Cluj – organized in cooperation with Babeș-Bolyai University. How did you remember Romania and which are the similarities regarding psychology of the Romanians and the Americans?
Robert Leahy: I have a great deal of professional and personal respect for Daniel David, who I have known for many years. He is a first rate intellect. Daniel has been a strong advocate of the work of Albert Ellis. As you know, both Ellis and Beck lay claim to being the founders of cognitive therapy. In my view, they both deserve credit. Other than the work of Professor David, I have to confess I am not that familiar with the Romanian work at this point. My recollections of Romania are very positive and I especially recall the warmth of the delegates and the beauty of the city.
Gáspár: In my clinical practice, I work mainly with couples. And one of the frequent (and recurrent) themes is jealousy. Your book, The Jealousy Cure, includes ideas which help us to better understand and confront this relational emotion. Why do you think the jealousy got such a negative fame in our modern society and which would be the healthy manner to avoid this emotion?
Robert LeahyL I don’t think we need to avoid jealousy. We can learn from it. For example, jealousy might tell us that someone is important to us and we do not want to lose that relationship. It may tell us that we may over-react to events and get hijacked by our thoughts and feelings. I think that couples often will have to live with the occasional feeling of jealousy, but feelings are not facts. So, one can feel jealous, but that feeling does not mean that there really is a threat. I also think that we need to realize in our relationships that our partner may have feelings that are uncomfortable for them and for us. Approaching them with compassion, validation and acceptance is going to work a lot better than telling them that they have to get rid of that feeling.
Gáspár: Also in my clinical work, I had clients who told me that they never feel jealousy. As an expert, what would you say… Is it possible the humans never feel that? Or is it about a difficult to recognize the jealousy?
Robert Leahy: I have seen some people who claim that they never feel jealous. It’s hard for me to imagine being that way myself – although I do not think of myself as a jealous person. But I often wonder about how much a person can be special to you if you cannot imagine the possibility of a threat to that relationship.
Gáspár: You have published countless of articles and a few books about anxiety management. We can say the anxiety became the actual state that we all feel, because of the recent changes. How could people manage it, so not to become a clinic disorder? What would be a few useful recommendations for our readers?
Robert Leahy: Anxiety is part of life, just as noise is part of living in a city. There are several techniques that can be helpful. I would encourage labeling the feeling, recognizing that your anxiety changes during the day, linking your anxiety to the threat that you are imagining, setting aside worry time, realizing that you are probably more resilient than you think you are, and grounding yourself in what is simple. For example, finding some things in your life that are simple that have meaning for you can help you feel less threatened. This can include simple exercise, simple food, simple reading, and staying in the moment. Hmm, that sounds like mindfulness, doesn’t it?
Gáspár: Dr. Leahy, I have to say that we are now at the end of our conversation. The #EpicTalk tradition is that the last question has to come from my guest. So, I am interested to find out which is your question for me – a question which a psychologist & psychotherapist (or a Hungarian who lives in Romania) could answer to.
Robert Leahy: I would be curious how people in Romania view the different schools of psychotherapy. I was told that, under Nicolae Ceaușescu, psychotherapy was often difficult to practice. Which schools of therapy have become popular in your country?
Gáspár: Indeed – under communist regime, the faculties of Psychology were abolished, and the schools of psychotherapy operated in secret. In time, starting from 1990, it was observed an ascending preoccupation with psychology. So, in the last 2-3 years, faculties of Psychologies had more candidates than faculties of Medicine.
Regarding psychotherapy schools, fortunately, we have a large diversity. It was a time when cognitive-behavioral approach was among the most popular choices – that’s because The Faculty of Psychology at Babeș-Bolyai University adopted a CBT orientation. Also, it existed a time when integrative approach has a huge success, with a lot of followers. Important are the psychodynamic approaches, too – no matter if classic psychoanalysis, Jungian analysis or psychodrama. And in the recent years, modern approaches are more and more studied – like the ones founded on attachment theory, systemic theory and interpersonal neurobiology – as it is our programme of relational therapy also. Obviously, successful are the therapy of schemes, the couple therapy based on emotion, the Imago therapy, too. Recently, we have a visible trend for systemic constellations, body therapies, and trauma interventions.