Category: Change

This transcription was auto-generated by YouTube and formatted by ChatGPT.

Have you ever wondered what’s the best type of psychotherapy? In this video, we’ll look at some different ways of answering this question and talk about the main elements that go into making therapy effective.

On the one hand, there are a number of empirically supported or evidence-based psychological treatments, which are specific treatments for specific psychological issues or disorders that have been shown effective in peer-reviewed randomized controlled trials. Most of these involve some form of cognitive-behavioral therapy or therapy that integrates CBT with mindfulness, like Acceptance and Commitment Therapy, Dialectical Behavior Therapy, or Mindfulness-Based Cognitive Therapy.

The American Psychological Association has a list that evaluates the strength of the research support for a number of types of therapy. Now, they changed their criteria for evaluating research support a few years ago, and so all of these [red new content tags] indicate that the treatment is pending re-evaluation under the new criteria, but the old criteria give you an idea of the types of treatments that are generally considered evidence-based or empirically supported, and I’ll link to this website in the description.

On the other hand, there’s the common factor school of thought who believe that outcomes are similar enough regardless of the type of therapy that the type of therapy itself isn’t what’s important. It’s factors that are common to all types of therapy that are responsible for successful outcomes. In other words, there aren’t specific factors associated with one type of therapy that make it more effective than other types of therapy. What makes therapy effective are the common factors that all types of therapy share.

An example of a specific factor is that cognitive therapy uses cognitive restructuring or cognitive reappraisal to help change and modify thoughts, whereas common factors that exist in any type of therapy are things like alliance, which is your bond with your therapist. Do the two of you click and your level of agreement about the goals and tasks of therapy? And empathy, do you feel like your therapist understands you and where you’re coming from and is empathetic to you and your situation? And expectations, do you have positive expectations for your therapy and how optimistic are you about whether and how much you expect to improve as a result of therapy?

The common factors proponents argue that it’s these common factors that are responsible for the outcome of therapy and not any specific therapeutic approach or techniques, and there are a couple of studies that have come up with a breakdown along the lines of about 50% of the outcome of therapy is the result of common factors, about 33% is due to things that happen outside of therapy, and about 17% is attributed to the specific type of therapy. In general, the more severe your symptoms, the more effective specific therapies are compared to common factors and non-specific techniques, and I’ll link to this research and some articles about the debate between common versus specific factors in the description.

So who’s right in this debate? I think this chapter sums it up well. There’s good evidence to support the assertion that certain common factors of several different psychotherapies are beneficial to the process of change across different disorders and treatments. Similarly, there’s good evidence that some treatments differ meaningfully from others, and that certain specific elements of some treatments may be viewed as unique contributions from particular types of psychotherapy.

So there’s evidence supporting both sides of this debate, and instead of continuing to debate this, there’s now more focus on how to integrate both models together in ways that will be most beneficial.

Which brings us to evidence-based practice, which is different from an evidence-based treatment. According to the American Psychological Association, evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences. This is sometimes known as the three-legged stool of evidence-based practice. The best available research will often indicate an empirically supported or evidence-based treatment, but that’s only one component, one leg of evidence-based practice. Research into the importance of common factors would also fall into this leg.

Evidence-based practice recognizes the importance of things such as alliance and empathy in client expectations, and one aspect of the clinical expertise leg is the ability to form a therapeutic relationship creating realistic but positive expectations and responding empathetically to the patient’s experiences and concerns, as well as the flexibility to be clinically effective with patients of diverse backgrounds. The importance of these common factors is also addressed under clinical expertise, and then the patient characteristics leg refers to the individual social and cultural context of the patient.

So what does this look like in real life? According to a paper from 2010, “What Do Psychotherapists Really Do in Practice?”, the most common therapeutic techniques are conveying warmth, caring, and respect, communicating that the client is accepted and prized, communicating understanding of clients’ experience, empathizing with the client’s situation, feelings, and struggles, promoting clear, direct expression of clients’ feelings, making reflective or clarifying comments, and focusing on cultivating therapeutic relationship and alliance. It makes sense that these techniques are the most common because they’re all common factor techniques, so they’re a part of therapy regardless of a therapist’s theoretical orientation. These are the only therapeutic techniques that were used by more than 60% of therapists.

Now, in terms of specific techniques associated with a certain type of psychotherapy, instead of focusing on a single therapeutic orientation like CBT or psychodynamic therapy, most therapists use what’s known as an eclectic approach that draws on techniques from more than one type of therapy, using whatever is best suited to meet a client’s needs. This aligns with the second and third elements of evidence-based practice: using clinical expertise to guide practice and tailoring therapy to the individual client.

This paper found that only 2% of therapists identified themselves completely with one orientation, so 98% of therapists are drawing on more than one type of therapy, and 79% include CBT in their practice, 41% mindfulness, 36% psychodynamic or analytic psychotherapy, and 31% rogerian or client-centered therapy. These numbers are from 2010, and now I suspect CBT and mindfulness percentages are higher today because that seems to be the trend.

According to a 2021 paper that looked at the predicted future of psychotherapy by polling a panel of experts about what they think psychotherapy will look like in the 2030s, the therapy practices that were predicted to increase the most were multicultural therapies, so again in line with evidence-based practice and respecting the needs of individual clients, mindfulness therapies, and cognitive-behavioral therapy.

Putting all of this together, the best type of therapy is an empirically supported treatment for any specific psychological issues or symptoms you’re experiencing, which will usually be a type of CBT or CBT plus mindfulness, with a therapist you have a strong alliance with, someone who’s able to use their clinical judgment along with your individual characteristics to tailor empirically supported treatments to best suit your needs and preferences.

American Psychological Association Policy Statement on Evidence-Based Practice in Psychology: https://www.apa.org/practice/guidelines/evidence-based-statement

Brown J. Specific Techniques Vs. Common Factors? Psychotherapy Integration and its Role in Ethical Practice. Am J Psychother. 2015;69(3):301-16. doi: 10.1176/appi.psychotherapy.2015.69.3.301

Budd R, Hughes I. The Dodo Bird Verdict–controversial, inevitable and important: a commentary on 30 years of meta-analyses. Clin Psychol Psychother. 2009 Nov-Dec;16(6):510-22. doi: 10.1002/cpp.648

Cook, J. M., Biyanova, T., Elhai, J., Schnurr, P. P., & Coyne, J. C. (2010). What do psychotherapists really do in practice? An Internet study of over 2,000 practitioners. Psychotherapy: Theory, Research, Practice, Training, 47(2), 260–267. https://doi.org/10.1037/a0019788

Cuijpers P, Driessen E, Hollon SD, van Oppen P, Barth J, Andersson G. The efficacy of non-directive supportive therapy for adult depression: a meta-analysis. Clin Psychol Rev. 2012 Jun;32(4):280-91. doi: 10.1016/j.cpr.2012.01.003

Laska, K. M., Gurman, A. S., & Wampold, B. E. (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51(4), 467–481. https://doi.org/10.1037/a0034332

McAleavey, Andrew A; Castonguay, Louis G (2015). “The process of change in psychotherapy: common and unique factors”. In Gelo, Omar CG; Pritz, Alfred; Rieken, Bernd (eds.). Psychotherapy research: foundations, process, and outcome. New York: Springer. pp. 293–310. doi:10.1007/978-3-7091-1382-0_15

Mulder R, Murray G, Rucklidge J. Common versus specific factors in psychotherapy: opening the black box. Lancet Psychiatry. 2017 Dec;4(12):953-962. doi: 10.1016/S2215-0366(17)30100-1

Norcross, J. C., Pfund, R. A., & Prochaska, J. O. (2013). Psychotherapy in 2022: A Delphi poll on its future. Professional Psychology: Research and Practice, 44(5), 363–370. https://doi.org/10.1037/a0034633

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

In this video we’re going to talk about change. And we’re going to learn a model that describes the process of change and the stages we need to go through in order to make change happen. And it’s known as the transtheoretical model of change, transtheoretical because it describes the process of change that unfolds regardless of the theory behind that change. And the part of the model that’s most well known and that we’re going to look at in this video are the stages of change.

And the stages of change model is often used in treating addiction, and for changes that involve adopting a healthier lifestyle, like getting in shape or losing weight. And the model applies to any sort of behavioral change, like changing a habit, and to almost any sort of change we might try to make for personal growth or just to improve the quality of our lives.

So there are six stages of change pre-contemplation: contemplation, preparation, action, maintenance— and then there’s relapse, which isn’t technically a stage, but a regression to an earlier stage and we move from the action or maintenance stage back to preparation contemplation or pre-contemplation—and finally termination.

And the stages of change model focuses on, how do we move from one stage of change on to the next. In other words, what needs to happen to move us from thinking about change, to actually initiating and maintaining that change.

So let’s look at these stages in more detail. In the pre-contemplation stage we’re not even contemplating change yet. Sometimes we don’t see our behavior as a problem so there’s no motivation to change anything. Or we may recognize there’s a problem but we don’t think we have any control over the problem, so we feel resigned to things staying the way they are.

We might have unsuccessfully tried to change a number of times in the past and that’s led us to believe that change isn’t even possible. Or maybe we feel like we’ve always been an angry person, there’s nothing i can do to control my anger, i was born that way, sometimes i just snap. And so again, we’re not contemplating change because we don’t even think change is possible.

In pre-contemplation, even though we’re not thinking about change, there are often other people who are urging us to change. Sometimes it’s a spouse or partner or family member who’s telling us we need to stop drinking or work on our anger issues. Or maybe a doctor is telling us to lose weight or change our diets or start exercising. Or maybe attending addictions counseling or anger management is a condition of probation. So in the pre-contemplation stage often someone else has identified an issue that they want us to change, even if we’re not on board with trying to change it and not even thinking about it.

So in order to move from pre-contemplation to contemplation there has to be some sort of shift in our perspectives. If we were to do a list of the pros and cons of changing, the pros part of the list would be pretty sparse. And we usually don’t start to contemplate change until we start to recognize more pros of changing.

But if we’re trying to encourage someone else to start contemplating change, the best thing we can do is to just listen to them be supportive and offer empathy. We can gently let them know how their behavior is affecting us, gently point out ways in which their behavior is negatively impacting them or isn’t aligned with some of their goals or values. We can offer information and encourage them to look at some of the pros of changing, and to assess the risks of their current behavior, and so on. But these are more things we would try in therapy, and could be really hard to pull off with a friend or loved one, and in the pre-contemplation stage they’re not likely to be very receptive.

And even when we do our best to be non-judgmental and gentle with them, we’re often met with defensiveness or anger. There’s no easy way to help someone move from pre-contemplation to contemplation, and it can be frustrating and aggravating to even attempt.

Now in the contemplation stage we acknowledge that there is, or might be a problem. And maybe we’ll try to do something about, it maybe we’ll try to change, and maybe we won’t. We can go back and forth, one day ready to start changing, and then having second thoughts the next.

The main strategy we use to help move us from contemplation to preparation is called decisional balance, which refers to weighing the pros and cons of change.

So we want to look at the pros and cons, or benefits versus costs, or advantages and disadvantages of changing; and the pros, benefits, advantages, and cons, costs and disadvantages of not changing.

So the pros of changing, the pros of cutting back on our drinking for example could be something like this. And then the cons of changing, the cons of cutting back on our drinking, could be something like this.

And then the pros and cons of not changing. And so the pros of not cutting back on our drinking could look something like this. And the cons of not cutting back on our drinking could look something like this.

And if the pros or benefits of changing and the costs of not changing, outweigh the costs of changing and benefits of not changing, then we may be ready to move on to the preparation stage.

But committing to change can be hard and so we can waver in our commitments to change. We can spend a lot of time contemplating change before ever deciding that we’re actually ready to start preparing to change. And sometimes we never even get out of the contemplation stage.

But if we’ve decided we’re ready to change we move into the preparation stage. So we sometimes start this stage by talking to people and getting advice, doing some research, maybe even watching a self-help video or reading a self-help book or working with a personal trainer or therapist, and eventually setting a goal for our change and coming up with a plan of action to make it happen.

Now sometimes the reason we find it difficult to change is that our goals are poorly formed. Maybe they’re too vague, like I’m going to get into shape. Or our goals are unrealistic, I’m never going to lose my temper again. Or our plans are poorly formed and unrealistic. I’m going to quit drinking by still going to the bar with my friends every weekend but I’m just going to order cranberry juice. I’m going to get in shape and lose weight by going to the gym seven days a week and not eating any junk food or fast food for the next three months.

So if we enter the action stage with unrealistic goals and poorly formed plans, our attempts to take action will usually not be successful. So the best thing we can do is to just accept and acknowledge that our goals and plans need some adjusting, go back to the preparation stage, and come up with more achievable goals and more actionable plans, and only then move back to the action stage and start initiating these plans. And I’ve got videos in the works on creating action plans and setting goals that I’ll link to in the description that go into a lot more detail than we have time for here.

And then once we’ve come up with a good plan of action in the preparation stage, the action stage is where we put our plans into action, and start initiating change. And so what we do at this stage will depend on our plans, but whatever the plan we need to realize that change is usually incremental and might not always happen as quickly as we’d like. So we need to be patient and compassionate towards ourselves reward our successes, but not beat up on ourselves if sometimes we take a step or two back.

And if we get a little stuck, we can see if we can revise our plans a bit to help us keep making progress, or strategize how to overcome any obstacles or difficulties we face, while still continuing to take some action, rather than completely withdrawing from the action stage and going back into preparation again.

And the first few times we get to the action stage and start trying to implement changes, it’s likely we won’t be completely successful. Most of the time it takes multiple attempts to be able to affect stable enough change to move on to the maintenance stage, so it’s not unlikely that we’ll relapse. Which in this model refers to regressing to an earlier stage, so moving from the action or maintenance stages, back to preparation or contemplation or even pre-contemplation.

So maybe we quit drinking for a couple of weeks but then we get drunk one weekend and then also the next. Or we start eating well and losing weight but then we have a bad day and binge junk food and then feel bad about that and binge the next day as well. Or we go a few weeks without losing our tempers but then one day we just explode.

And sometimes we can have a little slip up and continue taking action without actually relapsing and regressing to an earlier stage. But if we do relapse and aren’t able to just pick up from where we left off and continue with the change that we’ve started, again it’s important to try to practice self-compassion, as feeling guilt or shame about relapsing will only make it more difficult to recover from that relapse. So it’s great if we can give ourselves some credit for any progress we did make. And the more we’re able to do this the more likely it is we only regress to the preparation stage. And then maybe we’re ready to get back on that horse and start working on a new plan relatively quickly. But often we’ll regress back to the contemplation or pre-contemplation stages, and then need to find a way to recommit the change before we’re ready to enter the preparation stage again.

And in the stages of change model, relapse is seen as an upward spiral, which means that we learn from each relapse. So having relapsed, we can incorporate what we’ve learned from this attempt to change into our next attempts, making it more likely that they’ll be successful.

And if we do implement the changes in the action stage that we set out to make, we’re ready to move on to the maintenance stage, where we work on sustaining these changes and resist temptations that could lead to relapse or any gradual resumption of the behaviors we’ve changed and moved away from.

If we’ve lost some weight and developed some healthier habits we want to keep that weight off and continue with whatever habits helped us get to this stage keep doing what we’ve been doing that’s been working for us.

And in the maintenance stage we reaffirm our goals and commitments to change. And want to identify any triggers that could lead to relapse. And have plans in place to manage any barriers or obstacles that could make it hard for us to sustain our change.

And often maintenance is the final stage of change, because for many changes in behaviors complete termination of the old behaviors, where there’s never any temptation to resume those behaviors and absolutely no possibility of backsliding or relapse isn’t really that viable. And so it’s more about continuing with the maintenance stage indefinitely.

But sometimes we can reach the termination stage. If we used to be a smoker, it’s now like we never developed the habit in the first place. And there’s not really much to say about the termination stage, because here whatever problem we’ve identified that we wanted to change is no longer a problem, and it’s not going to be a problem again, and so there’s nothing left to do.

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276–288. https://doi.org/10.1037/h0088437

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Setting goals can seem like it’s relatively easy and the hard part is how do we reach our goals once we’ve set them, but one of the things that can make our goals challenging to achieve is that the goals we set for ourselves aren’t very well constructed. And if we can learn to frame our goals better in the first place, we make it more likely we’ll be able to achieve them.

Now you might have heard of smart goals. And we’re going to talk about more than just smart goals in this video, but they’re a good place to start. Smart is an acronym that stands for specific, rather than broad or general goals. Measurable so we can track our progress. Attainable or achievable, in other words our goals need to be realistic. Relevant, why are we setting this goal and how is it relevant to us? And time bound: having some sort of time frame or timeline tied to the goal.

So one of the most important parts of setting goals is that we make them specific. Consider goals like, I want to be healthier; I’m going to drink less; I want to advance my career; I want to be a better parent; I’m going to stop procrastinating. I like to think of these as aspirational goals. They give us a general sense of the direction we want to head, but they’re too vague and general to tell us where we actually want to end up, so it’s impossible to figure out the steps we need to take in order to get there. And we’re going to need to make these goals more specific if we want to be able to act on them.

So instead of I want to be healthier, something a little more specific would be I want to eat healthier, or I want to exercise more, or I want to lose some weight.

Instead of I want to advance my career, I want to get a promotion, or I’m going to get a higher paying job.

Instead of be a better parent, I’m going to spend more time with my kids and be less distracted and more patient when I’m with them.

Instead of I’m going to stop procrastinating, whenever I have something at work that I’m avoiding, instead of watching YouTube videos I’m going to get started on it. Or I’m going to clean the kitchen after dinner before I start watching tv.

Now measurable often goes hand in hand with making a goal more specific. I want to eat healthier by only eating out or ordering in once a week. Or I’m going to go to the gym three days a week. Or I’m going to lose 10 pounds. Instead of I’m going to drink less, I’m only going to drink on the weekends, or I’m only going to have one beer or one glass of wine a night. So these examples all include a means to measure our progress and success.

Now attainable or achievable. And the key here isn’t is our goal attainable in general or is our goal possible to achieve, but can we achieve this goal. And this is why in acceptance and commitment therapy the r in smart goals stands for realistic. And that’s the key here. Are we setting goals that are realistic for us given our current situations, abilities and resources, time, energy and so on.

Is it really realistic to think I’ll go to the gym three times a week if I hate the gym and haven’t been in years? Maybe a more achievable and realistic exercise goal is to walk for an hour three times a week, or to go to the gym once this week.

If I don’t like to cook and I’m really busy and I eat out or order in every night, instead of a goal like I’m going to eat out or order in just once over the next week, a more realistic and achievable goal might be I’m going to cook at least one meal for myself over the next week.

It can feel good to set ambitious goals. But we’re often just setting ourselves up to fail, which can then hurt our motivation to set similar goals in the future. And it’s better to start small and then build upon success rather than start too ambitiously and have to deal with failure.

And it’s also important that we set goals based on factors we have control over. Sometimes we think our goals are reasonable and achievable but it turns out they rely too much on factors outside our control.

I once set a goal for my channel to increase my number of views that seemed absolutely reasonable based on the rate my channel was growing. But to a large extent my views are a function of how often the algorithm decides to suggest my videos. And the algorithm decided to reduce how much it was suggesting my videos. And so not only didn’t my view count grow, I get fewer views than I did a year ago when I set this goal, despite having a lot more subscribers and videos and releasing them more frequently.

So I failed miserably at my goal. But it wasn’t due to a lack of effort. I devoted a lot more time to my videos and I think they’re better now than they used to be. My goal failed because the metric I chose to measure my goal is not something I have that much control over. It relies too much on the algorithm. So it would have been much better to frame the goal in terms of something I did have control over, like to release a new video at least every other week, or to spend at least 30 hours a week working on them.

Now let’s talk time bound. Smart goals were conceived for setting project or performance related goals. In a business context and it’s easy to set business related measurable and time-bound goals, but in the case of personal goals the time-bound aspect is often immediately. I’m going to go to the gym three days a week starting this week. Or I’m only going to drink one beer a night starting today. Or starting tonight I’m going to clean up the kitchen after dinner before watching tv.

We can add an arbitrary length of time, like for the next month, but often personal goals are about sustaining change, in which case it’s better to not specify a duration. So instead of I’m going to go to the gym three days a week for the next month, just I’m going to go to the gym three times this week. And then if we do that great now we do it again next week. And if we don’t succeed, then we reevaluate our goal and maybe we need to change it a bit. Or if the goal still seems reasonable we might need to come up with a better plan to help us achieve it.

And time frames are often the part of a goal that we have the least control over. If I have a goal to get a better paying job, why add in, I’m going to get a better paying job in the next six months? We want to get started on our goal right away, and we can make the steps in our plan to reach that goal time bound— I’m going to update my resume this week; I’m going to reach out to the following people in my professional network by the end of next week—because we do have control over the time frame of these steps. But to actually land a better paying job within the next six months, well there are a lot of factors outside of our control that can prevent us from being able to reach our goal within that time frame. So really the only time down part of our goal needs to be, I’m going to start working on my plan right away.

And the same goes for a goal like I’m going to lose 10 pounds over the next four months. What if we only lose five pounds in four months are we going to feel bad about that? Or if we notice that we’ve only lost one pound over the first month, are we going to become discouraged and lose motivation or maybe even give up?

Which is why I prefer goals that leave lots of room for success while still motivating ourselves to achieve as much as possible. So having some sort of composite goal, a goal with different tiers. Something like tier one: I’m going to track my calories every day. And tier two: and try to lose some weight—and so any amount of weight loss will count as success. And tier 3: and I’ll do my best to lose 10 pounds over the next four months. So I still have a goal of losing 10 pounds to strive for but even if I don’t reach that i’ve built in other less ambitious but more achievable goals that still allow for success.

Now let’s talk about relevance. Is our goal relevant to their bigger picture? Does it tie in to our overall life goals, priorities and aspirations? If it doesn’t, we’re not going to be that motivated to work towards achieving it.

In acceptance and commitment therapy the m in smart goals stands for meaningful. In order for our goal to be relevant it needs to be meaningful to us. It needs to be related to a domain of our lives that we’re currently prioritizing, such as work or relationships or family or health and so on, and it needs to be in line with our own values, and not just be something we think we should do or that other people are telling us to do.

For example if we set a goal to go to the gym five days a week, but right now the work domain of our lives is what’s most important to us, and we’re spending as much time as possible working trying to advance our careers, we’re going to struggle to prioritize our health related goal of going to the gym so often.

Or if we set a goal to get a promotion at work because we think we should be making more money or be further ahead in our careers, but what we value most right now is our leisure time and spending time with our families, it’s going to be hard to prioritize work and money when our values lie elsewhere. So it’s probably not the best goal to set for ourselves right now.

So we want to make our goals relatively smart. Specific enough that we can take action on them, and measurable and time-bound enough to be able to track our progress. And attainable not just in theory, but realistically achievable for us, based on things we can control. And perhaps most importantly we need to make sure that our goals are relevant and fit into the bigger picture and our overall life goals, and that they’re meaningful to us.

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

So we’ve set a goal to make a change in our lives. Now we need to come up with an action plan to help us get there. And if you’re still working on setting some goals, I have a video that can help with that. And in this video we’ll learn how to create effective action plans, and how to manage barriers that can get in the way of us reaching our goals. And you can download an action plan worksheet from the link in the description.

Now an action plan is a series of steps that helps us achieve our goals. And each step is sort of a mini goal along the way. And like goals the steps and our action plans need to be specific and time bound, we say exactly what we’re going to do and when we’re going to do it.

And measurable at least to some extent so we can tell whether or not we’ve completed that step. The steps need to be relevant to reaching our goals. And they need to be attainable, and the more attainable the better. We want our steps to be small and manageable and as easy to attain as possible. If we make some steps so trivial that we can do a few of them at once that’s fine, but we want to avoid making any steps so big that we get stuck on one of them and stop making progress.

And related to attainable, in acceptance and commitment therapy the r in smart stands for realistic. And that’s really the key. Our overall plans and each step of the plan needs to be realistic: something we have the capacity to do and the willingness to do.

So let’s say our goal is to get a new job. For some people this doesn’t require much of an action. Plan look for jobs; apply for jobs; go to interviews.

But for a lot of us that simple plan isn’t going to work, because we’re going to get stuck on at least one of these steps, because the steps may seem relatively small, but they’re often much bigger than they look.

Maybe we’re getting stuck at the apply for jobs part, because we haven’t updated our resumes in a while, and so we need to add that step. But when we go to update our resumes we get stuck because maybe there’s a gap in our resumes we don’t know how to address, so whenever we try to update it we don’t know what to do.

And so we need to add a step figure out what to do about the gap in our resumes. And that might be more than just one step. And so maybe we need to actually set a goal of updating our resumes, and come up with a plan to help us do that, and then that goal acts as one of the steps in our overall goal of finding a new job.

So anytime we find ourselves getting stuck on one of our steps, the first thing to do is ask ourselves, is there any way I can break this step down into smaller steps? And we make them as small as possible, the smaller the better. No step is too small or too simple if it’s going to help us get unstuck. And then at least we’re making some progress towards our goals. And often once we get unstuck and take a small step or two we’re then able to keep going.

Now once we do start progressing towards our goals we’re often going to run into barriers that make it hard to continue. And sometimes we can anticipate the sorts of barriers we’re likely to face in advance and build steps into our plans to help us overcome these barriers if they do arise.

So if we’re trying to reduce our drinking or drug use we can probably anticipate that there’ll be times when we’re going to be tempted to drink or use drugs. So we build that into the plan, maybe something like, if we get a craving to have a drink or use drugs we go to the gym instead. Or we meet up with a friend for coffee. Or if we’re in a 12-step program the plan is probably attend a meeting or reach out to our sponsors.

Or for example if our goal is to lose weight or reduce our drinking or drug use, a common barrier is that when we’re depressed or stressed or having a bad day we may tend to eat or drink or use drugs to help us cope. And so if that’s the case we need to account for this in our plans, and have a strategy in place to help us overcome this barrier, and develop alternative ways to manage stress and regulate our emotions, or we’re going to keep resorting to eating or drinking or using drugs as a way of coping, which is going to make it really hard for us to reach our goals.

Now making changes is hard and can require a lot of effort and sacrifice. And so we often try to start off with plans that offer the least resistance, something like, when I go to the bar with my friends to watch the game, I’ll just take enough cash for one drink and won’t bring my debit or credit cards so I won’t be able to drink any more than that.

Now that’s probably not going to work. If we decide we want to keep drinking one of our friends will buy us drinks. And even if we don’t want to keep drinking there’s a good chance someone will try to buy us a drink anyway. And we’re going to end up drinking as much or almost as much as we always do.

But it makes sense that we try to start off with a plan that offers as little disruption to our lives as possible, rather than a plan like: I want to reduce my drinking so if my friends invite me to go to the bar and watch the game with them, I’m not going to go. Because if that’s something we really like to do, we’re going to try to come up with a plan that allows us to keep doing it.

And that’s fine. Most of the time we try to make changes our initial plans aren’t successful. So if the plan doesn’t work, instead of getting discouraged and giving up, we need to regard our plans as just hypotheses. We tested out the hypothesis that we could go to the bar with our friends without drinking a lot and it didn’t work out. So now we need to come up with a new hypothesis or plan that takes what we’ve just learned into consideration. So maybe this time we include something about avoiding triggers for drinking and now this makes it more likely our next plan will be successful.

So sometimes the barriers we face are practical or situational problems, like how do I update my resume when I haven’t worked in over a year? What do I do when I’m trying to cut back on my drinking and my friends invite me out to the bar to watch the game? But sometimes there’s more to it than that.

Maybe when we go to update our resumes we start thinking, wow I can’t believe how pathetic this is. How can I be so far behind all my friends in my career? I’m such a loser. And we feel ashamed and depressed for the rest of the day. And maybe just the thought of updating our resumes makes us feel this way. And so we try to avoid even thinking about looking for a new job because of all the unpleasant thoughts and uncomfortable feelings that go along with it.

Or let’s say our goal is to be in a relationship. So we’ve joined a dating site and everything’s going fine until we get to the go out on a date step. And then we get stuck because we’re too afraid of rejection. Or because we have social anxiety and are scared of meeting up with someone because we don’t know what we’d say, and we think we’re boring and we’d be a terrible date, and it would just be awkward and uncomfortable and we’d embarrass ourselves. And we become so anxious just thinking about it we get a feeling of tightness in our chests. And so we decide not to even try going on any dates because we just can’t stand feeling this way.

So what can we do when uncomfortable thoughts, memories or worries, or unpleasant feelings and emotions and body sensations are the barriers that are getting in our ways and preventing us from moving on to the next steps? Well we can use cognitive behavioral therapy to help manage these sorts of barriers and modify our thinking and behaviors to reduce negative emotions enough that we’re able to carry on with our plans. Or we can go the acceptance and commitment therapy route.

Acceptance and commitment therapy incorporates the concept of willingness into action plans. Often we get stuck because we’re trying to avoid having certain negative unpleasant or uncomfortable experiences. So when coming up with our plans we need to consider what uncomfortable or unpleasant thoughts and memories, feelings and emotions, and body sensations and urges we’re willing to make room for and accept in order to allow us to reach our goals.

If we want to start dating, we need to be willing to experience some rejection. If our goal is to lose weight, we’re going to need to be willing to experience some hunger and pass up on some higher calorie foods or meals or cut out snacking for example, and be willing to experience cravings and urges to eat without acting on them.

And similarly if our goal is to reduce drinking or drug use we need to be willing to experience cravings or urges to drink or use drugs without acting on them. And we might need to be willing to give up some social activities that are associated with drinking or drug use. And if we don’t have the willingness to experience these things or make these sacrifices then we’re probably not going to be able to do what it takes in order for us to reach our goals.

Now change and growth usually involves some discomfort, some stepping outside of our comfort zones. So part of creating an action plan is predicting in advance the types of discomfort we’re likely to experience, and have a plan in place to help us navigate this discomfort so that we don’t get stuck and can keep moving forward.

So one way to approach this is with cognitive behavioral therapy. When I start having negative thoughts about going on dates like they’re not going to like me, I’m so boring, it’s just going to be awkward and uncomfortable and embarrassing, I’ll tell myself it’s completely natural to have these sorts of thoughts about going on a date and most people feel this way to some extent. And it probably won’t be as bad as I’m worrying it will be. But even if it is it’s not going to last that long; it’ll be uncomfortable for a while and then it’ll be over and I’ll be okay.

Values play an important role in acceptance and commitment therapy. And values refer to things like the importance we place on family or our careers or health or on being in a relationship. Now making any significant changes in our lives is difficult and takes a lot of commitment, and the more our goals reflect our values and what’s most important to us the more of a commitment we’re willing to make in order to attain them, which means not only do we work harder to achieve them, but we’re more willing to have certain uncomfortable or unpleasant experiences if that’s what it’s going to take in order for us to reach these goals.

And then our values and what’s important to us act as fuel that helps us move towards our goals, and as motivation to make us more willing to accept the discomfort we’re going to face along the road to reaching our goals. I’m willing to stop going to the bar to watch the game with my friends and to learn to manage stress and emotions without resorting to drinking if that’s what it’s going to take in order for me to be healthier and improve my relationship with my family.

And we can combine cbt and acceptance and commitment therapy: use some cbt techniques to reduce our negative thinking and negative emotions; and then be willing to make room for whatever negative thoughts and emotions remain, because achieving our goals and creating a meaningful life for ourselves is more important to us than avoiding discomfort.

And finally if we find ourselves getting stuck a lot or even having trouble getting started on our plans, often it has nothing to do with our plans themselves, but with the stage of change we find ourselves in. Sometimes we start making plans when we’re still in the contemplation stage (and if you don’t know what this refers to check out my video on the stages of change). But in the contemplation stage we’re still trying to decide whether or not we’re ready to make a change. Do we really want to leave our current jobs and start looking for something new or are we just contemplating it? Are we really ready to cut back on our drinking or just thinking about it?

If we try to embark on a plan when we’re still in the contemplation stage we’re unlikely to get very far, and instead we need to focus our efforts on progressing to the next stage of change, preparation, before we start thinking about a plan.