Break Free From Technology Addiction with CBT

Mike Christensen, MACP, RCC-ACS presents "Break Free From Technology Addiction with CBT," hosted by Jill Levitt, PhD.

IN THIS VIDEO:

Jill Levitt: Welcome everyone to this month's webinar from Feeling Good Institute on CBT for technology addiction. Help, I can't get off my phone, which I'm guessing many of you can relate to. I will just very briefly tell you guys a little bit about who we are at Feeling Good Institute and I'll introduce you to your awesome presenters and then kind of let them take it away.

So, I just want to take a moment to give you guys a quick snapshot about what we're all about here at Feeling Good Institute and share with you our mission, which is to make a difference in people's lives through elevating the practice of therapy. Our story started with one big goal, which was to make therapy better and to help people who are going through tough times. And we achieved this by training and certifying therapists and effective therapy techniques. We have a comprehensive five-level TEAM-CBT certification system that provides kind of a path to mastery in TEAM-CBT. And we're really proud of what we do, especially our therapists who all practice TEAM-CBT. We have treatment available in over 35 states across the U.S. and Canada, and we offer therapy both online and in person. 

And finally, we have an intensive one-on-one therapy program, which really speeds up recovery with extended and more frequent sessions. And we have a program to offer lower fee options, where we have clinicians that are supervised by advanced clinicians so that more people have access to high quality care. Let me tell you briefly how you get your CE credit today. So, you just need to be present now and for the rest of the hour with us. At about five of the hour, we'll drop the CE survey in the chat box. So, it'll be a link for you to click on. So, I'll draw your attention to that at the end of the webinar as well. You do need to complete the CE survey today right away. And then we will send you your certificate of completion within a week. So, you will not get your certificate immediately. We need to kind of check attendance and surveys, and then we'll email you your certificate of completion within a week. And if you have any questions about the CE part, email us at certification at feelinggoodinstitute.com. So, now I'm going to introduce your awesome panelists today of Mike and Tony. 

So, we'll start with you, Mike. Mike Christensen serves as the Director of Professional Development at the Feeling Good Institute. Mike is a registered clinical counselor with the British Columbia Association of Clinical Counselors, and he holds a Master of Arts in Counseling Psychology. Mike's diverse background in business, community organizations, and family support roles has provided Mike with a wide array of experience in leadership, administration, parent training, and team building. And Mike is a certified Level 5 Master TEAM-CBT Therapist and Trainer, and also the Director of Feeling Good Institute, Canada. Mike provides advanced level online training with the Feeling Good Institute for therapists around the world, and is also the co-author of the book, Deliberate Practice of Team CBT, with Maor Katz, Tony Roumanier, and Alex Vaz. And now let me introduce Tony to you. Tony Weiss is a Psychotherapist at the Feeling Good Institute. Tony is a certified Level 3 clinician who loves working with relationship issues, anxiety, and depression. And Tony also works as a court-appointed Psychotherapist for the United States pre-trial and probation system. And I know that you're really in for a treat. 

Mike Christensen: Awesome. Thanks so much, Jill. Well, today we're going to spend a little bit of time defining tech addiction. What is it anyway? Then explore assessing the resistance to change, and how do we bring that about? And then we're going to touch on two key methods that we utilize to help overcome the trap of technology addiction, as well as give you a little taste of some others, and then spend some time in Q&A. 

And our objectives for today are hopefully that you'll learn two things. One is to identify a specific tempting situation and the goal behavior as a foundational aspect of where do we build from there in our work in trying to overcome this problem that people have. And then also to use something that we call the double paradox table to address that resistance to change, to get to a deeper level of empathy and connection, and then assess the resistance so that we are on the same wavelength, the same page as our clients and our patients. 

If you looked at your DSM-5, the trustee manual for mental health criteria, you won't find technology addiction in there, certainly not smartphone use addiction. The closest we have is gambling addiction, a behavioral addiction, and then a suggestion for future study on gaming addiction. And so you can't actually be diagnosed based on the DSM-5 with a technology addiction for your smartphone use. Does that mean it's not a problem? It's not a huge stretch for any of us to recognize that it's a massively growing problem across age ranges. When we think of addiction, one way of defining it is, it is a strong physical or psychological need or urge to do something or use something. And it leads to an impaired control that we want to cut down, but we're not able to. 

And that leads to a longer term kind of problems. It impacts our daily life, our activities, such as relationship building, work, school and basic responsibilities. I worked in an addictions treatment center for seven years, and when it was an all-male one, eight-week inpatient, and when they would come in, they had a problem that was massively impacting their life. It was taking over and they'd lost control with it. That's how we define addiction. Their families were struggling with it too. They're like, ah, you've got a problem. You need help. But what about this technology addiction idea? A few years back, I was at a family gathering. I think there's 12 or 13 of us there. Grandchildren, kids, parents, grandparents, age range from 13 to 75. And I did a quick poll and I said, without judgment, just raise your hand if you think that you'd like to spend less time on your phone. 

If you agree with the statement, I spend more time on my phone than I would like to, then raise your hand. And the age range from 13 to 75, every single person raised their hand. And these are, what I would say, fairly well-adjusted people, successful people in life. And yet they all agreed that they spent more time on their phone than they would like to. And if we look at the statistics in the age ranges and where it's growing, it's not a huge stretch when we look at youth. All you have to do is take a cell phone away from a teenager and see what the reaction is to see how much they are connected to it, how much they rely on it. And I'm going to draw Tony in here to share a few of those stats with us. 

Tony Weiss: Some really alarming statistics. If you haven't checked recently, the daily average for an individual to spend on their phone is between four and six hours every day. That's the average. That's over 1,400 hours a year. And excessive smartphone use has been conclusively linked to a 40% increase in depression among adolescents. What's more, it's also very disruptive of sleep. About 70% of adults and 90% of teenagers admit to using their phones while they're in bed before they go to sleep. And there's tons of evidence about how that's very disruptive to sleeping patterns. And I could go on and on and on, but I'll close with this one. Around 40% of people report feeling anxious when they're away from their phone for just a little period of time, which signals that there's some withdrawal and addiction happening. They don't have their trusty device. 

Mike Christensen: One of the challenges is that our phones provide something beneficial to us. And so those things that are good in some ways get control over us. And this is where app developers and smartphone producers work very hard to capture our attention. And they use things like social media, gaming, online shopping, reels, shorts, shows, pornography is well-documented. Even our emails and group chats or texting can draw us in, and we can lose control over our time. And if I said to you, and I imagine some of you can relate to some of this, you're probably thinking, oh yeah, that's me. If you actually did check your phone to see how much time you spent on it in a day, did a tracking app. I've done it a couple of times and it was a bit alarming to me how much time I'm going to use the word waste or lose, and how much it impacts our life. 

But if I said to you, you want to be careful because when I worked in the addictions treatment center, I hear the stories about the guys, how did you first get started in it? And it was often a friend or a family member introduced them to alcohol or marijuana or drugs when they were younger. And then that just captured them and then got them to the point at which they need to get into treatment. So if I said to you, there's a drug dealer in your neighborhood, and this dealer is targeting toddlers and school-aged children to get them started, and he offers it free of charge with a lifetime guarantee that it's never going to cost you down the road for this drug, there'd be an outrage. And yet that's really what the smartphone producers and app developers are doing, and the parents are the drug dealers, if we characterize it in that way, which sounds kind of harsh, and yet it can be such an effective way of capturing the attention of a child for a while and help them calm down. And it starts there. And even for those of us that are a little bit older, I'm going to be 56 next week. And so I didn't grow up with a smartphone, but it's managed to capture my attention all the time beyond what I would like. So I'm going to give you a poll here. I'm going to have Jill run this poll and ask you two questions. 

We're a group of mental health professionals, caregivers, helping people to overcome things. And ask yourself the question with this statement, to strongly disagree, to strongly agree, I spend more time on my phone device than I would like to. And then the second question, you'll want to scroll down when you've done the first one and make sure you've got that one. I've been told by people in my life, I spend too much time on my phone or device. We'll just give you a few more seconds to fill that out. 

Jill Levitt: Yep, I can see that we're almost fully, almost got everybody participating in the poll.  So if you haven't, we'll give you one more second, and then I'm going to close the poll and share the results with you. All right, we'll wrap it up here. So I'll end the poll and then share the results.

Mike Christensen: Well, we can see here that even in this group of highly enlightened, well-educated mental health professionals, we have 21% that strongly agree that they spend more time on their phone than they would like to. And 33% agree. So we've got, you know, a significant portion of us, like 70 plus percent that feel like they spend more time than they would like to on their phone. 

And not as many, you know, have had people tell them we tend to be nicer in this context. But if we cloaked it another way, how many of you have been annoyed with somebody else that's been on their smartphone when you've been trying to connect with them that I suspect the numbers would be different. But even here, you know, we've got 27, almost 30% of the people have suggested that somebody in your life has been probably a little annoyed that you've spent more time on your phone than you want. And so it's a challenge for us. So what do we do about it? How do we work with this? Are addictions really problems? Like, is our smartphone usage really an issue? And, you know. 

Jill Levitt: I'm not seeing your slides for some reason. Wait, LJ, are you seeing Mike's slides? 

LJ Davis: Yes, I can see them. 

Jill Levitt: Oh, okay. That's good. I don't know. 

Mike Christensen: Awesome. Gotta be double checked. When I first started working in the treatment center, I used to think of addictions as problems. 

And yet in many ways, they are effective short-term solutions, right? For the young parent with a toddler, they can put that iPad in their toddler's hand and calm them down for a while. It's a solution to get them to be distracted, right? And for us, if we begin looking at addictions as actually highly advanced solutions that have consequences rather than just problems, it allows us to connect in a deep and empathic way with our clients and our patients. We need to see these addictions as powerful solutions that are no longer working anymore. 

Additionally, our ultimate goal is to support clients in finding new solutions. But before we do that, we need to honor the brilliance and the beauty of the current solution, the addictive behavior. Working in the treatment center totally changed my perspective on this. Some of the most brilliant and remarkable people I've ever met were ones who needed to get treatment in an addiction center because their addiction had captured their ability to control things. And yet when I heard the stories of their background and the relief that they were getting from their drug use, their alcohol use, it was actually a highly advanced solution to an intense problem. And I certainly would have been, I don't think any different had I experienced much of what they'd experienced.

The difficulty is that that solution was now causing them additional problems and it wasn't working anymore for them. And this is what happens with our phone use. It actually is super helpful to us. It allows us to do incredible things. The power we have in our hands is amazing. And yet with that, the overuse of it captures our time and steals our attention and our energy. So we're going to give a little bit of a client vignette taken from Tony's experience and my experience in working with others. And we've named this vignette Shane, gender neutral name. So if you think of Shane as a male or female or gender neutral, then whatever comes to mind for will be appropriate because it impacts us regardless of gender or age or impacts all of us. 

Tony Weiss: This is the story of Shane. Shane is a 25 year old person who was incredibly active, physically and was playing music and having tons of fun, really feeling like they were a part of life. They enjoyed soccer and hiking and playing the guitar. But currently Shane has been spending an average of seven to eight hours a day on their smartphone, sometimes way more. And they're missing out on connections with friends and really losing out on all that physical activity and creative activity they were previously engaged in. It's also causing them increase in anxiety and depression due to the lack of productivity and the just incredible inertia of being on their phone. At night, Shane struggles with staying on the phone, watching YouTube or going on Instagram, eBay, online shopping, checking their group chats and emails. 

This could go on for hours before they finally put the phone down and fall asleep. And they've identified some tempting thoughts or thoughts that are kind of seducing them towards this behavior, such as, I'll just go on my phone for five more minutes, or I'll get on track and I'll start my reading tomorrow, or I need to check in on the group chat so I don't miss anything. 

Mike Christensen: Anybody relate to any of those thoughts? 

Tony Weiss: Yeah, I know. I definitely relate to them. So in order to help Shane or anyone who comes to us with the habit, what we're going to need is a very specific moment in time so we can really isolate what exactly is going on for the client right before they engage in whatever their current problem behavior is. And we do this in order to get rid of generalities and abstractions. 

And if we can combat and really isolate the thoughts that are motivating the client to engage in their problematic behavior in this one moment, and they can learn how to defeat these thoughts, it will have a domino effect throughout all the other moments where they're struggling with this problem in the future. Yeah, so the current behavior or the drug of choice, so to speak, is Shane using their phone, scrolling YouTube, Instagram, online shopping, and checking the group chats and emails. And they're doing this starting around 10 p.m. every night. And it's important that we don't just get rid of or fight against the current behavior without doing anything else, right? We need to replace it with a goal behavior. What will replace the addictive behavior? And in this case, Shane has selected as their goal behavior reading for 30 minutes at 10 p.m. and then turning out the lights and going to bed. 

Mike Christensen: We want to keep in mind, too, that when we get to this specific moment in time, we've spent some time doing a full intake and some screening and really empathized with Shane, understood what the struggle is, and invited them, you know, do you want to get to work on this? Would you like some help with this? And Shane has said, yeah, I really need to overcome this. 

Then we hone in on the moment in time, you know, where Shane gets trapped or drawn into it and then define what the current behavior is. And I use the words drug of choice, even if it's a behavioral addiction, it helps bring it to kind of life for people more accurately. And then what does they really want? What they'd rather do? What's going to be the alternative, which may or may not be super pleasurable, but may be healthier for us. It's kind of like, you know, do you want to overcome eating ice cream and have a salad? Well, the salad is not going to be as tasty, but that's what my goal actually is. I want to feel healthier in the long run. Once we have the moment in time and the goal behavior and the drug of choice clearly specified, we use something called the double paradox to go to a deeper level of understanding of the pull or the draw of the addiction, as well as what might get in the way of the new goal behavior. 

What are the reasons why they may not want to engage in the new behavior? And so we look at something on the, this looks like a standard sort of cost benefit analysis at first look, but it's quite different than that. And we'll start with the left-hand column and here, LJ, you can maybe spot yourself here. I'm going to ask you, type in the chat to LJ directly. 

What do you think are the benefits or advantages of going on the smartphone? What's so wonderful about it? What's the purpose of it? Why is it so amazing? Why is it such a great solution in the evening for Shane scrolling on the phone at 10 PM? And as those are coming in, I'll share with you some of the ones that we came up with and then LJ you can add additional ones. But for Shane, the advantage of the benefits of going on the phone is to stay current with events and news, stay up to date. And it's a reward after a long day. 

It's relaxing and easy, right? It's handy and it can be entertaining and fun. It can be a form of self-care. We need to have some balance in life. Shane can also get some research done, right? Watching a TED talk or something that seems valuable. And it's important to maintain social connections. The phone is wonderful for that. Perhaps most importantly for Shane is Shane can escape for a while. If we look back in Shane's history, there have been some painful times. There've been some difficulties and work can be challenging and draining and exhausting. And it's just a way to get some freedom for a minute. So LJ, what are some of the other ones that are coming up? 

LJ Davis: You've hit a lot of the big ones, but there's almost 60 that have come in so far. So thanks to everybody for all the participation.And there are so many advantages. It's similar to what you have, but a little different flavors. It helps me to numb my distressing  thoughts, kind of just takes my brain somewhere else.

Mike Christensen: Love that

LJ Davis: Catching up with family and maintaining connections and also just like little simple things like, oh, I can find out what tomorrow's weather is going to be like. There's all these little minute details of life I can start to understand better. You got it easy and also just it doesn't take any energy at all. I just can do it automatically. Don't have to think about it. 

Mike Christensen: Awesome. Those are great. 

And now we're going to look at the other side. And this side is the disadvantages or cost side, but is not the disadvantages of going on the phone. We already know what that is, right? Loss of sleep and all the rest of that stuff. This is what is the disadvantages of engaging in the new goal behavior? What are the costs of doing that? What's the price that you have to pay? Why will it be such a downer, such a pain? What are you going to have to do? And so you can type those into LJ as well. And I'll run through some of the ones that we came up with and they'll maybe look familiar, miss out on the latest updates. It does take more energy and effort to actually get a paper book open and read it. It requires discipline. And I call this the two Ds, discipline and deprivation. You have to discipline yourself to do something and who loves discipline? No, thank you. 

And I also have to deprive myself of pleasure and escape, numbing the pain as somebody said so brilliantly. Who wants to deprive himselves of something that can be important? I don't, but that's what they're going to have to do. I think Tony and I, when we were doing our research, it was suggested that when people are scrolling, the average click on the screen is six to seven seconds, right? Well, I don't know about the books that you read in the paper, but I can't read a page in six seconds and the next page looks just the same. 

It's not as pleasurable in that way. It requires some effort to stay focused. And it can be a little bit boring, too much like work. Oh, I did read all day and did some other stuff. And then finally we have to experience the pain of withdrawal. The others that come up, LJ, are more reinforcing ones. I'd love to hear more. 

LJ Davis: We'll miss out on the latest updates is one that's coming in a lot. And just that I might lose connection with people who are important to me and that's when they communicate or how they communicate. And then reading a book is more intellectually taxing, so it doesn't have the same relaxation value for me. 

Mike Christensen: Yeah, for sure. And so once we come up with all of these, did some of these resonate with you? I imagine some of you are going, oh yeah, that's me. 

At least a few of them. Well, once we come up with these, we ask our client or our patient, in light of all of these wonderful benefits and the drawbacks of doing this, we do something we call the pivot question, which is, are you sure you'd want to make this change? Are you sure you want to give up your phone use at 10 p.m. and just read a book? And there are two purposes of the double paradox. The first is it's a deep form of empathy. The second is it puts the patient in the role of arguing for change. When you do that pivot question, suddenly Shane will say, oh yeah, but I'm so tired the next day. I stayed up till three in the morning, and I had to get up at seven, and then I was exhausted during that meeting. You'd hardly stay awake, and I can't focus. And so we now are putting ourselves deeply in Shane's shoes, but they now are the ones that are arguing for change. They're saying, no, no, I want to change. It's not us trying to convince them. I want to be careful that this is not a manipulative motivational technique. We don't use it to manipulate people. It would backfire if you tried that. For me, it's most important, and that's why I put it as number one. It's a deep form of empathy. I did this once, double paradox, when I was working in the treatment center with a gentleman who was struggling with a meth addiction. 

And when I said to him, what are the benefits of doing meth? What are the advantages? He said, nothing, it's ruining my life. And I often heard that from people who had been suffering. And I said to him, well, think back to when you first started using meth, what was it like? And he said, oh, you have energy for days. It's incredible what you can get done. Well, let's write that down. We both wrote it down together. And then we came up with six or seven other benefits. I can stay focused. I can escape. 

You can numb the pain. And after we came up with six or seven, I paused and I said to him, I have one other idea. And maybe this resonates with you. It might not, but what's it like to have sex on meth? And he looked up from the paper and looked me directly in the eyes. And he said, you've done meth. I know you have. And what he was really telling me was, you know exactly what it's like. You understand me completely. And that's why I see the double paradox as a powerful empathy tool, because I've never even smoked marijuana. I was a kind of geeky kid that was afraid to hang out with that crowd. I was probably a bit naive and sheltered, and I was more into athletics and other things. My addictions are totally different than his were, right? I love watching sports clips and going on YouTube and shopping for bike stuff. I love cycling as an athlete.

But he was telling me, you really get it, right? And so sometimes people say, oh, you can't work with people unless you've experienced it yourself. And I would say, if you learn how to do very powerful empathy skills and use things like the double paradox, you can get a deeper level of understanding where you're right with them. And then you can say, man, in light of all these wonderful things, are you sure you'd want to give that up? And then they begin to argue for change. Now once they do argue for change, what do we do? Where do we go from here? In her best-selling book, Dopamine Nation, which many of you will be familiar with, psychiatrist and Director of Addiction Medicine at Stanford University, who's not connected to the Feeling Good Institute, actually, Tony put me on to her work. I did send her an email saying, hey, I'm going to acknowledge your work, really appreciate what you've done. And she was grateful and said, thanks, I'm glad that you're appreciating.

But she's done a ton of research and wrote the book Dopamine Nation and suggests that we actually need to do detox from our devices to return this balance to our pain pleasure system. It gets out of whack. We become somewhat addicted in the same way as we would to a chemical addiction. And when we do a withdrawal, the things we'll experience are very similar. Just yesterday, I was working with a client who's trying to get away from his smartphone. And he phoned me actually for kind of an emergency session because when he was getting disconnected from some of his apps and some of the things he was working on, he actually began to have these suicidal thoughts like, oh, I've gone so far, I can't stop.

I had to beg to get connection on this chat group again. I told them to block me and then I begged them to let me back in even though they know I'm trying. And he actually became concerned that his suicidal thoughts were getting strong. And so we did a session to pause and do a safety plan and work through that. The impact of the phone use can be powerful. So how do we do it? What tools do we have available to us to overcome the power that phones can have in our lives? We're going to share two tools with you. And really, we're just scratching the surface on what's available. And it may take a whole lot more than that. Tony, anything you want to add regarding Dr. Lembke's work? I know you've done kind of more reading and read her book.

Tony Weiss: Yeah, I just want to give a quick plug for just searching her up on YouTube. And when you're scrolling on your phone late at night, you can watch one of her videos. She's got a great way of delivering the information. 

Mike Christensen: I love that you did that because the irony is I did do that.

I was trying to go to bed a little earlier a couple nights ago. I thought, oh, I'll just watch this other video from Dr. Lembke. And then when I started to watch that, I went, no, I've got to put her to the side. This is exactly what she's talking about. But the irony was poignant in it. So we're going to look at two specific methods.

Stimulus Control Method

The first one is called stimulus control, which is a very basic, simple method, yet it can be very powerful and challenging to do. And stimulus control is based on the idea that if you remove the stimulating trigger or the drug of choice from your present environment, so it's not accessible, then you're less likely to use it. You get to remove it from the tempting situation, right? So I've often said to people, you know, if you are struggling with an alcohol addiction, if you drink all the time before you go home after treatment, you need to phone your family and have them remove all the alcohol from the home.

So there's no alcohol in the home. Your family says they'll do whatever it takes. They'll support you. But you said your problem is you drink when you're at home. Remove all the alcohol. That's stimulus control. They're less likely then to drink. So for Shane, this required two stimulus control actions. The one is that Shane was really struggling in the evenings and staying up super late.

And so we set up a plan for Shane to take the phone and put it in another room, put it in the kitchen or in the office outside of the bedroom with the phone charger in another room at 9.45 p.m. every night. Go and plug it in there and leave it there so it's not beside the bed, because beside the bed, Shane could not control themself to to stay off of it. The other stimulus control action, because the idea of getting rid of your phone, although some have done it and it is possible, although difficult, in our day and age, for most of us, we can't get rid of our phone. It's the way we work or stay connected to our families. We rely on it. But we can remove some of the key apps.

And this isn't that I'm not an anti-Facebook or anti-Instagram person, but if that's what it takes, removing Facebook and Instagram and eBay and WhatsApp. And this is what Shane needed to do. And self-disclosure, I no longer have Instagram or Facebook on my phone because I couldn't handle it. I have ADD and I would get kind of caught in it and then I would be like, whoa, I spent way too much time here. And there's things I want to do. I want to do more training. I want to learn more. I want to become a better therapist. I want to spend my time with my children and my grandchildren. And Facebook and Instagram were getting in the way of that. Now, that may be just one technique, but we'll need more than that. And so this is when I almost always include in session in therapy, and it's called the Devil's Advocate. And Tony's going to walk us through it and we'll do a little demo. And Jill may interject on occasion to add some comments. And then we'll have some time for Q&A.

Devil’s Advocate Method

Tony Weiss: Yeah, so the Devil's Advocate is an incredibly powerful and really fun technique to use with the client. And in this method, it's a role play method where we challenge the seductive, tempting part of the client's brain. That part of their brain that promises relief or pleasure, usually in the short term, but delivers long term pain. And the therapist plays the role of the tempting thoughts or the devil, so to speak. You know, you can imagine an angel and a devil on the shoulder and the therapist will always be in the devil role and the patient will be in the angel role. They'll argue back with their rational, reasonable, self-controlling voice.

And the purpose of the method is to help the patient create their own positive, self-controlling thoughts that are 100 percent believable and allow them to gain control and defeat the tempting voice in their head. So as the first step in defeating any problem is to clarify what it is, we have Shane's tempting thoughts here, which are, I will just go on my phone for five more minutes. I'll get on track and start my reading tomorrow. And I need to check in on the group chat so I don't miss anything. And so the way that the method is delivered, the therapist will use a seductive and tempting voice using word for word the patient's thoughts. And the patient will hit, will respond to the therapist with the self-controlling voice. Mike, would you like to jump right into it? 

Mike Christensen: Yeah, why don't you go through the instructions first and we'll jump in and Jill can add any comments when we pause. 

Tony Weiss: Sure. So the patient will respond with their self-controlling voice or their positive thought. And after one interaction, the therapist will pause and check in with the client and ask who won, the devil, the tempting voice or the self-controlling voice? And what's more, we'll ask, was it a small win or a big win? And then was it big or huge? And it's important to note that there are no role reversals. If the patient cannot defeat the tempting thought, we fall back to empathy and we voice the resistance and sit with open hands, so to speak. 

Mike Christensen: So we're going to do a little bit of a demo. I'm going to play the role of Shane and I've done a little self-disclosure that Shane and I have a lot in common, so it won't be hard for me to imagine playing him. And Tony's going to play the therapist and then Jill will interject to describe kind of what we're doing at certain points. 

Tony Weiss: All right, so Shane, you've selected this thought that has a lot of power over you. That thought is, I'll just go on my phone for five more minutes. And you said that this thought is 95% convincing to you in that moment, right before you pick up your phone. So I'm going to play that dark, seductive side of you. And you're going to be your self-controlling, reasonable, rational self. And you're going to try and defeat me. Make sense? 

Mike Christensen: Okay, yeah.

Tony Weiss: Well, Shane, it's me again. It's that part of you that really just wants to remind you. You're just crawling into bed. It's been a long day and you really deserve to relax and do some scrolling. And remember, you'll just go on your phone for five more minutes. 

Mike Christensen: You know, I never just do five minutes. I tell myself that, but it always ends up being more than five minutes. 

Tony Weiss: So who won?

Mike Christensen: I think I did. 

Tony Weiss: Small win or a big win? 

Mike Christensen: I think that was a pretty big win.

Tony Weiss: Was it big or huge?

Mike Christensen: Maybe just big.

Tony Weiss: Yeah, maybe it's not a good idea to look at this. I mean, after all, going on your phone at night is a way of staying connected and socially acceptable. And it's a great escape. Maybe we shouldn't work on this problem. 

Jill Levitt: So I'll interject here just to make a quick comment and then turn it back to you guys. For those of you who are kind of new to seeing the devil's advocate and actually already got a question in the chat box that said, why wouldn't you do a role reversal? And that's kind of what you just saw in action there, right? So Mike came up with something that was a little bit compelling, but wasn't sort of hugely compelling. It wasn't totally convincing according to his own judgment. It was big, not huge.

And so instead of Tony, let's say, feeding him the answer, like you could say this or offer him to do a role reversal and then kind of arguing back, Tony actually kind of highlighted, maybe this isn't something that you'd want to work on after all, and sort of repeated why this feels really tempting or why this might actually be working for him, what a benefit of it is. And the reason that we do that, we call it sitting with open hands, right? Or even just pushing the paradox a bit more is because then the patient is truly in the role of arguing for change. And we're not chasing, convincing, doing the work for the patient. If they really are going to get over this, they're going to have to find the true motivation and be truly convincing. And a lot of times when we sit with open hands, that is exactly what happens. The patient actually will chase you and say, no, I really do want to work on that. And that's the place you want to be rather than being the therapist trying to convince the patient to change. 

Mike Christensen: We'll jump back into the role play and I'll jump back into Shane. And I would say, well, I mean, yeah, it is. I do deserve a break, but you know what? I know that if I go on the phone, it'll be two, three hours and I'll be exhausted tomorrow. And I've been setting aside this reading that I know when I do actually spend some time reading, I fall asleep sooner and I'm more relaxed. And so, I'm ready to challenge this thought again.I need to figure this out. 

Tony Weiss: Yeah. So, who won that round? 

Mike Christensen: I definitely won that round.

Tony Weiss: Yeah. Was it big or was it huge? 

Mike Christensen: That one was huge. 

Tony Weiss: Awesome. So, let's write that down. And then we would write down exactly what the client said. In this case, Shane said that, you know, five more minutes usually turns into two or three hours and they end up feeling exhausted and they've been setting aside their reading for forever. And they know that when they do read, they feel more relaxed and they fall asleep faster. So, but we also ask Shane, how true is that self-controlling thought on a scale from zero to a hundred? And it has to be a hundred percent true and believable for the patient in order for it to be effective. And then once we do that, we'll go back to the original tempting thought, which was, I'll just go on the phone for five more minutes.

And we'll ask them, how true is that on a scale from zero to a hundred now? Or how much convincing power does it have after the method? Mike Christensen: Now, if they can't argue back, then we do exactly what you saw in the model. We fall back to empathy and open hands. We go back to the double paradox. And if they're really trying hard, but they're just not able to come up with it, we may rely on other methods to help them generate content to argue back with. So we may come back to the devil's advocate and we say, well, let's look at some other methods to challenge that. And when I use the devil's advocate, I will often have them record their huge wins.

And then in the moment, just before they're tempted, play the recording of their own voice telling them that their own self-control voice. And that can be very powerful because when they get in the tempting situation again, and I think LJ is going to be doing a webinar in the future on relapse preparation and prevention, sometime later in the year. You'll want to catch that one. But we guarantee they are going to have a tempting situation again. There will be tempting thoughts again. And so you want to have a backup plan for them in those moments. And often I'll use the devil's advocate recorded in session so that they can take that with them. Keeping in mind that those are just two techniques and you may need more. And we've got things like self-monitoring.

There's apps on your phone where you can monitor your content. I have one on my YouTube. It says 30 minutes. And then at 30 minutes, it goes gray and says, you've used up your time. Now I can override it. And so then I probably need to do some devil's advocate with the overriding tempting thoughts. Oh, well, I'll just give myself five more minutes. And then when the thing comes up. Accountability check-in is a huge one where having support around you. And that often requires the last on the list, the self-disclosure. That's a huge one that Dr. Lemke suggests is we've got to be honest with people around us and tell us what our challenge is. It's a huge basis of a lot of the support groups is that accountability and self-disclosure.

We also have things called the problem solution method where we look at the problems to even our solutions and then figure out what's this problem? What is the solution to the problem that has arisen from that? It'll be fully charged, so I don't need to put it in the other room. Well, what's the solution to that? And then we have things called the decision-making form and many more that we don't have time for today. We'd love to go into, but I want to save a little bit of time for some Q&A. Jill, anything you want to add to clarify? Or Tony, before we move to Q&A?

Jill Levitt: No, you've done a beautiful job, both of you. And we've got lots and lots of questions from the audience. So happy to start relaying them to you when you're ready.

Mike Christensen: Awesome. Just a couple of resources. The healthy screens, that's the check that our poll was based on. I took two kind of modified questions from that one. I encourage you to take it and see where you land and it helps them with their research and Dr. Lembke's website is there. In our website, we actually have a ton of webinars.

There was one that was done earlier this year on habits and addictions and you can get a few more tools on habits and addictions there that can be used in the situation. And then Dr. Burns, who is the founder of the approach that we use, TEAM-CBT, he wrote a book just recently called Feeling Great. And when he was writing it, he sent me one of his manuscripts and I said, is there any way you can include a habit addiction chapter? I begged him and his publishers, I think, said, well, I don't think there's enough space for that. And so he's so generous. He offers that chapter for free off of his website. You just need to scroll to the bottom of his main page and then put your email in and he'll give you the free chapter on habits and addictions. So I encourage you to do that. 

Jill Levitt: Okay, great. So let me start with some questions and I won't be able to get to all the questions today, but we'll do the best that we can with the time that we have.

Q&A Session