CBT Cookies

No, not CBD! CBT, as in, cognitive behavioral therapy.

I fished this out of a fortune cookie last night:

Inspired, I’m thinking about ordering some custom cookies to hand out during sessions. The fortunes would take the form of rational emotive behavior therapy (REBT):

  • What was the activating event (A)?
  • What was the emotional and/or behavioral consequence (C)?
  • What did you tell yourself (B) about A to cause C?
  • Is that belief (B) logical? Empirical? Pragmatic?

I somehow think that Albert Ellis, who made therapy playful and engaging, would approve. ✸

Postscript. How do I know that Ellis was playful and engaging? I’ve read published transcripts of his sessions, and they are masterpieces. During one session, he advised a client thus: “Every time a human being gets upset—except when she’s in physical pain—she has always told herself some bullshit the second before she gets upset” (p. 228). That not only got the client’s attention, I can guarantee the lesson stuck.

SIMS Season — 2022

I’m privileged to serve as faculty for another season of Hazelden Betty Ford Foundation’s Summer Institute for Medical Students (SIMS). This page contains links to my teaching materials and some additional resources.

Many thanks to Kari Caldwell for involving me in SIMS and also the Professionals in Residence (PIR) program!

Screening, Brief Intervention & Referral to Treatment (v. 05/11/2022)
Motivational Interviewing Skills Session (v. 11/09/2022)

Key Readings [Mindy & Kari will provide copies]
Alcohol Use Disorder (textbook chapter)
Taboo Topics in Addiction Treatment: An Empirical Review of Clinical Folklore (J Subst Abuse Treat 1993;10(3):303-16. PMID: 8315704)
The 10 Most Important Things Known About Addiction (Addiction 2010;105(1):6-13. PMID: 19712126)

Patient Assessment
The ASAM Criteria Assessment Interview Guideline (Adult)
Tailoring Treatment (transtheoretical model)

Patient Resources
DBT Skills Training Handouts and Worksheets (see: Chain Analysis of Problem Behavior, p. 31)
Motivational Interviewing Workbook
REBT Pocket Companion for Clients
Rethinking Drinking (consumer health website)
Tips for Cutting Down on Drinking

I’ve long advised medical students and residents to acquire some psychotherapy skills, regardless of their eventual specialty. Motivational interviewing (MI) and cognitive behavioral therapy (CBT) are relatively easy to learn and have broad clinical utility.

Some MI resources include:

  • Miller WR, Rollnick S. Motivational Interviewing, 3d ed. New York: Guilford Press, 2013 [classic textbook]
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 1—brief intervention and motivational interviewing. Aust Fam Physician 2009;38(11):885-888 (PMID: 19893835; and here)
  • Sim MG, Wain T, Khong E. Influencing behaviour change in general practice. Part 2—motivational interviewing approaches. Aust Fam Physician 2009;38(12):986-989 (PMID: 20369152; and here)
  • Hall K, Gibbie T, Lubman DI. Motivational interviewing techniques—facilitating behaviour change in the general practice setting. Aust Fam Physician 2012;41(9):660-667 (PMID: 22962639; and here)
  • Searight HR. Counseling patients in primary care: evidence-based strategies. Am Fam Physician 2018;98(12):719-728 (PMID: 30525356)

In terms of CBT, I highly recommend the professional trainings at the Albert Ellis Institute, starting with the primary certificate practicum. Some other resources include:

  • DiGiuseppe RA, Doyle KA, Dryden W, Backx W. A Practitioner’s Guide to Rational Emotive Behavior Therapy, 3d ed. Oxford: Oxford University Press, 2014 [classic textbook]
  • Harden M. Cognitive behaviour therapy—incorporating therapy into general practice. Aust Fam Physician 2012;41(9):668-671 (PMID: 22962640; and here)
  • Stuart MR, Lieberman JA. The Fifteen Minute Hour, 6th ed. Boca Raton: CRC Press, 2019 [please see, in particular, Chapter 4]
  • Frenz DA. Another Arrow for Your Quiver: REBT for SUD. Minneapolis: David A. Frenz, M.D., 2018 [PowerPoint presentation]

Acceptance Is the Answer

Linda Picone, the editor of Minnesota Medicine, tapped me for its “Joy of Medicine” feature. The extended interview appears in the September–October issue.

Minnesota Medicine

I’ll let Linda’s work speak for itself—it’s an absolute gem—but offer the following references for those who might want to go deeper:

Sunday Sermon

Well, not exactly. They didn’t let me get anywhere near the pulpit!

I did, however, speak at Gustavus Adolphus Lutheran Church for its weekly Table Talk series (the title is a nod to Luther). Last week, I presented on addiction. Today, I held forth on Rational Emotive Behavior Therapy (REBT), which is a way to reduce emotional disturbances by thinking more clearly.

My “text” for last week was Romans 7:15. I also wandered through DSM-5 and Doug Sellman’s “Top 10” on my way to Gerald May’s brilliant conceptualization. I didn’t have a text today, however, “renew your mind” would have been apt.

Many thanks to Dr. Arland Hultgren  (see, also, Amazon) for inviting me to visit such a wonderful parish. And also Rev. Tim Nelson for connecting us.

P.S. I’m a PK (pastor’s kid) and so far have avoided seminary myself. But I wound up in the “belief business” anyway. §

Received Wisdom — 1



Mental suffering takes place when we don’t get what we want, or when we’re forced to live with and endure what we don’t want.

—Steve Hagen


Steve Hagen. Buddhism Plain and Simple. Boston: Charles E. Tuttle Co., 1997, p. 30

Received Wisdom is the big ideas that I use with patients. This post is the first in a series of many.