058: Ask David — Third-Wave Therapies & Exposure for OCD


Podcast 58, Ask David

David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn. Marilyn experienced a severe depression relapse eight weeks after her initial session with Matt and David, because of a painful metastasis to her rib cage which frightened and demoralized her. She graciously agreed to come in for a tune-up with David and Matt which will be published as a special podcast within the next week or so. You will not want to miss this session!

David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT. David stresses the difference between specific and non-specific therapeutic techniques. He also discusses the distressing but exciting fact that few or no therapies have proven to be much more effective than placebos in the treatment of depression, and why this is the case.

Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby. David concedes that if he’d thought of using Cognitive Flooding initially, it likely would have been effective. He also argues that Exposure and Response Prevention are not treatments for OCD, or for any anxiety disorder, but are simply tools one can use in treatment. David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. These models are discussed in detail on previous podcasts.

David and Fabrice appreciate your questions, and also encourage you to leave podcasts reviews on iTunes if you like what they are doing, since your reviews will help to popularize the Feeling Good Podcasts!


If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

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Thanks! David


6 thoughts on “058: Ask David — Third-Wave Therapies & Exposure for OCD

  1. Thank you for your response on 3rd wave cbt. It makes sense what you said about specific treatments. The only thing was I know a lot of CBT specialists that do utilise concepts from mindfulness in the treatment of OCD and anxiety (e.g David Veale, Rob Wilson, Paul Salkovskis in the UK) – particularly around mental ruminations and rituals (such as mental reassurance, mental checking etc) where if you use a cognitive reappraisal method it can become part of the mental ritual and strengthen the OCD cycle. So they use the mindfulness skills in this situation to observe the rumination and then engage in a valued meaningful life direction. I found for my own anxiety this has been so helpful together with exposure – so here the ‘specific’ aspect of the technique is using exposure with mindfulness to tackle obsessions and then mindfulness skills as the response prevention aspect to prevent mental reassurance rituals.

    Another point was I know that Richard Davidson (world renowned neuroscientist studying emotion and also meditation) has found that mindfulness can give a modest impact on the immune system like Fabrice said, although he is conservative and I’m sure he would not compare its effect to the flu jab, just that there is some noticeable benefit. Also Herbert Benson’s work on the relaxation response shows the benefit of meditation for relaxation in order to lower stress and its pretty established that lower stress improves immune function – again very modest effect but still significant?

    I look forward to seeing more clinical research on TEAM in the future – when do you anticipate these coming out, I would love to read some studies as from my reading of the literature pretty much all therapy can have some impact, as you say often not more than placebo, and it would be great to see studies showing a much more significant impact.

    I really like you’re tools not schools of therapy emphasis and also the 5 keys of effective communication has been invaluable to me, so thanks again for all your material!

    • You are welcome, Jonny, thanks for the thoughtful note! You can find some of the research that led to the development of TEAM-CBT on my website tab, “From CBT to TEAM.” You can also read about or listen to my Feeling Good Blogs and Feeling Good Podcasts on the four models I use in the treatment of all of the anxiety disorders, including OCD. The Cognitive Model actually does have tremendous value, as do the Exposure, Motivational, and Hidden Emotion Models. More later! david

  2. I just finished listening to the latest podcast and you requested feedback so here I am! I do think that both paradoxical agenda setting and the five secrets require a modest amount of self-awareness that not all people have. So I think that some mindfulness work might be necessary for a person to become self-aware to complete some of the methods of the TEAM-CBT. I have seen when a person can’t even begin the paradoxical agenda setting because they just don’t “get” it or “see things that way”. Without getting past that stage the rest of the methods never even come into play. It could be a huge barrier.

  3. Hi David,
    I am yet to go through the full prodcast. Browsed through some of the comments. My understanding is that our negative thoughts are driven by our sdb’s. They are kind of automatic. But, when we mindfully watch these thoughts they seem to loose their hold on us gradually. Transitioning from involved mode to observing mode cant happen all the time. I believe that meditation like transcendental meditation can raise our ability to do this. Do you think this is true. I also understand that your self monitoring tools work. But, is it really possible to defeat our sdb’s much of the time? Just the mere knowledge of some irrational belief can change it? How long does it take to really change our self defeating beliefs?


    • Thanks, Rajesh, will try to answer your question on Self-Defeating Beliefs on a podcast or Sunday FB live broadcast. Appreciate the thoughtful question! david

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