Dr. Michael A. Tompkins is a licensed psychologist and board certified in Behavioral and Cognitive Psychology. He is co-director of the San Francisco Bay Area Center for Cognitive Therapy and serves on the Advisory Board of Magination Press—the children’s press of the American Psychological Association—and on the editorial board of the Journal of Cognitive and Behavioral Practice. He specializes in the treatment of anxiety disorders and insomnia in adults, adolescents, and children, and provides training and consultation in Cognitive Behavior Therapy (CBT) for insomnia and other sleep problems.

We recently spoke with Dr. Tompkins to learn more about him, professionally and personally.

Beck Institute: Thank you for taking the time to speak with us today. To start off, we would love to hear about any upcoming Beck Institute training projects you are particularly excited about.

Dr. Tompkins: I am deeply flattered to serve as a faculty member of the Beck Institute. It is my most cherished professional relationship, and I’m thrilled any time I’m asked to participate in the Institute’s important mission. I’ve participated in a number of projects for the Beck Institute—most recently, I was asked to develop adaptations of the CBT Essentials I & II courses when working with youth. This was fun to do because it reminded me of the particular importance of conceptualization when working with young people. CBT with youth is a downward developmental extension of CBT with adults.

This means that CBT with youth considers the unique developmental, familial, social, and cultural factors that influence how CB interventions are staged and implemented. Throughout treatment with younger youth, we emphasize playful adaptations of standard interventions to increase the youth’s engagement with the goals and tasks of therapy, such as bullfrog thought records, or acting brave experiments (i.e., behavioral experiments).

Last, we consider developmental rather than chronologic age when we conceptualize our work with youth. A 12-year-old child with a neurocognitive condition such as ADHD may not function in the same way as a 12-year-old who is neurotypical. Or, when working with adolescents we would consider the unique mastery tasks that are part of this developmental stage (e.g., striving for autonomy and peer acceptance). Youth, unlike adults, are moving developmental targets. In other words, it is necessary for us to adjust the treatment to the kid, not the kid to treatment. It’s interesting to think about these issues and the adaptations of CBT to this population.

Perhaps the training I enjoy giving the most is the online CBT for insomnia (CBT-I) workshop. Sleep is a fascinating subject. In fact, in my opinion, sleep is the most sensitive index of our physical and emotional well-being. When we’re not sleeping well, we’re typically not doing well. CBT-I is a powerful and durable treatment for insomnia and few practitioners are trained to provide it. It is very fulfilling to train clinicians from around the world in this treatment and do my part to get this amazing treatment out into the world.

Beck Institute: What drew you to CBT?

Dr. Tompkins: In graduate school I learned of the work of Albert Bandura and his social learning theory. I was very struck by his idea of self-efficacy. Self-efficacy is a belief that influences our willingness to move toward certain goals. Agency might be another term for this. Confidence is the strength of this self-efficacy belief. So, if I believe that I have the skills and knowledge to achieve a specific goal, and believe it strongly, then I’m more likely to work toward that goal.

If you learned to ride a bicycle, then you know what this is like. Before you learned to ride a bicycle, you didn’t have much bicycle-riding skill and knowledge so your confidence as a bicycle rider was low. But, as you learned the basics of bicycle riding and practiced riding for a while, the strength of your belief in your bicycle-riding abilities increased over time. As I reflected on my life through the lens of this theory it made total sense to me.

Then I learned of Dr. Aaron Beck’s cognitive model and cognitive therapy. His model and therapy seemed to capture beautifully the role of self-efficacy in personal growth. As a skills-based, problem-solving approach, CBT directly enhances self-efficacy beliefs. Once we believe—and believe strongly—that we’re equipped to manage the problems that arise in our lives we’re then on the path of meaningful, life-altering change. How cool is that?

Chat
“Once we believe—and believe strongly—that we’re equipped to manage the problems that arise in our lives we’re then on the path of meaningful, life-altering change. How cool is that?”
Dr. Michael Tompkins

I was also drawn to CBT by the universality of Dr. Beck’s cognitive theory. The theory can explain much of human experience, including broader topics such as hate and violence, as he described in his book, Prisoners of Hate. It is such an elegant conceptual model and part of its elegance is in its simplicity. The model made intuitive sense to me when other psychological theories did not. I think this also explains the public’s embrace of the model and therapy.

Beck Institute: What’s one piece of advice you’d give to a new CBT therapist just starting out?

Dr. Tompkins: I recommend that you become an expert at case conceptualization. It is the most complex clinical skill that we acquire and once acquired and mastered can make the difference between a successful and unsuccessful treatment. Conceptualization is often underappreciated by those who practice CBT. Too often clinicians view CBT as a string of techniques that therapists throw at clients one after the other with the hope that one will stick. I believe well trained cognitive behavior therapists are much more thoughtful than that and conceptualization is central to that thoughtfulness. In a sense, an individualized case conceptualization is the back story for a client.

For example, think about your favorite show with multiple seasons and episodes. Each episode is written by one or more writers. Imagine that you’re sitting in the writer’s room and one writer suggests, “Hey, what do you think would happen if Joy’s long-lost brother shows up and discovers that Joy is dating a former friend who stole Joy’s brother’s girlfriend in college?” The other writers then brainstorm how Joy would react, and how the guy Joy’s dating might react, and how Joy’s single roommate with an unspoken crush on Joy might react. In this way, the writers are able to write a script that includes the reactions of every cast member because the writers have the back story for each character in the show. The writers can write one episode after another because they know how each member of the cast will respond to any situation or circumstance that they’re dropped into. In other words, the writers have a conceptualization for each character of the show. That’s how a conceptualization works in CBT too. If we have a client’s back story, we can understand why they’re reacting the way they’re reacting, and often predict how they’re going to react in the future.

Following through with the goals and tasks of CBT can be difficult for clients, and conceptualization helps us understand and work through these therapeutic difficulties. When I teach for the Beck Institute, I generally hear two types of questions from attendees. There are the “how to” questions: How do I develop behavioral experiments with clients? How do I restructure problematic automatic thoughts? How do I develop action plans? The answers to these questions are straightforward. The second type of question is a conceptualization question, and these are the questions experienced therapists tend to ask. These are “why” questions: Why does this client repeatedly fail to complete action plans? Why does this client have difficulty identifying their automatic thoughts? Why is this client repeatedly late to sessions? A comprehensive individualized case conceptualization helps us answer these questions and many more.

Beck Institute: You mentioned earlier how important sleep is to overall wellbeing. If a patient reported difficulty sleeping to their primary care physician, what would be the most important thing for the physician to do to help the patient?

Dr. Tompkins: Nearly three out of four patients with insomnia are treated in primary care, typically with sleep medications, and it is the second most frequent health complaint after pain. Most primary care physicians are eager for alternatives to standard sleep medications, particularly for their older patients. At the same time, primary care physicians are incredibly busy and often on a 15-minute per patient schedule. However, there are several simple yet powerful interventions that physicians can implement within a brief appointment.

First, review with patients their sleep hygiene. These are sleep habits that maintain high-quality sleep, such as avoiding caffeine and alcohol, following a consistent wind-down routine before bedtime to relax and downshift the mind and body toward sleep, and maintaining a consistent lights-out to sleep time and a get-out-of-bed time in the morning. Most importantly, we want patients to resist going to bed if they’re not sleepy and avoid staying in bed longer than 15-20 minutes if they’re awake.

Patients are more likely to follow these recommendations if they understand the sleep science that supports them, so it is worth a physician’s time to explain the science of sleep and insomnia. This includes the importance of optimizing sleep drive—our hunger for sleep. Also, accurate science-based information about sleep can correct many misperceptions and misunderstandings patients have about their sleep difficulties and how to correct them.

Beck Institute: Are there any causes you are particularly passionate about?

Dr. Tompkins: I am passionate about disseminating high-quality and high-fidelity CBT. At the same time, at this point in my career and life, I am more intentional about how I use my time. Yet, I will always have time to participate in the mission of the Beck Institute to improve lives worldwide.

Beck Institute: Are there any personal or professional goals you are working towards?

Dr. Tompkins: I’m working to complete a new book project for Magination Press. It’s a self-help book for teens who are experiencing panic attacks and panic disorder. Writing is a hobby, and I enjoy translating sometimes complicated ideas in a way that is engaging and helpful to teens struggling with mental health issues.

Dr. Tompkins leads our CBT for Insomnia for Medical Professionals on-demand webinar and our CBT for Hoarding Disorder on-demand webinar.

Read more from Dr. Tompkins: