While an accurate diagnosis is important, we believe it is most effective to focus on developing a structured treatment plan tailored to our clients’ specific needs and goals. We seek to empower adults and children with the knowledge and skills to live happier and healthier lives. Some of the problems we help with may have a name or label, and some may not. Regardless, we assume that ALL PROBLEMS HAVE SOLUTIONS.
Obsessive-compulsive Disorder (OCD)
OCD is an anxiety disorder characterized by distressing and unwanted thoughts, images, or impulses (obsessions) that result in strong urges to engage in repetitive thoughts or behaviors (compulsions) to reduce this distress. Common OCD symptoms include contamination fears, compulsive checking, intrusive thoughts of a violent or sexual nature, and perfectionism. However, OCD can present itself in many other ways.
Exposure and Response Prevention (ERP) is the type of Cognitive Behavioral Therapy (CBT) that is considered to be the most effective treatment for OCD (with or without medication) based on extensive clinical research over the past 30 years. Acceptance and Commitment Therapy (ACT), another form of CBT, may also be used to provide specific help for those who may have difficulty tolerating uncomfortable feelings and urges to do compulsions.
Panic Disorder is characterized by unexpected panic attacks that result in distressing symptoms (such as pounding heart, dizziness, difficulty breathing, intense anxiety, fear of dying or losing control) and fear of having more panic attacks. This fear can build over time and lead to a person avoiding situations, activities, or places that are identified with past panic attacks. This process often causes significant interference in the person’s life and typically leads to increased anxiety and more panic attacks in a self-perpetuating, ever-worsening cycle.
CBT is considered the most effective treatment for panic disorder (with or without medication). CBT teaches individuals to understand the nature of panic and how to overcome it by changing the way they think and respond to their symptoms of panic. The intensity of treatment can range from weekly sessions to daily sessions for more rapid change.
Agoraphobia is characterized by avoidance or sustained fear of situations from which escape might be difficult (or help unavailable) in the event of a panic attack or other incapacitating or embarrassing symptoms. This can mean fear of leaving the safety zone of one’s home, but can also manifest in other ways. Agoraphobia is often associated with Panic Disorder. CBT, as described above, is considered the most effective treatment for agoraphobia.
Generalized Anxiety Disorder (chronic worry)
It is not unusual to worry about life’s challenges, but worries can be debilitating when the thoughts are excessive and difficult to stop or control. Chronic worry is often pervasive (worrying about many different problems or challenges), and it is associated with symptoms such as muscle tension, fatigue, irritability, restlessness, and headaches, as well as problems with sleep, digestion, and concentration.
CBT teaches individuals mental strategies for dealing more effectively with uncertainty and worry, as well as relaxation and acceptance strategies designed to lower physiological arousal and tension. In this way, individuals are taught to break the cycle of worry and to live their lives more fully.
Strong irrational fears of specific situations, places or things (animals, heights, flying, test taking, performance, etc.) characterize specific phobias. These phobias can lead to increasing avoidance of associated places or activities that result in significant interference with a person’s functioning, goals, and mood. Though a person with a specific phobia often recognizes that their fear is excessive, this knowledge rarely helps them overcome their fears.
CBT is considered the most effective treatment for specific phobias. CBT uses graduated exposure to help individuals dramatically change their emotional and physical experience of feared situations, places and things. This allows them to get used to these fears so they no longer interfere with living life fully. Treatment can range from weekly sessions to daily sessions for more rapid change.
Social Phobia is characterized by excessive fear and inhibition associated with social situations, including fears of interacting with, performing before, or being observed by other people. Social inhibition, characterized by feelings of inadequacy and hypersensitivity to negative evaluation, is common and can have devastating effects on relationships, careers, and one’s quality of life.
CBT is a highly effective and proven treatment for social anxiety. CBT teaches individuals to change the way they think about social interactions (cognitive reframing) and to test and disconfirm their beliefs about feared consequences through graduated exposure to social situations.
Trichotillomania (Hair Pulling)
Considered an impulse control disorder or more recently termed a body-focused repetitive behavior, Trichotillomania is characterized by urges to pull out hair from the scalp, eyelashes, eyebrows, pubic or underarm area, or other parts of the body, and often results in noticeable bald patches and/or damage to the skin.
The most effective and helpful treatment for hair pulling is called Habit Reversal Training (HRT), a type of cognitive-behavioral therapy. HRT teaches individuals to monitor their pulling and to implement strategies designed to effectively stop impulsive hair pulling.
Dermotillomania (Skin Picking)
Compulsive skin picking, another body-focused repetitive behavior, is characterized by repetitive touching, rubbing, scratching, picking at, or digging into skin; these behaviors often result in skin discoloration, scarring, or even tissue damage.
Habit Reversal Training (a type of CBT) is often an important component of treatment. However, additional cognitive-behavioral interventions are at times necessary for significant symptom improvement.
We provide CBT for a range of eating disorders, including Anorexia and Bulimia Nervosa. Eating disorders are often characterized by a cognitive process in which shape, weight, dietary habits, and their control becomes central to how a person evaluates him or herself. For some individuals, this process leads to low weight and extreme dietary restrictions found in anorexia nervosa; for others, it leads to ever-worsening cycles of dietary restriction, binge eating, and/or purging. In whatever ways the eating disorder manifests, it is the cause of significant distress and functional impairment.
CBT has been shown in numerous research studies to help people address underlying social and emotional triggers and regain control of their eating patterns. As with CBT for anxiety disorders, CBT for eating disorders offers patients a set of skills to manage their behaviors, thoughts, and emotions. With these strategies, the cycle of rumination about body image, dietary restrictions, binge eating, and purging is weakened over time.
Individuals with health anxiety have an excessive fear of illness and/or death. Frequently, these individuals engage in excessive health “safety behaviors” such as scanning their body for “symptoms” or seeking excessive reassurance from loved ones and health professionals regarding their health status. Despite these efforts, they rarely find relief.
CBT has been shown to diminish the symptoms of health anxiety. Specifically, an approach using both Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT) may be most effective.
Some children experience significant anxiety about going to school. This anxiety often gets worse during the start of school in the fall, after long holiday breaks, or even after weekends. Children may exhibit oppositional behavior or complain of feeling sick in order to stay home from school. Parents commonly feel conflicted about sending their child to school with complaints of illness and extreme distress, and often give in to their child’s pleadings, inadvertently making the cycle of avoidance worse.
Treatment is individually tailored and typically combines a number of cognitive-behavioral approaches in working with the child, the parents, and the school.
Separation Anxiety Disorder
Children, teens, and adults with separation anxiety typically fear being away from loved ones and/or home. This can significantly interfere with social relationships given the reluctance to enter new social situations that require temporary separation from loved ones.
CBT, specifically an approach using graduated exposure along with cognitive reframing to help children address irrational thinking about the situation, has been found most effective for this issue.
Body Dysmorphic Disorder (BDD)
BDD involves an excessive concern about or preoccupation with a perceived defect or flaw in one’s physical appearance. All parts of the body are susceptible, but common sites include the face, hair, and legs. In order to relieve their distress, individuals with BDD typically engage in certain safety or compulsive behaviors such as body camouflaging with make-up or extra clothes, excessive mirror checking, reassurance seeking from loved ones, researching how to correct the perceived defect, avoiding social/public gatherings and, in extreme cases, having “corrective” surgery.
CBT, involving Exposure and Response Prevention (ERP) has been proven effective in treating BDD. Including Acceptance and Commitment Therapy (ACT) for those who have difficulty engaging in ERP may also be helpful.
Hoarding is a complex disorder that is characterized by collecting too many items, difficulty getting rid of items, and problems with organization. These problems can lead to significant amounts of clutter, which can severely limit the use of living spaces, pose safety and/or health risks, and result in significant distress and/or impairment in day-to-day living.
Both individual and group CBT have been found to be effective for diminishing hoarding behavior and increasing one’s ability and willingness to eliminate clutter.
Tourette Syndrome and other tic disorders are characterized by by chronic motor and vocal tics beginning before adulthood. Affected individuals typically have repetitive, stereotyped movements or vocalizations, such as blinking, sniffing, facial movements, or tensing of the abdominal muscles that are perceived as semi-voluntary. These disorders are now considered to be on the OCD spectrum as there is considerable overlap between symptoms, particularly in children.
Habit Reversal Therapy (HRT), during which individuals use competing responses to help resist the urge to tic, has been found to be the most effective treatment for tic disorders.
Autism Spectrum Disorders (ASDs)
ASD’s include Autism, Asperger Syndrome, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). These disorders are typically characterized by social deficits, communication difficulties, stereotyped or repetitive behaviors and interests, and in some cases, cognitive delays.
Selective Mutism is a psychiatric disorder in which a person who is normally capable of speech is unable to speak in given situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety. In fact, the majority of children diagnosed with selective mutism also have social anxiety. Therefore, some researchers speculate that selective mutism may be an avoidance strategy used by a subgroup of children with social anxiety disorder to reduce their distress in social situations.