What We Treat

What We Treat

Obsessive-Compulsive Disorder (OCD)
Description:

Obsessive compulsive disorder (OCD) is characterized in two parts: obsessions and compulsions. Obsessions are unwanted and intrusive thoughts or feelings that begin to cause anxiety and distress that interrupt daily tasks. In response to these thoughts or feelings the person begins to engage in repetitive behaviors that reduce the anxiety, called a compulsions or rituals. The compulsion is used to neutralize or counteract the anxiety. Although most suffereres recognize that their obsessions are irrational the compulsive behavior feels gratifying and causes the individual to feel less anxious and distressed.

Approximately 1-2% of the general population suffers from OCD, a condition that typically presents in adolescence or early adulthood, but symptoms present in very young children as well. Symptoms often flare-up during periods of increased stress. Many OCD sufferers do not seek treatment, often citing feelings of shame or embarrassment about the nature of their obsessions and/or compulsions. Studies suggest that OCD sufferers go between 12-17 years from the onset of symptoms before getting treatment from an ERP (Exposure and Response Prevention) specialist.

Obsessions include:
  • Fear of dirt, germs, or illnesses
  • Getting things just right
  • Self harm or harm to others
  • Anxiety about order, symmetry and/or lack of
  • Undesirable thoughts such as: profanity, sexual, or religious
  • Magic numbers or sequences of movement with superstitious avoidance
  • Perfectionism
  • Excessive doubt
  • Fear of dirt, germs, or illnesses
  • Getting things just right
  • Self harm or harm to others
  • Anxiety about order, symmetry and/or lack of
  • Undesirable thoughts such as: profanity, sexual, or religious
  • Magic numbers or sequences of movement with superstitious avoidance
  • Perfectionism
  • Excessive doubt
Compulsions include:
  • Decontamination and excessive bathroom routines
  • Checking locks, appliances, and doors
  • Mentally reviewing situations
  • Rearranging and ordering things in special ways
  • Reassurance seeking
  • Ritualistic religious behaviors
  • Counting
  • Tapping, blinking, and touching objects repeatedly
Treatment:

The gold standard, most effective treatment of OCD is called Exposure and Response Prevention (ERP). Treatment is particularly important for people who have developed ritualized, repetitive behaviors such as compulsions. ERP is a necessary component of CBT for most anxiety conditions, particularly OCD. The two components include exposures – facing fears in a systematic, gradual, and purposeful manner to elicit anxiety – and response (or ritual) prevention – actively resisting safety behaviors and other avoidant strategies that only offer short-term reduction of symptoms but maintain the cycle of anxiety and avoidance in the long-term. Both elements are critical for effective ERP. Through the ERP process, the individual overcomes fears, gains corrective information, and retrains the brain to no longer elicit a fight or flight reaction in the face of these “false alarms.” Our therapists will guide you to progressively face the situations and thoughts that provoke your OCD while learning how not to react with rituals, compulsions, reassurance seeking or avoidance.

We also offer an “Intensive Outpatient Program” (IOP) for OCD sufferers in cases where no available ERP specialists are in your geographic area, when services are simply not easily accessible, or because symptom severity is too high for weekly outpatient therapy. The treatment is customized to meet the level of need, availability, and readiness for change to address current symptoms and get the individual to a higher level of functioning whereby more traditional outpatient therapy can be the level of care. The goal of an IOP is to complete treatment with 4-6 weeks and therefore typically requires sessions back to back days, several hours per day, and sometimes over the weekend.

For More Information:

The International OCD Foundation
Exposure and Response Prevention
PANDAS Network

Panic Disorder/Agoraphobia
Description:

Panic disorder is characterized by a sudden onset of recurrent physical sensations called a panic attack. Individuals who suffer with panic disorder regularly experience panic attacks, or rushes of intense fear, anxiety, or discomfort that seemingly come from out of the blue, for no apparent reason. Importantly, not everyone who experiences panic attacks will develop panic disorder. During a panic attack an individual may experience several physical symptoms such as: dizziness, shortness of breath, heart palpitations, or numbness.

Often, there is a persistent fear of when the next panic attack might occur, and afflicted individuals will try to avoid or escape situations they have come to associate with panic attacks. Panic attacks can result in frequent visits to medical facilities and frequent absences from work or school. Panic disorder affects roughly 2% to 3% of adolescents, and 2% to 3% of adults in the general population. It can appear at any age, but most often develops by young adulthood.

Agoraphobia involves the experience of intense fear or anxiety in a wide range of situations, such as when using public transportation, being in open spaces or enclosed spaces, standing on line or being in a crowd, or being away from home alone. Individuals with agoraphobia may worry that something terrible will happen in these situations, or they may fear that they will not be able to escape or get help in the event that they experience panic-like or incapacitating symptoms. In extreme cases, agoraphobia can cause individuals to become homebound and dependent on others for basic needs. Agoraphobia affects approximately 2% of adolescents and 2% of adults in the general population. Agoraphobia typically develops in late adolescence or early adulthood, although it can occur at any age.

Symptoms of Panic Disorder:
  • Chills or hot flushed
  • Pounding heart, Chest pain or discomfort
  • Fear of dying or having a heart attack
  • Sweating/trembling
  • Nausea
  • Shortness of breath or smothering sensations
  • Feeling faint
  • Feeling detached from one’s self
  • Numbness
Situations individuals with agoraphobia may avoid:
  • Expressway traffic
  • Physical exercise
  • Crowds
  • Group activities
Treatment:

Treatment for panic disorder includes exposure practices inducing the physical symptoms associated with panic until a patient gets used to them and stops feeling anxious, called Interoceptive Exposure. Exposure therapy can also include the practice of overcoming the fears posed by the real life situations that usually end with avoidance. Exposures occur in office and out of office as necessary approximate the most real situations, which means your therapist will accompany you during shopping, driving, exercise or other activities that panic takes place. Cognitive therapy can also be used to help identify and change fearful or catastrophic beliefs that underlie anticipatory anxiety.

For More Information:

Anxiety and Depression Association of America

Social Anxiety Disorder
Description:

Social Anxiety Disorder or “Social Phobia” is when an individual feels emotional discomfort, anxiety, or fear about social situations. Individuals with social phobia will often feel that they are being judged or rejected by others. Physical sensations may accompany the phobia causing an increase in fear symptoms such as crying, blushing, sweating, or shaking. Social anxiety can create a fear of public situations like public speaking or cause an individual to avoid social events.

Social anxiety disorder is the third most common mental disorder, affecting upwards 5-12% of the general population at some point in life. Approximately 5% of children and adolescents suffer from social anxiety disorder. In general, females tend to be more affected by social anxiety than males, and this gender difference is usually more pronounced in adolescents and young adults. Although the majority of social anxiety disorders cases start in adolescence, these difficulties can start as early as preschool.

Individuals with Social Anxiety Disorder:
  • Avoid social situations or outings
  • See that that their social anxiety greatly interferes with their life
  • Have accompanied feeling like stomach distress, shaking, or concentration challenges
  • Fear that they will embarrass or humiliate themselves by acting in a way that could cause them to be judged
  • May experience a panic attack whenever they are in uncomfortable social situations
  • Thinking about oneself in highly negative, critical ways, or assuming that others are thinking extremely negative things
Treatment:

Whether the social anxiety is in specific presentation moments or in more generalized social scenarios, Exposure Therapy is the most effective treatment approach. Exposures can include practicing with virtual humans, role plays, practicing with real people via technology mediums (e.g., Skype, Facetime) as well as practice in vivo, with real people to address a variety of commonly affected social situations, such as starting, joining, or maintaining conversations, interacting in groups such as at parties or other social gatherings, dating or talking to romantic interests, participating or presenting in meetings or classes, talking to people in positions of authority, and public speaking. Treatment will focus on helping you gain social confidence and skills that lead to success.

For More Information:

Anxiety and Depression Association of America

Specific Phobias
Description:

Specific phobias are irrational or abrupt fears of an object or situation. Most individuals who suffer from specific phobias do not have a traumatic onset, such as fearing a spider and being bit by a spider. Specific phobias cause individuals to experience anxiety that can lead them to avoid situations or objects. Individuals are usually aware that their fear is irrational or excessive but their fear occurred during childhood and has overtaken their life.

In the United States it is estimated that 7% to 9% of adults suffer from a specific phobia. Women are twice as likely as men to be affected by specific phobias.

All children have certain items or situations that make them uneasy or fearful, but most are nevertheless able to carry out daily activities without incident. In contrast, children with specific phobias continually avoid specific situations or objects due to intense fear and anxiety, and the avoidance and distress consequently disrupt their lives in considerable ways. Upwards of 7% to 9% of children are estimated to have specific phobias (Schniering, Hudson & Rapee, 2000).

These are five types of specific phobias:
  • natural environment phobias (thunderstorms, water, or height)
  • animal phobias (dogs, snakes, spiders)
  • blood, injection, and injury phobias (sight of blood, receiving injections, or any bodily damage)
  • situational phobias (elevators, airplanes, boats)
  • other phobias (foods, sounds, vomiting)
Treatment:

The most effective method of treatment for specific phobias is Exposure therapy, which can include in vivo, imaginal, or media-augmented. As avoidance is a large part of the problem with anxiety, therapists accompany individuals into the avoided places and situations, and/or help them confront avoided thoughts, providing instruction and appropriate levels of reassurance. These strategies increase confidence in mastering similar situations in the future.

For More Information:

Anxiety and Depression Association of America

Generalized Anxiety Disorder (GAD)
Description:

Generalized anxiety disorder (GAD) is characterized by its excessive and constant worry from several aspects of life. Individuals with GAD worry about many different concerns of life such as money, close relationships, or health. Even though their worries are normal the difference is that they are unable to control the persistent concern and it goes on for months at a time. Although their worries are bothersome, they believe there is value in it by protecting theirs and others safety. These individuals also believe that their worry helps them maintain high standards in job performance and school work. Many children, adolescents, and adults with this disorder are constantly seeking reassurance from friends and families and can make those close to them feel as though they are being badgered.

Generalized anxiety disorder affects roughly 3% to 5% of children, 1% of adolescents, and 3% to 5% of adults in the general population, although only a small percentage of afflicted individuals seek treatment. Females are about twice as likely as males to experience generalized anxiety disorder.

Several symptoms include:
  • Trouble falling or staying asleep
  • Stomach distress
  • Difficulty concentrating
  • Muscle tension
  • Gastrointestinal pain
  • Fatigue
  • Irritability
  • Feeling tense
  • Head and neck pain
Treatment:

GAD is most commonly treated with Cognitive Therapy and medication. We will use cognitive therapy to teach the individual to tolerate doubt and how to solve problems that will help reduce tendencies towards perfectionism or trying to answer questions that have no guaranteed answers. Exposure therapy is also used to allow the patient to embrace uncertainty and engage in problem solving one step at a time.

For More Information:

Anxiety and Depression Association of America
National Institute of Mental Health

Post Traumatic Stress Disorder (PTSD)
Description:

Post Traumatic Stress Disorder (PTSD) is a condition affecting individuals who have been exposed to or witnessed a life threatening situation and who then develop an anxiety disorder following the traumatic event. The individual is unable to return to daily tasks even after an adjustment period of up to two months. Individuals will experience anxiety attacks or disruptive thoughts when remembering the traumatic event. PTSD affects up to 5% of adolescents and 3.5% of adults. The prevalence of PTSD is higher among veterans and in certain occupations (e.g., police, firefighters, emergency medical professionals), with the highest rates experienced by those exposed to sexual traumas and military related traumas.

Examples of trauma:
  • Auto accidents
  • Surviving extreme weather
  • Sexual assault
  • Physical assault
  • Animal attack
  • War
Symptoms of PTSD:
  • Flashbacks or nightmares of the trauma
  • difficulty sleeping or restlessness
  • Being on guard
  • Easily startled
  • Avoidance of people, places, or objects
Treatment:

The most evidence based treatments for PTSD includes prolonged exposure therapy where individuals can face their fears or memories until they no longer feel anxious, cognitive processing therapy, which will help re-work the thoughts that come with PTSD, and medication treatment.

For More Information:

Anxiety and Depression Association of America
International Society for Traumatic Stress Studies

Separation Anxiety
Description:

Separation Anxiety occurs when a child feels the threat of separation from their caretaker or anticipates the separation coming. Separation anxiety is common between the ages of 18 months and 3 years old. When older children or adults show developmentally inappropriate and excessive anxiety about leaving home or being away from loved ones, and when this anxiety interferes with daily life, this may indicate the presence of separation anxiety disorder. Children with separation anxiety resist any form of “goodbye” such as going to bed, school, or daycare. They often have extreme difficulty being away from home or attachment figures and they try to avoid these separation situations. In children, these fears must last for a period of one month or longer. Separation Anxiety affects approximately 4% of children.

Children may cry or throw a tantrum and beg to stay with their caretaker, others may refuse to go to these things overall. Children with a more severe form of separation anxiety may demand to be within reach of their caretakers.

Common Symptoms Include:
  • Difficulty going to bed on their own
  • Difficulty going to school, daycare of friends’ homes
  • Having a sleepover
  • Being at camp
  • Fear that something bad will happen to themselves (e.g., getting kidnapped) or to a loved one (e.g., never coming back, getting sick or dying) when away from them
  • Calling or texting parent figure or caregiver excessively
  • Complaints of physical symptoms (e.g., headache, stomach ache)
  • Tantrums when separation is about to happen
Treatment:

Treating this disorder involves exposure therapy that increasingly teaches a child that they can enjoy or endure separations. Another form of exposure therapy is imaginal exposure that helps children overcome thoughts about separation. The therapist will also teach caregivers to know how to help their child endure separation and how to use consequences (e.g., rewards and limit setting) in healthy ways.

Trichotillomania and Dermatillomania (Body Focused Repetitive Behaviors)
Description:

Body-focused repetitive behaviors (BFRBs) is when a person causes harm or damage to themselves or their appearance. A form of BFRB is trichotillomania (trich), a compulsive hair pulling disorder. Compulsive hair pulling can end in bald patches or hair loss. Hair is often pulled from spots that are easily reached, therefore easily noticeable. After pulling the hair an individual may eat or play with their hair. Individuals with trich experience embarrassment and shame and try to hide their hair loss with wigs, clothing, or makeup. Individuals may abstain from activities that reveal their hair loss such as going to hairdressers, being outside when it’s windy, or standing next to people who are taller than them. Despite repeated attempts to decrease or stop pulling, the person is unable to do so. Roughly 1% to 2% of the general population suffers from hair-pulling disorder, and females are 10 times more likely to be affected than males.

There is also dermatillomania, also called Excoriation, a compulsive skin picking disorder. This disorder involves excessive skin picking such as picking at blemishes, scabs, or scratching at skin. The goal for the individual is to achieve “smooth” skin by accelerating the healing process.

Forms of BFRBs:
  • Skin picking
  • Compulsive nail biting
  • Cheek biting
  • Nose picking
  • Hair pulling (scalp, eyebrows or lashes, leg or arm hair, pubic region)
  • Or a combo of these
Treatment:

To treat a BFRB we must first define why the individual is pulling or picking and create a customized plan of cognitive and behavioral strategies. Eventually these strategies will replace the BFRB with more adaptive behaviors. The goal is for an individual to no longer experience shame or embarrassment because of their picking or pulling but also cease the behavior of BFRBs that create a physical, emotional cognitive cycle.

For More Information:

The TLC Foundation

Health Anxiety/Illness Anxiety Disorder
Description:

Health anxiety is when an individual has an obsession or fear of being seriously or terminally ill without being diagnosed or fearing catastrophic outcomes from real medical issues such as food allergies, headaches, etc. The individual will misread minor symptoms as something serious or life threatening and search for reassurance or avoid any situations or triggers that they believe caused the minor symptoms. Individuals with health anxiety may frequently visit or switch health care providers to provide relief, seek out information about their disease even though they already know the information. Others may feel more susceptible to disease and avoid health care providers in fear of receiving bad news.

Symptoms can include:
  • Being preoccupied with having or getting a serious disease or health condition
  • Worrying that minor symptoms or body sensations mean you have a serious illness
  • Being easily alarmed about your health status
  • Finding little or no reassurance from negative test results or a doctor's reassurance that you're healthy
  • Worrying excessively about a specific medical condition or your risk of developing a medical condition because it runs in your family
  • Having so much distress about possible illnesses that it's hard for you to function
  • Repeatedly checking your body for signs of illness
  • Frequently making medical appointments for reassurance — or, avoiding medical care for fear of being diagnosed with a serious illness
  • Avoiding people, places or activities for fear of health risks
  • Constantly talking about your health and possible illnesses
  • Frequently searching the Internet for causes of symptoms or possible illnesses
Treatment:

Similar to other anxiety disorders that involve excessive fears and ritualistic and repetitive behaviors to calm one’s fears, health anxieties are most effectively treated with exposure therapy, reduction of reassurance seeing and avoidant behavior, and cognitive therapy to address misconceptions. Basic health education is also a key ingredient.

Depression
Description:

Depression is when an individual experiences persistent mood disorders or a loss of interest in daily activities. Symptoms of depression occur in several mood disorders like major depressive disorder, dysthymia, bipolar disorder, and disruptive mood dysregulation disorder (DMD). When an individual experiences depression they may also experience troubles with concentration, thoughts of dying, a loss in sleep, or being fatigued. Children and adolescents may have symptoms such as irritability, acting out/ lashing out at others, or poor performance in school.

Major depressive disorder affects approximately 2% of children, 4-8% of adolescents, and approximately 7% of adults. Adolescent girls and women are about twice as likely as males to experience depression.

Individuals with depression may experience:
  • Guilt
  • Irritability
  • Lack of enjoyment
  • Hopelessness
  • Withdrawing from close friends
  • Suicidal thoughts or behaviors
  • Repetitive negative thoughts and statements
  • Insomnia or Oversleeping
  • Change appetite or weight gain/loss
Disruptive mood dysregulation

was newly defined in the latest DSM-5; it aims to classify children between the age of 6 and 18 with extreme mood dysregulation and associated behavioral difficulties. Of note, symptoms of this disorder are characterized as frequently extreme in their emotional reactions and behaviors, in ways that are inconsistent with the situation, the child's age and the child's developmental level. Though prevalence rates have not yet been definitively studied, it has been estimated that the prevalence among children and adolescents is 2-5%, with higher prevalence in males and school-age children.

Treatment:

For any kind of mood disorder, a combination of Cognitive-Behavioral Therapy and medication treatment is proven most effective. However, depending on severity, age of onset, and current symptoms, medication treatment may not be warranted. Given the concerns of suicidality among individuals battling a mood disorder, safety monitoring and planning is always a key element in treatment planning.

For More Information:

Anxiety and Depression Association of America
Suicide Prevention Lifeline

ADHD
Description:

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that begins at childhood and can persist into adulthood. Although ADHD is commonly found in children it is not uncommon for an adult to have it as well. There are three features that causes a child or adult to be diagnosed as having ADHD: hyperactivity, negligence, and impulsivity. Problems with ADHD can lead to a low self-esteem, difficulty at work or school, and trouble with relationships.

ADHD affects 5% of children and 2.5% of adults. Boys are twice as likely to be diagnosed as girls. Girls diagnosed with ADHD are more likely to be diagnosed with the inattentive presentation. Children with ADHD are at greater risk than the general population to be diagnosed with a disruptive behavior disorder, with some research studies showing that as much as 50% of ADHD children demonstrating a co-occurring DBD.

Individuals with ADHD may have issues with:
  • Inattention:
    • Difficulty sustaining attention on tasks and activities
    • Does not seem to listen when spoken to directly
    • Fails to complete tasks and activities
    • Avoids tasks that requires sustained mental effort
    • Often loses things necessary for tasks and activities
  • Hyperactivity:
    • Often leaves seat in situations when remaining seated is required (i.e. classroom, mealtimes, religious services, workplace)
    • Often runs and climbs in situations in which it is appropriate
    • Is often “on the go” or acts as if “driven by a motor”
    • Talks excessively
    • Difficulty waiting turn (i.e., during games, in line)
Treatment:

Treating ADHD often requires medical, educational, behavioral and psychological interventions. This comprehensive approach to treatment is sometimes called “multimodal” and, depending on the age of the individual with ADHD, may include:

  • parent training
  • medication
  • skills training
  • counseling
  • behavioral therapy
  • educational supports
  • education regarding ADHD

Working closely with health care providers and other professionals, treatment should be tailored to the unique needs of each individual and family to help the patient control symptoms, cope with the disorder, improve overall psychological well-being and manage social relationships.

For More Information:

The National Resource on ADHD
Center for Disease Control and Prevention