Treatment

When people come to my office, they’re usually very clear about what their problem is… whether it’s obsessive thinking and behavior, worry, panic, stress, specific phobias, hair-pulling or skin-picking.  In other words, they already know what’s bothering them. However, they are unclear about the solution. My job is to help people learn constructive, effective, and adaptive solutions to their problems. I do that using Cognitive Behavioral Therapy (CBT).

What is Cognitive Behavioral Therapy? 

CBT is a wide term used for a group of psychological treatments that are proven effective in treating the problems outlined on this website. CBT is solution-focused, goal-focused, skills-oriented and generally short-term (often between 6 and 20 sessions). Typically, the more work you put into the therapy and practicing the skills you’ll learn, the better the results. Like learning a language, the more you practice, the greater your mastery.

Evidence-Based Practice

When searching for a therapist, our decisions are frequently guided by geography, insurance plan participation, session fees,  and provider’s schedule or availability. While these are certainly important variables, I like to make sure that clients also investigate whether a potential provider offers psychological approaches and technigues that are based on scientific research, known commonly as evidence-based practice (EBP). When looking for a therapist, ask whether they use EBPs, and specifically, which ones. Because people are frequently unaware that we have strong research and scientific evidence for specific treatments, they may spend months or years in long-term therapy without the success they might have experienced by choosing a clinician who follows “Best Practice” approaches for psychological symptom treatment.  It’s important to remember that you are the consumer; you have a right to know if you’re receiving effective treatment. The example I use: if I go to a medical doctor, I’d like to know what they’re treating me for, how they’re going to treat me, how that treatment works, and the efficacy of that treatment; I don’t just let people start sticking me with needles and hope for the best! I encourage you to be savvy and smart about finding a practitioner who is a specialist in these approaches.

For a more in-depth look at EBPs, follow this informative link:

http://www.abct.org/Professionals/?m=mPro&fa=WhatIsEBP

Here are some types of evidence-based treatments that are now widely available:

Dialectical Behavior Therapy (DBT)

DBT combines standard CBT techniques to help people become the observers of thoughts and feelings, rather than getting caught up in them and reacting, or sometimes overreacting. DBT teaches skills in four areas: mindfulness, distress tolerance, emotional regulation, and personal effectiveness. I’ve personally never met anyone, most definitely including myself, who couldn’t use some more coping skills or techniques in these four areas. I’ve not once heard someone complain that they were simply coping too well with life’s challenges.

Acceptance and Commitment Therapy (ACT)

ACT uses acceptance and mindfulness strategies combined with commitment and behavior-change strategies–these experiential exercises help people to live more freely by accepting thoughts and feelings rather than fighting or resisting them. ACT helps us live in service of our higher values and stop avoiding situations that are uncomfortable or distress-provoking. The core tenet of ACT is that suffering is created by avoidance, which results in us behaving in ways that go against our core beliefs.

Cognitive Processing Therapy (CPT)

 Cognitive Processing Therapy is another evidence-based form of CBT designed specifically for the treatment of Posttraumatic Stress Disorder (PTSD). It is a manualized therapy that typically consists of 12 sessions, and has been proven remarkably effective.

Prolonged Exposure (PE)

Prolonged Exposure is a highly efficacious type of therapy, and is the “number one” go-to for treatment of anxiety disorders and related conditions. In fact, most successful treatments for these problems contain some component of exposure.

As the name suggests, exposure therapy involves exposing a person to the thoughts, feelings, memories, or events that currently cause distress. By learning to experience distress on purpose rather than avoiding or resisting, we learn to engage in situations freely, and stop dreading them. We gain confidence and start to feel at home in our environment.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is based on the premise that when a traumatic or distressing experience occurs, it may overwhelm our abilities to cope, and that we ultimately process such events inadequately. The goal of EMDR is to process events correctly, thus reducing their impact and allowing individuals to cope more effectively and adaptively. EMDR was originally developed for PTSD, but has been applied to other conditions.

 

What about Medication? 

People frequently ask my opinion about medication versus CBT treatment, or the combination of the two. In my view, medication is most helpful if its intended use is to bring a person to the point they’re able to effectively concentrate and learn CBT tools. I frequently treat clients who come off their meds entirely after learning CBT techniques. I am not “anti” medication by any means, and I respect everyone’s personal choices. I also feel it’s important that people are properly informed regarding CBT treatment and medication, and I find that people are often unaware of how effect CBT really is.

For the treatment of anxiety and the related conditions I treat, research supports the following:

  • As a general rule, research shows CBT can do anything that meds do, and it can do so without causing side effects that are problematic in many medications.
  • Psychotropic medications treat symptoms, rather than underlying causes–therefore, meds only work as long as you are taking them, whereas CBT addresses causes on a more lasting basis.
Given this information, I’m a proponent of using all behavioral means possible, using medications sparingly on an as-needed basis, and always in conjunction with CBT. Some people have more severe symptoms and certainly need to continue on medications long-term.  However, it is far more common I see people with milder and more moderate conditions who have become convinced they will need medication for the rest of their lives. I like to make sure that everyone knows they have choices, and that they don’t necessarily need to be on meds forever, unless that is their personal preference.