Specialization

Generalized Anxiety is an anxiety disorder in which excessive anxiety and worry are focused on a variety of events and activities, for example, work, school, or relationships. The anxiety can be persistent and debilitating, making it difficult to function.

Do you...

• Experience anxiety and worry most days, about several different events or activities?

• Find that it is difficult to control the worry?

• Feel restless or on edge?

• Get easily fatigued?

• Have difficulty with concentration?

• Get easily irritated?

• Experience muscle tension?

• Suffer from sleep difficulties?

If these symptoms feel familiar to you, an assessment may be warranted. If you do have Generalized Anxiety Disorder, the good news is that it is treatable. Cognitive Behavioral Therapy (CBT) has been shown to be highly effective for anxiety disorders, including Generalized Anxiety Disorder. CBT can help you change the thought and behavior patterns that help keep you anxious, so you can improve your functioning and get back to living your life.

Panic attacks are one of the scariest experiences a person can have. Having a panic attack can feel like you are literally dying and losing all control. Panic disorder describes when a person has recurrent panic attacks, often completely out of the blue, and experiences a lot of fear and worry about having more panic attacks. Panic disorder can disrupt almost all aspects of your life, including work, relationships, hobbies and family life. You may feel you have to avoid situations that may trigger a panic attack (which can lead to agoraphobia), leaving you missing out on activities you enjoy.

Do you have recurrent panic attacks including the following symptoms?

• A surge of intense fear/anxiety.

• Increased heart rate.

• Pounding heart beat.

• Chest pain.

• Sweating/hot flushes.

• Shaking.

• Shortness of breath.

• Feelings of choking.

• Nausea.

• Dizziness.

• Numbness in your fingers or toes.

• Chills.

• Feeling detached from yourself or reality.

• Fear of losing control.

• Fear of dying.

If you are experiencing panic attacks, I want you to know that therapy can help and you do not have to suffer forever. CBT has been shown to be highly effective for panic disorder. Working together we will learn about the cycles of panic and anxiety that are keeping you stuck, and learn new ways of thinking about and responding to your anxiety symptoms that can help you overcome panic and get back to enjoying life.

Agoraphobia develops when you start to avoid certain situations because you fear that you will not be able to escape or get help if you have a panic attack or other anxiety symptom. Typical agoraphobia situations include:

• Driving/Flying.

• Traveling by subway, bus, boat or taxi.

• Waiting in lines, crowds.

• Stores, salons, restaurants, theaters.

• Traveling long distances from home.

• Being in unfamiliar areas.

• Taking long walks.

• Closed in spaces.

• Being home alone.

• Elevators, escalators.

Agoraphobia can be very debilitating as it can leave you unable to travel, work, or even do everyday activities. Luckily, Cognitive Behavioral Therapy is an evidence based treatment that is highly effective for treating agoraphobia. Working together, we can learn how to tackle your agoraphobia and get you back to doing the things you want to do.

Social Anxiety is a disorder in which social situations elicit fear, anxiety and worry. This anxiety can be debilitating, persistent, and can prevent you from doing the things you enjoy, having fulfilling relationships, and succeeding at work or school.

Do you...

• Experience fear or anxiety about social situations?

• Fear that you will be scrutinized or judged in social situations?

• Fear that in social situations, your behavior will reveal your anxiety, leading to judgement or embarrassment?

• Avoid social situations altogether?

• Endure social situations only with a very high level of fear and anxiety?

If these experiences feel familiar to you, an assessment may be warranted. If you do have Social Anxiety Disorder, the good news is that it is treatable and you do not have to suffer for the rest of your life. Cognitive Behavioral Therapy has been shown to be highly effective for anxiety disorders, including Social Anxiety. Working together we can learn about the thinking and behavior patterns that are keeping you stuck in the cycle of anxiety, and work to learn new skills that can help you overcome anxiety and engage in the world.

Health Anxiety Disorder is an anxiety disorder in which worry is focused on your health, or on getting a serious illness. You may feel on constant alert about symptoms in your body, and feel like you are always jumping to the worst case scenario about your health.

Do you...

• Feel preoccupied that you have, or will get, a serious illness, even when you don’t have severe or serious symptoms?

• Feel hyper-vigilant about your health, and feel very upset when you notice any physical symptoms, or changes to your health?

• Frequently monitor yourself for any sign of illness (for example, checking your pulse, blood pressure or temperature frequently)?

• Either avoid going to the doctor for fear of getting bad news, or go to the doctor very often, even for mild symptoms?

If these symptoms feel familiar to you, an assessment may be warranted. Health anxiety can take over your life, making your feel like you are always on the brink of a health disaster. The good news is that CBT is very effective for treating this type of anxiety, so you can get back to living a life not dominated by worry about your health.

A phobia describes when you have a very strong fear or anxiety about a specific object or situation. Having a phobia is more than just not liking something, or feeling a little anxious about something. It is a very strong fear, that causes you to either avoid that object or situation entirely, or feel like you just have to survive that situation with very high anxiety, until you can get away. Typical categories of phobic fears include:

• Animals (i.e. spiders, insects, dogs, snakes).

• Natural Environment (i.e. heights, storms, water).

• Blood-Injection-Injury (i.e. needles, injections, invasive medical procedures).

• Situational (i.e. flying on a plane, riding an elevator, being in enclosed spaces).

• Other (i.e. vomiting, choking, or any other feared object or situation).

Having a phobia can be very debilitating. Your fear may make it very difficult to do the things you want to do and be around the people and places you would like to be. Happily, Cognitive Behavioral Therapy is an evidence based treatment that is highly effective for treating phobias. Working together, we can learn how to tackle your fear and get you back to doing the things you want to do.

Insomnia is a common sleep disorder that describes frequent sleep difficulties. Insomnia can include having difficulty falling asleep, staying asleep, or feeling like your sleep quality is poor.

Do you…

• Have a hard time falling asleep?

• Wake up multiple times during the night, and have a hard time falling back asleep?

• Wake up very early in the morning (like 3:00am) and can’t get back to sleep?

• Feel like even when you do sleep, your sleep isn’t restorative or refreshing?

• Feel sleepy and fatigued in the daytime?

• Have concentration, memory or attention problems?

• Feel irritable?

• Worry about sleep problems or the impact of your poor sleep on your daytime activities?

There can be many causes of insomnia, including stress, anxiety, depression, or underlying medical problems. Insomnia can also exacerbate existing anxiety or depression. Happily, Cognitive Behavioral Therapy for Insomnia (CBT-I) is very well researched and is highly effective. In fact, it is the “gold standard” treatment for insomnia, meaning that it works better than any other treatment or medication. If you start treatment with me, we will work together to assess your current sleep pattern and behaviors. I will then teach you how to implement new sleep behaviors, as well as manage anxiety about sleep. Although insomnia can make you feel hopeless about ever getting a good night’s sleep again, CBT-I is very effective. You do not have to suffer sleepless nights forever!

Distressing perfectionism is my term to describe when the standards of perfectionism become so extreme that they negatively impact functioning, self-esteem or mood. People with this type of perfectionism may hold unrealistic standards for themselves, and when they fail to meet these standards may harshly criticize themselves, sometimes even losing their self-worth. This is opposed to a healthier type of perfectionism in which someone might hold themselves to very high standards, but still feel OK about themselves if they fail to meet those standards.

Do you...

• Harshly criticize yourself if you don't meet goals or expectations?

• Feel anxious or depressed about meeting the standards of perfection you have set?

• Seek approval from others and feel the need to be assured of your skills?

• Hold yourself to unrealistically high standards, and have an unrealistic assessment of your performance?

• Worry about making mistakes?

• Have difficulty with relationships due to your high standards for perfection in yourself or others?

• Feel that if you do not meet your standard for perfection, you are unworthy as a person?

• Feel that you have to be the perfect parent/spouse/friend, even if it results in negative outcomes for yourself?

• Find yourself procrastinating or avoiding starting tasks for fear of being unable to complete them perfectly?

• Feel a strong desire to control your environment, schedule or plans?

• Have a strong fear of letting others down?

If these experiences feel familiar to you, an assessment may be warranted. Distressing perfectionism can lead to anxiety, depression, loss of self worth and extreme procrastination. Perfectionism can also negatively impact your relationships and your ability to function at work or school. However, Cognitive Behavioral therapy has been shown to be helpful in treating the symptoms of distressing perfectionism. We can work together to learn about the thought and behavior patterns that are maintaining your perfectionism, and learn how to change those patterns.

Extreme procrastination happens when we continually delay starting or completing tasks. Often, procrastination comes along with distressing perfectionism, other times it doesn’t, but when you get caught up in the cycle of procrastination it can cause some very negative outcomes. You may experience high anxiety while procrastinating, or may have to face negative consequences due to missing deadlines.

Do you…

• Take a very long time to start or complete tasks?

• Do everything and anything else in the world to avoid starting or finishing a task (i.e. scroll social media, clean your bathrooms, organize your closets, etc.)?

• Wait until the very last minute (or beyond) to start tasks?

• Predict that you will be unable to turn tasks in on time or that your product will not meet the required standards?

• Turn assignments in late and miss deadlines?

• Have difficulty enjoying your resting time due to constant anxiety and worry about overdue tasks?

• Criticize and berate yourself for your procrastination?

• Avoid thinking about overdue tasks due to feeling overwhelmed and full of dread?

• Feel you are less worthy as a person due to your procrastination behaviors?

• Give up before you even start?

If these experiences feel familiar to you, an assessment may be warranted. Getting stuck in the cycle of procrastination can be miserable, and can result in lasting negative consequences. However, it is possible to learn new skills and new ways of thinking that can help you stop the cycle of procrastination and get back to living a less stressful and more productive life.

Managing the demands of modern life can sometimes feel overwhelmingly stressful. Work, school, family demands, relationships - at times it can feel like too much to handle. Happily, managing stress is a skill, just like any other, and it is a skill that can be learned. If you come to treatment to focus on stress management, we will work on learning ways to cope with and manage the stress in your life. Examples of skills we may work on include:

• Self care.

• Time management.

• Prioritizing.

• Mood tracking.

• Healthy sleep.

• Progressive muscle relaxation.

• Slow breathing.

• Mindfulness meditation.

• Communication skills.

• Boundary setting.

• CBT skills to help manage worry and overthinking.

If you feel overwhelmed with stress and would like to learn how to manage better, stress management skills training could be beneficial for you. Stress will always be a part of life, but you can learn to manage it in a healthy way.

Do you have difficulty standing up for yourself, saying no, expressing your opinion or setting healthy boundaries in your relationships? If so, you may benefit from learning assertiveness and boundary setting skills.

Assertiveness describes the ability to honestly and directly communicate, while respecting ourselves and others. This may sound simple, but assertive communication can be challenging! It may feel intimidating to ask for what we want, or to share our opinion with others. It may feel downright terrifying to tell someone "no", not to mention sticking with that "no" if someone else doesn't like it. Luckily, we aren't born as "good" or "bad" communicators. Assertiveness is a skill, just like any other, and it is a skill you can learn.

Setting healthy boundaries can mean many things, but in general, having healthy boundaries means that you understand and defend your limits (physical, mental, or emotional) within a relationship. Setting healthy boundaries helps us to define what we want, and protects us from getting stuck in toxic and unhealthy relationships. Again, this might sound simple, but setting healthy boundaries is difficult. It is hard to set limits and stick with them, especially when other people don't like it. Happily, learning to set boundaries is a skill you can learn.

Examples of the types of things we can work on in treatment include:

• How to say "no" without feeling guilty.

• How to have difficult conversations and stop avoiding conflict.

• How to "fight fair" in your relationships.

• How to express your opinion in groups, even if you disagree with other people.

• How to tell people how you feel, and ask for what you need.

• How to stop being taken advantage of, or roped into unwanted responsibilities.

• How to protect your time so you can take care of yourself.

• How to stop taking responsibility for adult children, relatives, work colleagues, or friends.

• How to stop relying on other people for your own happiness.

• How to stop sacrificing your own happiness to please others.

• How to stop taking responsibility for others' choices, behaviors or feelings.

• How to stop letting others' moods and behavior choices negatively impact you.

• How to protect yourself from toxic, manipulative or otherwise unhealthy relationships.

If you feel you struggle with being assertive or setting healthy boundaries, you could benefit from therapy. I will use Cognitive Behavioral techniques to help you understand your communication and relationship patterns and beliefs, and then we will work on learning and practicing new skills.