My Specialities

Anxiety Disorders

Anxiety Disorders can cause a person great discomfort and can affect every aspect of  their life.   Anxiety can cause someone to experience significant physiological symptoms such as shortness of breath, sweating, rapid heart rate or a sense of impending danger with some people going to the Emergency Room thinking that they are having a heart attack.  Anxiety can make it difficult to sleep, concentrate, socialize, go places, or ask a teacher or supervisor a question.  It can also cause a person to experience persistent worry and fatigue,   For all of these reasons, left untreated, anxiety, can lead to depression, physical health complications and substance use. 

Treating Anxiety Disorders with CBT and Exposure Therapy

Treatment combines CBT and Exposure Therapy to help you face what you have been avoiding and reduce the anxiety running your life.

In using CBT, we will be looking at the thoughts you have to situations that result in anxiety.  For example, if you report feeling anxious when driving, we will determine what thoughts you have about driving, for example, everyone in Massachusetts is a bad driver and I might lose control of the car and swerve into oncoming traffic.  Then we’ll discuss what physiological symptoms you’ve been experiencing as well as what behavior has resulted from the anxiety.  You might tell me that you have been worrying about driving about an hour before you need to drive and at times, are avoiding driving because of the anxiety it causes.  With this information, I would teach you ways to change unhelpful and inaccurate ways of thinking, and we might decide to add a relaxation or physical exercise routine before you drive.  I would teach you how avoidance perpetuates and reinforces the anxiety cycle and we would develop an exposure hierarchy with driving related exercises that you would regularly practice, starting with exercises that don’t cause too much distress and building up to harder ones. 

Obsessive-Compulsive Disorder

Everyone has scary thoughts at times.  Someone might be walking on a bridge and suddenly wonder ‘what if I jump off’ or they might be at work and suddenly worry that they left the curling iron on.  Someone without OCD, will have this thought briefly, and then move on with what they were doing  and not give the prior thought any attention.  The brain of a person with OCD, however, will get stuck on certain thoughts which cause significant distress. 

For example, if a person with OCD has the obsession that they might have left the curling iron on, their anxiety about it will significantly increase.  They may have difficulty thinking  of much else.  In order to control the anxiety, they might call a neighbor to go and make sure the curling iron is off or the person might ultimately drive home from work because the need to check the curling iron is so high.  Only when they engage in this compulsion – behavior to make the obsession go away- do they feel better.  If the person who has OCD obsesses about jumping off a bridge, that person might stop walking or driving over bridges.  While both the compulsive behaviors and the avoidance make the distress decrease, this relief only lasts for a short period of time and these behaviors are actually reinforcing the OCD cycle. 

Treating OCD with Exposure and Ritual/Response Prevention

I will complete a thorough assessment of either you (using Y-BOCS) or your child (using the CY-BOCS ) so that we have a thorough understanding of the obsessions and compulsions with which you or your child is struggling.  We will then create a hierarchy of exposure exercises with a range of exercises ranging from somewhat difficult to very difficult.  Frequently people will find that as the easier exercises cause less distress with practice, the harder exercises don’t feel nearly as overwhelming. 

Let’s say that your child obsesses about getting germs on his hands because he fears that he will get sick.  One exposure exercise might be him touching the bathroom sink all over without washing his hands.  This exercise will first be practiced in session and then you and your child will practice thie exercise daily.  With treatment, what is frequently learned is that the distress these exercises cause decrease with practice, that even though the distress caused is uncomfortable it is manageable and that usually the worst fear does not come true. 

Trauma & PTSD

Approximately 70% of people experience a trauma in their lifetime.  Following a trauma, it is normal to experience both physical and emotional symptoms which can include nightmares, changes in appetite, fatigue, feeling numb, on edge or guilt.  These symptoms tend to be worse over the first several weeks following the trauma and then get better over the next several months, although recovery is not linear.  However, some people’s symptoms do not get better as time goes on – approximately 3.6% of adults suffer from PTSD, while the number increases to 5% of adolescents. 

Treating PTSD with Prolonged Exposure and TF-CBT

For adults, I use Prolonged Exposure, a structured evidence-based treatment considered a first-line intervention for PTSD by the American Psychological Association and the primary protocol used by the VA for combat-related trauma. PE works by helping you gradually and safely approach the trauma-relatedmemories and situations you have been avoiding, reducing their power over time. I completed basic and advanced PE training through the Center for Deployment Psychology and the University of Pennsylvania CTSA.

For clients ages 5  to 18, I use Trauma-Focused CBT, designated by SAMHSA as the gold-standard trauma treatment for young people and one of the most extensively researched trauma interventions for children and teens. TF-CBT is age-appropriate, strengths-based, and almost always involves the caregiver. Parents and trusted adults are integral to the healing process. I work with caregivers in parallel sessions to help them understand trauma’s effects and respond in ways that support their child’s recovery. I have completed basic and advanced TF-CBT trainings through UMass Medical School and Baystate Health.

Tic Disorders

Approximately 24% of kids develop tics that are temporary and do not require medical attention.  However, if a child’s tics proceed to get worse , they should be brought to the attention of the child’s doctor.   A parent may notice increased difficulty in their child’s ability to concentrate, participate in social activities, sleep or in other aspects of their daily functioning. Tics can be confusing, embarrassing, and exhausting, for the person experiencing them and for their family. It is not unusual for conflict to develop between parents and child as parents want their child to “just stop.”

Treating Tic Disorders with CBIT

Comprehensive Behavioral Intervention for Tics is the evidence-based treatment for tic disorders and is recognized as the gold-standard behavioral approach by the Tourette Association of America.  

Treatment begins with a thorough understanding of your specific tics, when they are better or worse, and what situations tend to trigger or increase them. Stress, excitement, fatigue, and certain environments can all affect tics, and understanding these patterns is an important part of treatment.  

Next, we will work on awareness training so that you can learn how to recognize that a tic is about to occur.  Most people experience what is called a premonitory urge which is a sensation usually occurring in the area of the body where the tic will occur. 

Once you are able to recognize that urge, we will develop what’s known as a competing response.  A competing response is a behavior engaging certain muscles that are incompatible with your tic.  With continued practice, engaging in the competing response becomes more automatic with the goal of decreasing frequency and intensity of tics.