CBT for adolescents
Depression | Panic Attacks | OCD | Social Anxiety
Procrastination | Anger Management | Excessive/Constant Worry
Perfectionism | Fears/Phobias | Borderline Personality Disorder
Eating/Weight Struggles | Self-injury/Self-harm | Alcohol or
Drug Overuse | Hair Pulling
Almost everyone has felt “depressed” or “blue” at some point in their lifetime. It would be unusual to come across someone who has never experienced this type of “down” feeling. Feeling this way from time to time is normal and, as funny as it sounds, can be quite adaptive. For instance, feeling “depressed” or “blue” can inform us that something is missing from our lives and that we should consider making changes.
Occasionally feeling “depressed” is very different, though, from being really Depressed, otherwise know as Clinical Depression. When people are Depressed, as opposed to feeling “depressed” or “blue” they experience far more intense negative emotions that last for at least 2 weeks but usually much longer. They also experience some of the following symptoms: loss of energy, loss of interest in previous pleasurable activities or in life, sadness, increased or decreased appetite, weight gain or loss, feelings of hopelessness, physical complaints, social withdrawal, irritability, difficulty making decisions, and suicidal thinking. Depression is by far the most common type of mental health struggle in our country. Close to 19 million people suffer from it every year.
Depression is usually very draining and tends to interfere with people’s ability to function normally. We offer two types of therapies for Depression. Each serves a different purpose and both have been shown to be highly effective. Either can potentially be combined with other types of therapies, including medications. Indeed, for many people anti-depressant medication prescribed by a physician can be an essential part of treatment.
Cognitive Behavior Therapy for Depression, is intended for those who are currently in the midst of suffering from Depression which has not responded adequately to treatment by medication alone or who choose to try an alternative to medication. It is a relatively short-term treatment, usually around 20 weeks, and has been shown to be highly effective.
Another, Mindfulness Based Cognitive Therapy, is intended for those who suffer from a mild but recurrent Depression or who have already been able to significantly reduce Depression. A main feature of Depression is that it has a strong tendency to eventually return after it has been reduced or eliminated. The purpose of Mindfulness Based Cognitive Therapy is to teach specific skills in an effort to prevent a future recurrence of Depression. It is also a relatively short-term therapy, usually around 20 weeks, and has been shown to be highly effective for those with recurrent Depressive episodes.
Over 3 million people in the U.S. have, or one day will have, panic disorder. Panic disorder is the name used to describe the condition where someone has repeated panic attacks. Panic attacks usually happen very suddenly and often feel as if they are “out of the blue.” The attacks typically involve intense, overwhelming feelings that are very uncomfortable. Sometimes, and understandably so, people who experience repeated panic attacks start avoiding places or situations out of fear of having a panic attack. Whether or not avoidance is part of the picture, repeated panic attacks can be emotionally draining and make it hard for people to lead the types of lives they would like.
We offer a type of cognitive behavior therapy called Panic Control Treatment, which has been shown to be highly effective. It is a relatively short-term treatment that usually requires approximately 10-14 sessions. For clients who are already involved in a different type of therapy in the community, the Panic Control Treatment may be a useful, temporary addition.
Obsessive-Compulsive Disorder or OCD
Close to 4 million Americans have, or one day will have Obsessive-Compulsive Disorder, otherwise known as OCD. Obsessions are very upsetting thoughts, mental pictures, or impulses that just keep coming back uninvited. Compulsions are actions that people do in an attempt to decrease the very uncomfortable negative emotions caused by the obsessions. Most people with OCD have both obsessions and compulsions, although some people have one or the other.
More then anything, OCD has a tendency to trap people in a pattern of repetitive thoughts and behaviors that seem senseless and are distressing. This can make it very difficult to function well in many areas of life including at work, school, and in relationships. Unfortunately, these patterns can be hard to overcome and most people with these symptoms feel tremendous shame about having them, so they try to conceal the symptoms as best they can. This frequently delays their seeking treatment which is unfortunate since for most people their distress can be fairly rapidly reduced.
We offer a type of cognitive behavior therapy called Exposure and Response Prevention or ERP. It is a relatively short-term therapy which studies have shown it to be highly effective. For those coming to our program already involved in a different type of therapy, this treatment can serve as a useful, short-term addition.
Social Anxiety or Shyness
There are a number of social situations where people experience anxiety. These include public speaking, meeting new people, being at parties, asking for dates, eating in public, using public restrooms, speaking to people of authority, and disagreeing with others. Having a touch of anxiety in these situations can be useful and may actually improve performance. For example, when it comes to public speaking, anxiety in the right amount can motivate people to the point where they are well prepared.
On the other hand, having too much anxiety in social situations can have the opposite effect. It can be so intense and uncomfortable that it makes it hard to function well. Understandably, people may begin to avoid the anxiety provoking social situations altogether. They may stop asking questions in class, of certain people at work, or severely limit their overall social interactions. To varying degrees, social anxiety can make it difficult for people to reach their life goals. Around 4 million people struggle with significant social anxiety.
At our Center we offer a type of cognitive behavior therapy that has been specifically developed for social anxiety. It is a relatively brief therapy and has been shown to be highly effective. It is possible to combine this treatment with other types of therapy. For those coming to our center already in treatment, it can serve as a useful addition.
It is the rare person who has never experienced problems with procrastination. At one time or another, most of us have put things off until another time. We then usually feel pressured to get it done at the last minute.
There are all sorts of areas in life where people may procrastinate. People might procrastinate socially-they may not call friends, avoid initiating interactions with others, or not show up on time for gatherings. For others, procrastination may involve health issues-they avoid medical appointments or put off diets and exercise. Procrastination is also common in the workplace-people put off unpleasant tasks until later or do not do the things a boss wants done. Finally, people might procrastinate about their finances-they do not get tax information in, get proper insurance, or pay bills on time.
Procrastination is not necessarily a problem, especially if it only happens occasionally or with minor things. For some though, procrastination takes on a life of its own. It can bring on worry, depression, regret, and stress. Most of all, procrastination has the power to reduce people’s ability to function normally.
Like perfectionism, procrastination is sometimes the result of obsessive compulsive disorders and responds well to the approaches effective in treating OCD. At other times, procrastination may be the result of depression or anxiety and the cognitive behavior approaches useful in treating these disorders are effective. In still other instances, procrastination is the problem and the goal of treatment is to learn certain techniques that can reduce the procrastination.
Almost everyone knows what it is like to feel angry. Anger is a very common emotion. In a lot of ways, having the capacity to feel angry is part of being human. In fact, although there are major differences between people and cultures all around the world, recent research suggests that the capacity to feel anger is something that is shared by people worldwide. Anger is part of the fight-flight response that is built into us to ensure our survival as a species. It provides us with energy and motivation to change things that either prevent us from getting what we want, cause us pain, or violate our sense of right and wrong. It is also something that is learned over the years through our interactions with others.
What we do know for sure, as funny as it may sound, is that having the capacity to feel anger can at times be very useful. For instance, anger motivates some to take appropriate action and perform at a higher level then would otherwise be possible. It gets people to stand up for what they value and serves as a way of getting taken seriously by others. At other times, anger provides the necessary courage and energy so that people can protect or stick up for themselves. In certain amounts and situations, being able to experience anger is effective and useful.
Unfortunately, we also know that when anger is too intense, frequent, misplaced or shows up at inopportune times it makes life more difficult for us and for those around us. For example, anger can get in the way of those personal relationships with family and friends that are most important to us. At work, it can make it harder to keep a job or perform as well as might otherwise be possible. For some, it leads to health concerns such as high blood pressure and stomach problems.
Many of us have been taught that it is bad to “hold in anger” and that we need to express it or something bad will happen to us psychologically or physically. This is called the “catharsis theory.” Interestingly, many studies have been conducted about this theory and they all reach the same conclusion: acting angry increases anger. It is true, though, that when we try to ignore our anger, it sometimes gets expressed in ways that perplex and hurt both ourselves and the recipients. For example, if we have a lot of frustrations and stresses at work, we may be able to act appropriately there, but take it out at home by being irritable, critical and mean there.
At our Center we offer a type of cognitive behavior therapy called Anger Management Training that has been shown to be highly effective in the treatment of anger problems. It is a relatively short-term treatment that usually requires approximately 12-16 sessions. For those already involved in a different type of treatment outside of our Center, this particular therapy may serve as a useful, temporary addition.
Excessive or Constant Worry
Everyone worries. It is part of being human. We worry about our jobs, our family, our relationships, money, and the future. It might sound funny, but in the right amount, worrying can be highly effective. It can do such things as help us be better prepared for life. For some people, though, worrying gets so overdone and becomes so consuming that it turns into a major problem. Worrying can take up so much space that it leaves little room for anything else. Excessive worry sometimes makes it hard to enjoy relationships, perform at work, and be happy. Around 4 million people in our country have, or some day will have, struggles with excessive worry. The official name used to describe this type of difficulty is Generalized Anxiety Disorder or GAD.
At our Center we offer a relatively brief type of cognitive behavior therapy that has been shown to be effective in treating excessive worry or Generalized Anxiety Disorder. For those already involved in a different type of treatment outside of our Center, this particular therapy may serve as a useful, temporary addition.
Perfectionism often gets people to expect a great deal from both themselves and others. It may get people to put a lot on their plate and only be satisfied when tasks are completed “just right” or at a very high level. In many ways, perfectionism can serve as a challenge that ends up motivating or “driving” people to do well in life. Some of the most successful people are those who are perfectionistic at heart.
While perfectionism has value, it also can be overdone to the point where it actually makes it more difficult for people to be successful in life. Taking on a lot can slip into taking on too much, making it incredibly difficult to get anything done. Trying to do something perfectly or “just right” can use up so much time and energy that other important tasks that also have get done never get started.
Perfectionism is often a symptom of obsessive compulsive disorder (OCD) and it may be usefully addressed for some people using that approach. For others, perfectionism may have a very different meaning. Unlike most of the problems discussed on this page, there have not yet been any therapies specifically developed for addressing struggles with perfectionism when it is not a symptom of OCD. With this said, we have had success using a treatment that makes use of both cognitive behavior therapy and dialectical behavior therapy.
Fears and Phobias
Fear is a normal human emotion. Everyone has the capacity to feel it. Being fearful of specific things is also quite common. In fact, in a recent national survey, 60% of the people interviewed reported that they feared some situation or thing. The most common types of fears were those of flying, heights, public transportation, bugs, mice, water, closed spaces, storms, tunnels, and bridges.
Taken at face value, having specific fears is not necessarily a problem. For example, few would consider it problematic to experience a fear of being mugged while walking alone in dark alleys in a big city. Most people would experience fear in this situation. Similarly, fears of certain deadly insects may not be unrealistic when traveling through particular areas. On the other hand, fears can sometimes become excessive and extreme. They can lead people to unnecessarily experience large amounts of intense anxiety and to avoid certain situations. For approximately 3 million people, fear reaches a point where it impairs their life in some way. Phobia is the official term used to describe this type of fear. We offer a type of cognitive behavior therapy called Exposure and Response Prevention (ERP) that has been specifically developed to treat excessive fears or phobias. It is a relatively short-term treatment that has been shown to be highly effective. For those already involved in a different type of treatment outside of our center, this treatment may serve as a useful addition.
Borderline Personality Disorder
Compared to issues like depression, panic, eating or substance use disorders, and anxiety, where the names themselves say something about the type of problem, the name Borderline Personality Disorder, or BPD for short, offers very little information about the problem. In some ways, this is unfortunate since we know that more than 12 million people in our country suffer with BPD, and far too few get the needed and appropriate treatment. So what exactly is BPD? More then anything, BPD is a problem caused by exceptional sensitivity to extremes of emotions, or “emotional vulnerability.” Everyone experiences emotional discomfort or turmoil in their lifetime. Feeling emotions such as sadness, loss, anxiety, worry, loneliness, love, anger, and guilt are just part of being human. Unfortunately, some people are born more vulnerable than others to experiencing intense emotion. These people are told from a very early age in words, actions (or both!) that their feelings are wrong, unjustified or just plain crazy. This “invalidation” usually leads people to try to ignore or suppress their feelings as long as they can, but sometimes the emotions explode even larger than ever. Most of the time, these “eruptions” just lead to more “invalidation,” but every once in a while, they get the longed-for response. This interaction between emotional vulnerability and invalidation leads to BPD, according to Marsha Linehan, Ph.D. Instead of occasionally experiencing these “normal” emotions, people with BPD experience them either: (1) very frequently, (2) uncomfortably intensely, (3) for a horribly long time, or (4) any combination of the above. They also become extremely sensitive to “invalidation” and may feel it acutely when others would hardly notice it.
Understandably, people do not want to feel this way and search for relief from their distress. The “solutions” most available to people with BPD are often the “problems” that lead them to seek treatment or cause those who care about them to insist on treatment. Self-injury; losing control of food intake, drugs, alcohol or temper; abruptly ending relationships; and using up relationships are examples of behaviors that often occur because they provide momentary relief from intense emotional discomfort. One major problem here is that these behaviors, or attempted solutions, usually lead to even more problems and emotional distress for both the individual and those around them. For instance, any of the above behaviors may lead to even more guilt, shame, fear, isolation and invalidation.
Most of all, struggles with BPD and the emotional vulnerability and behavior problems that typically accompany it, tend to interfere with people¹s ability to lead a life that feels meaningful and worthwhile. At our Center we offer a type of therapy called Dialectical Behavior Therapy or DBT (click on DBT for more info) that has been shown to be effective in treating BPD. Both the American Psychological Association (APA) and the American Psychiatric Association ( another APA) currently consider DBT to be a first-line treatment for BPD (click on either APA for a link to their respective website). We offer both standard DBT and DBT as an adjunct to ongoing psychotherapy outside our Center. Standard DBT involves both weekly individual psychotherapy, a weekly skills training group and telephone consultation with a Center therapist who participates in a weekly Consultation Group designed to help the therapist be as effective as possible. We also offer Skills Training Groups and DBT-based group therapy for those who choose to continue in individual psychotherapy with a clinician who is not on the Center staff.
Eating and Weight Struggles
It goes without saying that we live in a culture that places a lot of value on being thin. This is especially true for women. Whether through such things as apparently innocent social comments or advertisements, it seems that around every turn there is some sort of message reminding us of how important it is to be thin. We are constantly surrounded with tempting advertisements for fast and tasty foods that promise both to save us time and make us feel good. Who knows, this might partly explain why the majority of people in our country have, at one time or another, tried some sort of dieting or exercise program. It would certainly be the rare person who has never been concerned about their weight or body image and done something, like dieting or exercise, to try to improve it in some way. It would also be the rare person who has never had times when they have eaten far too much food.
For some people, and understandably so, issues around weight, eating, and body image take on a life of their own and become problematic. This is unfortunately the case for over 5 million people in our country. While eating and weight struggles are very common, their nature and extent can vary widely from person to person. Sometimes, eating and weight struggles have to do with eating an overly large amount of food in a very short period of time. The official term used to describe this happening is binge-eating or binging. Other times the struggles involve doing things to avoid weight gain. These are commonly referred to as compensatory behaviors. Compensatory behaviors include not eating or severely restricting food, self-inducing vomiting, exercising excessively, or misusing laxatives and diuretics.
Finally, eating and weight struggles are often characterized by some mixture of both binging and compensating, although it is entirely possible to primarily struggle with one or the other. Different combinations of these habits, such as doing more binging then compensating, doing a lot of compensatory behaviors and little binging, or only binging, can lead to widely different body weights. For some, these habits can end up leaving them with a body weight that is too heavy. For others, they may have the opposite impact- leaving them with a body weight that is too low. Still others may be able to maintain normal body weight even though there is a significant amount of both binging and compensating.
Despite leading to these sometimes wide outward differences in terms of weight, inwardly, eating struggles tend to impact people in similar ways. They often lead people to have such feelings as sadness/depression, shame, guilt, anxiety, and disgust. Most of all, eating issues can decrease people’s ability to experience a sense of satisfaction and pleasure in life’s daily ups and downs. At our Center we offer a relatively short-term type of therapy that combines elements of cognitive behavior therapy and dialectical behavior therapy. This treatment has been shown to be effective in treating eating and weight struggles. For those already involved in a different type of treatment outside of our Center, this particular therapy may serve as a useful, temporary addition.
Self-injury or Self-harm
Whether it is sadness, loss, worry, guilt, anxiety, or another emotion, for better or worse, almost everyone will experience some sort of emotional discomfort in their lifetime. Although, of course, no one wants to feel this way, having emotional discomfort from time to time is just a part of being human. In small amounts, this “regular” type of emotional discomfort is at a level that is difficult for most, but also usually manageable.
Sometimes this very normal, yet unwanted, human experience gets overdone. When this happens, emotional discomfort tends to show up frequently, may last for prolonged periods, and often feels overwhelming. Understandably, people do not want to feel this way and search constantly for some sort of relief. Unfortunately, unlike “regular” emotional discomfort, this heightened experience is much more difficult to handle effectively.
Self-injury, or self-harm, (including recurrent suicide preoccupation or attempts) often occurs because it provides momentary relief from overwhelming emotional discomfort. One problem is that the attempted solution often leads to even more problems and emotional distress for both the individual and those around them. For example, self-injury may lead to even more guilt, shame, fear and isolation. Most of all, struggles with self-injurious behaviors tend to interfere with people’s ability to function normally and make it even more impossible to get a life that feels meaningful and worth living.
At our Center we offer a type of therapy called Dialectical Behavior Therapy (DBT) that has been shown to be highly effective in treating struggles with self-injury or self-harm that is the result of overwhelmingly intense emotions. When suicidal thoughts, plans or preoccupations are the result of a Major Depression, the most effective treatment is usually a combination of cognitive behavior therapy for depression and medication. When depression is not the only emotion that becomes overwhelming, and when urges suddenly leap up to self-harm or to act impulsively in other ways that interfere with the quality of life, DBT may be the most effective treatment. DBT is a compassionate behavior therapy that involves helping people learn skills to deal with distress, emotional turmoil, and interpersonal difficulties without resorting to habitual self-harm, other impulsive acts or recurrent hospitalizations. We offer both standard DBT and DBT as an adjunct to ongoing psychotherapy outside our Center. Standard DBT involves both weekly individual psychotherapy, a weekly skills training group and telephone consultation with a Center therapist who participates in a weekly Consultation Group designed to help the therapist be as effective as possible. We also offer Skills Training Groups and DBT-based group therapy for those who choose to continue in individual psychotherapy with a clinician who is not on the Center staff.
Alcohol or Drug Overuse
Nearly 90% of adults report some experiences with either alcohol or drugs during their lifetime. For an increasingly larger number people, alcohol or drug use reaches a point where it becomes a problem or more trouble then it is worth. Being held back from leading the type of hoped for lifestyle is the most common complaint.
Abandoning or making some changes in an alcohol or drug habit, particularly when it has been around for awhile is very difficult. We offer two types of relatively brief cognitive behavior therapies, both of which have been shown to be highly effective. It is possible to combine either with other types of therapies, including medications.
Relapse Prevention is specifically intended for those who have the overall goal of learning how to prevent themselves from falling back into an alcohol or drug habit. Once the habit has been broken, clients learn ways to keep it that way and avoid relapse or backsliding. Clients who come to our Center who have already stopped using a troublesome substance but are still plagued by urges to return to using it typically begin with the goal of learning how to maintain their accomplishment.
For others, giving up use completely is not the goal. In these instances, we offer a type of cognitive behavior therapy called Harm Reduction or Moderation Management. This treatment is designed to help clients who are not severely dependent on a substance learn how to reduce the negative impact alcohol or drug use has on their lives without completely stopping use. After achieving this goal, clients learn ways of maintaining their gains and avoiding backsliding. Moderation Management is not an appropriate treatment for those who are addicted to a substance.
Hair Pulling or Trichotillomania (TM)
Approximately 5 million people in our country struggle with the habit of hair pulling, otherwise known as Trichotillomania or TM for short. TM is far from a new problem, with the first cases appearing in this country well over a century ago. For such a common and longstanding problem, it is surprising that TM has received such little attention over the years. The good news is that this trend is starting to change. Over the past decade, in an effort to better understand and treat TM, more and more attention and research dollars have been devoted to its study.
So, what do we know about TM? We know for certain that TM is a recurrent habit that gets people to pull out their own hair, usually resulting in observable hair loss. While TM can impact any part of the body that has hair, the most commonly affected areas are the scalp, eyebrows, and eyelashes. TM is most often done in private so that others do not find out. It may happen while doing such ordinary activities as watching TV, reading, talking on the phone, and driving. TM sometimes is done automatically, with very little awareness or thought. At other times, it might be a completely intentional and conscious behavior.
TM sometimes occurs when people are seemingly relaxed and calm. In other instances, hair pulling may help to provide momentary relief from overwhelming emotional discomfort. One problem with this attempted solution is that it often leads to even more problems and emotional distress for both the individual and those around them. Regardless of when TM occurs, it often leads to feelings of shame and of being out of control. It can erode self-confidence and make it harder to have meaningful social and professional relationships. Most of all, struggles with TM tend to interfere with people’s ability to function normally and reach their life goals.
At our Center we offer a type of cognitive behavior therapy called habit reversal that has been shown to be effective in the treatment of TM. It is a relatively short-term treatment. For those already involved in a different type of treatment outside of our Center, this particular therapy may serve as a useful, temporary addition.