Areas of Specialization

• Anxiety & OCD

  From phobias to panic attacks to Obsessive Compulsive Disorder to just feeling anxious every day, people experience anxiety in many forms.

  There are a lot of reasons that people experience anxiety. Once people have an episode of anxiety, they do not want to feel anxious again, so they will avoid anything that might trigger the feeling. Unfortunately, that often makes the anxiety worse, and people end up more anxious about more things.

  My treatment looks at the thoughts and behaviors that maintain and intensify the anxiety. Starting with relatively manageable anxieties and working up to more frightening situations, my clients learn about the nature of anxiety, learn to face their fears, and watch their fears fade away. During treatment, they learn techniques such as exposure, decatastrophizing, time management, and contingency planning. Within a few months, clients often find their fears greatly reduced (no one is fearless). It is personally gratifying when I hear how their fears have stayed away.

   

  Panic attacks are reactions that occur when the brain and body decide there is an immediate threat and the fight/flight/freeze/fawn circuits kick in. Anxiety goes from baseline to 100% within seconds to minutes and all of a sudden the heart is pounding, nausea might kick in, it might feel hard to breathe, and you are sure you are going out of your mind. This experience is so bad that the brain immediately starts to make associations with things so that they can be avoided so that the panic will never happen again. So then there is the fear itself which was bad enough and then there is the fear of the fear. Treatment here starts with education about the nature of panic attacks. This helps give the understanding that the brain and body are doing what they are supposed to do given that level of threat. The problem is the system stating that it is such a high level of threat. From there, we can work to calm the system and start to face the situations in ways that, again, reduce the intensity of the fear and the whole system can start to spiral back to normal.

   

  OCD is a related condition in which the brain spirals into episodes of fear. In this case, the fears often center around very specific things such as checking or cleaning or other behaviors. The fear is that if the behavior is not done in a specific way, something very bad is going to happen and that must be avoided so the behavior(s) need to be done perfectly which can lead to hours spent doing and redoing to make sure they are right. And then the thought shows up, but what if I missed something or did it wrong? The standard treatment which usually works for this is called ERP, Exposure and Response Prevention. As is typically the case, treatment starts with an explanation of how and why ERP works followed by setting it up and then practicing along with troubleshooting when things get in the way.

   

  There is also a type of OCD known as Pure O. In this case, the compulsions are all inside the head. There is no handwashing but there are hours and hours of trying to argue inside the head that this did nor did not happen, do I love this person enough, I’m not falling in love with that person, I am (or am not) responsible for something. These thoughts can be a type of torture and the thoughts can not be convinced or argued away. Treatment is a bit more complicated as it is harder to pin down the focus of the obsession, but it can be done and follows a course similar to the ERP used in more conventional OCD.

• Depression

  Many people experience feelings of worthlessness or too much guilt, problems thinking or concentrating, loss of pleasure in activities, lack of energy, and even thoughts of suicide. 

  Most people have occasional negative thoughts about themselves, the world, and the future. Being depressed turns up the volume on all those negative thoughts. Being depressed can also lead to a lack of energy, making even simple tasks seem overwhelming. This can then feed the depression into a vicious cycle as people criticize themselves for being “lazy.” 

  My treatment focuses on the interaction between thoughts and behaviors. My clients learn specific techniques to change thought patterns (not just thinking happy thoughts). We work to increase activity levels, which can increase energy. We look at external stressors and each client’s history. Finally, we work to prevent relapse. Within a relatively short time, clients often become excited about their lives.

• Trauma

  Trauma can come from many different sources. Incidents such as car accidents, domestic violence, abuse, natural disasters, and terrorism can set the stage for trauma. 

  When trauma is ongoing, especially if it starts and continues in childhood, it can affect a person’s personality as they struggle to grow up and cope with a world that is not safe. We can work to mitigate the effects of this, but know that this journey is different from that of single-incident trauma or trauma that occurs in adulthood, where the goal is more of a return to baseline.

  When people are traumatized, their usual coping techniques often become overwhelmed. These events are too big to fit in the brain easily. While attempting to make sense of what happened, people can find that the memories intrude on their daily lives, interfering with concentration and causing nightmares. All these memories leave people feeling constantly anxious, so they try to avoid thinking about what happened. Some people even turn to alcohol/drugs/food/sex/internet… in an attempt to cope, which actually makes things worse. 

  The goal of therapy is to help my clients take back control of their lives; to speak the unspeakable so that they no longer have to hide from it, and to find a way for this event to become one of many memories rather than all of who they are.

  PTSD/CPTSD

  Traumas have an effect on people. Whether the symptoms are severe enough to warrant a diagnosis of PTSD is based on a lot of factors. The situation is also different based on whether the trauma was a one-time event or ongoing or if it occured in adulthood versus childhood. With the recognition of this, there is now a diagnosis which has not yet made it into the DSM but is commonly used: CPTSD/C-PTSD. This refers to complex PTSD and takes into account the effects of ongoing trauma on the brain. The healing journey from this kind of abuse is different and may seem more complex and messy.

• Addictions

  Addictions can show up in many forms. When asked, most people would list alcohol and street drugs as things people become addicted to. More recently, doomscrolling has become a thing along with other kinds of internet addictions. Other addictive behaviors can include things like gambling, shopping, eating, and sex.

  With addictions, what started as a choice stops being optional. The reasons that we start doing things are different from what maintains them. Behaviors that started as interesting can become ways of coping with stress and that can be ok for a while, and then they can take over and become the only way to deal with stress, and then they get out of control. They can become their own sources of stress, and it hijacks the brain so that it seems like this is the only thing that will give pleasure and nothing else has the same effect.

  The first step in therapy is to determine if it really is a problem. Some people can drink and it is not a problem. Others can’t. Some people can eat one piece of chocolate and stop. The point at which this becomes a problem is individual. The important thing is to figure out if it is a problem for you and if so, in what way. If we determine that this is a problem, we will look at what behaviors need to change, when/where/how does this behavior happen, and what can we do about that. We will also look at what is motivating the need for the addiction; what need is it fulfilling or what problem is it trying to solve. Therapy looks at both making changes and finding ways to continue new behaviors while letting go of old ones. Changing addictive behavior is hard. There is no quick fix or easy way around it. I can say that the results are worth the hard work.

  Note that some people are also in a program. That can be an awesome resource, whether AA, NA, CODA, SMART Recovery, or any other program. The goal is recovery and we want to do everything that works.

• Gambling

  Sometimes, people do things that start as fun but become a problem later. Gambling can be one of those things. People start gambling for a wide variety of reasons, including, but not limited to, having fun with friends, helping charities at work, school, or church, passing the time, or because it is a family tradition. Many people are able to decide that they have a certain amount of money and make a choice on how to spend it: movies or gambling. For those who can go in with a relatively small amount of money and stop when it has been lost and only do this occasionally, gambling may not be a problem. For others, gambling starts to take over. It becomes inconceivable not to gamble. Based on a few wins, people start to get the mistaken belief that they can make money gambling. People start to spend more time thinking about how to get money for gambling, and it starts to interfere with their family life or job performance. They start chasing their losses. At this point, the gambling is in control, and it is time to get help.

  If you are unsure if gambling is a problem for you, it may be useful to have a look at the Gambler’s Anonymous 20 Questions. 

  Gambling problems can be addressed in therapy. I work first to determine my client’s specific situation and assess the extent of the problem. I then work collaboratively with my clients to create a treatment plan designed to maximize the chances of returning to a life with excitement and meaning that goes beyond gambling. In addition to my other training in Cognitive Behavioral Therapy, I have completed specialized training through the California Problem Gambling Treatment Services Program.

• Eating Disorders

  We are taught from an early age to gain comfort through food. When children cry, parents often give them food or a pacifier. Children learn to use this to help them soothe themselves. As adults, we continue the same patterns, using food or lack of food as a means of controlling problems that are unrelated to food. At the same time, we receive a lot of messages about eating and weight, so the very thing that we are taught to use becomes a source for others to judge us. Then we start to judge ourselves. That judgment leads to even more dysfunction around eating. What started as a choice becomes a habit and then becomes seemingly unstoppable.

  The goal of therapy is to help you take back true control of your life. Time is taken to determine the probable causes or triggers for the problem. This information can be used to help disentangle the present from the past. We will work together to find new ways of taking care of yourself without having to turn to food. We will also look at the other thoughts and behaviors that are perpetuating the problem. Clients often find that what they were avoiding wasn’t so bad in the first place. Others need to come to closure about past incidents. Therapy is tailored to your needs as an individual.

• Stress

  We live in a world filled with stressors. We try to pack too many things into our day. We experience a lot of demands at home and work. We turn on the TV or radio and hear about all the bad things happening in the world. We get bad medical news or are awaiting results from tests. Even just getting to and from work can be stressful. Sometimes, it seems like we can’t handle one more thing.

  Stress can be experienced in many ways. It leaves us feeling off-center or unbalanced, unable to settle. It affects our sleep. It can lead to physical complaints like stomach trouble, headaches, or tense muscles. It makes us irritable. It robs us of our happiness. On top of that, it seems like everyone else is coping.

  My treatment is designed to bring back joy into people’s lives. We will look at the sources of stress and look for places where you might actually have agency to make a change. It might be learning to cope with the things that we cannot change. Does this need radical acceptance or meditation or exercise or all of the above or something else? Beyond that, we will also look at what messages are going around the brain judging us for having the stress and not coping with it as well as it seems others are (hint, they probably aren’t doing it as well as it looks). Although therapy cannot promise a stress-free life, we can learn to react and manage these things in a way that allows more space for happiness and joy.

• Sleep Disorders

  Many people suffer from sleep problems. In our hectic lives, it is hard enough to find time to sleep. It is very frustrating to lie in bed not sleeping and worrying about how we are going to cope without sleep. 

  Although most people have an occasional night when they don’t get as good of a sleep as they want, for some, it becomes more nights than not. As sleep deprivation continues, it becomes increasingly difficult to function during the day. People start to compensate by taking naps during the day or falling asleep in front of the TV, both of which can make sleep problems worse. They start to worry about whether they will be able to sleep tonight and frequently turn to prescription sleep aids as a quick solution. 

  Therapy takes a two-pronged approach. The first is to look at the behaviors around sleep. This is known as sleep hygiene, and there are some basic steps people can take to improve their ability to sleep. These steps include making sure you have scheduled enough time to sleep, knowing what to eat or drink and what not to eat or drink, moving exercise time earlier in the day, and eliminating naps. The other part of the treatment focuses on what is keeping you awake. For most, this is some type of worry. We work on finding ways to deal with the worry outside of sleep time. When people consistently implement these changes for a couple of weeks, they usually find their sleep greatly improved, and without the use of medications. 

• Seasonal Affective Disorder (SAD)

  Seasonal Affective Disorder (SAD) is a type of depression in which people become depressed regularly, usually but not always in the fall, and then perk up regularly, again usually in the spring. It is seen as related to the reduction in sunlight in the fall and winter. It is related to the reduction in sunlight in the fall and winter. People without full-blown SAD can feel the effects sometimes; on dark, dreary days, it is normal to feel the urge to curl up in front of a fire with a cup of tea and a good book. SAD is much more of a problem, though. It becomes very difficult to get out of bed. Motivation got packed away with the summer clothes. Chocolate and pasta have become dietary staples. Then a depression sets in, leading to the impulse to hibernate until spring.

  There are a variety of methods that have been used to treat SAD. The most frequently used one is light therapy. In this method, people spend time in front of very bright full-spectrum lights in order to make up for the sunlight they are not getting. They also try to spend more time outside (which would help if it would stop raining…). These lights can be very effective and have become very inexpensive, and can be found on Amazon.

  Sometimes, that is not enough, and at that point, we can add in therapy which will look a lot like the treatment for depression as we work on things like behavioral activation and challenging the negative thoughts and feelings. This can help with current functioning and can help with keeping the problem from becoming so overwhelming next fall.