ANXIETY TREATMENT

I help people with fears that interfere with daily life.

My anxiety work is active, short-term, and skills-based, and it’s tailored to your particular set of difficulties.

The goal is for you to master the tools you need to move about more freely in your life – from place to place and from day to day–without the energy-drain of anxiety symptoms.

Here are some of the issues I can help with:

panic disorder

briefly defined as repeated panic attacks accompanied by an increasing avoidance of panic-associated activities and locations

mobility problems

characterized by avoidance or extreme discomfort when riding subways, elevators, bridges, tunnels, etc., and which can significantly affect one’s quality of life

body-related anxieties

that may sound odd, but are not uncommon, and cause a great deal of stress and shame;  these include fears about fainting from the sight of blood or needles, anxieties about choking, swallowing, or vomiting, and fears about managing IBS symptoms.

generalized anxiety

which can be thought of as a chronic state of worry and tension, often characterized by a lot of “what if?” thoughts and negative scenarios

social anxiety

including symptoms ranging from severe shyness to panic about public speaking to extreme avoidance of social interactions, meetings, or activities

discontinuation of psychiatric medications

if recommended by your doctor, which can be a difficult and itself anxiety-producing experience

fear of flying

which can be incredibly limiting both personally and professionally.  Most of my fear of flying work is done in the office, but I have been known to take a flight or an Amtrak train with the client to coach them and strengthen their coping skills in real-time

health anxiety

which is often ridiculed as “hypochondria,” is a condition where people feel plagued by endless fears and worries about medical conditions

sleep problems

which can easily spiral, but can be tamed with tailored cognitive and behavioral interventions

TALK THERAPY

I work with clients on a wide range of issues, from relationship problems to work stress, from family issues to career goals, from life transitions to making big decisions.  When you’ve got significant stressors going on, sometimes it’s hard to function or feel your best.

Insights about a problem are hugely important in therapy, but with my Sophisticated CBT approach, my aim is to put the insights to work.

My therapy approach is practical, and the first step is to help you take a broader view of your “mental health project.”  Once we can think more creatively about the issues, my clients start to feel ready to try out some thoughtful, measured changes that can help them to re-set.

HABIT-CHANGE & SELF-CARE

Because cognitive therapy tends to focus on raising awareness of the triggers that can get us on the wrong track, my approach works well for habit change and improving self-care.

Here are some topics that I’ve woven into my clients’ sessions in order to meet their goals:

Stopping Procrastination by helping them to put new structures in place for accomplishing goals like writing a thesis or getting to the gym regularly

Increasing Assertiveness by learning to stop over-accommodating others so your relationships will function more smoothly

Improving Self-Care by providing tools and accountability to help my clients stay healthier as they manage medical conditions like IBS, migraine, and diabetes

Coaching on Their Career or Startup by providing structure and accountability, and a framework for discussing their progress and obstacles

getting started

People usually call me seeking help with anxiety that is getting in the way of their functioning their best at home or at work.

For example, people call for help with really specific anxieties like panic attacks; fears of flying, riding the subways or elevators;  fears about speaking in meetings; as well as more general stress and anxieties like being overwhelmed at work, having insomnia, chronic worry, “a nervous stomach,” or extreme shyness.

Once we start working together and my clients quickly gain some tools and start feeling better, they often ask if I can help them with something else! That’s a sign of a great working relationship, and I’m glad to broaden the work to other areas besides anxiety. So sometimes clients extend their sessions a while longer to sort out some relationship issues, work stress, or career goals.

what to expect

  • My agenda for the first session is to do a thorough assessment of the current issues and your background, give feedback on diagnosis and treatment options, and provide a sense of how I would approach your concerns.  It’s also a chance for us to see how the dialogue feels, and if it seems like a good match.

    At the end of the consultation, if either of us thinks you would be better served by some other professional or approach, I will try to provide an appropriate referral.  But assuming we agree to work together, my aim is to begin working right in the first session, and for you to start to feel better right away.

  • Cognitive therapy is designed to be short-term and focused, and my being a fast-paced New Yorker who likes to move apace, that works well for my practice!  CBT textbooks usually recommend 12 – 20 sessions to treat a specific anxiety disorder, but my clients usually report they are starting to feel better in the first few sessions, and often we move quicker than the textbooks say. To be safe, count on a few weeks to a few months of weekly therapy sessions to do the main work, followed by a number of sessions spaced at greater intervals, so that we can consolidate the gains that were made and prepare for post-therapy maintenance.  Bottom line:  there is a range;  some very focused problems require only a handful of sessions, while making lasting changes in core issues does take longer.

  • Some of my clients finish up a piece of therapy work, like getting subway panic attacks in check, and may return at a later point for a brief “tune-up” or to focus on another issue, say relationship or career concerns. Others work on their main issue, and then decide to extend the sessions in order to focus on another area. Given the nature of my approach, it must be obvious that my aim is not to conduct lifelong, ongoing psychotherapy.  I define the project and the time frame jointly with my clients, and I am flexible about when and how to proceed with sessions.

  • My clients are often surprised when they find that changing their perspective really does lead to better relationships with a partner or co-worker, to alleviating anxiety that is restricting their ability to interact comfortably with others, or to being able to change dysfunctional eating habits.

    But changing your perspective really does take practice, so I encourage my clients to do between-session assignments.   At first, these are cognitive therapy exercises that I will tailor to you.  But as we proceed, and you’ve mastered the basic tools, then we’ll be creative in tailoring the assignments together so they are most relevant for the specific changes you want to see.

  • This work is really energizing, for my clients and for me, too.  One of the best parts is witnessing the shift when a client starts to notice the change in a thought pattern, and is surprised to find themselves not having the panic attack when they usually would, or being able to fly comfortably for a business trip or family vacation, or being able to speak up in a meeting where they usually would have avoided it.  Seeing that kind of progress is a great moment for them, and it propels people forward in the work, to consolidate their gains and to keep building on their success.

  • While cognitive therapy often has a powerful effect on its own, clinical research, plus my professional experience, indicates that in some cases cognitive therapy plus medication is a more effective combination for mental health care.  As a result, while I tend to be conservative in recommending medication, I absolutely do make evaluation referrals when appropriate.  I stay in contact with a number of psychiatrists who specialize in psychopharmacology, and when I do refer to one of these colleagues, we work together to coordinate our treatment efforts.

CBT Basics

The basic premise of cognitive therapy (also called CBT, or cognitive-behavioral therapy) is that one’s interpretation of a situation, rather than the situation itself, determines the feelings and behaviors that follow. These interpretations take the form of super-fast, knee-jerk fleeting thoughts, called “automatic thoughts.” Over time, as we accumulate life experiences and interpret them in consistent ways, we develop patterns of understanding ourselves, other people, and the world around us.

The low-down

  • While most of our automatic thoughts are rational and adaptive, contributing to generally successful patterns of functioning, others are apt to be somewhat exaggerated, or to contain some inaccuracies, and therefore lead to unnecessarily distressing emotions and dysfunctional behaviors. Eventually, we can get stuck in negative cycles of feeling and behavior. Because cognitive therapy recognizes the centrality of thoughts in developing negative states like depression, anxiety, and relationship difficulties, it initially addresses these problems by directly targeting the inaccuracies in our cognitions.

  • Given the focus on thoughts that are, by definition, fleeting, the first step is to develop some skill at catching these thoughts as they fly by in particular situations. This takes some practice, but once you begin to notice automatic thoughts, you’ll see how central they are in the development of your distress. Next, we engage in a systematic evaluation of these havoc-wreaking thoughts, identifying their inaccuracies so that we can consider alternative, more realistic views of the triggering situations.

  • Note that the strategy is not to eradicate negative automatic thoughts. Not only is that an unattainable goal, but it wouldn’t make sense; sometimes anxious or sad thoughts are appropriate, useful, and crucial to healthy human experience. It is only when our range of cognitions is too restricted that we develop emotional distress. So, our basic strategy in cognitive therapy is to open up biased thinking patterns, allowing better functioning to flourish when we rely on more realistic cognitions. Then we also target the behaviors directly, as they are the other entry point for changing these patterns.