Specializations

Anger is an emotion that we are all wired to experience.  However, some people develop chronic problems where they experience anger chronically, intensely, or both.  Some individuals also learn unhealthy ways of responding when they are feeling anger.  Indeed, aggressive behavior can lead to all sorts of negative consequences for individuals and their relationships.

We help individuals who want to make changes to how often they feel angry and to how they handle it when they do.  We conduct a thorough psychological assessment, identify factors that may have contributed to dysfunctional anger patterns, and collaboratively work to help the individual make changes. Over time, people learn ways of managing themselves, situations, and relationships in a balanced, healthy way.  They often improve the way they communicate their needs and feelings to others, as well as improve their ability to perspective-take and be empathic.  They learn how to manage themselves when they are upset, so that less damage is done and they get much better at repairing when they have handled a situation negatively.

We probably treat more anxiety disorders than any other condition in the practice, as anxiety disorders are incredibly common. Some of the specific anxiety conditions we treat are OCD, panic, shyness, and frequent worry. Early in treatment you will learn a lot about the thoughts, negative predictions, behaviors, and body symptoms associated with each type of anxiety problem. You will learn about how these all interact and can fuel each other. Then you will be helped to take stock of all the ways your anxiety is triggered and all the situations you have learned to procrastinate and avoid. Your therapist will then help you learn special ways of facing situations and accomplishing what you want to accomplish, despite the old patterns of anxiety and worry. Research shows that the treatment for anxiety conditions by an expert can be very successful, even if you have been struggling for years.

Depression is a “whole-body” condition, involving your physiology, mood, thoughts, and behavior. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. It is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be willed or wished away. People with a depressive illness cannot merely “pull themselves together” and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

Cognitive behavioral therapy helps people break out of a depressive cycle. Your clinician will work with you to understand both what got the depression going and what keeps it going, which are often different things. You will learn to step outside the negative thoughts that are part of depression and to identify behaviors that keep you down. Avoidance, for instance, is often part of the depressive experience. You will learn to do what you need to do, not what you “feel like” doing. Research has shown that CBT for depression is usually highly effective, even if you have been down for a while or it is quite severe.

We treat a number of different eating disorders including bulimia, binge-eating, and anorexia. Strategies include regulating eating patterns, identifying triggers to episodes, addressing shape and weight concerns, and dealing with underlying issues. We attack symptoms aggressively and help to improve emotional health in general.

Loss is an inevitable part of life and by its nature brings sadness and other difficult emotions.  Most of the time feelings of grief fade over time and individuals find a way to cope and move on. However, some individuals become stuck in dysfunctional patterns when a loss has occurred.  They may constantly find themselves thinking about the loss, they may avoid doing things for their own well-being or self-care, and they feel sad and depressed. We can help individuals to understand their complicated reactions to a loss, to more fully process it and integrate it into their life story, and to find a way to be healthy in their changed world.

We use proven behavior therapy methods to treat all kinds of habits. Some severe habits we treat include hair-pulling, skin-picking, and nail-biting.

Hair-pulling (Trichotillomania). Some individuals develop a problem with pulling out hairs from their body as a nervous habit. Many individuals often have little awareness of what they are doing until it is too late. Other individuals experience intense emotional relief when they pull out hairs. Hair pulling can be a devastating problem leading to emotional and medical consequences. We use a proven, behavioral protocol to help individuals break their hair-pulling pattern. Working with a knowledgeable clinician in a structured way makes it possible to beat hair pulling that has been going on for years. Patients end up being more aware of their emotional state, more aware of when they are vulnerable, and able to engage in competing behaviors when they have urges to pull.

Skin-picking. Many people develop habits of picking at their skin when they are tense or stressed. They often check for imperfections and then attack those spots. The damage from picking doesn’t help to break the pattern. Family members are often at a loss about what to do, as nagging and yelling don’t work. We use behavior therapy strategies to help individuals break their skin-picking problem. They learn to increase awareness of when they are about to pick, engage in behaviors that prevent or interrupt the cycle, and learn other ways to deal with emotional tension. We also address the underlying and associated issues that surround the problem. Behavioral clinicians can help individuals with these sorts of problems in a way that a family member just is not equipped to do.

Nail-biting. There are a number of habits, like nail-biting, that can be annoying and difficult to extinguish. As behavior therapists, we pride ourselves on being able to use specific strategies to help people change all sorts of problematic habits.

Unfortunately, many individuals find themselves struggling with chronic pain and physical discomfort that does not go away.  Chronic pain can be extremely difficult to live with and manage.  Depression often follows when someone is constantly hurting. Much is known about the patterns that can develop when someone is in chronic pain.  Difficulties can emerge for instance, with either overexertion or avoiding too much of life. Many well-proven strategies have been developed to help people cope with pain and physical symptoms.  Though hopelessness is a frequent problem with individuals struggling with chronic pain, many people have found that when they are healthier emotionally and are more skilled and supported, their experience of life is markedly different.

Affairs. Unfortunately, marital affairs and infidelity are quite common.  They are also extremely traumatic for many individuals, shattering core assumptions about their partner, themselves, and relationships.  Affairs can be extremely destabilizing for an entire family.  People are often so distraught when an affair occurs, that their reactions make things worse. We treat many individuals and couples struggling with issues related to infidelity.  Fortunately, much is known about the causes and treatment of affairs.  Broadly, when an affair has been discovered, treatment will focus on: coping with the trauma, understanding the factors that contributed to the affair and maintained it, helping individuals and the couple decide how to move forward, either together or apart. We also work with many partners who have found themselves having an affair, feel conflicted and panicked, and want help figuring out what to do. We will work with individuals and couples without judgment and blame and help them to determine the steps to feeling healthy.

Communication. Many couples have difficulties communicating.  Some couples engage in frequent negative, conflictual exchanges.  For other couples, there is more quiet distance.  As the stresses of life mount, often communication between members of a couple gets worse. A big part of couple or marital therapy involves helping couples find ways of communicating effectively.  Our therapists will try to help couples learn to communicate more effectively, courageously, authentically, and sensitively.  In the safe space of the clinician’s office, couples often find they can speak from their softer, more emotional side, with less blaming and defensiveness. Though for many couples in distress it can be hard to picture communicating well again, numerous strategies have been developed that can lead both members of the couple to be surprised by how dramatically their patterns can change.

Sex. We help individuals and couples address a number of different issues related to sexuality.  These include low desire, erectile dysfunction, premature ejaculation, anxiety about sex and intimacy, concerns around body image, problems related to compulsive pornography use, and other sexual issues. Though it can be difficult to talk openly about these issues, individuals often experience intense relief learning about these problems and finding ways to make progress.

Most of us will have trouble sleeping from time to time and need no particular intervention.  However, some individuals develop chronic sleep difficulties that lead to major impairment in their lives. Sleep difficulties include trouble falling asleep, putting yourself back to sleep when awaking in the middle of the night, waking up too early, and not feeling rested after a night of sleep.  People can also develop significant anxiety worrying about whether they will be able to sleep tonight.

We have experts in sleep on staff.  We can conduct a thorough assessment of the psychological and behavioral factors contributing to sleep difficulties and develop a specific treatment plan for your situation.  We work with individuals to develop good habits related to sleep, to engage in exercises needed to break dysfunctional patterns, and to discuss underlying issues that may be interfering with sleep.

Tobacco use is one of the most complex and difficult habits to break. The average number of quit attempts for Americans is 4, with 3 to 7 years being the average duration for completing the process of successfully quitting. Despite the challenges, over the last 2 decades over 40 million persistent and determined Americans have successfully quit smoking! There is more good news. Most of the withdrawal effects subside in 7 to 10 days with all side effects (even very minor ones) abating in 1 to 3 months. The cravings and urges to smoke sometimes persist a while longer, but successful quitters learn how to cope with them as well as with stress and other emotions in healthy ways. Please reach out to us if you would like to discuss how we can help.

As a society we struggle with being overweight. Typical diets and knowledge about nutrition sometimes aren’t enough to create healthy habits.  In fact, many individuals with weight problems could probably write books about all the diets they have tried. Though no one can claim that there is an easy and permanent fix for weight problems, there are many behavioral strategies that, when combined, create meaningful and long-term changes to eating habits and foster weight loss and maintenance.

Working with an RICBT or OneCBT clinician on weight loss and maintenance would include the following: addressing the psychological aspects of eating and exercise behaviors, examining episodes of binge eating or emotional eating, learning the process of forming healthy habits, normalizing eating, schedules and patterns, placing weight issues in the context of life values & goals, experiencing a unique atmosphere in sessions of accountability, education, and support. Change around eating and exercise behaviors is possible.  RICBT and OneCBT weight loss and maintenance clinicians can help individuals set and reach attainable goals that lead to weight loss and emotional health.