It can be challenging to control your weight. In today’s modern world, it is more convenient to order take out than to cook a meal and take the elevator instead of the stairs. Over time, a pattern of eating unhealthy foods and being sedentary can lead to excessive weight gain. While many of the factors associated with weight (e.g., genetics, metabolism, finances, lived environment, etc.) are not in our complete control, there are lifestyle factors that can be adjusted. In particular, nutrition and physical activity have the strongest evidence for maintaining a healthy weight.
"What if” thinking is not unique to Obsessive-Compulsive Disorder (OCD). It is a feature to a greater or lesser extent in several other conditions. Using what we know about Exposure and Response Prevention (E/RP) for OCD might improve treatment for these other conditions.[i]
The virus has upended the world as we know it, and kids are struggling.Kids were not meant to live this way.None of us were meant to live this way, but as a child therapist, I have a special focus on kids and their well-being.
Back in 1994, I applied for a poster presentation for the ADAA annual conference based on my observations that there is a certain group of patients whose onset of OCD began after a certain level of trauma/PTSD. ADAA's committee accepted my presentation for a symposium which was supervised and led by one of the leading experts in the world on OCD and PTSD: Dr. Edna Foa (also an ADAA member).
Have your clients faced those situations where, in getting ready to make values-based exposure exercises, their minds come up with thoughts along the lines of, “It will be too much; I won’t be able to handle it; It will be a disaster; how do I know it’s going to work; Do I really have to do it?” And next thing they know, they’re in a battle with those thoughts, sometimes trying to prove them wrong, other times giving up and going along.
Anya, a 26-year-old, was in charge of organizing the schedule for the annual camping trip with her college classmates. She was excited and ready to make phone calls and gather prices for transportation, camping sites, etc. But in the middle of preparing for those errands, she noticed a red stain on the hardwood floor of her house. Quickly her mind came up with the thought, “Did I step on it? What if its blood? What if I get an illness?
The COVID-19 pandemic and subsequent increased awareness of systemic racism have left me, a white psychologist, at a loss for words. I wanted to write a post for other anti-racist allies who are also struggling to voice and act in increasingly anti-racist ways both personally and professionally. Here are some things that I have been working on, and I thought that it would be a useful list for other white psychologists who aim to promote anti-racism in their practices.
As I was being discharged from the hospital after an 11-day stay, a friend texted me: “The hard part’s over!” In one sense she was correct – I’d completed the antibiotics for COVID, my sepsis was gone, and my pneumonia and kidney function were improving. But that was just the physical battle.
Body Dysphoric Disorder (BDD) is described as the disease of “self- perceived ugliness” or “self-imagined ugliness.” It is also seen as a distressing preoccupation with one or more physical non-existence “defects.” In the DSM-5, BDD is classified under Obsessive Compulsive and Related Disorders. Within the general population, 1%-2% have being diagnosed with BDD, which is nearly 5 million people in the United States alone. Additionally, about 70 % of cases indicate that the onset of BDD occurs before the age of 18.
In the midst of the ongoing COVID-19 pandemic, the killings of George Floyd, Ahmaud Arbery, Breonna Taylor, and many others shine a glaring light on the continued presence of systemic racism in the police system and many other U.S. institutions.
A new wave of high school dropouts is looming and the stakes couldn’t be higher. Dropping out of high school has been linked to higher instances of suicide attempts, substance abuse, and criminal activity.
Though none are immune to COVID-19, the rippling impacts of the current pandemic are unequal, due in part to pressing economic and social needs of minorities in the United States that are largely overlooked in response efforts.
In an already challenged, and often under-resourced mental health care system, the COVID-19 pandemic has led to an increase in mental health needs across the globe1,2. The World Health Organization’s models of pandemic impacts project a significant uptick in these needs both in the acute and long-term outcomes of this crisis3. To rapidly respond and continue the vital mental health services we need in the changing reality of wide-spread isolation measures, governments and insurance companies have rapidly aligned to adjust policy for telehealth.
The night of Sunday April 19, I stayed home with my dog Ritz watching TV and eating takeout from one of my favorite restaurants. Later that night I became very ill, surprising because I’d been eating at that place for a decade without issue. When my alarm went off Monday morning, I felt terrible and my temperature was 100.9°. When Ritz and I take our morning walk we usually go two to three miles, and Sunday had been no exception, but Monday morning I struggled to make it 100 feet. I knew something was wrong.
The use of positive behavioral strategies in the treatment of anxiety and comorbid behavior disorders is incredibly helpful during therapy sessions. Whether the child is practicing exposures or destroying the therapy room, these strategies can help therapists to increase therapeutic time and decrease frustration for all involved. Just remember the basic principle of consequences in operant conditioning (a la B. F. Skinner):
Overnight the world changed. Public health terms have become common phrases; we hear people talking about flattening the curve and social distancing. Scientists have become household names, with Dr. Anthony Fauci not only appearing in press briefings but chatting with Stephen Curry. And people are staying home. Millions of people’s homes have suddenly become their workplaces. For many, that brings new challenges like learning how to join videoconference calls and not disturb family members.
In the early 2000s, patients started reporting a new worry to their OCD therapists: what if I’m gay? This thought was often prefaced by patients declaring that they weren’t homophobic, but the fear was still there. The theme was dubbed homosexual OCD or HOCD. However, around that the same time, patients who were gay had a very similar fear: what if I’m actually straight? The issue of sexual orientation creeping into OCD is a sign of the ever-evolving societal environment.
*With the pandemic creating untold new challenges for us all, many therapists have completely switched to video visits with their patients. For those of you who are new to telehealth, it may be useful to check out some of these links for technical and ethical guidance:
Before COVID-19 was declared a pandemic, many of us in mental health became aggressively helpful. We gave interviews to media outlets small and large and wrote content for wide distribution. Just before the World Health Organization made its declaration, some of us were already fatigued. We decreased our output and refused interviews. Much like medical experts had exhausted the limits of their advice—keep your social distance, cover your coughs and sneezes, do not touch your face, wash your hands for at least 20 seconds—we’d said all there was to say.
This consists of compulsive urges to pull one’s hair resulting in noticeable hair loss. Hair-pulling can be any part of the body like arms, pubic hair, eye lashing, legs, etc.
Why do people do this?
TTM often begins in childhood/adolescence during stress or tension. The pulling is not painful, but soothing or pleasurable, which might explain the maladaptive impulses to continue. Subgroup that falls into mild trance/altered awareness when pulling, unaware of their actions. Usually followed by guilt and remorse.
What is OCD? OCD is composed of two components: obsessions and compulsions. Obsessions are recurrent and persistent thoughts, impulses, or images. The thoughts, impulses, or images are not excessive worries about real-life problems. Individuals attempt to ignore, suppress, or neutralize such thoughts, impulses, or images. Typically, individuals recognize the thoughts, impulses, or images that are merely products of his/her own mind. For example, an individual might have a fear of being contaminated, losing control, or might focus on an idea excessively.
There are clear treatment standards for the treatment of obsessive compulsive disorder (OCD) which offer impressive outcomes and allows individuals to return to high-levels of functioning. Exposure with response prevention (ERP) and a combination of medication are the gold-standard treatment for OCD and through a goal-oriented treatment approach, individuals with OCD (across severity levels) can significantly reduce their overall symptomology, learn tools for relapse prevention and enter the maintenance stage for their diagnosis.
My newest way to explain OCD to a patient and family.
I love trying to come up with new ways to explain OCD to new patients and families. In my 20 years of treating OCD, I like to think that I have honed in on it pretty well, and thought I would share it with all of you. I would appreciate your feedback and would love to hear if you use it with your patients and how it went.
Prior to joining the Stress, Trauma and Anxiety Research Clinic (STARC) at Wayne State University (WSU), I did not know much about the refugee community, aside from what was publicized as a political point of contention during the 2016 election. I now see it as the crisis that it truly is. The STARC team, directed by of Dr. Arash Javanbakht, had found a high prevalence of anxiety and depression in both Syrian and Iraqi refugee adults and children, with symptoms shared between mothers and their children. While watching a CNN report on this research work, an art therapist at WSU, Dr.
I presented a complex case recently at the Anxiety and Depression Association of America that challenged my clinical skills, but more importantly, deeply affected the quality of life of the person I was treating. It is always an honor to walk alongside my clients on their journey to living well with anxiety and OCD. This particular person struggled from a trauma he experienced when he was young and from there he developed severe OCD with themes of harming, responsibility, and perfectionism. I am happy to say he is living his life fully now.
You may already feel overwhelmed by reading the title of this blog! How do I keep up with the changing trends and use social media effectively to promote myself? It’s easy to use social media as a form of entertainment, to post personal pictures and videos, and to connect with others who have similar interests. But, when it comes to having a professional presence on-line, it can be difficult to know where to start.
In this blog post we will provide a description of Problematic Internet Use, describe screening measures existing in the field and key unanswered questions, provide clinical patients examples, introduce COST project, suggest a design of an upcoming study, describe applications (“apps”) available for intervention, and will seek patient advocates feedback for the proposed study design, screening measures development and feedback on different digital apps available.
Postpartum mood disorders are among the most common and debilitating mental health problems in the U.S. (1-2), with the capacity to interfere with maternal function, infant health (3-4), and maternal-infant bonds (5). There are unique concerns that clinicians and patients should know to recognize and treat these conditions. In my recent ADAA continuing education webinar, I discuss the structure and techniques of an effective behavioral intervention for perinatal depression.
1) Certainly experience is a major factor in making a job application impressive. However, two factors that are particularly appealing are the applicant’s ability to convey eagerness to learn and genuinely communicating a desire to be involved in the prospective employer’s work. Applicants who communicate in a diplomatic fashion that they are familiar with your work while simultaneously highlighting good experience and a desire to take their own program of research and practice to the “next level” are particularly ideal.
Are you a newly trained CBT therapist, wondering how to start your first independent practice? Perhaps you want to join an existing group of therapists, or you dream of renting an office and having your own practice. When I talk to clinicians who are working towards having a practice -- from those who are still deciding what degree is best for them to those who have started a practice and want help marketing -- I start by saying that I love my job. I feel privileged every day to work with clients, and seeing them get well and go on to live successful lives free of the limitations of anxi
Kids and teens often react with anger to the prospect of facing their fears. Doing things like engaging in exposure therapy or going to school when they are feeling panicked or overwhelmed, can trigger fight-or-flight responses, in which anxious children not only experience a desire to avoid things but sometimes actively fight or resist when we try to push them.
On average, it takes 17 years for an evidence-based treatment to reach the community, and because of stigma, it may take an additional 10 years before a person suffering from mental illness actually receives treatment. The goal of implementation science is to address this gap between science and practice, helping the most vulnerable people to access high quality care. Providers and researchers are both crucial to bridging research to practice, especially in community settings.
Focal brain stimulation techniques are potentially powerful tools for the investigation and treatment of neuropsychiatric disorders. These approaches include transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and deep brain stimulation among others. In general, focal brain stimulation applies electrical stimulation to a discrete region of the brain to generate neurophysiological effects.
We have all felt afraid. Fear makes some feel unique, alone, embarrassed, or ashamed, while others may become angry, defensive, or hostile. Socially, group experiences of fear of the unknown and xenophobia can drive negative political movements and mass hysteria.
Elizabeth Spencer and I just finished giving an ADAA continuing education webinar called, The Magic of CBT for Anxiety and Depression. We have found, from our workshops, that many master level clinicians have never learned the foundations of cognitive behavioral therapy. This is unfortunate in that it becomes difficult to understand some of the more advanced concepts of CBT with ERP if you don’t know the basics. We were thrilled with the number of participants in this webinar.
This participatory CE/CME workshop will provide a theoretical basis for understanding the impact of current stressors on our competence as mental health professionals and outline evidence-based approaches to caring for ourselves and our colleagues.
Founded in 1979, ADAA is an international nonprofit organization dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders through aligning research, practice and education.