Phobias are anxiety conditions characterized by intense fear and triggered by specific situations. Unlike more general anxiety, people with specific phobias do quite well as long as they are avoiding these specific triggers. Some of these situations are easy to avoid while avoiding other situations can make life pretty difficult. For example, being afraid of elevators when you work in an office in a high level floor may have negative effects. As one continues to avoid they experience more and more fear about exposure to the situation.

Common phobias include social, animals, airplanes, blood/injury, clowns, loud noises, crowded places, going over bridges or under tunnels, storms, heights, water and more.

Cognitive Behavioral Therapy is an effective treatment for Phobias. Exposure based exercises are crucial to decrease the anxiety associated with the specific feared situation. During the exercises the client is gradually exposed to aspects of the feared object. For example they might begin by simply talking about a spider or looking at a photo online. Through the process, the individual begins feelings more comfortable and is able to move closer and closer to being in the presence of an actual spider.

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Self-Esteem issues may arise at any point in life and occur in connection with other struggles including depression, anxiety, and life changes. Our self-esteem is affected by many things: physical development, appearance, racism, the quality of our relationships, our successes, and our social and financial status. These issues impact us differently at different ages and stages of life. If we don’t manage our self esteem in health ways more detrimental consequences can ensue including disordered eating, isolation/withdrawal, overspending, substance us, and adopting a false identify.

It is unrealistic to feel great or even good about ourselves in every situation. However, feeling bad about yourself in most situations is keeping you from vital experiences and connections that would likely assist in increasing self-esteem. As a result, Cognitive Behavioral Therapy is a great starting point for understanding thoughts, feelings, and behaviors that exacerbate self-esteem struggles. Additionally, Dialectical Behavioral Therapy lends itself well to self-esteem issues as it values the notion that there are some things we must accept and other things we can change. Together CBT and DBT set a nice foundation for working on self-esteem issues across the lifespan.

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When a person experiences OCD their brain is constantly telling them that danger is just around the corner. As a result a person begins to comply with compulsions or experience frequent and distressing obsessions which impact their ability to engage in life (work, school, relationships).One can receive a diagnosis of OCD if they experience either obsessions or compulsions however, often time individuals experience both.

Obsessions represent thoughts, impulses, and images that happen over and over again. The individual feels overwhelmed by these thoughts and often finds it hard to focus on anything else. Frequently experienced obsessions include thoughts and images of harming others, religious obsessions, concerns of physical illness, superstitious thoughts, perfectionism, losing control, unwanted sexual thoughts and impulses, and contamination/germ concerns.

Compulsions are the ritualistic behaviors which must be completed in order feel a small, and usually temporary reduction in an individual’s anxiety. These behaviors can be extremely time consuming and lead to high level of embarrassment when the behaviors are noticed by others. Frequent compulsive behaviors include washing and cleaning, mental compulsions (counting or praying), checking that you did something (turned off the oven), or repeating things multiple times.

Cognitive Behavioral Therapy is an effective treatment for OCD. Exposure and Response Prevention (ERP) is the strategy used in the behavioral component of CBT. In ERP the client is supported in confronting the obsessions and not acting on the compulsion if one is present. Initially, clients will experience a high level of anxiety but over time this anxiety will drop as the individual realizes that the awful things their mind told them would happen didn’t actually happen or aren’t actually true.

In some cases, medication management may be recommended, and may be just temporary in depending on the specific symptoms, how much these symptoms impact functioning, and how much a person is able to benefit from exposure and response prevention and other therapeutic strategies.

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Identify issues arise when people have ongoing struggles with aspects of who they are. Identity is comprised of our gender, sexuality, race, ethnicity, competence, education, and many other experiences which shape us into who we are. Identity struggles are most common during adolescence when teens are trying on different hats to see what fits. However, often times teens may adopt an identity and later in life have regrets about their choices. Unfortunately adopting an identity comes with consequences which include people’s reactions and judgments. Some teens and young adults would rather avoid that at all costs but may later realized that they aren’t fulfilled with who they are or the life they have created.

Common identity concerns that lead people to seek therapy include gender identity, sexual identity, and racial/ethnic identity which is especially common during the process of acculturation. Cognitive Behavioral Therapy assists individuals in identifying thoughts, feelings, and behaviors that in their current state, are maintaining and exacerbating various identity struggles. Incorporating skills from Dialectical Behavioral Therapy and Acceptance & Commitment Therapy helps client to make progress towards finding their true self.

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Many things happen in day to day life that can cause conflict between family members. When conflict continues in a consistent manner and resentment between family members is present then it may be time for help.

Family comes in all shapes and sizes and each set of relationships and dynamics is unique.
When seeking family therapy for relationship issues it is the therapists job to begin understanding the specific relationships and dynamics of your family. When this process is navigated the therapist can work towards helping to resolve issues between specific family members and improve family communication and overall functioning.

In the case of family conflict there may be unintentional things that a family members is doing to keep the dysfunction going. As a result it is important to understand each member’s role even if they are not directly related to the conflict.

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Indecisiveness is extremely common when setting out to choose a career path. There are so many things to consider and the job market is tougher than it’s ever been. Even with a college degree finding a job that you like can be quite the challenge. This confusion can lead to patterns of avoidance and moving further and further away from the life you want for yourself. Anxiety and depression are common experiences which may either trigger these this type of identity confusion or the uncertainty about the might trigger symptoms of anxiety and/or depression.

Some individuals are set on certain career paths which are heavily influenced by those around them. This may mean taking over the family business or going to law school because that’s what the three generations before you did. Although some people wish they had this type of influence or setup, those who do understand that it holds its own set of challenges.

Working on professional and career concerns is a multifaceted process which involves getting to know the person’s true self/identity, understanding their values and experiences, activating behavior in the direction of opportunities in line with these things, and identifying thoughts which impact their struggles to move forward. My approach to working on these struggles can be described as integrating Cognitive Behavioral Therapy (CBT) with exercises and skills from Acceptance & Commitment Therapy (ACT).

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Most parents are well intentioned and want the best for their children. Despite this, there are times and circumstance where parents begin feeling out of control and struggle to manage their children’s behavior. When behaviors begins all of a sudden this is usually a result of either something occurring within the child, something going on in the parent-child relationship, or a combination of both.

Although there are some aspects of treatment that are geared towards working with the child, successful treatment relies on working with the parents. There is likely a need for the child to feel heard and work through the triggers to their behavior while also working to tighten up rules and consequences and setting firmer expectations for their behavior. Since parents are really at the top of the pyramid the discipline and expectations need to come from them. When this happens oftentimes respect increases and family dynamics shift for the better.

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Each person responds to traumatic experiences in different ways depending on many different factors and circumstances. There is a long list of traumatic incidents which a person may have experienced including physical abuse, domestic violence, emotional abuse, sexual abuse, witnessing a bad accident, and seeing someone killed. Trauma survivors may come to therapy at many different points in the process, some right after an incident and others quite some time after. Additionally, many individuals have experienced more than one traumatic event which is termed complex trauma. In children trauma may be revealed by a child who is noticed to be playing out a traumatic incident or who has had a drastic change in their observed behavior.

There are quite a few symptoms of PTSD that have the potential significantly impact a persons functioning. For some traumatic events are followed by intense and distressing thoughts and hypervigilance. These experiences are usually accompanied by shame and self-blame intensified by thoughts a person may have about why this incident occurred. Another common and unhealthy symptom in avoidance and the best trauma interventions are ones which get to work on this avoidance right away.

Trauma Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence based and effective intervention for treating trauma in children and adolescents. The treatment model begins with the PRAC skills which focus on Psychoeducation, Relaxation, Affective Modulation, and Cognitions. Once the child and supportive parent/caregiver have set the foundation by understanding and using the skills treatment progresses to the trauma narrative. This is where the child creates their story about what happened in whatever way is developmentally appropriate and most comfortable for them. This could be a typed story, a picture book, a cartoon strip, or take shape in many other forms. The child will then be supported in using their PRAC skills to work through and process their story. Together the exposure, processing, and skills assist the client in reducing the prevalence and intensity of trauma symptoms.

Treating Trauma in Adults- Cognitive Processing Therapy (CPT) is an adaptation of Cognitive Behavioral Therapy created to assist individuals with Post-Traumatic Stress Disorder and other traumatic experiences that may not meet full criteria for PTSD. CPT assists the client in becoming more aware of their thoughts and feelings and processing the details of the incident(s). Clients are supported in learning skills to work through the trauma by challenge and changing thoughts and behavior which have been helping to maintain trauma symptoms.

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Life is truly a series of transitions and adjustments. For those who don’t handle change well this can be particularly difficult. These individuals tend to avoid anything that takes them out of their comfort zone. Despite attempts at avoiding change there are many things that happen that are just simply out of our control.

Loss of a loved one: The loss of a loved one may be one of the most difficult things we experience. Many factors impact the grieving process and may lead to complicated bereavement which may be similar to and even be classified as depression. When depressive symptoms play a role individuals end up disconnecting more and more from the things that we know to be helpful in coping with loss.

Divorce/Breakups: Again, depending on many situational details breakups and divorces can have significant impacts on individuals and even more so, when children are involved. The most difficult part becomes taking care of yourself and your own process while balancing that with the needs of you children during a time filled with confusion and uncertainty.

Blended Families: Blending families are a challenge no matter what the specific circumstances are. The process of blending families is a significant change for all involved and must be handled with a high level of care and understanding in order for everyone to adapt as successfully as possible.

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We all have different thresholds for stress, a totally different number of straws that it takes to break the camel’s back. Some individuals tend to take on so much but sweep the emotions of it all under the rug and totally crumble when things get to be too much. For these individuals it is vital to learn stress management techniques and practice making time in the midst of all the stress to actually manage it.

Physiologically, when our body is under stress we tense our muscles and breath heavily but a manifestation of stress that is one the rise is gastrointestinal issues. When stress manifests in this way it may be with or without overt feelings of anxiety, distress, or anger. When we don’t find ways to manage the cognitive and physiological symptoms of stress we put ourself at risk more severe physical (heart problems, high blood pressure, lower immune system, skin problems, pain, diabetes, infertility) and more severe emotional problems (depression, anxiety, substance use)

No matter what age and stage of life you are at there are tons of fun, quick, and relaxing stress management skills to add into your daily routine that can have you back on track and a little more clear headed in just a few minutes.

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