Anxiety & OCD Treatment

Anxiety & OCD Treatment

Offering behavioral therapy in-person and via telehealth for anxiety, OCD, & related disorders.

What is an Anxiety Disorder?

An anxiety disorder is when a person has excessive fear of a specific object or situation or has uncontrollable worries about potential future events, typically with fears that the worst-case scenario will occur and that one could not handle it. Anxiety is often accompanied by physical symptoms in the body, such as a racing heart, sweating, rapid breathing, stomach discomfort, or muscle tension, and perhaps alongside other symptoms like trouble with concentration or sleep, feeling restless or on edge, fatigue, or irritability.

When a person feels anxious, they may behave in certain ways to try to reduce their discomfort, such as avoiding or escaping certain situations, bringing “safe people” with them, seeking reassurance from others, or procrastinating.

Of course, some anxiety is normal and even helpful, but excessive anxiety that is persistent, difficult to control, interferes with life, or is distressing, is considered to be an anxiety disorder.

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The core feature of most anxiety disorders is an “intolerance of uncertainty,” that is, difficulties facing and accepting the unknown – and life is full of unknowns! If you believe you may be suffering from an anxiety disorder, you are not alone. Research has found that anxiety disorders affect 15.7 million individuals in the United States every year, and 30 million people in the United States at some time point in their lives.

There are several different types of anxiety disorders, which vary in terms of the types of situations or objects that cause the anxiety and/or are avoided. These subtypes include:

Generalized Anxiety Disorder:

Excessive, persistent, and difficult to control worry about a number of events or activities such as school or work, finances, relationships, health, safety, minor matters, or community/world affairs. These worries are often accompanied by symptoms of restlessness, fatigue, irritability, muscle tension, or difficulties with concentration or sleep.

Social Anxiety Disorder:

Strong anxiety of social situations in which one fears being negatively judged by others, or that one may do or say something that will be humiliating or embarrassing. These feared social situations may include social interactions (e.g., initiating conversations, talking on the phone), performance situations (e.g., giving a presentation), or being observed by others (e.g., eating in public, using public restrooms).

Panic Disorder:

Frequent panic attacks which are characterized by a sudden increase in at least 4 physical symptoms such as rapid heart rate, sweating, shaking, shortness of breath, feelings of choking, chest discomfort, nausea/stomach distress, lightheadedness, chills/heat, numbing/tingling, feeling detached, and a fear of losing control, going crazy, or dying. These panic attacks must also be accompanied by a persistent worry that one will have additional attacks or that there will be negative consequences, or changes in one’s behavior because of the attacks, such as avoiding certain places or activities or only going places with someone.

Agoraphobia:

Severe anxiety in at least 2 of the following 5 situations due to fear that one may have panicky or embarrassing symptoms and that escape may be difficult or help may not be available: i) enclosed spaces, ii) open spaces (e.g., parking lots, bridges), iii) transportation, iv) standing in line or being in a crowd, and v) being outside of the home alone. These places are often avoided or only visited with a trusted person.

Specific phobias:

Strong fear of a specific object or situation such as driving, flying, vomit, insects, heights, receiving a shot, and so forth. Typically, this object or situation is actively avoided, or if that is not possible, it is endured with intense fear. The fear or avoidance must be to the extent that it interferes with one’s life or is very distressing.

Illness Anxiety Disorder:

Also known as health anxiety. Excessive fear and concern about having or getting a serious medical condition or illness that is disproportionate to its true likelihood. This is accompanied by unhelpful health-related behaviors such as repeatedly checking one’s bodily symptoms or vital signs, spending hours searching the internet for health-related information, or avoiding going to the doctor or going too frequently.

Separation Anxiety Disorder:

Excessive fear about possible separation from close others (e.g., parents, caregivers) that is developmentally inappropriate. This typically involves frequent and excessive distress or physical symptoms of anxiety when thinking about or separating from home or a close other, persistent worry about losing close others or potential harm that may come to them, excessive anxiety about a negative event that may cause separation, recurrent reluctance to go out or be home alone due to fears of separation, or frequent nightmares about separation.

What is OCD?

Obsessive-compulsive disorder (OCD) is defined as having unwanted and intrusive thoughts, urges, or images that cause intense distress (i.e., obsessions), often with accompanying efforts to get rid of these thoughts by pushing them away or performing a ritual (i.e., compulsions). The main emotions that are typically present in OCD are high levels of fear, anxiety, disgust, guilt, and shame. OCD can cause significant impairment and distress in a person’s life, as it may take hours per day to perform all of the compulsions, or the thoughts may be present for much of the day causing severe distress. OCD is a common disorder, with a lifetime prevalence in the United States of 2.3%, meaning that it will affect about 7.6 million people in the United States at some time point in their lives.

Commonly known types of OCD include fears of contamination leading to cleaning rituals, or doubts about appliances being left on or doors being unlocked leading to checking behaviors. OCD can also take many other forms, such as doubting one’s sexuality or gender, having intrusive and unwanted thoughts about harming loved ones or vulnerable people (despite having absolutely no desire to do so), repeating tasks until they feel “just right,” or strong superstitious beliefs about having to do a certain activity in a specific way to prevent harm, just to name a few. It is important to note that compulsions are not always observable behaviors such as handwashing or checking, but often take the form of mental compulsions that are unobservable to others, such as mentally reviewing one’s past actions or repeating something in one’s mind. Another common behavior to try to manage OCD symptoms is avoidance of any potential triggers of one’s OCD, such as avoiding certain types of people, places, or objects, so as not to trigger the obsessions.

There are other difficulties that are related to but distinct from OCD, which include:

Body Dysmorphic Disorder:

A preoccupation with a perceived flaw or defect in one’s physical appearance, such as one’s hair, nose, skin, tattoos, etc. In response to these appearance concerns, the preoccupation is accompanied by actions such as repetitive behaviors like mirror checking, reassurance-seeking, excessive grooming, or mental actions such as excessive comparisons with other people’s appearance.

Hoarding Disorder:

Persistent difficulties with discarding or letting go of one’s possessions due to believing that one needs to save these items, and severe distress associated with discarding them. These symptoms lead to the accumulation of possessions that amass and interfere with one’s ability to live in the space and use the rooms or space as intended, such as being unable to use a bathroom or sleep on one’s bed.

Trichotillomania:

Also known as hair-pulling disorder. Repeated pulling out of one’s hair to the extent that it causes hair loss, with efforts to decrease or stop doing so. This behavior may not be due to a physiological reason such as the effects of a substance or medical condition, and must be to the extent that it causes interference or distress in one’s life.

Excoriation Disorder:

Also known as skin-picking disorder. Repeated skin picking to the extent that it causes skin lesions, with efforts to decrease or stop doing so. This behavior may not be due to a physiological reason such as the effects of a substance or medical condition, and must be to the extent that it causes interference or distress in one’s life.

Evidence-Based Treatments

Cognitive Behavioral Therapy (CBT) is widely considered to be the gold standard therapy for the treatment of most mental health disorders, including anxiety disorders and OCD. It is a skills-based and collaborative approach based on the idea that emotions are comprised of thoughts, physical sensations, and behaviors that are all interrelated. Together with the clinician, patients work to target all 3 of these components to break the cycle of anxiety. For example, patients learn to identify their automatic, unhelpful thoughts and shift them to be more accurate, balanced, and useful. Patients are also taught to notice any behaviors that are not serving them, or that fuel their symptoms, and to move towards more effective and values-based actions.

Exposure and Response Prevention (ERP) is a form of CBT, particularly when it is applied to OCD. ERP involves facing one’s triggers or fears directly, allowing oneself to experience the emotions and uncertainty, and refraining from engaging in any mental or observable rituals. By stopping the rituals, patients can break out of the OCD cycle and learn that the feared outcome does not come true or that they can tolerate and ride out the associated discomfort. Exposure therapy is also an important component of treating anxiety disorders, and involves facing feared situations such as social situations like parties, activities that trigger intense physical sensations like exercise, or phobias such as animals or needles.

Acceptance and Commitment Therapy (ACT) is part of the CBT family, and involves shifting one’s relationship with one’s thoughts, accepting the presence of human emotions and being willing to experience them, and moving towards living a values-based life. As such, the areas of focus include increasing mindfulness and acceptance, unhooking from thoughts, taking committed action, and living in accordance with one’s values, with the overall goal of increasing psychological flexibility.

Intensive Outpatient Program (IOP) – Treatment can be provided at a higher level of care than traditional 1-2x/week sessions, in a format called an Intensive Outpatient Program (IOP). IOPs typically involve meeting several times per week for a few hours with a team of clinicians, on a short-term basis, to learn and practice therapy skills in an accelerated fashion. This high- dose treatment program can help patients jump start their treatment, get back on track, learn strong foundational CBT knowledge, gain valuable treatment skills and exposure practice, and become their own CBT therapist. IOPs offer a more intensive dose of treatment than traditional weekly outpatient therapy, while keeping the patient in their home setting to practice the new skills and exposures in their own environment.

What We Offer

At CPG, we are committed to providing high-quality, evidence-based treatment for anxiety & OCD in the following formats:

Individual Therapy

Many of our clinicians specialize in the treatment of anxiety disorders, OCD, and related disorders. Individual therapy is based in Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and Acceptance and Commitment Therapy (ACT), as well as other complementary evidence-based practices depending on a client’s needs. Clinicians specialize in treatment across the lifespan, from anxiety in very young children to older adulthood.

Intensive Program

Intensive CBT treatment is a highly specialized form of concentrated and accelerated therapy that directly targets your specific anxiety using concrete tools and strategies. It is a short-term, 2-week program in which you meet 1-on-1 with a team of qualified clinicians. Prior to starting the formal 2- week treatment program, you will complete a 2- hour assessment and 1-hour treatment planning session with your assigned senior clinician to determine your clinical diagnoses, create a personalized treatment plan, and ensure that this format of treatment is a good fit for your needs.

Our intensive program provides structured cognitive behavioral therapy (CBT) and exposure and response prevention (ERP). The program includes 18 hours of 1-on-1 personalized therapy, in person and via telehealth.

Couples & Family Therapy

Family members often want to be supportive and helpful to their loved ones but may not know how to do so. Importantly, close relationships often impact and are impacted by a client’s symptoms. As such, it can be beneficial to include partners and family members in a client’s treatment for anxiety and OCD. These sessions can take place with or without the client present, and may focus on parent training, communication strategies, or reducing symptom accommodation patterns. Couples and family therapy are effective ways to significantly improve both the client’s symptoms and the relationships.

Group Therapy

Our OCD Skills & Support Group provides an opportunity for individuals with OCD to receive weekly support, learn from peers, celebrate successes, set behavioral goals, and discuss Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) skills. Most importantly, this group allows attendees to connect with others who have shared, lived experiences with OCD to feel truly understood and supported. The group meets weekly on Zoom.

Woman participating in Managing Perfectionism group on Zoom

Our Anxiety Skills Group offers individuals with anxiety the opportunity to learn, discuss, and practice Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) skills. The group also allows clients to provide and receive peer learning and support, celebrate successes, set goals, and stay motivated. The group meets weekly on Zoom.

Woman participating in Managing Perfectionism group on Zoom

The ACT for Anxiety & Depression group is a skills and support group for adults with anxiety, depression, or related problems who want to apply mindfulness, compassionate acceptance, and values-based action in their lives. The group meets weekly on Zoom.

Man participating in ACT group for anxiety disorders on his computer

Our Managing Perfectionism group focuses on building awareness about perfectionistic behaviors, the thoughts driving these behaviors, and cognitive- behavioral strategies to address them. It is appropriate for adults who struggle with high standards and perfectionism in the workplace, school, social situations, or responsibilities at home. The group meets weekly on Zoom.

Woman participating in Managing Perfectionism group on Zoom

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