Additional Areas of Expertise

Trichotillomania and other body-focused repetitive behaviors (BFRBs)

BFRBs include trichotillomania (compulsive hair pulling), skin picking and nail biting. These problems can be very difficult to overcome and can cause people who suffer from them a great deal of distress and functional impairment. The state-of-the-art treatment for BFRBs is based on the ComB model and includes a thorough assessment of the individual, tailoring treatment to his or her particular needs, and relapse prevention. In addition, maintaining motivation to work on a BFRB can be particularly challenging and is often a focus of treatment.

Posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) may occur as a result of experiencing one or more traumatic incidents. The traumas must involve experiencing or witnessing an event that involves actual or threatened death or a threat to the physical integrity of self or others. It should also involve a fear response. Traumas can occur as a single incident (such as a rape) or can be ongoing (such as combat or child abuse). Common PTSD symptoms include nightmares, flashbacks (a recurrence of a memory, feeling or perception from the past), intrusive thoughts about the incident, avoidance of situations reminiscent of the incident, avoidance of thoughts and feelings about the incident, isolativeness, anhedonia (lack of pleasure in usual activities), feeling numb, a sense of foreshortened future, irritability, poor sleep, poor concentration, poor memory, guilt, hypervigilence (excessive scanning of the environment for threat), and an exaggerated startle response. To be diagnosed with PTSD, there must be a significant adverse impact on functioning, typically involving interpersonal relationships.

Alcoholism and Problem Drinking

Treatment for individuals with alcohol problems is usually short-term and relies on both cognitive-behavioral techniques as well as strategies to enhance motivation to change. I follow a model that focuses on learning skills for either eliminating or reducing drinking. Components include alcohol education, identification of triggers, recognition of both positive and negative consequences, development of an action plan, drink refusal skills, urge control techniques, and relapse prevention. Additional components may be added as needed. As part of the treatment, patients choose either moderation or abstinence as their goal.
Although many in the alcohol treatment field insist that abstinence is the only acceptable goal, there are reasons to consider moderation as a goal with less severely dependent drinkers:
1. Most people with alcohol problems will initially attempt to become moderate drinkers on their own.
2. Learning skills to do so may improve their chances of success.
3. After attempting to become moderate drinkers, if it is clear that the problem drinker will be unsuccessful, the clinician is in a better position to help them pursue a goal of abstinence.
4. Many people who initially become moderate drinkers later shift to abstinence.
5. Problem drinkers are more likely to pursue treatment if they are not forced to pursue a goal of abstinence.

Research has shown that individuals who are less severely alcohol dependent or “problem drinkers” can successfully learn to control their alcohol intake and become “social drinkers.”

Anger management and assertiveness training

Although anger is a normal human emotion, problems managing anger are all too common. Cognitive and behavioral techniques can be used to help clients gain control of their anger by learning to recognize high risk situations for angry responses and planning accordingly. Examples of interventions include pausing to question whether there was any disrespect intended and whether the situation was really that important to warrant an angry response. In the heat of the moment, implementing these kinds of interventions can be difficult, but with the recognition that anger control is an important personal goal and continued practice, better anger management can become a reality.

Difficulty being assertive often underlies both depression and anger management problems. Assertiveness is a style of behavior whereby both the individual’s rights and the rights of others are considered. Assertiveness is contrasted with three other behavioral styles: passive, aggressive, and passive-aggressive. The passive person will forego their own rights in deference to others. He or she will avoid making decisions for fear of offending someone else. Ironically, although the goal of this style of behavior is to please others, this can often backfire as others in their sphere become frustrated with their inability to make a decision and put off by their lack of backbone. The aggressive style is the opposite of the passive style in that this individual disregards the rights of others whenever they conflict with his or her own. In the short run, this can be an effective means for the aggressive individual to have his or her needs met. However, in the long run, friends and family become resentful that they always have to give in to them to avoid a tirade or other form of intimidation. The passive-aggressive person might appear passive on the surface, but they attempt to get their needs met indirectly. Typical passive-aggressive behavior can include procrastination, the “silent” treatment, door-slamming, no-showing, and arriving late. Assertiveness training involves learning to recognize one’s style of behavior, and learning to formulate and implement assertive responses.

Stress management

It is ironic that with all the advances in technology designed to save time, people are busier than ever. Stress continues to be a significant problem for many people, along with stress-related disorders such as chronic headache, irritable bowel syndrome, and hypertension. Cognitive therapy, relaxation training, assertiveness training, and time organizational skills can help individuals learn to cope better with the stress in their lives and these strategies have also been shown to be effective for the aforementioned stress-related disorders.

Help with “life” problems

The term “life problems” refers to a number of difficulties that many of us experience all too often. These include (but are not limited to) romantic relationships (or lack thereof); infertility and IVF; unplanned pregnancies; unemployment or other occupational issues; separation and divorce; difficult children; difficult parents (elderly or otherwise); difficult neighbors; responding to teasing (adolescents); issues with friendships, legal problems, and financial problems. Although encountering life problems is inevitable, in some cases the challenge of overcoming some difficulty or making a tough choice may seem daunting. Over time, you may feel “stuck.” Cognitive and behavioral techniques are well suited to helping people make tough decisions and cope with difficult situations.