Behavior therapy is the treatment of choice for anxiety disorders, OCD, impulse control disorders, and ADHD. I practice behavior therapy because psychological literature repeatedly demonstrates the efficacy of behavioral therapy and lays out strict principles for treatment.
In behavioral therapy, I first diagnose the problem. I then work with the patient to create an individualized treatment plan, incorporating the patient's goals and the skills he or she would like to learn. Treating the core issue often takes 6-8 weeks. Changing behavior often reveals additional emotional concerns that prompt me to adjust the treatment plan. Throughout treatment, I act as a coach to the patient. I am the expert who advises the patient on how achieve their goals. However, I ensure that the patient drives the treatment.I often partner with a psychiatrist or attending physician if the patient needs medication. Many find relief with behavior therapy alone. Some find a combination of behavior therapy and medication to be most effective.
Ultimately, I aim to reduce anxiety, create comfort, and stop repetitive and unwanted behavior. Patients have been highly satisfied with this approach and experience significant short and long-term relief.
Exposure and Response Prevention (ERP) Using ERP, the patient and I define a hierarchy of obsessions and compulsions and gradually confront them. I expose the patient to triggers that elicit obsessions and then prevent the patient from engaging in related rituals. Rituals temporarily reduce anxiety; however, they increase anxiety in the long-run. Both physical and cognitive rituals can be successfully treated with ERP.
I use ERP to treat OCD, anxiety disorders, and impulse control disorders. For example, I help patients with Acrophobia (fear of heights) feel comfortable on the 3rd floor, the 4th floor, and the 5th floor, until they graduate at the top of the space needle. I treat patients with social phobias by coaching them through different types of social activities until they feel comfortable and confident.
ERP is highly effective for patients with Panic Disorder (the fear of fear). ERP helps patients learn to be comfortable in situations that they once associated with panic attacks. I also incorporate relaxation/breathing training, mindfulness training, stress management, and assertiveness training to treat such anxiety disorders. To treat impulse control disorders, I use ERP to break the connection between excessive behaviors and the cues that trigger those behaviors. Such treatment reduces the urge to be impulsive in high risk situations.
Contingency Management I treat ADHD by using immediate external contingencies to control attentive and on-task behavior. I work with the patient, the patient's family, and the patient's educational providers to arrange an environment that supports specific behaviors with positive long-term consequences. Treatment often includes coordination with the patient's school to obtain appropriate accommodations and educational resources.