Battling Anxiety

Dealing with anxiety can be exhausting. It takes away from the enjoyment of everyday life – keeping you from being your best self at school, at work, and with your friends and family. If you're considering starting the challenging but rewarding journey toward beating anxiety, I'm here to help.

I am a bilingual, licensed clinical psychologist serving the South Florida community and specializing in the treatment of anxiety and related challenges in children and adults (e.g., excessive worry, social anxiety, panic, OCD). In a warm and supportive environment, we will work together to help you or your child learn to challenge anxious thoughts and to gradually face the fears that keep you from living life to the fullest.

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Looking for treatment in a metropolitan area like South Florida can feel overwhelming because there are endless options across the Miami and Fort Lauderdale areas. How do you know which therapist is right for you? Well, it’s certainly important to have a connection with your therapist – to feel that your therapist “gets you.” In addition, if you or your child struggle with anxiety, it is critical that you find a therapist who specializes in anxiety. Lots of research has been done on anxiety treatment and based on study findings, we have a good idea of what usually works for most people: cognitive behavioral therapy (CBT). I have extensive training and experience in CBT, and enjoy using this approach with my patients for one simple reason: it helps most people feel better. I tailor the treatment to meet each person’s specific needs, and as needed will incorporate other approaches, such as mindfulness, family systems, and acceptance-based techniques.

What is Cognitive Behavioral Therapy?​

Cognitive Behavioral Therapy (CBT) is a type of treatment that helps you change the way you think, and consequently, helps you change the way you behave. Within CBT treatment, we will work together to help identify the specific thoughts related to your worry and anxiety. Then, we will try out different strategies to help you challenge these anxious thoughts. In other words, you will learn how to “talk back” to your anxiety and reexamine the accuracy of those thoughts. Then, the most critical component of treatment involves gradually facing your fears. Psychologists refer to this process of facing your fears as “exposures” because you are exposing yourself to situations that tend to make you feel anxious, and then using the tools learned in therapy to cope with this anxiety.

For individuals who are struggling with Obsessive Compulsive Disorder (OCD), the CBT tools described above are helpful, but an additional key component of treatment is Exposure and Response Prevention (ERP). ERP is an evidence-based treatment that is used to help individuals gradually reduce their engagement in compulsive rituals. In other words, for individuals with OCD, during an exposure, we will work together to gradually help you fight the urge to engage in a specific compulsion. For example, you might try to delay the compulsion, change it or mess it up in some way, before you eventually try to keep yourself from doing the compulsion altogether.

At the end of a successful course of CBT and/or ERP treatment, you should feel confident that when a situation arises that might make you feel uncomfortable or nervous, you will know exactly how to handle it.

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What might Cognitive Behavior Therapy (CBT) look like for me?

​Anxiety presents unique challenges for each individual, and we will work together to identify and practice specific strategies that will help you succeed. That said, sometimes therapy feels “mysterious” – what’s going to happen? What will the therapist ask?  What will he/she ask me to do?  Let’s take a way some of that mystery, and give you a sneak peek into what Cognitive Behavior Therapy (CBT) for anxiety can look like, depending on the type of anxiety that you are dealing with.

These are just a few examples of the kinds of anxiety-related issues I often help patients with in treatment and is not meant to be an exhaustive list. 

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Themes covered in therapy:

• Identifying the worry
• ​​Talking back to worry thoughts
• Exposure (facing your fear)

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Social Anxiety

Panic Attacks

Obsessive Compulsive Disorder

Separation Anxiety

Specific Phobia

Intensive Outpatient Treatment for Anxiety, OCD, and Related Disorders

For some individuals, anxiety is impairing their lives in a very significant way (e.g., unable to separate from parent to attend school, difficulty going to work, difficulty leaving home), and they want to see change quickly. In these cases, an intensive outpatient (IOP) program may be the best mode of treatment. Within the IOP program, we will follow the same CBT treatment approach described above, but we will have longer and more frequent sessions (e.g., 4 – 6 hours per week of therapy) in order to make progress more quickly and to restore functioning. Our main goal within the IOP program is to help you or your child resume your everyday lives as soon as possible. For more information regarding my IOP services offered through Pediatric Psychology Associates, please click here.

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Want to learn more about Cognitive Behavior Therapy (CBT)?

Check out these great websites:

• http://www.helpguide.org/articles/anxiety/therapy-for-anxiety-disorders.htm
• https://www.anxietybc.com/what-cbt-1
• http://www.apa.org/helpcenter/anxiety-treatment.aspx

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Social Anxiety

Worry Talking Back Exposure

• Identify worry thought:

  If I make a mistake while ordering my food at a restaurant, I’ll look so stupid.

• Talk back to the worry with facts/evidence:

  I’ve been to this restaurant before, and the waiters are usually friendly, so even if I fumble over my words, he/she probably won’t think much of it.

• Gradual exposure:

  • Go with a friend, and have him/her order my food. I might order my drink.
  • Go with a friend. Order both my food and drink order on my own.
  • Go to restaurant alone, and order both my food and drink.

Panic Attacks

Worry Talking Back Exposure

• Identify worry thought:

  I notice that my heart is beating a little faster than usual, so I should probably leave this situation in order to prevent a panic attack.

• Talk back to the worry with facts/evidence:

  My heart could be beating faster than usual because I’m walking quickly. I’ve had this sensation before and it does not usually lead to a panic attack. If I do have a panic attack, it will be very uncomfortable, but it will pass quickly.

• Gradual exposure:

  • Do activities that lead to the experience of a fast heart beat (e.g., run vigorously or do jumping jacks for a minute)
  • Do these activities in situations where it might be difficult to leave quickly

Obsessive Compulsive Disorder

Worry Talking Back Exposure

• Identify worry thought:

  I’m not sure I did that quite right (e.g., a task, a conversation), and that makes me feel very anxious/uncomfortable. I will [insert compulsion] to help myself feel better

  Compulsions are quite varied and can include: mental rituals (counting or repeating a phrase in your mind), reordering/arranging, hand-washing, etc.

• Talk back to the worry with facts/evidence:

  Even though I feel uncomfortable about messing up, the compulsion will not actually fix anything, it’ll just help me take the edge off or now.

• Gradual exposure and response prevention (ERP):

  In OCD treatment, the focus is on reducing the compulsive responses and learning to manage the obsessions in a more effective manner. To engage in ERP in the current example, you might start with purposefully doing something not quite right (e.g., mess up on a minor task) and experiencing feeling some anxiety/discomfort. Then, you would gradually work on the response prevention component:

  • Allow myself to engage in the compulsion minimally (e.g., repeat phrase in mind only two times rather than ten times).
  • Delay the compulsion: wait one minute before repeating the phrase
  • Do the compulsion differently: Say the phrase, but only part of it or say it backwards.
  • Do not engage in the compulsion

Separation Anxiety (child)

Worry Talking Back Exposure

• Identify worry thought:

  After Mom drops me off at school, I will miss her too much and will have a long, terrible day at school. So I’m going to try to stay with her as long as possible.

• Talk back to the worry with facts/evidence:

  Even though I will miss Mom while I’m at school, there are some things that I could do, like talk with my friends or go to the playground.

• Gradual exposure:

  • Spend time separate from Mom in fun places (e.g., at a friend’s house).
  • At school drop-off time, walk with Mom into the classroom and stay with her for a few minutes before she leaves.
  • At school drop-off time, walk with Mom to the school entrance and say goodbye there.

Specific Phobia: Vomit (also known as emetophobia)

Worry Talking Back Exposure

• Identify worry thought:

  My stomach feels a little queasy, which means I might throw up. If I throw up, I will feel terrible/disgusting/very nervous. Others might notice, and think I am gross.

• Talk back to the worry with facts/evidence:

  Since my stomach is feeling queasy, there’s a small chance that I may throw up. I’ve thrown up before and it is uncomfortable, but it is not harmful and I can handle it.

• Gradual exposure:

  • Read stories about vomiting
  • Look at pictures and watch videos of people vomiting
  • Engage in activities that could lead to nausea (e.g., spin in chair to get dizzy, shake head quickly from side to side for a full minute, eat foods that may have been previously avoided due to fear of vomiting)