CBT for Anxiety
Anxiety disorders are the most common mental health complaints.
If you’re feeling nervous, worried, or on edge, please know that you’re not alone.
Today, however, many of the threats we encounter are less visible. We worry about things that might go wrong in the future. We fear failure at work or school, disappointing others, the safety of people and animals we love. And yet our bodies still respond with that same fight-flight-or-freeze response. It’s the right response but it’s happening at the wrong time because the threats are in our minds, not out there in the world. Those physical symptoms can’t help us battle those threats.
There are several different anxiety disorders, including generalized anxiety disorder, social anxiety disorder, specific phobias, and panic disorder and agoraphobia.
Anxiety disorders are characterized by symptoms like:
- uncontrollable worry
- feeling restless
- difficulty sleeping
- feeling overwhelmed
- panic attacks
We use primarily Cognitive Behavioral Therapy (CBT) and exposure and response prevention interventions for working with anxiety.
CBT is based on the idea that thoughts (cognitions), behaviors, and emotions all work together. To decrease anxiety, we work with clients on several different strategies to change negative thoughts, including developing a more flexible, realistic mindset, mindfulness skills to slow down and become aware of the impact of negative thoughts, and learning to tolerate uncertainty. We also work with clients to set behavioral goals to gradually face feared situations and decrease avoidance with exposure therapy. This helps our clients to get unstuck and move forward in living a life they love.
It’s important that our work in therapy is collaborative. We know a lot about CBT in general, but you are the expert on your own anxiety. In our initial work, you’ll develop a treatment plan and a shared understanding of your symptoms with your therapist. By combining your knowledge, you and your therapist will take general principles and strategies and start to understand how they apply specifically to you.
CBT for anxiety is an active, skills based treatment. It’s meant to be a time-limited intervention so each of your sessions is productive and focused on helping you develop new skills and strategies for dealing with anxiety. There will be information, in session practice of new coping skills, and homework and worksheets between sessions where you’ll get a chance to put the ideas you talk about with your therapist into action. Our goal is to teach you as much as we can about CBT so you can work toward being your own therapist.
Exposure Therapy for OCD
Obsessive compulsive disorder can cause a lot of distress and get in the way of you living the life you want. If you’re dealing with these symptoms, we know you’re struggling with a unique kind of misery.
We have an idea from mainstream media what OCD looks like. The typical example involves fear of germs or maybe having things arranged in a certain way or put in a specific order. But OCD can actually look really different from person to person.
The symptoms that define OCD involve both intrusive thoughts and rituals/ compulsive behaviors. OCD sets up a cycle of anxiety through obsessions (the thoughts) and behaviors done to cope with the anxiety (the compulsions) that comes from the obsessions.
Compulsions or rituals are the behaviors (including mental rituals) that are done right after the intrusive thoughts to manage anxiety.
The typical example is cleaning or checking the doors or the stove. Other common behaviors are taking photos to have evidence that you did something, internet searching, and avoidance.
We also very commonly see mental compulsions/rituals.. When we talk to people who describe overthinking, many times what’s actually happening is a mental ritual. Rumination, worry, figuring it out, replaying past events, and self-reassurance are all examples of mental rituals. Rituals might involve trying to figure out why you have these thoughts, what they mean about you as person, if they’re true or not and how you can find out if they’re true.
If these symptoms sound like you, feel free to schedule your free 15 minute consultation.
Examples of common obsessions and compulsions
Some common obsessions include:
- Fear of contamination from germs, bodily fluids, or household chemicals
- Fear of losing control and acting on an impulse to blurt out something inappropriate or an impulse to harm someone
- Fear of harming others through not being careful enough or being responsible for something terrible happening to others (fire, burglary, dropping something that might cause someone to trip and hurt themselves)
- Fear of forbidden sexual thoughts (about incest, children, homosexuality, or aggression)
- Fear of offending God or concerns about morality
- Fear of developing a serious disease
- Perfectionism, including fears of losing or forgetting things, indecision, and concerns about evenness
Some common compulsions/rituals include:
- Washing and cleaning
- Figuring it out
- Internet searching
- Mental review of conversations or interactions
- Counting or special numbers
- Arranging things until they feel “right”
- Repeating body movements (tapping, blinking)
- Repeating routines (setting items down, getting in and out of chairs, going through doors)
- Seeking reassurance from others
The gold-standard intervention for OCD is called exposure and response prevention (EX/RP).
This treatment has decades of research to support it and is the most effective strategy for decreasing symptoms of OCD.
With exposure therapy, you’re always in the driver’s seat. I’ll be right there with you on the passenger side, giving directions, encouragement, and sometimes pushing you out of your comfort zone but you control the treatment process. We work together to develop exposure tasks to help you get the most out of treatment. I’ll never suggest an exposure task that I wouldn’t do myself and whenever possible, we’ll do them together to start.
OCD in Children and Teens
Seeing your child struggle is one of the most difficult things a parent can deal with. If your child seems highly anxious and seems to get stuck in anxiety loops, they may have OCD.
Just like in adults, OCD in kids and teens shows up as scary thoughts and a set of repetitive behaviors done to temporarily reduce the anxiety associated with the thoughts. While it’s normal to have scary thoughts from time to time, kids with OCD may seem preoccupied with their fears and overly focused on preventing them.
Common fears or intrusive thoughts in kids include:
- fears of getting sick or hurt
- fears of loved ones getting sick or hurt
- fears of germs
- fears of being responsible for something bad happening
- fears of making mistakes
Common rituals or responses to these thoughts include:
- refusing to be around people, places, or things that might trigger the thoughts
- checking doors, locks, appliances, or candles over and over
- repeating certain behaviors until it feels right
- repeatedly asking for reassurance that things will be okay
- insisting that family members do certain things or avoid certain things in order to prevent their anxiety
Social Anxiety in Teens
Intense anxiety in social or performance-based situations is the hallmark feature of social anxiety.
Many kids with social anxiety also do whatever they can to avoid social situations.
They may complain of feeling sick and ask to skip the event or stay home from school. If they can’t avoid these situations, they endure them with a lot of distress. Your child may ask you for a lot of reassurance before attending these kinds of events, wanting to know who will be there and how long it will last or they may insist that you go with them to the event. While avoidance might work to alleviate anxiety in the short term, in the long term your child is likely missing out on important life experiences that are key for social development and maintaining anxiety.
CBT for social anxiety in kids and teens involves developing new skills and strategies for dealing with anxiety.
These skills might include learning to identify negative thoughts or expectations that are getting in the way, practicing relaxation techniques, and problem solving to start taking small steps toward facing fears.
If you think your child is struggling with social anxiety disorder, please schedule a free, 15 minute phone consultation with our care coordinator.
Health anxiety refers to excessive worries and preoccupations about physical sensations or symptoms and their meaning.
After ruling out the possibility of a health condition, we use CBT and ERP (exposure and response prevention) therapy to help you get unstuck from the health anxiety cycle.
CBT focuses on helping you change your thoughts and behaviors so that you can get back to living your life.
Another element of treatment for health anxiety is learning to change your behaviors. Often times people with health anxiety learn to temporarily soothe themselves with behaviors that only make things worse in the long run. For example, asking others for reassurance about symptoms (doctors or loved ones, for example) may make you feel better for a little while but over time you may come to depend on others. In therapy you’ll learn to cope with the anxiety on your own, without checking with other people (or google). You’ll also practice reducing avoidance of triggers so you can do the things you want to do and live a full and meaningful life.
For people with emetophobia, it’s also common to have developed another set of behaviors to deal with symptoms when avoidance isn’t possible.
These include body scanning or monitoring symptoms that might indicate that you (or someone else) is getting sick. You might engage in worry or trying to figure out if you or someone in your household is sick. It’s also common to engage in reassurance seeking, where you ask others to confirm that they aren’t experiencing symptoms or you check their symptoms (for example, using a thermometer or checking if they feel hot). Excessive washing or cleaning of hands, dishes, cooking utensils and preparation surfaces to avoid contamination that might cause sickness is also common.
If this pattern of symptoms and experiences describes you, you are not alone!
We frequently treat emetophobia can teach you skills and strategies for working with anxiety and living a full life, doing all the things you want to do. Our goal is to help you live a life where you make important decisions about where you go, who you spend time with, and the activities that you do—not your anxiety.
Panic attacks are sudden and intense rushes of fear or physical discomfort. For many people, the attacks feel like they come totally out of the blue. For other people, the attacks are clearly triggered by something in the environment or by a thought or feeling. Panic attacks tend to reach their worst point after 10 minutes then start to gradually decrease.
Common symptoms of panic attacks include:
- racing heart
- tightness in your chest
- difficult breathing
- trembling or shaking
- stomach or GI distress
- rapid breathing
- tingling in hands or feet
- feeling of derealization or depersonalization
- fears of losing control, going crazy, or dying
Many people mistakenly think the symptoms of a panic attack are a signal that something dangerous is happening and go to urgent care or the emergency room. After a panic attack, you may start worrying about the possibility of having another attack. This worry may lead you to change your behavior in an effort to prevent another attack. If you had your attack in a certain situation, for example while driving, at work, or in a store, you may start to avoid those places. Over time, you may start avoiding other places out of fear of having the symptoms again. You may start to feel afraid of being alone or going places alone. It’s also common to start to rely on other safety behaviors, for example carrying your phone, water bottle, essential oils, medication, or other objects with you to prevent uncomfortable sensations or another attack.
Therapy for Panic Attacks and Panic Disorder
We use Cognitive Behavioral Therapy and exposure therapy to treat panic attacks and panic disorder. CBT teaches new ways of thinking about uncomfortable symptoms. Rather than interpreting these symptoms as a signal of danger, we work together to practice tolerating and allowing those uncomfortable sensations, realizing that discomfort does not mean danger. We also use a specific kind of exposure therapy called interoceptive exposure. Interoceptive exposures are focused on helping you learn to experience internal sensations in a more controlled way. We’ll practice generating some of your feared sensations on purpose so that your brain can learn a new way of responding to them. In addition, we’ll practice real life exposures to help you get back out into the world and doing the things that matter most to you, like seeing friends, going to a show, shopping, seeing a movie, and traveling.
Online Therapy for Anxiety and OCD
Online therapy is more widely available now than ever before. If you live in Missouri, you can see any of our therapists online. If you live in another state, you may be able to work with one of our psychologists.
We are considered out of network providers with insurance panels. Many people are not familiar with using out-of-network benefits and so we try to make the process as easy as possible. We can prepare the paperwork (called a superbill), and help you submit that to your insurance company. You can also use a Flexible Spending Account or Health Savings Account to pay for services, which are tax free funds and can also help to reduce the costs.
The fees for our clinicians range from $170 to $40 and are based on clinician education and experience. You will be responsible for the full session fee at the time of service and then your insurance company will reimburse you based on your out of network benefits.
Working as out of network providers allows us to dedicate more time to your treatment. Rather than trying to see as many clients as possible and spending hours on billing and paperwork, we’re able to focus on you and your treatment. We prefer to use that time to attend conferences, read and discuss new research, consult with colleagues, and ensure that we continue to provide cutting edge therapy based on the newest scientific findings.