Our Areas of Expertise

Anxiety Disorders

Anxiety disorders are clinical syndromes, which are characterized by irrational fears, avoidance, and consequent interference in functioning. Irrational fears are fears that occur in non-threatening situations. Obviously, fears of unsafe situations (e.g. walking a tightrope) are adaptive and therefore not a characteristic of anxiety disorders. Avoidance is a common sequelae of both rational and irrational fear. Avoidance resulting from irrational fears can be maladaptive when it impinges upon an individual’s functioning. For example, developing a fear of driving can have a significant impact on a person’s functioning. So, if you experience fear in the face of normal, relatively safe situations and, as a result, you avoid that situations (or situations like) it and this avoidance interferes with your ability to function, it is likely that you have an anxiety disorder. The Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013) has organized anxiety syndromes into diagnosable disorders. These include panic disorder, agoraphobia, social anxiety disorder (formerly social phobia), specific phobia, and generalized anxiety disorder (GAD). Obsessive compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) were formerly categorized as anxiety disorders, but now have their own categories in the DSM-5.

Clinical research studies have shown that cognitive-behavioral therapy is the most effective approach for treating anxiety and anxiety disorders, in many cases more effective than medication. Some studies have shown success rates to be as high as 80-90%. Cognitive-behavioral therapy (CBT) is a problem-oriented, time-limited form of therapy where techniques for changing, thoughts, behavior and physiological responses are learned. Specific techniques include education about anxiety, relaxation training, breathing re-training, cognitive restructuring, exposure (typically graduated), and systematic desensitization.

Obsessive Compulsive Disorder (OCD)

Up until recently, OCD has been categorized as an anxiety disorder. However, in the most recent version of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5; APA, 2013), OCD now has it’s own category and is grouped with “related disorders,” for example, hoarding and body dysmorphic disorder (BDD). Persons with OCD experience persistent intrusions which are often very distressing as they may go against important values and beliefs. These intrusions are recognized as being “all in the head” but at the same time seem impossible to get rid of. Persons with OCD will attempt to cope with them through engaging in rituals (either behavioral or mental) or through avoidance of situations that trigger the thoughts. Cognitive-behavioral therapy (CBT), specifically exposure and response prevention often in combination with cognitive therapy has been shown to be the most effective form of treatment for OCD.

Major Depressive Disorder

Extensive research has shown cognitive-behavioral therapy (CBT) to be an effective treatment for depressive disorders. Interventions center on changing maladaptive thought patterns that are believed to give rise to depressive symptoms. The primary underlying principle is that thoughts determine feelings. Ergo, individuals who experience depressive thoughts develop depressive feelings and symptoms. Thought patterns are believed to be learned, and therefore, can be unlearned. Individuals who are seen for CBT learn skills to “unlearn” depressive thoughts and re-learn more rationale less depressive thought patterns. In addition, it is also very important to engage in behaviors (e.g. increasing pleasurable activities, exercising) that can reduce depressive symptoms.