Clinical Services

Cognitive-Behavioral Therapy

Cognitive Behavior Therapy (or CBT) is a form of psychological treatment that has been shown to be very effective with a wide variety of psychiatric and psychological problems. Cognitive-behavior therapy can be delivered in either a weekly or intensive (daily) format. Intensive CBT generally involves 90-minute therapy sessions held daily for approximately 2 to 4 weeks and is particularly suitable for severe cases or for those who do not have access to local CBT providers.

CBT for obsessive-compulsive disorder (OCD)

Studies with CBT for obsessive-compulsive disorder (OCD) show a very high success rate in both adults and children. In fact, about 80-85% of adults and children with OCD make substantial improvements following a course of CBT. For example, clinical research studies reported that up to 86% of people who completed CBT were significantly improved. In children, the results are quite similar. In fact, a recent study completed by our program found that about 85% of children were rated as significantly improved after CBT. The findings in these studies of CBT, as well as other outcome studies, suggest that benefits are maintained after treatment is concluded.

CBT for OCD is based primarily on two principles: exposure and response prevention and cognitive therapy. Exposure is an essential practice in CBT for OCD that most simply may be described as having the patient face his or her fear. This is an anxiety-provoking activity for patients at first. In fact, some clinicians are uncomfortable with intentionally increasing patient's anxiety, which may contribute to the scarcity of therapists who are able to conduct CBT. In the clinical setting it has been demonstrated that exposure results in a habituation of anxiety, that is, through repeatedly confronting their fears, OCD patients experience a decrease in anxiety. This is similar to "getting back on the horse after you've fallen off".

Response prevention, also called ritual prevention, follows exposure and involves the patient with OCD refraining from engaging in repetitive compulsive activities that consume time and interfere with his or her functioning. Often these repetitive rituals or compulsive activities function to ease anxiety. Again, numerous studies have shown that through response prevention patients may decrease and eventually eliminate these time consuming and interfering compulsive rituals that they engage in so often.

Finally, cognitive exercises such as restructuring teach the patient to challenge anxious thought processes and the necessity of performing compulsive behaviors are included. This is similar to talking back to worried thoughts.

Having helpful family support can be an important asset in treatment. This is why we tend to include parents of children in our sessions. Similarly, our approach is to teach the person to be his or her own therapist. With this attitude, we are able to teach people all about OCD and what is the best manner of dealing with their symptoms. We believe that this helps reduce symptom return and improves overall treatment outcome.

Intensive CBT for obsessive-compulsive disorder (OCD)

Our intensive cognitive-behavior therapy (CBT) program is particularly well-suited for patients who lack access to trained CBT providers and for patients with severe or treatment-refractory obsessive-compulsive disorder (OCD). Generally speaking, the treatment received in the intensive program is the same treatment that patients undergoing standard weekly CBT receive, with the major exception being that treatment is condensed into a 2 to 4 week time frame.

Packaging CBT into this more succinct and focused manner has many potential benefits, including increased access to evidence-based care, enhanced patient motivation, and rapid symptom relief. In fact, our own data indicate that the intensive program is as effective as weekly CBT in both youth and adults with OCD. The vast majority of patients who participated in a trial of our intensive CBT program had positive treatment responses. Specifically, 90% percent of youth and 88% of adults who completed our intensive CBT program were considered treatment responders, with the majority of these patients maintaining their gains 3-months after treatment.

Similar to standard weekly treatment, intensive CBT for OCD is based primarily on two principles: exposure and response prevention and cognitive therapy. Exposure is an essential practice in CBT for OCD that most simply may be described as having the patient face his or her fear. This is an anxiety provoking activity for patients at first. In the clinical setting it has been demonstrated that exposure results in a habituation of anxiety; that is, through repeatedly confronting their fears, OCD patients experience a decrease in anxiety. Response prevention, also called ritual prevention, follows exposure and involves refraining from engaging in compulsive activities that often function to ease anxiety temporarily at the expense of interfering with life. Again, numerous studies have shown through response prevention patients may decrease and eventually eliminate these time-consuming and interfering compulsive rituals that they engage in.

Cognitive exercises such as thought restructuring teach the patient to challenge anxious thought processes and the necessity of performing compulsive behaviors are included. Finally, family involvement is often central to the success of CBT. Family members may accommodate the patient's symptoms by facilitating avoidance, assisting with ritualistic behaviors, or inadvertently facilitating the development of the disorder by participating in rituals (e.g., providing reassurance, allowing compulsive avoidance of feared stimuli, and tolerating delays associated with ritual completion). Given this, our intensive CBT program often includes the patient's spouse, parents, and other significant others in the treatment process.

Findings from randomized, controlled trials comparing CBT, pharmacological treatment, and placebo/waitlist conditions have established strong support for the efficacy of CBT, pharmacological treatment, and their combination. In light of the existing data, we also offer expert pharmacological interventions for OCD and, when it is clinically appropriate, patients undergoing intensive CBT may be seen concurrently by Dr. Tanya Murphy, an expert psychiatrist in OCD and tic disorders.

CBT for body dysmorphic disorder

Body Dysmorphic Disorder (BDD) is characterized by preoccupation with an imagined or slight physical defect in appearance that causes significant distress or impairment in functioning. Frequent targets of concern include the hair, nose, and skin, though BDD patients may also become negatively fixated on other areas of the body or face and most patients engage in repetitive and time-consuming behaviors (e.g., mirror gazing, excessive grooming, skin picking) to reduce their distress. Left untreated, BDD tends to be a chronic and disabling condition that negatively impacts quality of life.

Cognitive behavior therapy is a form of psychological treatment that has been shown to be effective in treating BDD in adult populations. Treatment consists of two components, exposure and response prevention (ERP) and cognitive therapy. In ERP, patients are gradually exposed to anxiety-provoking stimuli/situations while refraining from engaging in anxiety-reducing rituals. Extended and repeated exposure to feared stimuli/situations results in habituation of anxiety and patients learn that their fears are not as daunting as initially perceived. Complementing ERP are cognitive techniques that teach patients to identify and correct anxiety-provoking cognitions that often motivate compulsive behaviors. As dysfunctional thoughts are replaced with more objective and realistic cognitions, the need to engage in ritualistic behavior tends to decrease.

In our clinic, we offer both once or twice weekly CBT or intensive CBT for people with BDD. Our intensive CBT program is particularly well-suited for patients who lack access to trained CBT providers and for patients with severe or treatment-refractory BDD. Generally speaking, the treatment received in the intensive program is the same treatment that patients undergoing standard weekly CBT receive, with the major exception being that treatment is condensed into a 2 to 4 week time frame and the sessions are a bit longer in duration (approximately 90 minutes). We also offer expert pharmacological interventions for BDD and, when clinically appropriate, a combination of medication management and CBT.