What treatments do we offer?

Below are the answers to some common questions we receive about the treatments we offer at the Anxiety Clinic. You can learn more about these from your therapist.

What is cognitive-behavioral therapy (CBT)?

Cognitive Behavioral Therapy (CBT) generally refers to the use of cognitive (example: ways we think to help us cope with anxiety) and behavioral (example: learning to approach anxiety-provoking but non-harmful situations) techniques to help individuals with anxiety disorders. A hallmark of CBT is its emphasis on collaboration between a therapist and client, both of whom bring their own expertise and take an active role in the treatment process.  Cognitive behavioral approaches for treating anxiety are diverse but usually involve exposure (see below). Aside from exposure, other common elements found in behavior and cognitive behavioral therapies include: psychoeducation, relaxation, and cognitive strategies. Psychoeducation involves learning about the components of anxiety and learning how to distinguish between problematic and non-problematic anxiety, how to monitor levels of anxiety across situations, and eventually overcome problematic anxiety. Relaxation entails learning how to relax through breathing exercises or by progressive muscle relaxation. Cognitive strategies involve learning how to identify negative thoughts and change ones thinking in order to change how one feels about an anxiety-provoking situation. CBT also involves discussion about how to maintain new gains and skills, so the individual can continue to benefit from these skills after treatment ends. CBT has been found to be effective in the treatment of children, adolescents, and adults with anxiety disorders.

What is exposure therapy?

The strategy of exposure is a key component of CBT for anxiety in children, adolescents, and adults. Exposure treatment involves having an individual confront the (non-dangerous) situations that they are afraid of, with the goal that the individual will learn that her/his anxiety will decrease over time. Exposure can be conducted in two major variations, namely, whether the feared stimulus is confronted directly (in vivo exposure) or whether it is imagined (imaginal or in vitro exposure). Often, exposure therapy involves using a hierarchy or fear ladder such that individuals start with exposure to situations that are moderately stressful and work towards ones that are more difficult.  For example, if a woman is afraid of public speaking, she would practice talking first to one person numerous times until she felt less anxious about doing so, and would then increase the difficulty of the task, by then talking to a small group of people, and then to a larger group of people. Using exposure in this manner allows you to build up to doing what you are most afraid of, establishing mastery and increasing confidence. The effectiveness of exposure has been studied widely, and has been shown to reduce fears and anxiety in children, adolescents, and adults.

What is exposure and response prevention (ERP)?

Exposure with response prevention (ERP) is a treatment that has been found to be helpful for people with obsessive-compulsive disorder (OCD).  ERP typically includes exposure to obsessional cues (i.e. unwanted thoughts, ideas, impulses that cause anxiety) while NOT doing the rituals/compulsions  (i.e. repetitive behaviors or mental acts meant to reduce anxiety) that usually accompany the obsessions.  Exposures are done in our office and in real-life settings that cause anxiety.  Exposures can also be done imaginally.  ERP is thought to work because as people are exposed to feared thoughts and situations, they are able to collect information that disproves their thoughts that formerly kept them carrying out rituals.  Exposures are done gradually by confronting cues that cause only moderate stress and then working up to more distressing cues.  ERP is done in session with a therapist, and also between sessions as homework.        

What is habit reversal training (HRT)?

Habit reversal training is a technique used in the treatment of a variety of disorders including: trichotillomania, skin picking, and tics. The technique typically includes several components:  increased awareness (by tracking or monitoring the behavior), substituting a competing response (something to do INSTEAD of the habit), contingency management training (rewarding yourself for success), relaxation (skills to help you feel calm), and generalization training (strategies to help you maintain gains in new situations).

What is Trauma Focused Cognitive Behavioral Therapy (TFCBT)? 

TFCBT is a psychological treatment for individuals who are experiencing symptoms of post-traumatic stress disorder, anxiety and/or sadness resulting from a traumatic event. TFCBT usually includes psychoeducation, relaxation training, cognitive strategies for how to manage distressing thoughts and emotions, and gradual exposure to distressing memories and reminders of the trauma.

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© Michael A. Southam-Gerow 2003-16 
Virginia Commonwealth University,  Center for Psychological Services and Development, and the Department of Psychology