Cognitive Behavioral Therapy (CBT) is a type of therapy that explores the interplay between our thoughts, feelings, and behaviors. It is an evidence-based and well researched form of therapy that has been shown to be effective at treating a wide variety of mental health diagnoses, including depression and anxiety disorders. Many studies show CBT to be as effective or sometimes even more effective than other forms of psychological therapy or psychiatric medications. CBT has been around and well researched for many years, and thus there is ample scientific evidence that CBT methods actually produce change in client's lives. This differs from many other therapy modalities that are not as well researched or developed.

In an nutshell, CBT is a great first-line treatment for many mental health issues because of its strong research backing. I always say that especially for anxiety disorders, if you haven't had a solid course of CBT then that is a great place to start before considering other types of therapies/treatments. In my experience, I have had many clients come to me who are starting to believe therapy doesn't work because they have tried so much, and it turns out they have never had a therapist do basic CBT with them before. ACT, DBT, and ERP are all rooted in CBT priciples.

________________________________________________________________________________________________________________________________________________"What's it like to do CBT with Ashley?"

In my approach, and especially for clients coming in to work on anxiety disorders, OCD, and/or depression, I like to start clients with some basic CBT work and build from there as needed. Typically we start with some education around the relationship between thoughts, feelings and behaviors, and how this applies to the current struggles you're facing. I would likely give you some homework to do in addition to talking about this in sessions. This can look like tracking anxious or depressed thoughts in a thought record, identifying core beliefs, identifying core fears, challenging unhelpful thinking patterns, building more helpful behaviors into daily life, and more. I'll utilize other forms of therapy, such as ACT, to assist clients in building on these foundational mental health skills. 

"How long does CBT take?"

I'm committed to helping my clients get back into their life as quickly as possible, whatever that looks like for them, and CBT is often a great approach to assist clients in not only gaining insight in therapy sessions, but gaining skills they can use daily outside of therapy to help them engage more with their life in a meaningful way. Clients typically start out meeting with me weekly, and then we step down to every other week or once a month as it makes sense based on their progress in treatment.

If you'd like to know more about how I'd use a CBT based approach to assist you, please reach out to schedule a free consultation call! 

Exposure and Response Prevention (ERP) is considered the gold standard for the treatment of Obsessive-Compulsive Disorder (OCD). ERP is considered a first-line treatment in the treatment of OCD - meaning if you have an OCD diagnosis and have not tried ERP, you are missing out on the most evidence-based and well research treatment for the disorder, and it is likely worthwhile to give it a try. ERP is a form of CBT and has a very strong evidence base in reducing symptoms and improving functioning for people with OCD.

Exposure = the practice of facing thoughts, images, objects, or situations that trigger your fears/anxiety; facing the source of your fears and uncertainties that fuel your thoughts.

Response Prevention = Resisting the urge to engage in the compulsive behaviors in response to the obsessions.

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"What's it like to do ERP? "

For clients seeking ERP, I typically start by doing a thorough assessment of their current OCD symptoms, called the YBOCS or C-YBOCS. This will give great info on the types of obsessions and compulsions the client is struggling with, as well as a severity rating of the symptoms. We will use the information from this assessment to create a plan for ERP treatment. Often the next step is creating a hierarchy and working through feared situations/stimuli. This can be real life exposures, or what we refer to as in-vivo exposures (such as if a client has a fear of germs/contamination then we might try touching something considered dirty and not washing hands), or imaginal exposures (such as writing a scenario where the client touches something they worry is contaminated and sitting with the anxiety of what would/could happen next). 

"What if doing exposures is too hard? Building a hierarchy and doing the things I fear sounds terrifying! "

I collaborate with clients to develop an ERP plan that meets them where they are in treatment - there is no one-size-fits-all approach! We tailor the exposures to a client's specific fears/worries/OCD symptoms, and build the hierarchy based off where the client feels they are willing to start and what they feel they can tolerate. My experience has been that clients often are surprised with how much they can actually handle when engaging in exposures, and this builds hope and allows them to feel proud of themselves for conquering anxiety, obsessions, fears, and intrusive thoughts.

Exposure and Repsonse Prevention is often hard work but I find time and time again that the clients who come to me ready to try it make progress in getting their symptoms managed and learn how to get back to living their lives! 

"Is ERP only used for OCD? What if I think I'd benefit from ERP for a different problem I'm facing?"

I have successfully utilized ERP to assist clients struggling with OCD (across many/all subtypes such as contamination, religious/scrupulosity, harm, relationship, sexual, checking, etc.) anxiety / excessive worries, specific phobias (such as emetophobia), and panic disorders / panic attacks.

If you'd like to know more about how I'd use ERP to assist you in meeting your unique therapy goals, please reach out to schedule a free consultation call! 

Acceptance and Commitment Therapy (ACT) expands the foundations of CBT to helping clients connect with what they value, and how to acknowledge and accept feelings without necessarily changing them. ACT can be incredibly useful for clients struggling with intense anxiety, OCD, depression and more mental health diagnoses, as well as for clients who are just generally looking to understand themselves and improve their life. While CBT is based in challenging thoughts, ACT assists clients in learning how to create a different relationship with their thoughts. 

Two of the main tenants of ACT are: 

Acceptance - Accepting that thoughts and emotions are appropriate responses to certain situations

Commitment - Committing to making changes in your life that align with your values

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"What does it look like to do ACT?"

For clients who are interested in doing ACT work, we might start by engaging in an activity that assists clients in identifying their values. From there, we might move on to creating the ACT matrix, which is a tool that helps clients identify and visualize their values and what things might be keeping them from living the life they want to live. These foundational tools of ACT assist clients who would like to better understand what they feel, how their feelings impact their life, what they value, and how to take steps towards meaningful changes.

"How can ACT help with OCD?"

For clients with OCD, I find ACT to be a great supplement to Exposure and Response Prevention work (see below) and this is supported by research as well. While ERP encourages clients to learn how to sit more effectively with uncomfortable thoughts and feelings, ACT helps clients identify what things they wish to gain from their life, what they value, and how to build a life worth living regardless of the content of their OCD thoughts. 

If you'd like to know more about how I'd use ACT to assist you in meeting your therapy goals, please reach out to schedule a free consultation call!