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Hoarding treatment: Choosing the right therapist

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If you are an individual who struggles with hoarding, you might have been frustrated by negative treatment experiences in the past.  For most individuals who hoard, treatment can be challenging.  However, it is an essential ingredient for regaining control and reclaiming your life. When selecting a therapist to help you address your hoarding, make sure that your potential therapist practices cognitive behavioral therapy for hoarding (or CBT for hoarding).  Based on research studies, this type of treatment is most likely to be effective in supporting long-term positive changes and leaving you less vulnerable to relapse.  Unfortunately, there are very few South Florida psychologists who have formal experience with hoarding treatment.  Make sure that when you interview your potential psychologist, you ask them about their experience in treating hoarding.  A CBT orientation alone is not sufficient; make sure that they’ve treated other...

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Specific phobias: symptoms & CBT treatment (reader question)

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Question: Basically, I wanted to know from an expert, what can a phobia do to a person? How does it affect them mentally? Also I see that you’ve got a new treatment philosophy — is there any way you can talk me through it? One of the goals of cognitive behavioral therapy (CBT) is to learn to better understand the interrelationships among thoughts, feelings, and behaviors.  Once you understand how these things are connected, it gives you a lot of power to implement change. Most people who seek therapy do so because they are experiencing an emotion they don’t want to have.  In the case of depression, the person might feel sad.  In the case of a phobia, the person might feel scared.  People often have trouble modifying these feelings directly because emotions tend to be somewhat involuntary.  If...

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ERP therapy for OCD: Shifting from destructive to constructive to gestalt notions

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Here’s a question for you: Is exposure and response prevention (ERP) fundamentally a destructive or constructive process? I think that many people naturally conceptualize it as more of the former than the latter. They conceive of ERP as being the process by which we can “unlearn” or “weaken” maladaptive associations. We learn, through repetition, to no longer be afraid of those things that previously incited fear. On the surface, this appears to be a notion predicated on destruction. In actuality, it is not. If you ever take the time to refer back to the basic animal literature on fear learning and fear “unlearning”, you’ll find that associations appear to be weakened largely as a consequence of new learning taking place. This new learning competes with (and weakens the expression of) previous learning. It is this process that accounts for...

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OCD guilt, shame, disgust, anxiety & depression: Why treatment sometimes fails (and what to do about it)

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OCD isn’t just about anxiety. Although anxiety is certainly a prominent feature of the disorder, clinicians who only attend to anxious symptoms can easily overlook some of its other core features. As a psychologist in Palm Beach, Florida, I work closely with kids, teens, and adults throughout the greater Palm Beach, Fort Lauderdale, and Miami areas on strategies for recovering from OCD. In the patients I treat, anxiety is often accompanied by significant guilt, shame, disgust, and depression. These features are not necessarily related to, or caused by, anxiety; they can be distinct processes. If you (or your psychologist) conceptualize exposure and response prevention (ERP) as only a means to habituate to anxiety but fail to consider how treatment must also address these other features, you are likely to have a suboptimal treatment response and will continue to experience significant...

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OCD, ERP, & doubt sensitivity: Shattering the illusion of certainty

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Many individuals with OCD hunger for certainty. It’s a craving that often can’t be easily sated. Early conceptions of OCD from the 19th century acknowledged this issue directly, in that OCD was often termed the “doubting disease.” It is this need for certainty, the need to eliminate doubt, that leads many people with OCD to perform repetitive behaviors, which are known as rituals. For example, it is doubt about whether one’s hands are sufficiently clean that leads one to engage in repetitive hand-washing rituals. Likewise, uncertainty about whether a stove has been turned off (and worry about potentially dire consequences) can underlie checking rituals. Many different types of rituals involve reassurance-seeking behaviors. For people with OCD who have intrusive bad thoughts (e.g., What if I secretly want to hurt a family member? What if I don’t believe in God...

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