It's not all about the ocd with exposure therapy!

I have a mission to use the skills I developed over the last four decades to help as many anxious people as possible find peace. I believe the best way to do this is by offering exposure therapy where it works best. There are several conditions I treat in addition to Obsessive-Compulsive Disorder (OCD), my main focus.

What is it?

OCD is a pattern of obsessive thinking that generates anxiety combined with compulsive rituals to relieve the anxiety. People with OCD commonly have frequent, uncontrollable intrusive thoughts, such as fears of harming other people or fears of contamination. 

There are several subtypes of OCD:

   o Contamination (obsessions about germs or cleanliness, compulsive washing or cleaning).

   o Checking (obsessions about whether safety precautions like turning off the stove or locking the house door were done, compulsive returns to check over and over again).

   o Harm (obsessive fear of doing harm to someone without meaning to, compulsive checking to make sure that didn’t happen).

   o Superstitious (obsessive fear of doing things a certain evil number of times, compulsive need to do things a certain good number of times).

   o Symmetry/Order (obsessive anxiety about things not being just right and in a certain arrangement, and a compulsive need to arrange things the right way).

   o Religiosity or Scrupulosity (obsessive anxiety about violating a religious requirement or ethical principle, compulsive need to make up for sins or ethical infractions or keep every action strictly moral and ethical).

   o Sexual Orientation (obsessive anxiety that sexual orientation is going to suddenly change, like a straight man who fears he will become gay or a lesbian who fears she will become straight or is straight and doesn’t know it, with a compulsive need to prove one’s sexual orientation and avoid contact with people or things that might make one feel like one’s sexual orientation is unstable).

   o Somatic (obsessive anxiety about health or body functions, like breathing, and compulsive need to pay attention to them, as if you might run out of air if you didn’t make sure to breathe often enough).

   o Hoarding/Collecting (compulsive need to collect and keep items even those that have no objective worth or value, and extreme anxiety or grief about letting go of them).

OCD tends to get worse without treatment. It is not common for people to get over OCD without making intense efforts, guided by treatment protocols developed in research labs. 

How I can help!

I have recently taken a brief sabbatical to reflect on my best cases, and I concluded that I am especially effective and excited by my OCD cases. The treatment for OCD, called Exposure and Response Prevention (ExRP) works remarkably well, and the principles by which it works are elegant. It gives me and my clients a lot of creative license to do fun and imaginative things to fight and win against OCD.

When I refer

I might refer you if you need exposure therapy in the real world (called in vivo) and you don’t live in and can’t come to the Columbus area for that treatment. I might also refer you to someone else if my practice is full at that time or if I feel another therapist would be better suited to your needs. 

What is it? 

If you are afraid of certain places, like being on an airplane or bus, or in a mall or big store, or outside alone, you may have agoraphobia. Exposure therapy works wonders here too! If you have agoraphobia and aren’t comfortable coming to my office, we can do telehealth, and coming to my office comfortably could be a treatment goal. 

How I can help! 

Agoraphobia works in a similar way to other phobias, and exposure therapy works for the same reason. Through exposure, you can learn that you can safely face feared situations. This learning changes your brain’s emotional circuits. In the end, you could go to places you now fear without experiencing much discomfort. Exposure therapy works wonders for agoraphobia but only if it is done with skill by a well-trained practitioner.

When I refer

People with agoraphobia sometimes suffer from other mental health problems that require different approaches and expertise that I don’t have, or resources I can’t provide. In these case I refer to others.  

What is it?

Some people experience episodes of depression that last weeks or longer, and other episodes of mania or hypomania that last at least several days. Mania usually involves going without sleep or with very little sleep for at least a few days without feeling tired, while doing risky things. 

How I can help!

Bipolar Illness requires a specialized approach. There have been rapid advances in the past several years. A gold standard option is called Social Rhythm Therapy, part of the general tradition of evidence based cognitive behavioral therapy. I know this in general but am not specifically trained in it.

When I refer

If you have bipolar disorder and you also have anxiety, I would consider treating you only if you have mental health providers (psychiatrist and psychotherapist) who agree that my treatment would not interfere with theirs. I refer people with bipolar disorder to other therapists and psychiatrists to ensure they get the help needed. 

What is it? 

If your moods go negative easily and only slowly return to balance, and your relationships are often stormy because others disappoint you so much, you might have Borderline Personality Disorder (BPD). I think of this as a consequence of a certain type of complex trauma in childhood combined with a genetic tendency toward anger. The first and best treatment was developed by Dr. Marsha Linehan, who had BPD herself. The treatment she developed was based on her own experience, her experience treating many suicidal patients, and her deep science training.

How I can help!

I was trained by Dr. Marsha Linehan in Dialectical-Behavior Therapy (DBT) shortly after she published her treatment manual for this condition. She has been one of the most inspiring psychologists I have had the good fortune to meet. I use her principles of treatment every day, with every client, and in my own life. Her skills training manual is an encyclopedia of healthy ways to cope with life. Dr. Linehan was trained by Dr. Gerald Davison, who also trained me, so my therapy has a family relationship to hers. Dr. Linehan is a strong believer in exposure therapy, and she incorporates exposure to painful emotions in DBT.

First, I am always happy to treat people for an anxiety disorder if they also have Borderline Personality Disorder. The anxiety disorder can be treated, and the treatment may need to include elements of DBT, which I have deep expertise in. 

Second, I do not offer the full treatment package known as DBT. That requires several therapists closely working together as a team in a group practice, clinic, or hospital setting. What I do offer I like to call Dialectically Informed Behavior Therapy, or DIBT. This means I teach life skills in therapy sessions (rather than running a group for skills training). 

When I refer

However, I do refer out in many cases if I believe a person with BPD needs the full DBT treatment, with all of its components.

What is it?

For some people gambling is not only about the excitement of the win, it’s a way to distract from pain points in life. A breakup. A job loss. Mounting debts. 

How I can help!

If this is you, guess what? Exposure therapy combined with cognitive tools can dramatically change your experience of betting. Through tailoring of treatment to your own particular pattern, an expert in CBT would likely be able to give control back to you. Gambling is fun until it becomes a compulsion, and then it’s a nightmare. Luck isn’t such a lady when that happens. 

A special area of expertise for me is the math of probability. A lot of this math was developed by geeks for use by gamblers, and my own special way to help gamblers is to train them in the basics of this math. When you learn how to decide which bets are rational and which ones are not, you gain a huge edge over the house. 

I’m willing to bet the costs of my treatment are nothing compared to the costs of your gambling problem! Take a chance on yourself and your future today by setting up a no-cost consult.

What is it?

Depression is one of the most disabling illnesses, even when compared to cancer, diabetes, and heart disease. If you have lost the joy you used to feel, have little energy, are sleeping way more or less than normal, and your appetite is off, you may have depression.

How I can help! 

I do treat depression as well. Anxiety is the mother of depression, and most people with an anxiety disorder suffer some degree of depression as well. In my experience, and based on my review of evidence, I believe most people who overcome their depression still have an anxiety disorder in the background. Until that anxiety is well treated, the depression is likely to return. 

I work particularly well with people who are depressed about a temporary life situation or relationship problem. Exposure works here too, in a way. Depression is often the mind’s way of trying to get you to face a very painful reality that is overwhelming. 

Through treatment, I help my depressed patients face that pain head on and develop and enact a plan to cope with it. When the depression lifts, it is important to overcome a pattern of avoiding painful situations until they become triggers of depression.

When I refer

I am likely to refer you out, though, if you have severe depression that needs a higher level of care than I can offer, such as an Intensive Outpatient Program. Ohio State has an excellent program for people with severe depression who need that level of care. I also tend to refer out if your primary problem is bipolar depression. While I know the major treatments for bipolar disorder well and have worked with many bipolar patients successfully, I find that focusing tightly on people who can benefit from exposure-based behavior therapy allows me to develop specialized skills and maximize my impact. The very best approach I know for bipolar depression is called Social Rhythm Therapy, and I tend to refer to a practitioner of that approach or another highly trained cognitive-behavioral therapist when a client suffers from bipolar disorder.  

What is it?

Although addiction is not an official diagnostic label (at least in DSM), it means the loss of control over your use of a drug, alcohol, or a medication. People with addiction try to quit but wind up using again, and when they start using, they use more than they mean to when they started. They know it’s bad for their health or relationship, and they continue anyway.

How I can help!

While I am not a specialist in this area, many of my clients with anxiety also have troubles with things they use to help. These often include alcohol, cannabis, medications, or street drugs. If your primary issue is an anxiety disorder and your anxiety has led to addictive behavior, I can still help you if you are completely committed to ending your alcohol or drug use while you undergo anxiety treatment. 

When I refer

If you are not yet committed, I would refer you to an expert in the treatment of alcohol and drug problems or to a program that specializes in addiction recovery.  

What is it?

OCPD is a different condition than OCD, one where a deep and pervasive perfectionism poisons joy and relationships. 

How I can help!

I also treat this condition, thought the treatment is not as easy to focus in the laser like way ExRP focuses on the core issue that keeps OCD going. Sometimes, OCPD shows up as workaholism or a Type A behavior pattern. If you are never happy with the standards other people hold themselves to, you may have OCPD. 

When I refer to others

OCPD requires a more long term treatment, and motivation is difficult for most sufferers. I might refer you to another therapist if I feel you need to work on insight or motivation before you are ready for the intensity of exposure therapy for your OCPD.  

What is it?

A phobia is an irrational fear of a particular object or situation leading people to avoid normal things. If you have one or a few very specific feared situations or objects, you may have a phobia.

How I can help!

People with a more focused fear of certain situations, such as riding elevators or speaking in public, benefit just as much from exposure therapy as OCD patients. I have ridden elevators, gone driving, and handled spiders with patients who suffer from phobias. 

When I refer

I might refer you to another provider if I feel your phobia would be better handled by that person, or if you need real life exposure therapy and we cannot meet in person due to your location (outside of Columbus and unable to travel to my office). Some phobias can be very well treated by telehealth with the client in the real world setting, while others (like driving phobias) should not be treated that way.

 What is it?
Do you have sudden intense waves of anxiety where you are afraid you may pass out or die, or go crazy and never get better? A true panic attack is sudden and unexpected, and it reaches a peak within about 10 minutes. Often people think they are having heart attacks because the symptoms are so similar, so panic attacks can make people drive up enormous ambulance and ER bills. 

How I can help!

I use a focused protocol for panic treatment that involves exposure to the feelings of panic that happen in the body. I train my clients that they can trigger their own panic feelings, which strangely helps take the mystery out of them. In panic disorder, people get frightened of fear itself. Just as in OCD, exposure treatment works extremely well in a brief and focused set of sessions. 

When I refer

Sometimes people with panic attacks are also troubled by other pretty big mental health problems, including severe depression, bipolar illness, drug and alcohol problems, and or schizophrenia. In such cases, I would likely refer you to another therapist, a psychiatrist, and/or an inpatient program or residential treatment program. 

 What is it?

If you have experienced a traumatic event, which could include the trauma of many overwhelming stressors in childhood combined with a lack of family support, you may have an overly reactive nervous system which keeps you on edge all the time, looking for threats. 

How I can help!

I have treated many clients with PTSD successfully using cognitive-behavioral methods. These days, I primarily rely on Prolonged Exposure and Cognitive-Processing Therapy. However, PTSD is not an area of special focus for me, so if this is your primary problem, I might refer you to one of the PTSD experts I know well.

When I refer

If you want a treatment I don’t offer, such as Ketamine assisted therapy, EMDR (Eye Movement Desensitization and Reprocessing), IFS (Internal Family Systems), Brainspotting, Somatic Therapy, or psychoanalytic therapy, I would refer you to another provider. There are many wonderful developments in PTSD treatment in the past few years, and there are many excellent approaches. You can choose based on your own needs and preferences. I encourage you also to look into the scientific evidence that supports whatever treatment you choose.