My overall therapy approach is known as cognitive-behavioral therapy (CBT) or mindfulness-based cognitive-behavioral
therapy (MBCBT). I draw upon Acceptance and Commitment Therapy (ACT) and the relationship research of John Gottman, PhD.
Anxiety disorders (such fear
of panic attacks, agoraphobia and other phobias) and obsessions and compulsive rituals, usually involve some degree of physical
distress along with an overwhelming sense that something has to be escaped or avoided and that it cannot be
faced. Compulsions involve the sense that something has to be done and/or that certain intrusive thoughts have to
be thought about. It turns out that giving into these very strong thoughts and feelings makes the problem worse. Typically,
a large portion of the person's life thus wasted. The usual efforts to find relief sometimes only compound the problems.
points to my recommending, as needed, mindfulness meditation and other attention-management tactics. To over simplify, there
are two basic skills to develop: One is being able to observe, notice, consider, etc. a distressing thought, feeling, memory,
image, worry, or the like, as if from a distance and without getting involved in it. The other is being
able to merely notice the thought, or whatever, and then being able to shift your focus to something else that is not distressing.
Use of these skills is often central to effectively dealing with the presenting problems. Further, there is more and
more scientific evidence, from brain-scan studies, that regular practice of mindfulness meditation, such as in breath-awareness
practice, causes positive brain growth associated with reduction in overall negative emotional reactivity. As always, exercise helps.
Mindfulness cognitive-behavioral therapy involves my actively coaching you in the use of practical psychological
tactics, based on scientific findings and my clinical experience. While this approach also involves supportively and empathetically
understanding your relevant life history and your feelings, MCBT importantly focuses on your adding to yourself toward your
having better ways of handling your present and future symptoms, problems, challenges, and opportunities.
Life brings difficulties; it is not wise to be overly
invested in escaping or avoiding them, such that living a full and meaningful life is neglected
in the process.
frequently involves asking you to use, when appropriate, softer, less emphatic language when speaking and thinking of negative
things, within you and in your life. For example, as a training exercise, consider variations on this (admittedly long-winded)
statement, "There's a part of me that is finding this situation difficult at the moment." Sometimes, "difficult"
or "unpleasant" are better than "can't."
MCBT also frequently involves asking you to make small steps now toward the goals you set for yourself, which generally
lead to more composure, competence and confidence in over-coming symptoms and difficult situations. For example, with anxiety,
panic and phobias, a frequent strategy involves exposure, in a gentle, "baby-step," under-your-control manner, to
situations and symptoms you may have been avoiding or escaping. Accumulating small successes results in increased competence
and, thus, increased confidence.
Mindfulness-based cognitive therapy is generally
compatible with and may sometimes be used instead of psychiatric medications. It is generally not true that you can
get better only with psychiatric medications or that you neccessarily need such medications
The number of visits needed varies greatly, depending upon the problems.
8 to 10 visits is a good, rough initial estimate for substantial work. On the other hand, I make efforts to have to therapy
proceed rapidly. You usually can tell within a very few visits whether you like working with me and whether my approach to
your problems is likely to prove worthwhile. Be aware, though, that our success will depend upon the work you do. As has been
said, "The power is in the practice."
Please call and talk with me if you have questions.