Areas of Specialization
Anxiety Disorders & OCD
Some degree of anxiety is completely normal! We wouldn’t be human if we didn’t feel anxiety to a certain extent. However, it’s when that anxiety prevents us from living the life that we want where it becomes an issue. Anxiety is why we do things like checking food for mold before eating or why we look both ways before crossing the street: It’s a survival mechanism. If we didn’t have anxiety, we’d have an extremely short lifespan.
How Can a Behavior Analyst Help Me Manage Anxiety?
Acceptance and commitment therapy (ACT), offers help for anxiety through a unique lens. Rather than trying to control the anxious thoughts or reframing (turning a negative into a positive), ACT is focused on getting “close and personal” with the anxiety and identifying it within your body. From there, we will identify new behaviors that can help with management and living a more fulfilling life.
One thing to note is that I cannot guarantee that your anxiety symptoms will go away. However, I can give you the tools and skills to identify how to move forward with anxiety and allow you to live as fulfilling a life as possible. It is not the anxiety itself that is the root of the issues, but rather the associated avoidance behaviors.
Typically, as we start to identify coping skills and new behaviors, the anxiety will begin to subside since you’re finding new ways to move forward in life and make it part of your experience.
Is Online Therapy a Good Fit for Anxiety?
Yes! Online therapy is wonderful for working with anxiety since it allows you to attend session from anywhere rather than having to come to a physical office. This also provides the opportunity to have session in environments in which you’re struggling, so that you can practice coping skills within the moment (we call this natural environment teaching or “NET” in behavior analysis).
The only time online therapy isn’t a good fit is if one is in active crisis, active medical monitoring necessary (such as with a severe eating disorder), or one is actively suicidal or homicidal or planning suicide or homicide.
Sadly, eating disorders have some of the highest mortality rates of any psychological condition. The main eating disorders are anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). At its core, AN is based on extreme anxiety around food and weight. This leads to restricting behavior that can have detrimental consequences for the body. BN is centered around a cycle of binging and purging (typically self-induced vomiting, excessive exercise, and/or laxative abuse). This cycle of purging can lead to dental and cardiac issues, among other physiologically based consequences. Finally, BED is centered around binging, which is often triggered by things such as stress. However, it is important to note that everyone is different, so behaviors and triggers will vary from person to person.
Besides learning disabilities, ADHD, and LGBT+ issues, working with children through young adults with eating disorders is one of my areas of passion. While these issues are clinically difficult, I find that younger individuals are highly capable of change and recovery with a strong treatment and support team in place.
One important thing to note is that if you or your child require active medical monitoring, telehealth might not be the best fit. However, I’m happy to have a free consultation to discuss the specifics of your case prior to making a determination whether or not to move forward together.
While modern times have led to wider acceptance of LGBT+ individuals, discrimination still exists. I work with LGBT+ children, teenagers, and adults to help identify and engage in affirming behaviors. For example, when working with an individual with gender dysphoria, that might look like identifying ways to feel more masculine, feminine, or non-binary.
At the time of this writing, I am working towards my license as a clinical social worker and plan to expand my service offerings to writing letters for hormone blockers and hormone replacement therapy (HRT). If you desire either of these things, that does not preclude us working together at this time; however, I will refer out to one of my colleagues for that portion of your or your child’s treatment.
An area of clinical practice that often gets overlooked is working with individuals with disabilities. As a behavior analyst, I can’t cure you or your child’s disability; however, our work together will center around accepting disability and developing strategies to live life to the fullest protentional possible.
While I’m competent at working with a wide range of disabilities, I’m most experienced in working with:
Pediatric and adult learning disabilities/ADHD
Physical disabilities, such as cerebral palsy.
Autism Spectrum Disorder
As a legally blind and partially deaf individual with cerebral palsy, I will share my lived experience if it’s clinically relevant. For example, if you are considering working with the Virginia Department for the Blind and Vision Impaired (DBVI), I can help with guiding you in getting started and sharing my own experience. When working with children and teenagers, I will often share my experiences of going through school and college with an IEP/504 to help identify strategies or accommodations that they find helpful.
If an accommodation for school or college is desired, I am happy to write a letter of support. However, it is important to note that currently the accommodation request needs to be behavioral in nature. What exactly does that mean? That means that the accommodation will need to be based on a new behavior, such as the ability to take breaks from schoolwork. With that being said, if you or child have an idea for an accommodation, don’t hesitate to run it by me.
Acceptance and Commitment Therapy
Acceptance and commitment therapy (ACT) is a “new age” behavior therapy rooted in the science of behavior analysis and relational frame theory. It uses the principles of mindfulness, meditation, and committed action to facilitate change in an individual’s life. It is a wonderful tool for working with a myriad of psychological disorders, coping with life’s stressors, or even just finding direction in one’s life or career. It’s an extremely flexible and customizable therapy that involves close collaboration with the patient and therapist. Due to the customizable nature and flexibility of ACT, I cannot provide a “roadmap” for what this might look like. However, ACT makes use of the following core principles:
Defusion is about noticing your emotional side as a separate entity as your core self. In observing your anxiety and your struggle, you naturally get curious and ‘get close to’ the very thing experience that you are most often turning away from and avoiding. By turning towards this struggle and objectifying it as something separate from you, you are shifting your relationship from being a blind sufferer to an outside observer, which can really help to lessen the threatening nature of the experience that you were once desperate to escape. Defusion can oftentimes be the most “fun” part of ACT, your therapist will have a large selection of exercises and techniques that you can try to separate yourself from, or “defuse” from, this inner emotional experience that you are struggling with. Everyone finds their own unique strategy here.
Acceptance is about making room for this emotional experience. By carefully getting to a safe place with your anxiety and/or depression (with the help of your therapist), your therapist may ask you some thoughtful questions such as “do you think that you can make room for your anxiety to be here in this space, if it means that can you move forward with doing XYZ?” (XYZ being something that you feel your symptoms are preventing you from being able to do). A large part of acceptance is self-compassion, and here you can expect to learn how to talk to yourself in a much kinder way, and to also see your anxiety and depression in a much more positive light than before- as something that wasn't nearly as terrible as you were making it out to be. Your symptoms are not always what they seem to be after you get to know them a little bit more.
CONTACTING THE PRESENT MOMENT:
Check in with each of your senses, notice all that is around you. Getting present helps you get in touch with reality- in other words, it helps you to ‘get out of your mind, and into your life’. When you are present, you can contact yourself, your values, your goals, and the tangible situation that you are currently in. Once you are here, you can be safe, and defusion and acceptance can take place.
Values are what you are all about. Values are who you are, what matters to you, what makes life feel good. Everyone has a different set of values, but many share several common values, such as: being kind, being understanding, being open, and being authentic. Your values are your helpers, they are your moral compass when anxiety and strong emotions are trying to push you around. When you make space for your struggles, you often make this space in service of following through with your values.
There is a part of you that notices everything that happens to you. The self-as-context is the "Observer self," from a spiritual side people may refer to this as their soul or their spirit. When you check in with your senses to get present, there is a part of you that is noticing and naming each of your sensual experiences. There is a part of you that notices and reports the thoughts in your mind, and the feelings in your body when your therapist asks about it. This is the part of you that is your voice of reason and that sees the bigger picture.
Now that you are present and checked in with your self-as-context, what are your values in this situation that you are in? What do you want to be about here? What are your bigger goals, and what small actions can you take right here, right now that will bring you a little bit closer to those goals? Identify your preferred course of action, give yourself that encouraging self-talk, and go for it.