Generalized Anxiety Treatment in Oakland (Bay Area)

Exposure therapy can be practiced in different ways and at different paces. The approach I use, called graded exposure, involves us working together to construct a fear hierarchy. The hierarchy is a list of your specific feared situations ranked according to difficulty. We begin with mildly or moderately difficult exposures, then progress to harder ones. There are several variations of exposure therapy including: In Vivo Exposure: directly facing a feared situation in real life Imaginal Exposure or Virtual Reality (VR) Exposure: vividly imagining the feared situation or using VR to simulate being in the feared environment Interoceptive Exposure: deliberately bringing on physical sensations that are harmless, yet feared, in order to learn that they are tolerable and safe Adapted from American Psychological Association Div. 12 (Society of Clinical Psychology)

Exposure therapy can be effective in several ways, including: Habituation: Over time, people find that their reactions to feared objects or situations decrease. Extinction: Exposure can help weaken your previously learned associations between feared objects, activities, or situations and bad outcomes. Self-efficacy: Exposure can help show you that you are capable of confronting your fears and can manage the feelings of anxiety. Emotional processing: During exposure, you can learn new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear. Adapted from American Psychological Association Div. 12 (Society of Clinical Psychology)

Exposure Therapy is a collaborative process. My goal as your therapist is to help you overcome your fear so that you can live your life more freely. In order to help you get there, I will encourage you to challenge yourself in therapy. However, I will never force you to do any exposure tasks that you do not feel willing and motivated to do. This is important for two reasons: 1) Your trust in me is essential for you to make progress. 2) Exposure therapy is simply not effective if you are “white knuckling” your way through your exposure tasks. The brain does not learn anything new or useful from this kind of experience. In order for exposure to be effective, you must be able to stay present and mindful of what is happening during the exposure task. This is when new learning occurs and how fear becomes more tolerable.

ERP is a type of Exposure Therapy that is specifically used to treat Obsessive Compulsive Disorder. This difference between Exposure Therapy and ERP is that with ERP we are not only gradually exposing you to the feared situation, we are also intentionally reducing or preventing the unhelpful responses (called compulsions) that you usually perform. You will learn more about how ERP works in the first few sessions of treatment.

The process for OCD treatment is the same as described above, with the caveat that a thorough evaluation will likely require additional sessions at each stage described above. With OCD, in contrast to a single phobia, there are often many feared situations or “content areas.” For example, a person with OCD may be fearful of germs, of having violent thoughts, and of their physical environment being altered by others. In a case like this, we would need to assess each of these content areas and the treatment plan would be designed to treat all of them.