NESCA is currently accepting Therapy and Executive Function Coaching clients from middle school-age through adulthood with Therapist/Executive Function Coach/Parent Coach Carly Loureiro, MSW, LCSW. Carly specializes in the ASD population and also sees individuals who are highly anxious, depressed, or suffer with low self-esteem. She also offers parent coaching and family sessions when needed. For more information or to schedule appointments, please complete our Intake Form.

Tag

CBT

15

The Power of Mindset

By | NESCA Notes 2024

By: Carly Loureiro, MSW, LCSW
Licensed Clinical Social Worker and Executive Function Coach

Phrases like “mind over matter,” “the glass is half full,” and “making lemonade out of lemons,” are more than just popular sayings; they capture the essence of having a positive mindset. With the complexities that everyday life can bring, maintaining a positive mindset can feel overwhelming. Negative thoughts and emotions often creep in, clouding our judgment and affecting our mental health. Learning how to maintain a positive mindset can help individuals overcome these negative thoughts, leading to a decrease in anxiety and depression symptoms, higher self-esteem, as well as improved physical well-being and interpersonal relationships. Those needing assistance in gaining control of their mindset should consider Cognitive Behavioral Therapy, a therapeutic intervention that can aid in strengthening this skill, leading to desired outcomes.

Understanding Mindset

A mindset is a set of beliefs or attitudes that shape how we perceive and respond to situations. Broadly, mindset can be categorized as positive or negative:

  • Positive Mindset: Involves seeing challenges as opportunities, maintaining optimism, and focusing on potential rather than limitations.
  • Negative Mindset: Involves focusing on problems, expecting unfavorable outcomes, and feeling overwhelmed by obstacles.

Mindset shapes our internal dialogue and emotional responses, such as how we react to challenges. A positive mindset promotes constructive thoughts and emotions, leading to feelings of hope, joy, and contentment. For example, someone with a positive mindset is more likely to engage in proactive coping strategies, such as going for a walk, engaging in positive self-talk, and practicing mindfulness and gratitude. Conversely, a negative mindset can foster destructive thoughts and emotions, leading to avoidance, self-sabotage, or other harmful behaviors.

The Role of Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is a powerful and effective psychotherapeutic treatment that helps individuals understand how their thoughts, feelings, and behaviors are interconnected. A CBT therapist helps clients learn new skills and strategies to gain more control of their thoughts, leading to a happier and healthier approach to problem solving. CBT is widely used to treat a range of mental health disorders, including depression, anxiety, phobias, and PTSD.

See below a visual of the cognitive triangle, often used to help people better understand the concept of CBT and how it applies to their own personal experiences:

Components of CBT That Contribute to Positive Mindset:

  1. Self-awareness: Becoming aware of your thought patterns and where they originated, noticing when you tend to think negatively, and really understanding how it influences your feelings and behaviors
  2. Cognitive Reframing: Challenging negative thought patterns when you notice them and replacing them with thoughts that are more positive, leading to actions that are productive
  3. Mindfulness and Relaxation Techniques: In order to gain more control of your thoughts, incorporating mindfulness and relaxation techniques can help individuals reset and shift their thinking patterns
  4. Gratitude Practice: Regularly reflecting on things you’re grateful for can also help shift your focus from what’s lacking to what’s abundant in your life, increasing motivation and self-esteem
  5. Positive Affirmations: Reinforcing your self-worth and capabilities with positive affirmations
  6. Homework: CBT therapists may assign tasks to be completed in between sessions in order to practice newly learned skills

An Example:

Tanya, a ninth grade student, has an upcoming history final. Final exams tend to be difficult, as her slower processing speed impacts her ability to grasp a magnitude of details. With her executive function coach, Tanya has learned new ways to memorize larger quantities of information, such as making associations and using mnemonic devices and visuals. In the past, prior to a test or quiz, Tanya got stuck in negative thinking patterns, such as telling herself she will not get a passing score, or that she isn’t smart enough. These negative thoughts would make her feel hopeless, inadequate, and self-conscious. Before the test or quiz, she’d become distracted by these thoughts, not putting forth her best effort, resulting in scores that didn’t reflect her knowledge.

Tanya began working with a CBT therapist to help her mitigate the impact of her performance anxiety. By incorporating mindfulness, gratitude, and thought log exercises (see examples below), she learned how to reframe unhelpful thoughts into productive ones, leading to scores that matched her knowledge and skill set. Instead of telling herself, “I won’t pass this test,” she’d tell herself, “I studied for this test, therefore I have the knowledge and my score will reflect that!” By shifting her mindset and correcting the negative thoughts, Tanya learned the impact they had on her performance. She’s now learning how to apply these strategies to all of her academic classes to normalize having a positive mindset.

Examples of Exercises:

Mindfulness exercise: Each morning while eating breakfast, Tanya listens to a quick 2-minute guided meditation, helping her become more present and ready for the day, moving away from negative thoughts that could impede her success.

Gratitude exercise: Tanya completes a prompt in her gratitude journal before bed, reflecting on daily highlights, such as something that made her smile that day, or a way she helped a friend or classmate.

Thought log exercise: Tanya’s therapist created a thought log for her to challenge her negative thoughts when she found herself experiencing them, and replacing them with an uplifting thought.

Looking for support in this area?

Negative thoughts can be difficult to overcome alone. If you are interested in CBT to receive support in gaining control of harmful thinking patterns, you can book a free introductory call with me by filling out our online intake form.

  

About the Author

Carly Loureiro is a Licensed Clinical Social Worker practicing in Massachusetts and Rhode Island. Having worked both in private practice and schools, she has extensive experience supporting students, families and educational teams to make positive changes. Mrs. Loureiro provides executive function coaching and psychotherapy to clients ranging from middle school through adulthood. She also offers consultation to schools and families in order to support her clients across home and community environments.

To schedule an appointment with one of NESCA’s counselors, coaches, or other experts, please complete our online intake form. 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham, Massachusetts; Londonderry, New Hampshire; and staff in the greater Burlington, Vermont region and Brooklyn, New York, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

1

NESCA Goes to Brain Camp – Exploring the Connections among Brain Anatomy, Emotional Health, and Neuropsychology

By | Nesca Notes 2023

By Angela Currie, Ph.D.
Pediatric Neuropsychologist; NH Director, NESCA

For three days every July, students, clinicians, and researchers from around the country descend upon Milwaukee for Marquette University’s Neuroanatomical Dissection Course. This Marquette course is the only one in the world that provides a continuing education opportunity to learn about advances in neuroscience research while also engaging in hands-on brain dissection within the university’s gross anatomy lab. This past July, my NESCA colleague, Dr. Erin Gibbons, and I had the pleasure of being two of the participants.

Perhaps not unexpectedly, the lab components of the course were insightful and impactful. This included watching 3-D computer-aided brain maps within the visualization lab at the engineering school, as well as hands-on brain dissection of donor specimens, some of which presented with unique pathologies that had never been seen first-hand within the lab. Across the three days of the seminar, lectures covered a range of topics, such as neuroanatomy, how emotions function in the brain, and functional and neurological presentation of brain pathology. We also had the opportunity to select from a range of presentations that provided a “deep dive” into more specific topics. There was a host of information that directly speaks to our practice as pediatric neuropsychologists. That said, as someone who often works with clients who face depression, anxiety, and trauma, certain information stood out as most relevant to my daily practice.

First, there is an increasing amount of research indicating that early-onset (onset in childhood or adolescence), prolonged depression can significantly reduce the growth and volume of particular brain areas related to learning and memory; however, this negative impact can be ameliorated with antidepressant medication.1,2 Often times, when working with clients, families are understandably reticent about giving medication to their developing child. While individual response to treatment cannot be predicted, this research shows that, when appropriate to the client’s needs, medication can actually protect brain development, and thereby better support learning and memory over the lifespan.

Another topic that was covered was the impact of trauma on brain development and later self-regulation challenges and treatment response. As a clinician who often sees children with developmental, complex trauma, I am often in the position of explaining to families how trauma affects brain development. There is research to suggest that ongoing adversity early in childhood inhibits development in areas of the brain that manage inhibition, emotions, and processing, and this may contribute to later difficulties understanding emotion and modulating stress.3 While trauma may affect brain development in any child, there are also some children who appear to persist through adversity with lesser effect. There is research to suggest that this “resiliency” may not just be a personality characteristic, but may be a result of a larger, better-developed area of the brain that is thought to integrate emotional and cognitive information, allowing them to better manage emotional responses.4 Stronger development in this area can also predict better response to cognitive behavior therapy in older individuals with PTSD. 5 While it is not always clear what allowed those individuals to have stronger brain development, research shows that early treatment and access to social supports results in improved emotion processing and brain function in children with trauma, emphasizing neuroplasticity within the brain.6,7

The message that can be extracted from the above research is that the brain is highly vulnerable, but it can also be very resilient and adaptable. While our experiences and genetic vulnerabilities may present their challenges to neurological development, proper therapies, social supports, and medications can change a person’s developmental course and support long-term gains. Actually measuring brain volume and conducting imaging is not necessary for understanding how these factors present within an individual person. Instead, comprehensive assessment of their neurocognitive functioning, processing, learning, and social/emotional functioning can elucidate their resiliency factors, as well as targets for intervention. This is what we have always strived to do at NESCA, and now with the advantage of the Marquette Neuroanatomical Dissection Course, we can demonstrate how our clinical process, values, and goals are supported by current brain research.

 

References

  1. Schmaal, L., Veltman, D., van Erp, T. et al.(2016). Subcortical brain alterations in major depressive disorder: findings from the ENIGMA Major Depressive Disorder working group. Molecular Psychiatry, 21: 806–812. https://doi.org/10.1038/mp.2015.69
  2. Sheline YI, Gado MH, Kraemer HC. (2003). Untreated depression and hippocampal volume loss. American Journal of Psychiatry,160(8):1516-1518. doi: 10.1176/appi.ajp.160.8.1516.
  3. Zhai ZW, Yip SW, Lacadie CM, Sinha R, Mayes LC, Potenza MN. (2019). Childhood trauma moderates inhibitory control and anterior cingulate cortex activation during stress. Neuroimage, 185:111-118. doi: 10.1016/j.neuroimage.2018.10.049.
  4. Stevens, JS, Ely, E.D., Sawamura, T., et al. (2013). Childhood maltreatment predicts inhibition-related activity in the rostral anterior cingulate in PTSD, but not trauma-exposed control. Depression and Anxiety, 33(7): 614-622. https://doi.org/10.1002/da.22506
  5. Bryant RA, Felmingham K, Whitford TJ, et al. (2008). Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder. Journal of Psychiatry and Neuroscience, 2008, 33(2):142-6. PMID: 18330460.
  6. Wymbs, NF, Orr, C, Albaugh, MD, et al. (2020). Social supports moderate the effects of child adversity on neural correlates of threat processing. Child Abuse & Neglect, 102: 104413. https://doi.org/10.1016/j.chiabu.2020.104413.
  7. Garrett A, Cohen JA, Zack S, C, et al. (2019). Longitudinal changes in brain function associated with symptom improvement in youth with PTSD. Journal of Psychiatric Research,114:161-169. doi: 10.1016/j.jpsychires.2019.04.021.

 

About the Author

Dr. Currie specializes in evaluating children, teens, and young adults with complex profiles, working to tease apart the various factors lending to their challenges, such as underlying learning, attentional, social, or emotional difficulties. She particularly enjoys working with the seemingly “unmotivated” child, as well as children who have “flown under the radar” for years due to their desire to succeed.

 

To book an evaluation with Dr. Currie or one of our many other expert neuropsychologists, complete NESCA’s online intake form. Indicate whether you are seeking an “evaluation” or “consultation” and your preferred clinician in the referral line.

 

NESCA is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Plainville, and Hingham (coming soon), Massachusetts; Londonderry, New Hampshire; and the greater Burlington, Vermont region, serving clients from infancy through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

39

So, You Are Taking a Leave of Absence from College—Now What?

By | Nesca Notes 2023

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

Almost 75% of college students reported moderate to severe psychological distress during the 2020-2021 school year (National College Health Assessment, American College Health Association, 2021). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. My appointment calendar is often made up of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com, call 617-658-9800 or complete our online Intake Form.

39

So, You Are Taking a Leave of Absence from College—Now What?

By | NESCA Notes 2022

By: Kelley Challen, Ed.M., CAS
Director of Transition Services; Transition Specialist, NESCA

Almost 75% of college students reported moderate to severe psychological distress during the 2020-2021 school year (National College Health Assessment, American College Health Association, 2021). College students across the country are continuing to struggle with depression, anxiety, self-harm, and suicidal thoughts this school year. In the weeks leading up to Thanksgiving, my appointment calendar consisted primarily of meetings with college students or parents of college students beginning the process of taking a leave of absence and wondering what to do next. Here are some tips that I shared with many of these students and families.

Get Treatment

Many students need to participate in skill-based therapies (cognitive behavioral therapy, dialectical behavioral therapy, exposure and response prevention, acceptance and commitment therapy, etc.) in order to build up coping skills that may not have been developed in high school. Depending on the severity of current mental health issues, a student may need to participate in an intensive inpatient or outpatient treatment. Ultimately, many students need to find a supportive outpatient therapist—ideally someone who will be able to continue treating the student if they plan to make a future college attempt.

Psychopharmacological intervention (i.e., medication) can be important to consider. Sometimes students have not been taking medications as prescribed or they are taking medications exactly as prescribed but not gaining the intended benefits. Consulting with a prescriber can be an important treatment step for determining whether medication, or medication changes, are necessary.

Get Exercise

For any student, having a regular routine for exercise, sleep, and healthy diet has an impact. However, this is even more critical for students who are vulnerable to anxiety and/or depression. Exercise does not have to start big. Walking (with or without the dog), hiking, or just moving along to a YouTube fitness video for 10 minutes a day will make a difference. It’s critical to schedule the exercise in and often easiest if this is part of a morning or evening routine. For some students, working with a personal trainer or attending scheduled classes helps with accountability. Using a wearable exercise tracker like a Fitbit, Garmin Watch, or Apple Watch can also help with motivation and consistency.

Get a Job

Over the past 25 years, we have seen a notable decrease in the number of high school students who have participated in paid employment. Many students went off to college without taking time to connect college participation with future career interests. Using time off from school to explore work preferences and build transferrable skills (and a resume) can help students experience efficacy and improve mood. As a college student, no one is particularly excited when you show up to class, and the professor certainly doesn’t depend on you in order to get their job done. However, as an employee, students can experience tangible success through accomplishing work activities, receiving gratitude from coworkers and supervisors, and earning money. Work can also provide an important social experience. This is also an historic time to be looking for a first or early career position in the American workforce. Entry-level workers can make good wages. and there are plenty of part-time job openings across industries. Moreover, it’s difficult to get fired right now because good help is truly hard to find.

For students who are not ready to commit to paid work, and need time to recover and build energies up, volunteer jobs are also good opportunities. Some students will do better with brief drop-in volunteer activities while others my want to schedule more routine work hours.

Consider Taking Classes

When students take a leave of absence from college, the assumption is that the student will want to return to a college experience. But many students take a leave of absence and determine that they do not want to go back to college or that they do not want to go back to the same college. If a student wants to keep up academic skills, they can audit or take one or more college courses during the spring semester (depending on their college’s policies and whether they are planning to return). Community colleges, state colleges, and part-time or online college programs (like Harvard Extension School) are good options to explore for classes of interest as a non-degree seeking student. Starting back with a class that is high interest or a low degree of difficulty can be helpful for students who need to rebuild confidence. Additionally, when students are unsure if they are going to return to college or uncertain of a potential future major, it can be good to try classes that are likely to transfer and generally meet basic liberal arts requirements.

Get a Coach

Some students with mental health issues have other underlying challenges that contributed to their struggles in college. There could be a learning disability that wasn’t appropriately being addressed with accommodations, executive function challenges that impacted keeping up with pace, or volume of academics, social challenges that were exacerbated by the highly social dorm environment, or other issues. It is important to consider whether there are skill deficits that may have contributed to a student experiencing anxiety or depression. Some students will benefit from life skills, executive function, or social coaching in order to build up areas that are weaker before heading back to college (or may want to continue with that coaching when they head back).

Other students may want to take time to work with a career or transition coach to do some self-exploration. Taking a step back to participate in self-assessment related to one’s preferences and interests and to determine how those align with potential college major and future career interests can be helpful. I have worked with several students on leave to go through a career planning process. For some, they discover that they chose exactly the right college and major, and that can increase motivation when they get back to school, with proper supports in place. For others, this process sets a student on a completely new path.

Let us know, in our online Intake Form, if your student needs support during their time off from school and/or coaching to assist during their time off or when they return to college.

 

About the Author
Kelley Challen, Ed.M., CAS, is NESCA’s Director of Transition Services, overseeing planning, consultation, evaluation, coaching, case management, training and program development services. Ms. Challen also provides expert witness testimony in legal proceedings related to special education. She is also the Assistant Director of NESCA, working under Dr. Ann Helmus to support day-to-day operations of the practice. Ms. Challen began facilitating programs for children and adolescents with special needs in 2004. After receiving her Master’s Degree and Certificate of Advanced Study in Risk and Prevention Counseling from Harvard Graduate School of Education, Ms. Challen spent several years at the MGH Aspire Program where she founded an array of social, life and career skill development programs for teens and young adults with Asperger’s Syndrome and related profiles. She additionally worked at the Northeast Arc as Program Director for the Spotlight Program, a drama-based social pragmatics program, serving youth with a wide range of diagnoses and collaborating with several school districts to design in-house social skills and transition programs. Ms. Challen is co-author of the chapter “Technologies to Support Interventions for Social- Emotional Intelligence, Self-Awareness, Personality Style, and Self-Regulation” for the book Technology Tools for Students with Autism. She is also a proud mother of two energetic boys, ages six and three. While Ms. Challen has special expertise in supporting students with Autism Spectrum Disorders, she provides support to individuals with a wide range of developmental and learning abilities, including students with complex medical needs.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com, call 617-658-9800 or complete our online Intake Form.

2

The Enemy of the Good

By | NESCA Notes 2020

By Jason McCormick, Psy.D.
Pediatric Neuropsychologist

As a neuropsychologist who has primarily focused on assessment of middle school, high school and college students, I have worked with many children, adolescents and young adults plagued with perfectionism. On the surface level, perfectionism is defined as a refusal to accept any standard short of perfection. Digging deeper, at the roots of perfection are fears of making mistakes, fears of being judged, and, ultimately, fears of being inadequate.

By definition, students with perfectionism hold impossibly high standards, which can severely undermine productivity and can lead to high levels of emotional distress. The adage, perfection is the enemy of the good, “perfectly” describes these students’ challenges. Students with perfectionism often run into “blank-screen syndrome,” presenting with such a harsh self-censor that they shoot down their own good ideas before they have a chance to develop them. Further, with the additional time needed to “gild the lily,” students often end up blowing past paper deadlines, thus undermining their grades.

Complicating treatment, many students – even those with recognition of their impossibly high standards – view a call to work on ameliorating their perfectionism as an intolerable directive to lower their standards or even as an affront to their intelligence and ability levels. Thus, despite the emotional distress and work production challenges perfectionism causes, many students with perfectionism present with insufficient motivation to change.

In response, treatment needs to begin with helping these students appreciate the negative impact perfectionism can have on their mental health, and, from a more mercenary standpoint, on their grades. Further, it will be important for these students to be able to broaden their definition of success beyond mere quality to include a balance of quality and efficiency. An A paper turned in two weeks late might earn a B, C or even (depending on the philosophy of the teacher or professor) a failing grade, due to its tardiness.

After securing some buy-in, work with a therapist or therapeutic tutor, with background in cognitive-behavioral therapy, is often needed to move the needle on perfectionism. More specifically, the use of exposure and response prevention (ERP) can be effective. Typically used to treat obsessive-compulsive disorder (OCD) and phobias, ERP involves exposing an individual to their feared stimulus (e.g., heights, snakes and in this case sub-perfect work) and not allowing for the avoidant response (in this case, over-reviewing/over-thinking behaviors that are used to avoid the possibility of mistakes). For instance, an ERP assignment might involve a student setting a reasonable time limit to complete a given task and having the student pass in that work, no matter what final state it is in. Over time, such work can help a student progress toward their ultimate goal of producing “the good enough paper.”

To be clear, this progress does not happen overnight, and it can feel difficult and mentally painful. However, it is important work, as learning to strike a reasonable balance between quality and efficiency is a critical element of the “hidden curriculum,” needed for success in college and the workforce.

 

About the Author:

Dr. Jason McCormick is a senior clinician at NESCA, sees children, adolescents and young adults with a variety of presenting issues, including Attention Deficit Hyperactivity Disorder (AD/HD), dyslexia and non-verbal learning disability. He has expertise in Asperger’s Disorder and has volunteered at the Asperger’s Association of New England (AANE). Dr. McCormick mainly sees individuals ranging from age 10 through the college years, and he has a particular interest in the often difficult transition between high school and college. As part of his work with older students, Dr. McCormick is very familiar with the documentation requirements of standardized testing boards. He also holds an advisory and consultative role with a prestigious local university, assisting in the provision of appropriate academic accommodations to their students with learning disabilities and other issues complicating their education.

 

To book a consultation with Dr. McCormick or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

5

Intensive Cognitive-Behavioral Therapy (CBT) for Anxiety

By | NESCA Notes 2018

 

By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

Deciding to enroll your child in mental health treatment is a big step in and of itself. Before initiating the process, there is often a trial and error period of interventions to improve the situation, whether at home or in school, and then coming to terms with the fact that they might not be enough to sufficiently address your child’s needs. Finding the right therapy and therapist match for your child can also prove challenging. Not only are there numerous therapeutic approaches available, but there are also varying levels of care depending on the severity of your child’s symptoms and amount of support he or she requires. This ranges from once weekly outpatient therapy to day treatment programs to inpatient hospitalizations for more acute psychiatric issues that may require crisis stabilization (i.e., suicidality, self-harm, etc.)

One type of treatment that has garnered considerable empirical support for treating youth anxiety and depression (conditions we regularly treat at NESCA) is Cognitive-Behavioral Therapy (CBT). CBT focuses on the intersection between our thoughts, emotions, bodily sensations and behaviors. The goal of CBT is to better manage overall emotional distress and reduce physiological symptoms by changing negative thoughts or unhelpful thinking patterns, ineffective coping strategies, and maladaptive behaviors that might be reinforcing uncomfortable feelings. CBT aims to teach children and their parents new, adaptive coping skills while providing opportunities both in and between sessions to practice these skills. CBT is a short-term, targeted treatment that promotes “approach” behaviors (as opposed to “avoidance”) through “exposures,” or exercises designed to practice facing fears gradually, in a safe environment. CBT might also include learning mindfulness, emotion regulation, and distress tolerance; techniques that have been shown to enhance treatment outcomes.

While some youth make progress in meeting with a therapist once per week, others benefit from a condensed, “intensive” format where they receive CBT treatment daily and over a shorter period of time. The accelerated nature of these types of programs, offered in both outpatient and hospital-based settings, allows for quicker acquisition of strategies, substantial exposure practice, and generalization of newly learned skills to other settings in a child’s life. Think of it as a crash-course in CBT.

You may want to consider an intensive therapy program for your child if: 

  • Your child’s symptoms are greatly interfering with his or her life, such as attending school or school performance, family life, and friendships.
  • Your child has tried different therapies in the past but there has been minimal carryover from session to session and/or you haven’t noticed much progress overall.
  • Your child is experiencing distress but other commitments during the school year have hindered attending therapy on a consistent basis, making school breaks or the summer an ideal time to work on it.

At NESCA, we are pleased to offer a highly specialized and immersive therapy experience through our 2-Week Summer Intensive CBT Program for anxiety. We work with children and adolescents who present with all types of anxiety, including generalized anxiety, separation anxiety, social anxiety, specific fears (e.g., dog phobia, vomit phobia, etc.) and obsessive-compulsive disorder (OCD).

What does NESCA’s 2-Week Summer Intensive Program consist of? 

  • Intake evaluation – A meeting is held with the child and parents to gain a comprehensive understanding of the child, provide an assessment of symptoms and discuss goals for treatment, all of which will inform the treatment plan.
  • 1:1 therapy sessions – Individual CBT therapy sessions with the child or teen are conducted 5 days/week for 90 minutes. Homework will also be assigned between therapy sessions to reinforce skills learned.
  • Parent involvement – Parent participation is vital in treating childhood anxiety. Parent sessions are held 5 days/week for 30 minutes. During these meetings, parents will be educated about their child’s anxiety, receive progress updates and also acquire tools to better support their child. Parents might also be asked to help children practice the new skills they are learning.
  • Discharge planning – Families will be assisted in determining follow up support that will be helpful in order to maintain treatment gains.
  • Treatment summary – Following the conclusion of the program, families will receive a written summary that reviews the course of treatment, progress made and discharge recommendations.

There are circumstances in which the frequency, duration and/or structure of the program can be modified to best fit your child’s needs.

For more information about NESCA’s Summer Intensive CBT Program or to find out if the program is appropriate for your child, please contact Dr. Ryan Ruth Conway at (617) 658-9831 or rconway@nesca-newton.com.

 

About the Author:

Conway

Ryan Ruth Conway, Psy.D., is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal.

 

If you are interested in working with Dr. Conway or have any additional questions about NESCA’s therapy services, please complete NESCA’s online intake form.

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.

 

4

Director’s Update

By | NESCA Notes 2017

 

By:  Ann Helmus, Ph.D.
NESCA Founder/Director

NESCA was founded on the idea that a thorough evaluation reflecting careful analysis of information gathered from history, observations, and testing data is crucial in formulating a comprehensive, individualized plan for supporting a child to realize their potential. Increasingly, NESCA is expanding its intervention services, which allows for a higher level of integration between the evaluator and treater. Clearly recognizing the benefit of psychopharmacological intervention for many children and adolescents, at NESCA, we focus on the powerful benefits of many non-medication approaches.

Our experience, supported by research, is that significant improvements in functioning result from psychoeducation, direct teaching of strategies to parents and students, and intervention at the physical level. Psychoeducation refers to the process of educating clients and their parents about the nature of challenges such as anxiety or ADHD.  Beyond gaining a thorough understanding of the challenges faced by a client, parents, teachers, and students need strategies for managing problematic symptoms and behaviors. Teaching and helping parents and students practice these strategies often yields huge changes in functioning.  Finally, the mind and body are interconnected and intervening at the physical level is often more straight-forward for many of our clients, leading to impressive changes in cognitive and emotional functioning.

NESCA offers the following therapeutic interventions:

Cognitive Behavioral Therapy (CBT):

CBT is an evidence-based therapy that focuses on identifying and changing thoughts patterns and behaviors that are interfering with functioning.  Of note, we have a therapist who is highly experienced in psychotherapeutic intervention with children and adolescents who are on the autism spectrum, including the use of the Sidekicks app developed by the Affinity Project.

Acceptance and Commitment Therapy (ACT):

ACT uses approaches such as mindfulness and behavioral change strategies to help clients increase flexibility and reach goals.

Intensive Outpatient Therapy:

Many children require more frequent meetings in order to master the strategies that are being taught for behavioral/emotional regulation or social functioning. NESCA’s intensive out-patient therapy programs generally involve three weekly sessions of direct service for the child followed by brief parent guidance meetings.

Therapy Groups:

NESCA offers a group for school-age children with ADHD and their parents. Children meet in one group while their parents meet concurrently in another group, both led by experienced psychologists.  Starting in 2018, NESCA will be offering drama-based therapy groups based on the Spotlight model developed at the Northeast Arc and researched by the Social Competence and Treatment Lab at Stony Brook University.

Back to School Program:

This intensive program was developed to address school refusal through both home-based and center-based psychotherapy, parent guidance and school consultation.

Community Based Skills Coaching:

Many clients struggle to generalize strategies that they have learned in therapy to daily living. NESCA has highly skilled coaches that work with adolescents and young adults in the community to practice skills and strategies.

Postsecondary Transition Planning:

Adolescents with developmental challenges, learning disabilities, and psychiatric issues often need support in planning for “life after high school”. Our veteran transition specialists work with adolescents and their parents to identify strengths, formulate realistic goals and a plan for reaching goals over their high school years.

Yoga-Based Therapy:

Individual or small group interventions in our yoga studio to build self-awareness and the ability to use breath and movement to address symptoms of anxiety and enhance attention.

Acupuncture/Acupressure:

These ancient treatments can be highly effective for treating anxiety,  ADHD, and other childhood conditions.

 

About the Author:

NESCA Founder/Director Ann Helmus, Ph.D. is a licensed clinical neuropsychologist who has been practicing for almost 20 years. In 1996, she jointly founded the  Children’s Evaluation Center (CEC) in Newton, Massachusetts, serving as co-director there for almost ten years. During that time, CEC emerged as a leading regional center for the diagnosis and remediation of both learning disabilities and Autism Spectrum Disorders.

In September of 2007, Dr. Helmus established NESCA (Neuropsychology & Education Services for Children & Adolescents), a client and family-centered group of seasoned neuropsychologists and allied staff, many of whom she trained, striving to create and refine innovative clinical protocols and dedicated to setting new standards of care in the field.

Dr. Helmus specializes in the evaluation of children with learning disabilities, attention and executive function deficits and primary neurological disorders. In addition to assessing children, she also provides consultation and training to both public and private school systems. She frequently makes presentations to groups of parents, particularly on the topics of non-verbal learning disability and executive functioning.

 

To book a consultation with Dr. Helmus or one of our many other expert neuropsychologists, complete NESCA’s online intake form.

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, Massachusetts, Plainville, Massachusetts, and Londonderry, New Hampshire, serving clients from preschool through young adulthood and their families. For more information, please email info@nesca-newton.com or call 617-658-9800.