Tag

CBT

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.

 

Taking parents to SPACE! A groundbreaking treatment for parents of children with anxiety

By | NESCA Notes 2019

By: Ryan Ruth Conway, PsyD
Clinical Psychologist

As a child and adolescent psychologist who specializes in treating anxiety, it is very rare that I work solely with the individual. More commonly, in working with anxious youth, I engage the caregivers in treatment as well, as they serve a unique role in helping children better manage their symptoms. Sometimes I even meet with parents without ever seeing their anxious child, usually in situations where children are either very young or having difficulty participating in treatment.

Anxiety is a universal emotion that we all experience, and it can be quite helpful in alerting us to danger. However, some people experience heightened anxiety related to things or situations that do not actually pose a real threat, even though it truly feels that way. There are three parts of anxiety that impact each other – 1) cognitions (worrisome thoughts), 2) feelings (emotions and physiological sensations e.g., racing heart, stomachaches), and 3) behaviors (fight/flight/freeze response e.g., having tantrums, avoidance of anxiety-provoking stimuli).

Children will go to great lengths to find relief from anxiety. One of the typical ways they do so is by avoiding things they find scary. For instance, a child with separation anxiety may decline invitations for sleepovers and/or refuse to go to school. As their “go to” for support, children oftentimes manage anxiety by eliciting their parents to make them feel better. For a child with social anxiety, parents might step in and speak for the child when confronting strangers. When a teenager is facing persistent and obsessive thoughts about germs and cleanliness, parents might wash and re-wash the child’s clothing. For the individual who worries about a bunch of different things, parents might find themselves providing reassurance by answering a lot of their child’s questions or responding to repeated text messages ensuring the parents’ safety.

Anxiety has an interesting way of entangling family members into its “worry web,” and families fall victim to its demands to maintain peace in the household, largely without even realizing they are doing so! We call this parent accommodation, or any actions caregivers take or deliberately do not take because of their child’s anxiety. Accommodation is incredibly common and understandable. Parents will do anything and everything to protect their children and make them feel better. While accommodation might alleviate anxiety symptoms quickly and reduce anxiety in the short-term, unfortunately it is unhelpful in the long-term. Anxiety is tricky – the more parents accommodate, the more the worry web continues to grow, and children end up relying on their parents to bring relief as opposed to learning to manage anxiety on their own.

Last month I had the pleasure of attending a training for the SPACE (Supportive Parenting for Anxious Childhood Emotions) program, an innovative, short-term intervention developed at Yale University’s Child Study Center under the leadership of Dr. Eli Lebowitz, a prominent child therapist, researcher and author. As an empirically-supported treatment, SPACE has been well researched and, in a recent study, shown to be just as effective as individual cognitive-behavioral therapy (CBT) in treating child and adolescent anxiety (Click here).

SPACE is unique in that the treatment is delivered only to parents. In considering the interpersonal nature of anxiety and different reactions parents can have to their child’s symptoms, it brings caregivers together to send consistent, supportive messages. The aim of SPACE is two-fold. One goal is to help parents respond effectively to their child, in a way that both validates the child’s experience of anxiety and also shows confidence in the child’s ability to tolerate discomfort. Parents also work collaboratively with the therapist to develop a clear plan to take small, gradual steps in reducing accommodations. In addition, parents receive guidance on how to respond to their child’s reactions to these changes. Parents are not viewed as the problem, but rather as part of the solution. The result is a child or teen who can better self-regulate and cope with anxiety independently.

The interested reader can access additional articles about the SPACE program here:

https://www.jaacap.org/article/S0890-8567(19)30173-X/pdf

https://www.sciencedirect.com/science/article/pii/S1077722913000977?via%3Dihub

Dr. Conway offers SPACE to parents at NESCA’s Newton location. For caregivers who would like to participate in this treatment or have any questions, feel free to contact Dr. Conway at rconway@nesca-newton.com or 617-658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, 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 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.

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton and 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.

Blog Update: Intensive Therapy

By | NESCA Notes 2018

By: Ryan Ruth Conway, PsyD
Clinical Psychologist, NESCA

Earlier this month, the New York Times published an article about intensive therapy, a type of treatment that is more accelerated and condensed than traditional once weekly therapy. The author described a “new wave” of therapy programs popping up around the country designed to help clients with all types of anxiety experience relief more quickly. The article cited new research to explain the growing popularity of concentrated treatment, which shows that the approach is generally just as effective, and in some ways more effective, than longer-term care for both children and adults. Also noteworthy is that fewer clients dropped out of the intensive treatment, which suggests that clients are more likely to “stick with” therapy when it is delivered in a shortened, consistent format.

In short-term therapies, clients have the opportunity to practice using newly learned skills to face their fears in all different situations and environments that elicit anxiety. For instance, a client with social fears might be instructed to order for himself at a restaurant, ask a stranger for directions or purposely do something embarrassing in public. By practicing daily in session and also for homework, you see a lot of carryover from day to day and faster acquisition of skills, which is a huge confidence booster! Exposure and Response Prevention (ERP), a technique often used in Cognitive Behavioral Therapy (CBT), helps clients approach anxiety-provoking situations and learn that anxiety eventually habituates, or dissipates, on its own over time, and those other behaviors they have been using to manage their fears (e.g., excessive washing, checking, seeking reassurance from parents or avoidance) are neither helpful nor necessary.

NESCA offers intensive CBT “boot camps” for children and adolescents with anxiety, including (but not limited to) social anxiety, phobias, OCD and generalized anxiety. NESCA clinicians thoroughly enjoyed helping clients build coping skills and feel better through intensive treatments this past summer, and received a positive response from children and their families! Our treatment programs are individually tailored for each client and also include parent sessions in order to teach caregivers the tools they need to best support their child. Summer or school breaks can be the perfect time to focus on mental health without the distractions of the academic year or other extracurricular activities.

To learn more about intensive therapy and NESCA’s program visit: http://www.nesca-news.com/2018/03/intensive-cognitive-behavioral-therapy.html

For any questions about NESCA’s intensive treatment program or to sign up please contact Ryan Ruth Conway, PsyD at rconway@nesca-newton.com or (617) 658-9831.

 

About the Author: 
Conway

Ryan Ruth Conway, PsyD, 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.

 

 

 

 

Neuropsychology & Education Services for Children & Adolescents (NESCA) is a pediatric neuropsychology practice and integrative treatment center with offices in Newton, 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.

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.

 

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.