cognitive behavioral therapy

Strong Mental Health is So Important During a Pandemic

By | NESCA Notes 2020

By Dot Lucci, M.Ed., CAGS

Director of Consultation and Psychoeducational Services, NESCA

In March, 2020, a poll conducted by the American Psychiatric Association found that more than a third of all Americans (36%) stated that Covid-19 is having a serious impact on their mental health; 59% said it is a having a major impact on their daily lives; 48% are anxious about contracting Covid-19; 62% are anxious about a loved one becoming ill; and 68% feel it will have a serious impact on our economy. Needless to say, we are living in an unprecedented time due to Covid-19, and it will have a serious impact on people’s mental and physical health both now and for some time. It has created stress, anxiety and depression even as we are learning to cope and adjust to this current new normal.

Given these numbers, many adults, teens and children are struggling with a myriad of challenges, stressors and losses during this pandemic (i.e. missing graduations, births, food insecurity and financial insecurities, including job losses, etc.). Deciding how to alleviate the pain and suffering can be daunting. Psychological, medical/psychopharmacological, complementary (i.e. acupuncture), behavioral and educational treatments are possible choices and can assist in alleviating some pain and suffering. What better time than now to get yourself and your loved ones some mental health support?

This blog will review a variety of treatment approaches which are now being offered through telehealth. There are many HIPAA-protected platforms that clinicians are using to meet their client’s needs as well as some “wearables” to assist in treatment. Wearables transmit your biophysiological data to your clinician so s/he may use it in conjunction with and/or inform treatment.

Mental health treatments include many different types: psychotherapy (also known as “talk therapy” or “insight-based therapy”), psychoeducational, biofeedback, social training, mindfulness/relaxation and so many more. Approaches to psychological treatment may include individual, group, family or couples work, and there is no one single approach that works for everyone. Psychological treatment is typically provided by a licensed psychologist, social worker, mental health counselor, expressive therapist, psychiatrist and/or psychiatric nurse.  Many factors go into making psychological treatment decisions, but when it comes to therapy it is most important to have “goodness of fit” between the clinician and the client. The client needs to “get along with” and feel valued, supported and understood by their practitioner. This enhances the effectiveness of whatever treatment approach or method is utilized.

Reviewing the differences between treatment approaches may help you in your decision- making process beyond “the goodness of fit.” Psychotherapy involves talking with a clinician to address emotional, psychological and behavioral challenges that can be both conscious and unconscious. The client’s past experiences, perceptions and history play an important role in psychotherapy. The client “tells their story,” which helps the clinician understand their life experiences through their eyes, which allows treatment to be tailored to their experiences. By working through one’s thoughts, past experiences and stressors with a caring clinician, the client is able to gain insight, perspective and strategies to alleviate pain and suffering and manage unhealthy thought patterns and behaviors. The aim is to help the client understand their past and to recognize its influence on their current situation. Often psychotherapy is long- term and involves good communication/language skills as well as higher level thinking and insight capacity. However, psychotherapy can also be short-term and specifically focused on the thoughts, feelings and behaviors associated with Covid-19 and its impact on a person’s life.

Psychoeducational treatment is somewhat different than psychotherapy. Psychoeducational treatment can be provided to individuals, groups, family member, couples, employers and others. Education is central to treatment, and it is a more directive approach. It can have very specific goals and may be short-term. The past is not actively addressed; the purpose is to educate the client to acknowledge, accept and understand their disability and/or mental health condition and provide ways to support growth, change and meet goals. Psychoeducational treatment may include informative reading material, video analysis, homework, data collection, biofeedback, journal writing and much more.

Some of the goals of both treatment approaches are to connect how thoughts, feelings and behavior are connected, improve coping and problem solving to better deal with life stressors, increase positive self-regard, and to recognize and better deal with strong emotions. Many clinicians have training in specific techniques and use a combination of approaches in their practice. Yet, sometimes a specific approach may be the best method of choice given a specific condition or specific goal of treatment. For example, Covid-19 is having a mental health impact on many people, and seeking short-term treatment may be warranted.

When seeking treatment, determining what technique is most appropriate can be accomplished by considering a variety of areas: the reason/goal of treatment, age and diagnosis of the client, the personality, cognitive and language capacity of the client as well as the cultural/family background and personal experiences. There are upwards of 100 different types of psychotherapeutic approaches, so knowing which one to try is an important decision. Many clients at NESCA present with learning differences, anxiety, OCD, depression, trauma, substance abuse and more. The following partial list includes some of the treatment approaches beneficial to and used by many NESCA clients.

Acceptance and Commitment Therapy

Attachment-based Therapy

Animal-assisted Therapy


Cognitive Behavior Therapy (CBT)

Dialectic Behavior Therapy (DBT)

Exposure & Response Prevention Therapy

Expressive Therapy (Art, music, drama, etc.)

Mindfulness-based Cognitive Therapy

Motivational Interviewing

Parent-Child Interaction Therapy

Play Therapy

Psychoeducational Counseling

Trauma-focused Cognitive Behavioral Therapy

At NESCA, we are currently offering short-term psychological treatment for Covid-19 mental health challenges as well as long-term psychoeducational treatment. If you are interested in learning about these options, visit: https://nesca-newton.com/integrativetherapeutic/.

More information about treatment approaches can be found at: https://www.psychologytoday.com/us/types-of-therapy








About the Author

NESCA’s Director of Consultation and Psychoeducational Services Dot Lucci has been active in the fields of education, psychology, research and academia for over 30 years. She is a national consultant and speaker on program design and the inclusion of children and adolescents with special needs, especially those diagnosed with Autism Spectrum Disorder (ASD). Prior to joining NESCA, Ms. Lucci was the Principal of the Partners Program/EDCO Collaborative and previously the Program Director and Director of Consultation at MGH/Aspire for 13 years, where she built child, teen and young adult programs and established the 3-Ss (self-awareness, social competency and stress management) as the programming backbone. She also served as director of the Autism Support Center. Ms. Lucci was previously an elementary classroom teacher, special educator, researcher, school psychologist, college professor and director of public schools, a private special education school and an education collaborative.

Ms. Lucci directs NESCA’s consultation services to public and private schools, colleges and universities, businesses and community agencies. She also provides psychoeducational counseling directly to students and parents. Ms. Lucci’s clinical interests include mind-body practices, positive psychology, and the use of technology and biofeedback devices in the instruction of social and emotional learning, especially as they apply to neurodiverse individuals.


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


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.


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.


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:


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.