Psychological Treatment Services

The Vancouver CBT Centre offers individual psychological treatment for a number of anxiety and mood disorders, including:

(click any item '' for a definition)

Generalized Anxiety Disorder (GAD)

GAD is an anxiety disorder that has excessive worry as its main symptom. People with GAD have “what if?” thoughts most of the day, and these worries are typically about daily life events (e.g., worries about punctuality, work/school, family/relationships, health, and the health of loved ones). People with GAD tend to worry about the same things that other people do, however they worry more, more often, and have a harder time controlling their worries. GAD is a chronic condition, that is, most people with GAD describe having been “worriers” their whole lives. Physical symptoms associated with GAD include:

-feelings of restlessness, being keyed up, on edge
-irritability
-fatigue
-concentration difficulties
-muscle tension
-sleep problems (e.g., difficulty falling asleep, staying asleep, or restless sleep)

Everyone worries from time to time, and this is normal. People with GAD however feel as if they are always “in their head”, and have a hard time enjoying their lives as they are constantly worried about negative events in the future. Although it is not uncommon for people with GAD to have successful lives (e.g., friends, family, career), they will often describe feeling melancholy, exhausted, and demoralized in their daily lives.

 

Health Anxiety (Hypochondriasis)

Health anxiety, or hypochondriasis, involves an excessive fear of having a serious illness (e.g., cancer, AIDS, MS). People with health anxiety will typically consult with doctors frequently and/or check for symptoms on the internet. Although visits to medical professionals can provide some relief when there is no evidence of a serious illness, this reassurance is short-lived, and people with health anxiety will often check and scan their bodies for symptoms of disease.

We all have concerns about our health from time to time, and it is of course recommended to have regular medical check-ups. However, people with health anxiety will typically worry most days about their health and excessively consult with doctors and specialists. Many people with health anxiety find themselves frustrated over time, as the more often they consult with their doctors, the less they feel they are taken seriously.

 

Obsessive-Compulsive Disorder

OCD is an anxiety disorder that involves the presence of either obsessions, compulsions, or both. Obsessions are unwanted, unpleasant thoughts that lead to feelings of anxiety, and compulsions are deliberate behaviours or mental rituals performed to prevent something ‘bad’ from happening or to reduce feelings of anxiety.

Common OCD symptoms can include:

-Fear of contamination and excessive washing/cleaning compulsions

-Fears of doubt and checking (e.g., checking locks, doors, checking that no harm has come to one’s self or others)

-Superstitious rituals (e.g., touching or tapping objects a certain number of times, avoiding specific numbers, colours, people or places out of a fear that something “bad” will happen)

-Unwanted and intrusive thoughts, images, or urges of a sexual, aggressive, or blasphemous nature (e.g., unwanted urge to drive into traffic, unwanted thought of touching someone inappropriately)

-Ordering and arranging compulsions (a need to have things placed in a certain way either to avoid something “bad” happening or in order for things to “feel just right”)

Most people will occasionally engage in superstitious behaviours, or double-check things such as doors and the stove. In OCD however, obsessions and compulsions are time-consuming and distressing, and interfere with the person’s enjoyment of life. Many people with OCD feel shame about their behaviour and might conceal it from others either by hiding their compulsions or not telling others about the distressing unwanted thoughts they experience.

 

Body Dismorphic Disorder (BDD)

Body Dysmorphic Disorder (BDD) is broadly considered to be an obsessive-compulsive spectrum disorder as it shares many features with OCD. BDD is an excessive concern and preoccupation with a perceived flaw, or a tendency to magnify the importance of a minute anomaly. The person with BDD may spend hours scrutinizing themselves in the mirror, comparing themselves with others, using a variety of camouflage strategies (e.g., wearing hats, baggy clothing, carefully applied makeup), and often engaging in extensive avoidance (e.g., difficulty leaving the house). Many people will seek out costly surgical or dermatological fixes, but are often not happy with the outcome of these procedures. People with BDD often feel that they are unacceptable to others as a result of deficits in their appearance. The most common areas of concern include facial features (e.g., eyes too small or too close together, nose, ears), hair (e.g., thinning on the head, too much body hair), skin (e.g., large pores, uneven skin tone, blemishes), and body/shape (e.g., breast size, buttocks, thighs). Some people are concerned about body asymetry (e.g., left earlobe is longer than the right earlobe), whereas others believe their facial features do not 'fit' together. It is also common for the area of concern to switch focus. Amongst body builders, approximately 8% experience muscle dysmorphia, which is the belief that one's muscles are too small and that the person is 'scrawny'.

 

Impulse Control Disorders (trichotillomania, compulsive skin picking,
body dismorphic disorder)

Trichotillomania is an impulse control disorder that involves repetitive hair pulling from any place on the body, including the head, eyebrows, legs and arms, or pubic area. People with trichotillomania feel a strong urge or pressure to pull their hair and often experience pleasure while doing it, although they will also feel shame or anxiety about this behaviour as well. It is not uncommon for people with trichotillomania to play with or eat the hair, or bite the root.

Skin Picking is also an impulse control disorder that involves picking or scratching at pimples, bumps, or scabs on the skin, usually on the face, chest, or back. Most people who pick their skin feel shame and embarrassment over their picking, although the motivation for it is often to clear up the skin and remove imperfections.

Although it is normal to occasionally pick at your skin or pull a hair, excessive skin picking or hair pulling leads to significant anxiety or distress to the individual. For those with trichotillomania, significant hair loss and bald patches can occur, and excessive skin picking can lead to bleeding, irritation of the skin, or scarring, all of which can cause great distress and interference in the person’s life.

 

Panic Disorder with or without Agoraphobia

Panic disorder is an anxiety disorder that involves having panic attacks that seem to occur “out of the blue”. Panic attacks can include a number of physical symptoms, including,

-racing heart
-difficulty breathing, shortness of breath
-sweating
-trembling, shaking
-feelings of dizziness, depersonalization, or unreality
-stomach problems (e.g., nausea, diarrhea)
- hot or cold flushes

People with panic disorder are afraid of panic attacks, as they fear that the attacks are a sign that they are having a heart attack, a stroke, going crazy, or that they might somehow lose control and embarrass themselves.

Because of this, people with panic disorder are extremely anxious about having more panic attacks, and will often engage in agoraphobia.

Agoraphobia is a fear and avoidance of situations or places where escape might be difficult. Typical avoided places for people with panic disorder include:

-driving or riding in a car
-crowded places (malls, supermarkets)
-elevators
-public transportation (e.g., bus)
-being far away from home
-being alone
- taking a plane

Many people will have a panic attack at some point in their lives, but not everyone develops panic disorder. Individuals can have a panic attack as a result of stress or fatigue, or in response to a fearful situation. For example, a student who stays up all night studying for an exam might have a panic attack on the way to school, or someone with a phobia of dogs might have a panic attack if they suddenly see a dog while walking on the street. However, the important difference between having panic attacks and developing panic disorder is that people with panic disorder are afraid of the panic attack itself. The student going to the exam is afraid of the exam, and the person with a phobia of dogs is afraid of the dog; neither is likely to afraid of the panic attack.

 

Post-Traumatic Stress Disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that can occur following a traumatic event. Traumas that can lead to PTSD include,

-Witnessing a physical or sexual assault
-Being physically or sexually assaulted
-Witnessing a murder or the death of an individual
-Being in or witnessing a motor vehicle accident
-Combat (witnessing or engaging in violent acts during war time)
-Natural disasters (earthquakes, floods, hurricanes)

People with PTSD can have a variety of distressing symptoms, however they will typically have symptoms that relate to the following clusters:

1) Reexperiencing or reliving the event (e.g., nightmares, flashbacks, intrusive memories)

2) Avoidance (e.g., avoiding people, places, or conversations related to the trauma, inability to recall certain aspects of the traumatic event)

3) Increased physical arousal (e.g., 'hypervigilance', exaggerated startle response, irritability, being on edge)

Although it is necessary to have experienced some form of trauma in order to develop PTSD, all people who experience a trauma do not necessarily have PTSD. It is common for people to feel distressed or anxious after living through a traumatic event, and these feelings will often pass over time. However if anxiety symptoms persist for over a month after a trauma, this might be a sign of PTSD.

 

Social Anxiety Disorder

Social anxiety disorder involves an excessive fear of social situations where one might be negatively evaluated or judged by others. People with social anxiety are fearful that they will embarrass themselves in front of others, or be seen as stupid, foolish, or boring. As a result, they will often avoid a number of situations, including:

talking to strangers
initiating or maintaining conversations
participating in classes/meetings
socializing with others/going to parties
being assertive
talking to people in authority

Some people with social anxiety disorder are particularly anxious when completing daily tasks where they might be evaluated by others, such as writing or eating, and will avoid doing this in front of others. Although it is normal for some people to be shy, social anxiety is more severe, and can lead people to miss out on opportunities in life (such as school, jobs) and become socially isolated.

 

Specific Phobias (for example, fear of bridges, fear of needles/blood,
fear of medical/dental interventions, fear of choking/vomiting)

Specific phobia is an anxiety disorder that involves an excessive and unrealistic fear of a particular situation, place, object, or event. People can have all sorts of different phobias, which leads to either avoidance of the feared object or situation or to extreme distress when facing the fear. Common phobias include:

Needles, injections, blood
Travel by airplane
Animals (insects, dogs, snakes, spiders)
Heights, storms, water
Small enclosed spaces, elevators
Driving, bridges
Dental/medical procedures
Choking or Vomiting

Most everyone is fearful of some situations, particularly since some things are naturally more unpleasant. For example, few people enjoy getting a shot, having blood drawn, or going to the dentist, and it is quite common for many people to dislike insects, snakes, or spiders. However, people with a specific phobia are not only terrified of a feared situation or object, they also find that their lives are significantly affected by their fear. For example, someone with a phobia of needles might avoid getting necessary medical tests, someone with a dental phobia might avoid going to the dentist even if they are experiencing significant tooth pain, and someone with a choking or vomiting phobia might avoid eating solid foods.

 

Depression

Depression is a mood disorder that goes beyond occasional feelings of sadness. People with clinical depression report severe low mood and a loss of interest in activities that they used to enjoy, and these feelings are present most of the day, every day. Depression is also associated with other symptoms, including:

-A noticeable increase or decrease in appetite
-A noticeable increase or decrease in sleep
-Feeling physically slowed down or noticeably agitated and restless
-Fatigue and low energy
-Feelings of worthlessness or inappropriate guilt
-Problems concentrating and difficulty thinking
-Thoughts of suicide

Some people can experience a condition called dysthymia. People with dysthymia also report feelings of low mood and a decreased interest in previously enjoyed activities, however these feelings are less severe than with depression, and they last a longer time. Dysthymia is associated with feelings of low mood for a minimum of two years. Although people with dysthymia can have periods of time where they feel like their “old selves”, this feeling will not last more than two months in a row.

It is normal to occasionally feel down, sad, or blue, especially in times of stress or after a period of loss (e.g., death of a loved one). However, depression and dysthymia is like a constant dark cloud over one’s head, and it can have a strong negative impact on our ability to work or interact with friends and loved ones.

 


MBCT GROUP for ANXIETY and DEPRESSION




CHILD/ADOLESCENT SERVICES

The Vancouver CBT Centre offers evidence-based psychological treatment for children and adolescents. In addition to the disorders listed above, treatment is also available for the following problems in children and teens:

School Refusal

Over 25% of children will present with difficulties attending school, including refusal to attend, during their education. The reasons are varied, and can range from a kindergartener who is unsure of starting school and wants to stay home with mum, to more complex situations such as a thirteen year old boy who has good grades, friends, and a supportive family, and yet misses school on average three times a month. When a child refuses to attend school s/he may exhibit a range of behaviours including tantrums, crying and clinging, negotiating, pleading, and even lying and deceit. The function of a youth’s school refusal can be categorized into four sub-types:

·To avoid or escape from situations that generate negative feelings such as anxiety, depression, or physical complaints

·To avoid or escape from distressing social or evaluative interactions stemming from peers, teachers, tests, or academic demands

·To obtain attention from others

·To obtain goods or pleasant experiences outside of school

Although children may refuse school at any age, there appear to be two common peaks in refusal: 1) age 5-6 when children enter into primary school, and 2) age 13-15 following the transition into secondary school. No matter the age at which school refusal occurs, it is a significant problem that can negatively impact a child’s academic, social, and developmental progress. Furthermore, it can place tremendous stress upon families as they struggle to manage. Cognitive-behaviour therapy is an efficacious assessment and treatment approach that can provide youths and their families with a comprehensive understanding of the function of a particular child's school refusal, as well as targeted skills to aid in returning to school. If anxiety is a primary reason for the refusal, treatment can include teaching anxiety management skills such as:

· Progressive muscle relaxation

· Diaphragmatic deep breathing

· Imagery training

· Adaptive self-talk

· Cognitive restructuring

· Social skills training

· Gradual exposure

· Incentive systems


Separation Anxiety Disorder

It is normal for toddlers and young preschoolers to become anxious when separated from their parents or caregivers. For some this anxiety is mild, exhibited by a few tears and the need for extra hugs before separating; for others, the anxiety can be more pronounced. However, most children can manage periodic separations and quickly return to their normal selves. In fact, as children mature and transition into primary school, this type of anxiety can often go away altogether.

Yet, for approximately 3-5% of children, separation anxiety persists and worsens over time, with routine separations causing significant distress to the child and family, as well as negatively impacting the child’s ability to function socially and academically. Children with separation anxiety often have persistent worry about losing a loved one or harm befalling that person, or that the child may become lost or kidnapped. As a result, routine activities become grounds for refusal, and the child can miss out on school, recreational activities, parties, sleepovers, and more. Separation Anxiety Disorder can be diagnosed any time before age 18 years, but is most common in children between the ages of seven and nine. Typical signs of Separation Anxiety Disorder include:

Episodes of crying, clinging, or tantrums when separating or expecting to separate from a parent or caregiver, and/or difficulty remaining apart so that the child spends his/her time calling home, checking with others that their loved one will return, and/or being unable to participate in activities because of preoccupation with separation;

Persistent reluctance or refusal to go to school, after-school care, camps, etc. because of fear of separation;

Difficulty being alone, or without a parent or caregiver at home or in other settings;

Persistent reluctance or refusal to go to sleep without being near a parent or caregiver, or to go to sleepovers or sleep-away camps;

Nightmares involving themes of being separated;

Somatic complaints (e.g. headaches, stomachaches, nausea, or vomiting) designed to keep the child at home with a parent.

 

Selective Mutism

Selective mutism (SM) is a childhood anxiety disorder characterized by a child’s consistent failure to speak in specific social situations despite speaking elsewhere. For example, the child may be talkative and outgoing at home or when interacting with family members, but become silent at school and in the community when there is an expectation for speaking to others. Unlike children who are quiet and reluctant to speak in new settings, but gradually become comfortable speaking to peers and familiar adults, children with SM remain silent for months and sometimes years despite the kindness and encouragement of those around them. This failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation. Although many children with SM are typically functioning in other areas of their lives, some also have developmental delays, impaired social skills, communication disorders, and additional anxiety disorders. For children with SM, their silence can interfere greatly with their educational, occupational, and social achievements. These children may miss out on opportunities to develop friendships, acquire language and academic skills, and gain mastery in important developmental milestones. SM typically occurs between the ages of two to four years, although for many of these children it is not until they enter school where the problem becomes more evident, that they are diagnosed. Selective Mutism affects approximately 0.5% of children, although evidence suggests that it may be under-diagnosed.

 

Attention-deficit/hyperactive Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a neurobiological disorder characterized by a pervasive pattern of impulsivity, inattention, and in some cases, hyperactivity, that is considered atypical for age and developmental level. ADHD is a disorder that negatively affects the brain’s ability to help organize, integrate, and store incoming information. Although it is common for children to occasionally be distracted, have difficulty focusing or sitting still, or struggle to control their impulses, for youths with ADHD these behaviours occur most of the time and in multiple settings. Because of difficulties developing meaningful friendships, meeting academic expectations, and performing up to their abilities in a variety of areas, children with ADHD can experience significant impairments in their social development, school performance, and work functioning. The following list, while not exhaustive, represents some of the common symptoms of ADHD:

Difficulty paying close attention to details or making careless mistakes in schoolwork, work, or other activities

Trouble listening to the directions of others

Poor follow-through with requests, especially on multi-step instructions

Disorganization and difficulty locating important things such as school papers, athletic uniform, toys, etc.

Inattention and poor focus with an activity or task

Difficulty remaining seated or still, acting as if driven by a motor

Trouble keeping hands to themselves

Inability to wait for a turn

Difficulty staying quiet or waiting to speak when called upon

For a diagnosis of ADHD to be made, symptoms must be present before age seven and have existed for at least six months. At this time there is no single test to diagnose ADHD; a clinical interview is required, as well as various in-office tests to determine when ADHD is present.

 


PARENT TRAINING
is also available at the Vancouver CBT Centre, and offered by Dr. Katherine Martinez.

Parent training and education is an empirically-supported therapy approach using principles and techniques derived from behaviour therapy, attachment theory and neuroscience. Parent training invites parents and caregivers to identify and examine the impact of various influences upon the parent-child relationship. These influences can include personal history, cultural values, lifestyle choices, the home environment, community, child’s developmental level, personality, and more. Once these influences are identified and the impact better understood, parents can begin to modify their own behaviours and expectations as well as those of their children, to accomplish personal goals such as improved family closeness, reduced arguing and fighting between parents and siblings, and increased family quality time. In individual sessions, on a weekly to biweekly schedule, parents will learn a range of behavioural, developmental, and mindfulness-based skills. They then work with the clinician to customize a family plan utilizing those strategies that are best matched with their unique family needs.

Families that might benefit from parent training and education may be seeking guidance with the following:
·     Establishing an effective and smooth morning routine
·     Sitting down for family meals
·     Getting your kids to bed on time with reduced conflict
·     Cultivating pleasurable family time
·     Encouraging resilient and responsible children
·     Transitioning from full-time parenting to back to the workforce
·     Relocating homes and communities
·     Arrival of a new sibling
·     Sibling rivalry

Although there are many parenting books and articles, there is no guidebook on how to manage each scenario that arises. For those who struggle to decode what is best for both their child and family, parent training can bridge this gap. All parents have the capacity to create an environment that meets their children’s needs and supports them in their development, while retaining their own values. It is through the larger context of parents understanding themselves and their children that builds the foundation for a healthy and strong family relationship.