Evaluation and treatment of Generalized Anxiety, Panic Attacks, and Social Anxiety (also any underlying Avoidant Personality and/or Mild ASD or Asperger Syndrome complicating Anxiety)

Consult-liaison with Psychiatry for the conditions above when medication is indicated, concurrent with psychotherapy

During your initial visit with me, I will review information you  provided prior to your visit; in addition to any introductory email information you may have provided, a medical, social, symptom and treatment history questionnaire and any psychometrics, e.g. Generalized Anxiety (GAD), Social Anxiety (SAD) and Avoidant Personality (AvPD) inventories I've asked you to complete to help with differential diagnosis. Otherwise to assist with diagnostic accuracy and treatment planning, I may have you complete lengthier standardized testing, e.g. the MMPI-2-RF.

If we decide after this initial visit to proceed with psychotherapy, you can expect a doctor-patient  relationship which feels supportive and safe, free of judgment as we work to identify and modify your life circumstances or coping behaviors or habitual ways of thinking which are fueling your social anxiety and other issues or conditions and everyday coping difficulties. My treatment approach is balanced between non-directive listening (facilitating emotional processing and insight) and action-oriented skills training and application (facilitating change).  My experience is that successful treatment outcomes require a commitment to both insight and action and that one without the other is ultimately ineffective.

To generate insight and a framework for change and action (establish with you the kinds of skills and strategies and goals necessary for you to meet your treatment goals), I rely on the best of  Cognitive-Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Functional Analytic Psychotherapy (FAP) along with instruction on and practice with breath control (relaxation / fight-or-flight reduction breathing) and mindfulness meditation and mindfulness as a way of being aware of what's happening without doing anything about it - a passive or neutral awareness we can employ at will in any moments we choose so as to separate who we are in terms of our core values from what our minds spin out and 'would have us believe' about who we are; a natural or free-floating awareness we can embrace so as to simply notice whatever may cross our minds (e.g. stress-triggering or negative emotions or disturbing thoughts or images or memories) rather than helplessly participating in the 'mind clutter' and being hooked into the idea that we have to stop or change it.
The Physiological Sigh (a way of breathing which quickly decreases heart rate and other fight-or-flight or sympathetic nervous system hyperarousal)
https://www.google.com/search?q=andrew+huberman+physiological+sigh&rlz=1C1LENN_enUS483US483&oq=andrew+huberman+physiological+sigh&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIGCAEQRRg90gEJMTAzODhqMGo3qAIAsAIA&sourceid=chrome&ie=UTF-8#fpstate=ive&vld=cid:bc5dd8fe,vid:Sva2A9yXiM4,st:0
Mindfulness Meditation (Natural Awareness) Audios (Diana Winston, Director of UCLA Mindfulness Education
https://dianawinston.com/meditations
Mindfulness Meditation (Natural Awareness) Scripts from Diana Winston's Little Book of Being: Practice and Guidance for Uncovering Your Natural Awareness
practices_and_guidance_for_uncovering_your_natural_awareness__diana_winston.pdf
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https://www.amazon.com/Little-Book-Being-Practices-Uncovering/dp/1683642171  The Little Book of Being: Practices and Guidance for Uncovering Your Natural Awareness by Diana Winston, Sounds True Publications

​https://www.amazon.com/Anxiety-Worry-Workbook-Cognitive-Behavioral/dp/B0C5YM8Y2D​ The Anxiety and Worry Workbook: The Cognitive Behavioral Solution by David A Clark, PhD & Aaron t Beck, MD, The Guilford Press, 2023 outlines the CBT treatment model and its key methods. This resource with case examples and worksheets can help me teach you CBT skills, for example how to identify and break negative thought patterns and  identify and change problematic core beliefs (negative 'life scripts' usually established early in life owing to family of origin issues  or other kinds of social dysfunction or trauma).

CBT's most important coping and behavior change skills or 'tools' are well explained by Dr.'s Clark & Beck and your practicing and succeeding with those tools is facilitated by their easy-to-complete worksheets, e.g. forms to record emotionally and behaviorally maladaptive thoughts, others to identify and document the evidence invalidating those thoughts and arguing toward alternative, more adaptive ones.  

​This workbook provides a good summary of the common thinking errors fueling social anxiety and avoidant personality and builds upon those from David Burns, MD, his 1980 book Feeling Good: The New Mood Therapy. This 1980  publication is what first popularized cognitive-behavioral therapy (Dr. Burns' Ten Forms of Twisted Thinking and Ten Way to Untwist the Thinking,  downloadable files  below).
Cognitive Distortions: Ten Forms of Twisted Thinking (David Burns MD)
cognitive_distortion_twisted_think.pdf
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Ten Ways to Untwist Your Thinking (David Burns MD)
ten_ways_to_untwist_your_thinking.pdf
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https://www.google.com/books/edition/ACT_Made_Simple/g9uTmri248kC?hl=en&gbpv=1&printsec=frontcover ​ ACT Made Simple: A Quick-Start Guide to ACT Basics and Beyond by Russ Harris, PhD, New Harbinger Publications, 2009 offers a straightforward summary of this treatment model's contribution to psychotherapy. According to ACT, we end up stuck feeling unhappy or stressed-overwhelmed trying to cope with life or solve personal problems, generally because of our habit of 1) dwelling on the past and the future, 2) over-attaching to self-concept (fusing or entangling ourselves with images or roles or stories about who we are or were or should be or believing and identifying with whatever ends up crossing our minds),  3) denying or avoiding negative emotion and the self-defeating and relationship-jeopardizing or socially disruptive things we do (e.g. anesthetizing ourselves with drugs or alcohol or otherwise blocking instead of processing; cutting-off emotionally from the problems or misdirection we need to correct), and so  4) doing what's not working for us, over and over again (keeping ourselves out of touch with what we need and want or lacking the motivation and/or skills to take the actions necessary to do the things that will make us most happy, i.e. do whatever it takes to 'live our values').  

​ACT briefly stated encourages being present via mindfulness so as to watch your thinking, accept what's not working for you, know what matters, and do what it takes to change.

ttps://www.google.com/books/edition/Functional_Analytic_Psychotherapy_Made_S/KpNrDgAAQBAJ?hl=en&gbpv=1&printsec=frontcover
​Functional Analytic Psychotherapy Made Simple: A Practical Guide to Therapeutic Relationships by Gareth Holman, Jonathan W. Kanter, Mavis Tsai, Robert Kohlenberg, & Steven C. Hayes, New Harbinger Publications, 2017 (Chapter 3 for the best summary of FAP's core principles and methods) is a good resource to help you understand what treatment with me includes in terms of the FAP treatment model, particularly its key goals and methods as outlined in Chapter 3. 

Functional analytic psychotherapy (FAP) is a form of behavior therapy which emphasizes use of the therapist–client relationship for providing powerful in vivo learning opportunities (Functional Analytic Psychotherapy v 841 Encyclopedia of Psychotherapy VOLUME 1Copyright 2002, Elsevier Science (USA). Robert J. Kohlenberg University of Washington Mavis Tsai Seattle, WA). It is a relational approach to psychotherapy which considers in-session client–therapist interactions to be critical information, useful for knowing what's not working and needs to be changed to improve everyday relationships.

As part of your psychotherapy with me, informed by FAP treatment guidelines, it is understood that the social interaction (relationship) behaviors which are keeping you 'stuck' in unhappy relationships or causing stress and strife for you in generally happy relationships are going to eventually show up when you interact with your psychotherapist.  And when they do show up, under my care you can expect open and honest discussion, collaboration towards sorting out what's happening and why: 'functional analysis', e.g. identifying ways in which problematic ways of operating with others may be grounded in societal or parental scripts or role modeling if not childhood-family trauma or loss; and no matter how you got to where you are with people, what is to be gained and lost if you let go and adopt new more adaptive ways of interacting:  In the short-term, what is it you'll need to face or accept? And what alternative behaviors would better serve you and your everyday relationships; and  why not commit to moving toward those behaviors, what gets in the way?

As part of your therapy relationship, under my care, you can expect me to encourage  whatever healthy alternative behaviors we’ve identified. And if you open up to healthy social interaction ‘reinforcement’ and practice during your psychotherapy visits, you'll find it generalizing to your everyday relationships.

As defined in Holman's Functional Analytic Psychotherapy Made Simple, Chapter 3 - Clinically relevant behaviors (CRBs) represent categories of change that occur as part of FAP. And there are three general categories:  CRB1s are the problematic behaviors that occur in-session and become the focus of change. CRB2s are the healthy alternative behaviors that are identified as effective, desirable replacements for the CRB1s, and CRB3s refer to statements or rules you internalize, i.e. self-talk/cues you come up with to help make the shift toward those CRB2s and to better adopt and maintain them as your 'go to' in relationships.  FAP processing is in this way in line with the cognitive restructuring (and in turn replacement of unhealthy behaviors with healthy alternatives) which is basic to cognitive behavioral therapy (CBT).
Integrated ACT-CBT-FAP Questions: Helpful for Psychotherapy Processing & Behavior Change
integrated_act-cbt-fap_questions.pdf
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