• OCD • ANXIETY • TICS • PTSD • STRESS • SPECIALIZED TREATMENT

Treatments

Rationale & Approach

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TREATMENT RATIONALE

Dr. Curiel strongly believes in providing gold-standard, evidence-based treatments (EBTs) for the scope of disorders she has chosen to treat (all of which have symptoms that closely relate and/or require treatments with similar interventions).  This means that she strives to abide by approaches that research says are the most effective.  EBTs increase the chances of optimal symptom relief, a successful treatment outcome, a shorter treatment duration, and lower costs over time.  Dr. Curiel maintains her knowledge of the latest developments in research via literature review and trainings/conferences provided by renowned experts in their respective fields.  


Because many of these conditions are neurobehavioral, where the brain involuntarily "fires" false alarm signals of discomfort, intolerance, or danger, it would be unhelpful to treat symptoms with therapy that emphasizes searching for a hidden cause or larger meaning.  It is often thought unresolved trauma must have caused the condition, but trauma is actually not related to the condition in most instances (on occasion it is related, but when this is the case it is very clear and not hidden to where it needs to be searched for, linked, and identified).  Simply exploring or trying to "reason" through symptoms typically causes the individual to remain stuck, particularly if they know their fears are irrational (or that their tics are disruptive) and they are capable of the same methods of logic independently.  Furthermore, sometimes finding logic and using rationalization can be forms of compulsions (rumination, reassurance) which make the condition worse.  Similar to process therapies, traditional play therapy for children will often not yield the same outcomes as the treatments listed below.  CBT and Exposure Therapies emphasize education on the mechanisms that allow the condition to thrive and changing mental and behavioral responses to the brain's "firings."  Imaginal and in-vivo exposures are completed in the office and in natural settings to generalize results to real-life settings.  When games are utilized, they are tailored to precisely target the maladaptive mental and behavioral responses.


TREATMENT APPROACHES

The Cognitive-Behavioral approaches utilized are supported by research as the gold-standard treatments for OCRDs, Tics, and Anxiety Disorders.

  • Cognitive-Behavioral Therapy (CBT)
  • Exposure (and Response Prevention) (ERP)
  • Prolonged Exposure (PE)
  • Habit Reversal
  • Comprehensive Behavioral Intervention for Tics (CBIT)
  • Comprehensive Model for Behavioral Treatment (ComB)


SUPPLEMENTAL INTERVENTIONS/SKILLS

  • Dialectical Behavior Therapy (DBT)
  • Acceptance and Commitment Therapy (ACT)


TREATMENT PROGRAM EXPERIENCE

Patients should approach treatment like a program they are joining that has an end goal of graduation. Attendance, willingness, participation, and hard work are key factors in getting the most out of this experience.  Frequent cancelations or prematurely discontinuing treatment could lead to further suffering down the road, stall recovery, and delay achievement of goals and milestones.  Treatment typically includes four components:  assessment, education, skills, and behavioral practice/exposure.  To move more quickly through the beginning stages of treatment, some patients choose to complete two sessions a week (for approximately 2-3 weeks) until the full practice phase begins and then they switch to one session a week.  For smaller children, a parent is typically present for all sessions and plays a major role in generalizing skills and practice at home.  For teens and adults, a loved one often joins the education session where information on the respective condition is provided as well as how the family should respond when it is evident the condition is affecting family and home dynamics.  At the end of the treatment episode, relapse prevention is addressed and booster sessions are possible if necessary.


If for some reason you would not be able to be treated at the outpatient level of care at the time, Dr. Curiel will attempt to work with you (and your family if needed) to try and find a higher level of care that is the best fit and perhaps after completion of that step, you could return to this office for outpatient treatment.  If you have a second condition (that Dr. Curiel does not treat) that is a greater problem and impairing your life to where it needs to be addressed first, Dr. Curiel will attempt to find an appropriate referral so that issue can be addressed first.


LEVELS OF CARE

  • Traditional Outpatient (one individual therapy session per week) and
  • Informal Intensive Outpatient (two or more individual sessions per week) are offered within a private practice setting

CBT Rationale for Anxiety Disorders

Rethinking anxiety: Learning to face fear | Dawn Huebner