Michael Checknoff - Psychotherapist
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Philosophy for Treating Anxiety Disorders

My philosophy follows the principles of Cognitive Behavioral Therapy, or CBT.

Whether a person is suffering from Panic Disorder, Generalized Anxiety, Social Anxiety, a Specific Phobia or an Obsessive Compulsive Spectrum Disorder, it is crucial to stop avoiding the anxiety and learn to face it. This is the cognitive part. By "avoiding the anxiety" I mean both avoiding the anxiety provoking situations AND wanting to avoid feeling the anxiety experience itself. We all have a relationship with our anxiety experiences. We react to a big wave of anxiety in particular ways. When the anxiety experience is distressing enough, the natural reaction is to fight it, try desperately to try to relax, hate the feelings, and/or try to push away unwanted thoughts. However, these natural reactions tend to sustain or exacerbate the anxiety. It's like you're trying to scream inside, "Make it stop!!!" Screaming inside is not relaxing! Since fighting or trying not to think about the anxiety and the unwanted thoughts does not work, all one does is increase the agitation.

When the anxiety is severe, the solution is not to learn how to relax.

Consciously trying to suppress the anxiety and/or unwanted thoughts is impossible. The solution is to go through a learning process to stop hating the anxiety and to begin to tolerate it. Then you progress to learning the attitude of to allowing the anxiety to happen. The ultimate goal is acceptance. If you have a severe case of anxiety the prospect of allowing the anxiety to happen is probably both difficult to understand and extremely daunting. It's counterintuitive. Anxiety can be excruciating. However, to take the attitude that it is really uncomfortable, but not dangerous is the most healing attitude that you can take. Your anxiety, distorted thoughts or OCD thoughts are trying to trick your brain into thinking they are dangerous and important. You can learn to not fall for the trick. This is the "ironic process." You learn to outsmart your anxiety and/or unwanted thoughts and to accept them rather than resist them. This is both the mainstream approach among specialists treating people with anxiety and the evidence-based approach. It takes time. Accepting the anxiety is a process that is learned incrementally.

"Facing it" often involves Exposure Based Therapy.

The behavioral part involves gradually facing the feared situations. It's also known as Exposure Therapy, or, for OCD, ERP--Exposure and Ritual Prevention. The person in treatment is of course reluctant to do this, and preparation is needed before exposure work can begin. There is power in deliberately exposing oneself to feared situations, both in terms of healing and in terms of feeling less distressed than one would expect to feel while doing it. There is so much variation in how this is done, depending on the individual with whom I'm working, that it would be better to discuss this personally than to write more on this website.

I love my work.

I was originally trained as an insight oriented psychotherapist. As a psychodynamic psychotherapist, I had the mistaken idea that cognitive behavioral therapy, which is the approach I am describing and that I primarily use, is mechanical, shallow and dull. I have found that CBT, cognitive behavioral therapy, actually requires me to use all my brainpower and creative energies. It's one thing to set up behavioral plans that follow textbooks, and another to design them so that they work for each individual patient. I incorporate what I've learned from my training and experience in psychodynamic psychotherapy and and my later training in doing family therapy into my current work; I'm interested in getting to know
my patients.

CBT for Depression

I also treat people for depression, often when it co-occurs with anxiety. While the depression and the anxiety are not separate parts of any individual with symptoms of both, CBT for this depressive part is somewhat different, often involving identifying and correcting negative thoughts, or cognitive distortions. There is much more to CBT for depression that I can explain to someone who is interested in seeking treatment with me.

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