Anxiety

What is Anxiety?

Anxiety is a basic emotion, and part of the normal human experience. When it disrupts quality of life or impedes functioning, it may be time to seek help.

Anxiety is experienced in different ways by different people, however there are some useful categories for understanding types of anxiety.

Panic - people experience spontaneous, seemingly out-of-the-blue, panic attacks and are very preoccupied with the fear of a recurring attack. These attacks include shortness of breath, heart racing, a fear of dying or going crazy.
Generalized Anxiety - recurring worries related to multiple areas of life
Phobias - specific fears, including fear of animals, insects, heights, and needles
Anxiety in social situations and relationships is very common. We address social anxiety using evidence based approaches including cognitive behavioral therapy and acceptance and mindfulness based approaches.

Obsessive Compulsive Disorder (OCD)

What is Obsessive Compulsive Disorder (OCD)?

“OCD” as a term has entered everyday lexicon to describe someone who likes things to be tidy or well-ordered, but this flippant use of the term minimizes the very real disorder that can severely impact people’s quality of life and make it hard to cope day-to-day.

Obsessive Compulsive Disorder is a mental health disorder that involves obsessive thoughts, feelings, sensations, urges, and compulsive behaviors.

Obsessions are repeated thoughts, urges, or mental images that cause anxiety. Common symptoms include:
- Fear of germs or contamination.
- Unwanted forbidden or taboo thoughts involving sex, religion, or harm.
- Over-focusing on internal body sensations and experiences such as breathing.
- Feeling like your brain is “stuck” on specific words, numbers, or thoughts, and playing them “on repeat.”
- Having things symmetrical or in a perfect order.
Compulsions are repetitive behaviors that a person with OCD feels the urge to do in an attempt to reduce the anxiety and uncertainty created by intrusive thoughts. Common compulsions include:
- Excessive cleaning and/or handwashing.
- Ordering and arranging things in a particular, precise way.
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off.
- Compulsive counting.
- Trying to achieve a “just right” feeling.
Common symptoms of OCD involve:
- Severe degrees of anxiety, panic, worry, and fear.
- High levels of uncertainty, anticipatory anxiety, and dread.
- Feeling “stuck” in thoughts, feelings, and behaviors.
- Lack of motivation to engage in daily activities.
- Struggling to stop compulsive behaviors and feeling bad for not being able to do so.
- Worrying “What if my thoughts are true?”
Treatment for Obsessive Compulsive Disorder can involve therapy or medication. Evidence suggests that a combination of medication and Exposure and Response Prevention therapy is the most effective OCD treatment.
Exposure and Response Prevention is a treatment strategy used to help you face your fears while also practicing not engaging in compulsions. The goal of ERP therapy is to practice allowing fear and uncertainty instead of engaging in compulsive behaviors. Therapists practicing ERP will:
- Support you as you gradually face your fears.
- Teach mindfulness, acceptance, and distress tolerance skills.
- Help you move toward values and what is meaningful.
Hudson Valley Mental Health does not prescribe medication but can work with your primary care doctor or psychiatrist if medication is indicated. You can find more information about treatment for OCD at the International OCD Foundation.
First, do your research to learn more about this disorder! The International OCD Foundation is a great resource to start with.
We also recommend looking into SPACE Treatment to learn more about parent involvement. SPACE stands for Supportive Parenting for Anxious Child Emotions, and is a type of treatment that parents can attend to help them learn skills and tools to help their child with anxiety, OCD, and related problems.
First, understand that OCD is not responsive to traditional talk therapy, which can make symptoms worse. Do your research (start with the IOCDF), and reach out for support where necessary. Schedule a consultation with a provider specializing in this area or refer your client to a specialist if necessary.

Parenting Challenges

What are Parenting Challenges?

Parenting can be challenging and demanding. Add in an anxiety or OCD related problem, and families can feel stretched thin. HVMH specializes in supporting parents through these challenges, giving them the tools they need to help their children and adolescents learn to cope with anxiety and begin to thrive. Hudson Valley Mental Health addresses parenting challenges with evidence based approaches, including SPACE (you can learn more about this treatment here) as well as cognitive behavioral therapy.

Trichotillomania

Trichotillomania (Hair Pulling), Skin Picking, and other Body-Focused Repetitive Behaviors

What are body-focused repetitive behaviors? Why do I pull my hair out? Why can’t I stop picking my skin? If you’ve ever asked these questions, you might be engaging in Body-Focused Repetitive Behaviors (BFRBs). BFRB is a general term for a group of complex disorders characterized by the hard-to-control urge to touch, pick, or pull at the body. These disorders can cause people to pull out their hair (Trichotillomania), pick at their skin (sometimes referred to as Dermatillomania), or bite their nails to a degree that can cause physical damage.

Why do I pull my hair out? Why can’t I stop picking my skin? If you’ve ever asked these questions, you might be engaging in Body-Focused Repetitive Behaviors (BFRBs). BFRB is a general term for a group of complex disorders characterized by the hard-to-control urge to touch, pick, or pull at the body. These disorders can cause people to pull out their hair (Trichotillomania), pick at their skin (sometimes referred to as Dermatillomania), or bite their nails to a degree that can cause physical damage.
Signs of Trichotillomania may include:
- Persistent pulling of hair from different parts of the body (common places include the scalp, eyebrows, beard, or eyelashes, though those are not the only areas), or picking or scratching at skin
- Performing these behaviors privately, as there tends to be shame associated with them
- Performing related behaviors such as continually feeling the hair or skin for smoothness or feeling for particular types of hair.
- Feeling like the behavior is “out of control” or like it’s difficult to stop, even when you want to.
Treatment for Trichotillomania and skin picking is not as easy as “just stopping” and is not a matter of willpower. In fact, “just stopping” pulling your hair or picking your skin can lead to significant distress and can even cause symptoms to increase. Trying to stop without support and training can make the urge to pick or pull feel even more out of control and unmanageable.
Working with a therapist to treat your Trichotillomania or other BFRB disorder can give you the tools and techniques you need to help manage these urges. It’s important to find a therapist who is trained to treat these disorders. With therapy you can learn:
- Mindfulness skills to help you work with the urge to pick or pull
- “Habit reversal training,” a treatment skill that will help you more effectively manage the urge to pick or pull
- How to respond with kindness and self-compassion when experiencing the urge to pick or pull
The most important way you can support your child if they perform body-focused repetitive behaviors is to work to understand their experience. They may feel ashamed, distressed, or out of control, and punishing them or shaming them for their behavior may only worsen these feelings. Find a therapist who specializes in treating these types of behaviors. You can also find resources at The TLC Foundation for Body-Focused Repetitive Behaviors.
Hair pulling and skin picking are common–and often hidden–concerns for clients. If a client reports struggling with these behaviors, normalize and validate their experiences and feelings. Do your research (start with The TLC Foundation) and reach out for support where necessary. Schedule a consultation with a provider specializing in this area if you decide to continue treating the client, or refer your client to a specialist if necessary.

I help people with anxiety, OCD, phobias, and depression.

Specialties