Child and Adolescent Psychiatry Consulting

• Cognitive-behavioral treatment (CBT):  This is a treatment that teachers people with anxiety to change the ways they think and behave to assist a child or adolescent  control their anxiety and regain more normal function. Through CBT a child or adolescent learns, in a step–by–step fashion, to master the situations that cause anxiety. CBT includes:
  • educating the child (and caregivers) about the nature of anxiety
  • helping  the child identify unhealthy, negative beliefs and behaviors and replace them with positive ones,
  • teaching specific skills for managing the physical sensations, negative thoughts, and problematic behaviors that accompany anxiety.

• Exposure and Response Prevention (ERP) In ERP treatment, patients learn to resist the compulsion to perform rituals and are eventually able to stop engaging in these behaviours

• • The patient is either directly exposed  or imagines exposure to the anxiety-provoking trigger in a controlled setting.
  • The patient is asked not to engage in their ritual “response” when the exposure occurs.
  • Over time, the patient will have less and less anxiety in response to the exposure, with a reduced need to engage in the ritual response

• Habit Reversal Training (HRT)

Habit reversal (HR) is a behaviorally based treatment that is used to reduce repetitive behaviors which may bothersome and serve no adaptive function, such as tic disorders, nailbiting, thumbsucking,  hairpulling(trichotillomania) and other nervous habits.

HR is based on the premise that people are often not aware each time a tic or other repetitive behavior occurs, and that repetitive behaviors often follow an urge or feeling of discomfort which is only relieved by engaging in the behavior itself. HR works to increase awareness of one’s behaviors, and to provide relief with strategies that replace the unwanted behavior with a less bothersome behavior.

HR has been used and found effective, rapid and lasting in treating chronic tics, other repetitive behaviors, and Tourette’s Disorder. Despite numerous studies, only a few controlled studies have been conducted. In these studies HR was found effective when compared to individuals on a wait list and when compared to supportive psychotherapy. When compared to exposure and response prevention treatment, no differences were found and both treatments were found effective. Overall, a large body of evidence supports the effectiveness of habit reversal. It is critical that additional research be conducted, using controlled studies with larger sample sizes and comparing behavioral interventions with medication.

• Relaxation techniques
• Biofeedback (to control stress and muscle tension)
• Family therapy
• Parent training
• Medications:  may be prescribed to help youngsters feel calmer as they work toward healthier everyday functioning