Shoshana Shira Twersky

PTSD is very treatable and the treatment of choice is called Prolonged Exposure (PE). It’s a slow process and takes time but it’s important not to rush it. I would suggest that you find a therapist in your area that offers this treatment modality if you’re not already working with someone. A good resource is PsychologyToday.com you can search for a therapist by area code and you can filter by male/female, your insurance, diagnosis, treatment modality, etc.

Absolutely. A lot of changes happened for you since the accident and adjustments are never easy. Sometimes when we go through a major life event we forget about the fact that there’s a long list of things in our life that are not broken, that are functioning quite well, and do not need fixing at all. It’s important to maintain a balanced approach and both learn to manage and work through your feelings and changes but also to make room for just as much focus and attention on the things you continue to appreciate; otherwise, you’d be ignoring half the truth and that wouldn’t be fair to you!

Telehealth is not the preferred method of therapy but since the pandemic we were kind of forced into it and I think we’ve been doing pretty well overall. I still maintain that ideally it’s good to be face to face with your therapist in person but depending on the relationship, so long as you are with the right person you definitely can develop a solid and strong therapeutic alliance and do effective therapy work via Telehealth.

Not at all. It sounds like you possibly are using food to cope with feelings and a good cognitive behavioral therapist (CBT) can help you work through this.

The evidence based treatment recommended for social anxiety is CBT, cognitive behavior therapy. Specifically, the treatment would involve “exposure” exercises to help you face feared situations. At the core of social anxiety is the fear about being judged by others or being embarrassed in social situations. It will be important to understand that even if your fears/feelings are intense in a given moment, that is not a cue that there is danger or something happening that you can’t handle! Feelings are not dangerous and they can’t hurt you. I wish you all the best.

Generally speaking, group counselling with a competent facilitator can be incredibly powerful. The benefits of a group that you cannot get from individual therapy is the understanding and validation from others who truly “get it” having been through similar circumstances, and group members can therefore support each other in valuable ways. Group members can offer shared experiences and suggest ways they’ve coped with similar circumstances.

The answer to this question very much depends on your needs as a couple, the progress you make, the pace at which you work in therapy, other issues that may come up outside of communication issues, and so much more. This is a good question to discuss with the therapist you decide to move forward with.

No, these are two different disorders and anxiety does not cause psychosis. It is possible, however, to have co-occurring disorders. What you may be referring to is when someone has very severe anxiety it sometimes results in panic attacks that have symptoms of psychosis, however, this is not real psychosis because the person is not losing touch with reality. The symptoms of anxiety psychosis will decrease as the anxiety decreases, unlike actual psychosis.

Stress is how your mind (psychological) or body (physical) responds to things that are happening in your life (external circumstances). We don’t necessarily have much control over things we are faced with (such as who asked for the pandemic, right?) but we all have 100% control over how we RESPOND/COPE with the circumstances we are dealt. Healthy responses will lead to reduced stress. For example, person A can spend his days complaining about the restrictions the pandemic brought about, feeling depressed, angry about social restrictions, and anxious about what the new normal will look like. Person B, on the other hand, may spend his time enjoying the ability to skip the commute to and from school/work due to distance learning or working from home, appreciating more intimate family time he doesn’t typically get, involving himself with hobbies and perhaps learning a new language or playing video games with friends. Person A and B are both hit with the pandemic which is not within their control but they respond differently and therefore their psychological stress levels will be completely different.

The short answer is yes. A psychologist will be able to help you is several ways, including being a part of your support system, processing your pain, helping you learn from your experiences, and you will also likely gain new ways of looking at things that not only will help you heal from the heartbreak you describe, but the important thing will be to learn and be able to generalize the new ways of coping to other areas of your life.

I am going to assume you are referring to the pandemic in your reference to being on “lockdown.” You mentioned not much has changed with your eating habits, though I wonder whether other things have changed in your daily routine that may be impacting your health including your weight. Perhaps you are moving much less than you used to; even if you didn’t have a regular exercise regimen before, just by the fact that you mention the term “lockdown” gives us a clue as to how your mind may be perceiving your circumstances and that in and of itself will impact you. The emotional toll the pandemic has had on individuals such as yourself cannot be ignored. I operate from what’s called a bio-psycho-social model which means that we cannot separate the medical from the emotional from the psychological aspects of the person. You are one person, and when one part of you is affected, the rest of you is affected as well.

You are ahead of the game by the fact that you recognize that your thoughts are in fact automatic! We call them automatic because we don’t control thoughts that pop into our head, right? We just find the thoughts there. If that’s the case then, what are OUR thoughts? That’s where your question comes into play. It’s what we DO with the thoughts we find in our head. We get to decide whether it is a helpful thought, a productive thought, one that’s going to serve us well. If so, great, keep it! If not, you can do several things with the thought. You can completely dismiss it (that’s pretty extreme) you can reframe it, you can put a positive spin on it... In essence what you’re doing here is called meta cognition which is “thinking about the thinking”. It’s basically a higher level of thinking rather than just doing simple surface level thinking which would have been accepting a thought just because you found it in your head and erroneously believed it was yours.

It depends what we mean when asking about the treatment “working” which is part of what you would explore in therapy. We want to be careful not to have unrealistic goals because inevitably that will only lead to disappointment. With depression, for starters, a good goal would be to feel a little bit better than you otherwise are feeling. To begin to engage in activities that you otherwise would be engaging in if you were not feeling depressed. As the queen of baby steps, I can tell you that it is valuable to have your short term goals in addition to long term ones. The therapy is “working” very early on in the process if you are motivated for change, engaged in the process, committed, and sticking with it even though at times it feels like hard work!

I imagine when your daughter and the things around her are sprayed with the diluted rubbing alcohol it calms her in those moments because in her mind, it takes care of the contamination from germs. The problem with the spray is that she equates the spraying with what keeps her safe and she never has the opportunity to learn that in fact she is safe because she is safe. The spraying has become her “safety behavior” and in order to help her get well she would need professional help. An experienced cognitive behavioral therapist can treat her using exposure response prevention techniques which ultimately will teach her that she has the ability to tolerate the discomfort of the obsessive thoughts and she is capable of resisting the compulsive spraying. She will learn to challenge her thoughts and once she begins to have experiences of success she will learn that she is not in danger and her anxiety will decrease.

The evidence based treatment for depression is called behavioral activation. You would pick one small thing you were doing prior to feeling depressed and commit to doing it (i.e., a weekly Zoom call with a friend, crochet, or a run) and do that thing consistently. It’s like the fake it till you make it.

When treating depression, an evidence-based method we use is called behavioral activation. What that means is we would figure out what are the things you would be doing if you were not depressed, and we would take baby steps towards doing something from that list. It’s sort of like the “fake it ‘till you make it” strategy only you’re not really “faking” it, you’re doing what you’re doing what you would be otherwise doing if you were not feeling depressed.

There are many factors that likely contribute to drug abuse. I work from a biopsychosocial model that discusses the biological, psychological, and social aspects of the person. Some people are born genetically predisposed to addiction, meaning these people are at greater risk to become addicted and abuse drugs based on genetics alone regardless of other factors. Others may abuse drugs because of environmental reasons, poor role modeling by primary care givers, escape/avoidance of problems, maladaptive coping skills, boredom, peer pressure, or accidentally becoming addicted from prolonged use following a legitimate reason such as recovery from a surgery to name a few; the reasons are endless.

When someone experiences a traumatic event, symptoms are not necessarily going to disappear merely because the event is in the past. Especially if the event was particularly traumatic and the person did not deal with the emotional effects, the memories and the impact can linger and get "stuck" in the person. The symptoms will get expressed in various ways such as insomnia, nightmares, flashbacks, anger, apathy, and perhaps the use of drugs to cope. Psychotherapy is treatment to help support a person to heal from the trauma and there are many types of therapy that can do this. Personally, I work from a cognitive behavioral model and somer of the methods I use are cognitive restructuring, exposure therapy and grounding/mindfulness-based techniques. There are others methods such as EMDR.

To best understand this, I would encourage you to research a concept called the gate control theory for pain. Once you understand that theory, you will see that the fact that physical problems influence pain is only a part of the equation. Psychological variables greatly affect how a person perceives pain and consequently responds to treatment. The goal is to “close the gate” to reduce pain perception and there are several ways to do this including relaxation techniques, concentration and distraction, medication, grounding and mindfulness strategies, and acceptance to name a few.
In general, to reduce chronic pain it’s important to improve physical function and decrease behaviors that increase pain, improve personal control and self-esteem, and increase social supports and activities that will distract from the pain.
The CBT approach evaluates the cognitions such as the meaning you attach to the pain, the behaviors that you engage in that may increase the pain (such as decreasing activities) and the emotions such as potential sadness or grief over the loss of earlier functioning. The good news is that we wouldn’t need to make a change with all 3 (cognitions, behaviors and emotions). If we focus on just one, let’s say the thinking and challenge or reframe the thoughts, the behaviors and feelings will shift and consequently the pain will decrease.

The idea of course is for talk therapy to help you get better. One thing that is probably most important is for you to have a sense of safety with your therapist. It is important to interview therapists until you find someone that feels right. A great resource is PsychologyToday.com You can search by area code and the site allows you to filter by insurance, male/female, type of therapy, disorder or issues you're coming to treatment for etc. and it has a picture and write up from each therapist. You can request an initial phone call before meeting to ask some questions and get a sense of how the therapist would be working with you. Of course it will take time to build an alliance but typically you will be able to get a feel for someone pretty quickly.