Thursday, March 29, 2018

Understanding PTSD and Available Treatments

Available Treatments for PTSD in Cranberry Twp, Monroeville & Mt. Lebanon, PA

The National Comorbidity Survey Replication estimates that approximately 6.8% of the population will develop Posttraumatic Stress Disorder (PTSD) at some point in life.  Women are more than twice as likely than men to develop symptoms of PTSD after a trauma.  Traumas can vary from physical or sexual assaults, natural disasters, acts of terrorism, witnessing deaths or serious injuries, vehicle accidents, combat experiences, or any situation where individuals may fear death or serious injury.  The previous examples are not meant to be all-inclusive.  Trauma is very subjective and relies on the cognitive and emotional processing of the individuals who experience the events.

The DSM-V lists four symptom clusters for PTSD.  Individuals may re-experience the trauma through intrusive thoughts, nightmares, flashbacks, or by experiencing distress when encountering reminders of the incident.  Individuals tend to make active efforts to avoid thoughts, feelings, or reminders of the trauma.  After the trauma, negative thoughts and feelings tend to worsen.  This worsening may be apparent in a more negative view of the world, feelings of guilt, more frequent negative emotions, feelings of isolation, or decreased interest in activities.  Individuals may have a higher level of arousal and reactivity after traumas.  This increase in arousal may be apparent in increased irritability, risky behavior, feeling edgy/jumpy, difficulty concentrating, or issues with sleep.  It is normal for the body to respond to trauma in a way that facilitates survival.  Issues may arise when this response lasts for a significant period and interferes with life and happiness.

PTSD may vary in complexity.  Individuals who experience childhood, interpersonal or repeated traumas may have a more complex form of PTSD.  Complex PTSD may require longer and different treatments.  Typical treatments for PTSD are brief and time-limited.  Most treatments for PTSD include elements of cognitive behavioral therapy.  Effective treatments typically teach individuals new ways to regulate reactivity and/or integrate exposure-based activities.  Exposure-based therapies utilize the security of the therapeutic relationship to expose individuals to symptoms of PTSD and reminders of the trauma.  Through this process, the reactivity to the symptoms and reminders tends to less, and individuals are typically better able to engage life more fully.

The PTSD diagnosis cannot be made unless difficulties are present for at least one month.  This fact should not deter people from seeking help sooner.  Individuals who are experiencing distress should seek help as soon as possible.  They do not have to wait until the pain becomes unbearable.  It is important to choose a clinician who has specific training and experience in providing the previously discussed treatments.

You can contact the Cognitive Behavior Institute if you live in Western Pennsylvania and need help.  The Cognitive Behavior Institute provides clinical services that are consistent with the approaches described previously.  You can also contact the Academy of Cognitive Therapy to find resources nationally.

Thomas M. Workman, PhD, LPC, NCC, ACS

Clinical Supervisor at the Cognitive Behavior Institute

Assistant Professor of Clinical Mental Health Counseling at Franciscan University

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This article was originally posted on Cognitive Behavior Institute March 2018


Tuesday, March 20, 2018

Marathon Therapy for Couples

Providing Marathon Therapy for Couples in Cranberry Twp, Monroeville and Mt. Lebanon, Pennsylvania

marathon therapy for couplesIf you’re anything like me, any title that begins with “Marathon”, conjures up immediate reactions like, “Yuck!” “That’s not for me!”, or “Can I take a rain check?” as well as a whole host of uncomfortable emotions like intimidation and fear.  If you’re a runner, perhaps your curiosity is already piqued.  What is Marathon Therapy for Couples and why would anyone inflict this kind of rigor on their intimate partner relationship?

Why Marathon Therapy?

Marathon Therapy is an intensive treatment modality tailored specifically for couples who are interested in repairing or enhancing their relationship with the support and guidance of a relationship expert over the course of one weekend.  You might be thinking, “Is marathon therapy the right move for me and my partner?” This is an important question to consider.

From our perspective, here are some of the distinct advantages of investing a dedicated chunk of time rehabbing your relationship through Marathon Therapy for Couples (MTC) at the Cognitive Behavior Institute:

  • In traditional marital/couple therapy, sessions are only 50 minutes long in duration.  There are many occasions in which you are just starting to dive into an important relationship issue and it is time to wrap up the session which disrupts the therapeutic process leaving all parties feeling frustrated.  MTC carves out the necessary time to really talk things through and to re-establish an emotional connection and mutual understanding.
  • Rather than spreading out weekly sessions over the course of 3-6 months or sometimes even longer, you can experience more immediate relationship results instead of waiting for the process to unfold over an extended period of time.
  • MTC accommodates couples with full schedules who are unable to carve out 2-3 hours each week (travel time + therapy time) to participate in weekly couple’s therapy.
  • MTC provides a powerful treatment option for long distance couples who reside in different cities or for couples who do not have local access to a seasoned, expert in couple’s therapy.

Does Marathon Therapy Work?

You might be thinking, “What in the world could we possibly talk about for 2 consecutive, 8-hour days (8:30am-5:00pm) and how is that even helpful?”  There is some preliminary research which suggests that this modality of couple therapy may be even more effective than the traditional “meet once a week” model.  In a seminal study, Boegner & Zielenbach-Coenen (1984) compared three groups: 1) This group received 14 sessions of couple therapy on a weekly basis; 2) This group received the same amount of therapy hours (14) but these sessions were collapsed into a far shorter span of time; and 3) This group received no treatment at all.  They discovered that the group who received the most intensive treatment in a shortest amount of time obtained the best treatment outcomes.  They discovered that Group #2 got the biggest bang for their buck outperforming the other two groups.  The couples in group #2 on average made greater progress on their treatment goals & experienced significantly less relapse than the other 2 groups when tested 8 months after treatment.  In another randomized clinical trial, Babcock, Gottman, Ryan & Gottman (2013) discovered that a weekend relationship workshop that focuses both on friendship enhancement and conflict management maximizes positive outcomes for couples.  In summary, there is a growing body of research that validates this approach to couple’s therapy.  If you are interested in learning more about Marathon Therapy for Couples please contact Cognitive Behavior Institute's office at 724-609-5002.

This article was originally published on March 2018

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Wednesday, March 7, 2018

Conduct Disorder

Child Behavior Therapy in Cranberry Twp, Monroeville and Mt. Lebanon, PA

Late childhood into adolescence can be a trying time for both parents and children. Developing an identity, coupled with social pressures, can lead to a wide range of behavioral changes in children, including acting out and defiance. However, when a child’s behavior shifts from typical parent-child conflict to a markedly violation and disregard of the people and property around them, further evaluation may be warranted. This type of behavior may be indicative of a behavioral diagnosis known as Conduct Disorder.

What is conduct disorder? According to the DSM-V, Conduct Disorder is “a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.” Conduct Disorder is typically diagnosed in adolescents under the age of 18, and is often a precursor to Antisocial Personality Disorder. The symptoms of Conduct Disorder must be present 12 months prior to diagnosis. Symptoms include, but are not limited to, aggressive and/or physically cruel behavior towards other humans or animals, physical altercations, truancy, lying, stealing, property destruction, and running away from home. ADHD and Oppositional Defiant Disorder (ODD) are common premorbid disorders diagnosed in younger children before a diagnosis of Conduct Disorder is determined during adolescence.

According to the APA, Conduct Disorder has a 2-10% prevalence rate. It is more common in males; however, this may be due to the tendency for males to act out in more overt, physical ways, such as fighting and physical aggression towards others. Females are more likely to engage in acting out via interpersonal relationships in more covert, passive means such as cyberbullying, peer rejection, and lying. Conduct Disorder is more prevalent in children who have experienced abuse, neglect or have experienced overly permissive parenting styles. Parental mental health history may also place a child at risk for developing these behaviors. Several studies suggest that Conduct Disorder may be heritable; further, different tolerances to various neurotransmitters as well as brain injury to the prefrontal cortex may also play a role in its presentation.

Having an adolescent with Conduct Disorder is difficult to manage, however, treatment is possible. Cognitive behavioral therapy is an evidence-based intervention that works to change a child’s thoughts and, in turn, behavior. Additionally, family therapy techniques with an emphasis on parenting style and behavioral management interventions can also invoke change. If needed, adolescents may also warrant the need for pharmacological interventions.

At Cognitive Behavior Institute, we are able to provide such evidence-based treatments, as well as offer psychiatric services for medication management. We have child psychologists, psychiatrists, and licensed clinicians with experience in working with children and adolescents with behavioral difficulties such as those seen in Conduct Disorder. Our staff will work with your child and family to provide the best possible treatment to ensure the best possible outcome. We invite you to contact us with any questions you may have at 724-609-5002 or check us out on our website,

This article was originally posted on Cognitive Behavior Institute 3/7/18
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Wednesday, February 28, 2018

Employee Assistance Programs for Mental Health

Employee Assistance Program Benefits

Let’s face it: working can be stressful! And going to work while dealing with different sources of stress can make things even worse. Sometimes this stress manifests into physical illness, fatigue, and a decline in workplace morale and production. With Americans notoriously under-using their paid vacation time, having stressed-out workers spells trouble for many companies.

You may work for one of the 54% of American employers offering an EAP. An EAP, or Employee Assistance Program, offers free or discounted mental health counseling amongst a plethora of other services; however, it is estimated that less than 10% of employees take advantage of these programs. Many don’t even know they exist! Yet the benefits of an EAP are enormous: while costing a minimal amount for employers, complete usage (i.e. using up all allotted therapy sessions) of an EAP reduced employee absenteeism from 2.37 days of tardy/unscheduled days in the 30-day period prior to EAP use to only .91 days afterward. In addition, usage of an EAP results in less work-related injuries, sick days taken, and workplace satisfaction.

The Cognitive Behavior Institute (CBI) is developing an EAP designed to perfectly fit you and your company’s needs. We offer a “buffet-style” of services, allowing your employer to pick and choose services based on company needs, size, and anything else! With a competitive price and a utilization-based model, we strive to provide the best mental health counseling at the best possible price to maximize company happiness.

If your company does not yet have an EAP, encourage your employer to look into our program! If you are the owner of a company without an EAP, we would be happy to answer any questions you have about the advantages of adding an EAP to your company benefits. Give us a call at 724-609-5002 or check out our website to see our clinicians and services offered at We look forward to hearing from you!

This article was originally posted on

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Thursday, February 22, 2018

In Health and Hope: Advice for Recovering Addicts

There is Hope for Recovering Addicts!

Written by: Adam Cook

Recovering addicts face a troubling ordeal. Recovery means total abstinence from drugs and alcohol, a daunting “new norm” that many simply aren’t able to maintain. The love and support of family and friends can help addicts achieve sobriety by supporting a loved one through a jarring lifestyle change. Sometimes, that support is the difference between success and relapse. And it can help smooth the addict’s attempt to go back to work, re-enter social life, and regain a semblance of normalcy. Confronting emotions and being honest with oneself about the past is difficult for anyone; for a recovering addict, it is essential to embracing the harsh truth of addiction and maintaining a clean and sober lifestyle. Recovery is, in a real sense, a fragile rebirth, the success of which depends on many factors.

Seek support

Often, a recovering addict is overcome by shame and a desire to withdraw from day-to-day life. The desire to avoid places and faces that remind you of a painful and failed past is a common response, but experts insist that it’s important to re-engage with life and find your inner strength. There’s great benefit to be derived from having a loved one who can help you confront the past, to make sense of your feelings and overcome guilt, sadness, and anger so that you can move forward in hope. It’s possible that you may feel uncomfortable reaching out to someone you know, or there may be too many personal bridges to rebuild for that to happen right away. If so, look to a professional who’s experienced at helping recovering addicts.

Above all, seek out a support group. Many scientific studies have concluded that those who take part in treatment were able to maintain abstinence at a higher rate than other populations and indicated a higher level of satisfaction with their treatment programs. Those who took part in peer support groups also were less likely to be homeless. Clearly, recovering addicts stand to benefit from the support and perspective they are likely to gain from taking part in a support group.

Healthy relationships

Part of finding support and understanding is seeking out and emphasizing relationships that don’t threaten your sobriety. In other words, you need to avoid circumstances and old friendships that will put you back in contact with drugs or alcohol. It’s important to avoid groups and individuals who make it difficult to break with harmful behaviors. Triggers—stimuli that can lead to a relapse—could arise anywhere, anytime. And they can confront you in the form of places, old and new, and people who are reminders of substance abuse. They could be smells or sounds, anything your brain might associate with drug or alcohol use. They’re temptations that must be avoided.

Yoga and meditation

Meditative exercise is an effective practice for individuals who are seeking to break with a negative past and achieve inner peace. Yoga utilizes mental and physical methods which reach that portion of your brain that’s most vulnerable to substance abuse. It’s a mental discipline that can strengthen your resolve and make it easier for you to resist stress triggers that come up unexpectedly. As a meditative, focusing exercise, yoga is uniquely effective at helping recovering addicts connect to a deeper consciousness. Meditation is another proven-effective, self-reflective means of preventing relapse. A 2014 study revealed that more than 200 recovering addicts who had taken part in a meditation program had a reduced rate of relapse six months later.

Staying busy

Occupying your mind and body with a hobby, or even a new business venture, is a good way to avoid relapse. If you’re fond of animals, consider becoming a pet sitter. There’s always a need for a good, reliable sitter (veterinarians and animal shelters can be expensive and difficult to book). There are significant benefits to being in the company of dogs during recovery; they’re good and loyal friends who can help reduce depression and anxiety.

A painful process

Addiction recovery is a slow and painful process. There are many triggers and temptations that can get in the way of your efforts to reestablish some degree of normalcy, to hold down a job, and maintain relationships. It’s very important to find support from friends, family, or support groups as you work through your emotions and strive to remain sober.

Courtesy of Pixabay

This article was originally posted on February 2018


Saturday, February 10, 2018

Trauma Associated With Sexual Assault

Trauma. We read about it in newspapers, we hear about it on television, we see the hashtags on social media. The American Psychological Association defines trauma as an “emotional response to a terrible event like an accident, rape, or natural disaster.” As can be seen with this definition, there are multiple types of experiences that can be defined as trauma. More recently, we’ve heard the term trauma utilized by women and men who are no longer afraid to speak out. These people, though, aren’t speaking out about car accidents or natural disasters, they are speaking out about their experience with sexual assault.

Although sexual assault is not included as part of this definition, many who have experienced  such incidents perceive these as such and these should be valued as equally. Trauma is often based on how someone perceives an experience. Given this, it is important to recognize the language used to describe trauma as it relates to sexual assault.The nation’s largest anti-sexual violence organization, RAINN, defines sexual assault as, “sexual contact or behavior that occurs without explicit consent of the victim.” This may be considered an umbrella term as it covers a wide range of behavior and can be vague in interpretation. So, then, what contact or behavior can we consider sexual assault? Sexual assault is attempted rape, fondling or unwanted touching, forcing a victim to perform sexual acts like oral sex, and penetration of the victim’s body which is known as rape.

Statistics show that one in six women have been victims of attempted rape or rape. One in thirty three men have been victims of attempted rape or rape. Sixty-three thousand children between 2009-2013 were victims of sexual abuse. Every 98 seconds, someone is sexually assaulted. We have seen these staggering statistics come to light in recent months. With women like, Tarana Burke creator of the #METOO movement, who took social media by storm and started a conversation where it is safe to speak out. TIME Magazine’s highlight of women and men who have spoken out against sexual assault and their perpetrators. Efforts likes these have garnered people courage to speak out against those in power who abused them.

Although, the tides in our country and the world are changing and women and men are riding those waves to create a new conversation that empowers victims to become their own hero, our efforts must expand to consider the emotional impact these experiences have on their victims. As seen in the above definition of sexual assault, we typically equate force to the use of physical force. However, force isn’t always physical. It may be manipulative or take the form of a threat to force compliance. This kind of force is emotional. It expands beyond the physical assault to an assault of our psychological well-being. This type of assault may the worse type of all.

This type of emotional impact can result in the form of a behavioral health diagnosis known as Post-Traumatic Stress Disorder (PTSD). PTSD is defined as a disorder that develops in some people who have experienced a shocking, scary, or dangerous event. People with PTSD can suffer from nightmares, flashbacks, loss of appetite, and intrusive thoughts. They may experience feelings of guilt and self-blame. They are often hyper vigilant to their surrounding and may avoid people, places, and activities that remind them of the event. This further can result in difficulty with sleep and concentration.

At Cognitive Behavior Institute we are not only joining the conversation about sexual assault, but we are leading a campaign around these efforts to support our community in dealing with the emotional impact of such trauma. Along with providing evidence-based treatment to combat PTSD, we are furthering these efforts by training therapist in the Pittsburgh area in effective trauma therapy techniques to increase access to this type of treatment. We are dedicated to helping and empowering survivors and loved ones of survivors. For more information about our treatment, or if you are a survivor or want to join our campaign, please visit our website at We have offices in Cranberry Township, Monroeville and Mt. Lebanan, PA.  In addition, we offer distance counseling.  Your experiences are valid, you are important, you are loved, and you are not alone.

Originally posted on February 2018

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Monday, February 5, 2018

Social Anxiety Disorder

We Offer Social Anxiety Disorder Services in Cranberry Twp, Monroeville and Mt. Lebanon, PA


There’s a lot of us who don’t particularly enjoy public speaking or interacting with crowds of people. But what if that hesitation becomes excessive to the point of avoidance and extreme anxiety? Social Anxiety Disorder (SAD), or social phobia, is a common anxiety disorder that is first and foremost defined as an intense and persistent fear of social or performance-type situations. This could mean a fear of speaking in front of a larger crowd of people or even simply interacting with others on your college campus. There must be an intense fear of being humiliated or becoming embarrassed while in said social or performance situation; being judged, laughed at, rejected, or ignored are all common fears experienced by people with social anxiety. This fear often is accompanied by physical symptoms of anxiety, such as blushing, sweating, shaking, or even panic attacks, or else an overwhelming sense of anxiety while out in social situations. Some people may avoid these triggers, and occupational, social, academic, and other kinds of functioning may become impaired.


SAD is one of the most commonly diagnosed anxiety disorders, with a prevalence of around 6.8% at any given time. This adds up to around 15 million Americans suffering from social anxiety each year. Unlike some other anxiety disorders, like GAD or Panic Disorder, SAD affects men and women equally, with the age of onset starting around 13 years old. And this is not necessarily a disorder that is easy to grow out of: the Anxiety and Depression Association of America conducted a study in 2007 that found 36% of people with SAD diagnoses reporting experiencing symptoms for 10 or more years before seeking treatment. That’s over a decade of panic, fear of scrutiny, and impaired functioning in daily routines!


The good news is that SAD responds incredibly well to certain forms of therapeutic interventions, most notably being cognitive behavioral therapy or CBT. CBT has evidence-based results showing marked improvements and even complete cures from SAD with the hard work of both therapist and client. CBT works to alter negative thoughts you may have regarding yourself or social situations. It shows that anxiety can be controlled and you have the power to do so. With repetition in implementing CBT techniques learned in the therapy office, many people report success and improvement at completion of treatment and even months beyond. Group therapy is also incredibly effective, using solidarity in members with SAD diagnoses and CBT techniques that can be implemented with other group members. A supportive environment such as a social anxiety therapy group can do wonders in improving SAD.


Here at Cognitive Behavior Institute, we are proud to be the regional clinic for the National Social Anxiety Center (NSAC). We are located in Cranberry Township with additional satellite offices in Mt. Lebanon and Monroeville. Our clinicians are trained to use CBT and other evidence-based methods to specifically address social anxiety and any other mental health issues that may be going on in your life. To learn more about who we are and to meet our growing list of talented clinicians, you can visit our website at To schedule an appointment for you or a loved one’s social anxiety or for additional information, you can give us a call at 724-609-5002.

This article was originally posted on February 2018