Dr. Albert Jerome

Thoughts on Psychotherapy and Behavior Change

Dr. Jerome Featured in an Article About Bullying

Posted by Draljerome on July 20, 2010

Clinical Psychologist Dr. Albert Jerome was featured in a recent article published by Elizabeth Coe in the Loudoun Times Mirror.

Ms. Coe wrote that bullying among school-aged children is a widespread and serious issue. According to the U.S. Dept. of Health and Human Services, studies show that between 15 and 25 percent of American students are bullied. Several examples of specific cases of bullying were described in the article.

Dr. Jerome was cited as a local expert on bullying, who has both knowledge of the relevant research literature and clinical experience working with youngsters and families that are dealing with bullying. Dr. Jerome stated that bullying can have a significant impact on children and can lead to significant distress, withdrawal from activities, and even refusal to go to school.

He also talked about how schools can best address bullying. The ideal approach involves the whole school, including school administrators, teachers, and students. Schools should keep track of what is happening by collecting detailed incident reports, and school administrators and teachers need to communicate known problems so that everyone can be aware. It is also important for children who are having difficulties to have someone whom they can trust and talk with in the school–a teacher, guidance counselor, or administrator.

In his clinical practice with families, Dr. Jerome works both individually with the child being bullied and also by reaching out to the school to make sure that they understand the severity of the problem and have appropriate resources in place for the child who is being bullied.

A further approach is to provide “resiliency” training for children so that they are less emotionally distressed by and reactive to bullying. Dr. Jerome stressed that the school should always be informed of what is happening and that children should not be advised to take things into their own hands by fighting. However, in some cases, learning to be less reactive can be helpful in reducing or eliminating verbal teasing.

Dr. Jerome is available for assisting families with issues related to bullying, anxiety and fears, OCD, depression, school refusal, and a variety of other behavioral problems.

He can be reached by email at draljerome@gmail.com or by calling Ashburn Psychological Services (703-723-2999).

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So What About Negative Thinking?

Posted by Draljerome on March 14, 2010

My clients complain about negative thinking. And I understand. Therapists are people, too, and we are susceptible to the same foibles as our clients. Maybe my thoughts are less intense or disruptive; maybe not.

The truth of the matter is that all people are susceptible to negative thoughts, and many of us experience a negative “verbal track” that courses through our minds for at least some part of the day. In some schools of thought, negative thinking is the root of disorder (e.g., depression) and therapy involves changing the negative thoughts to thoughts that are more positive or at least more “rationale.”

There is, however, a different approach that is a blend of both ancient and modern thinking. Mindfulness-based cognitive therapy blends modern cognitive-behavioral therapy with the wisdom of Buddhist philosophy and concepts of mind. In this approach, the goal of therapy is not to change the content of thoughts but, rather, to change the function of thoughts.

So what does it mean to change the function of thoughts? What it means is that the content of thoughts becomes much less important. Thoughts are viewed as conditioned phenomenon that develop over time, as a function of your history and interaction with the world. Once ingrained, they are extremely difficult to change. However, although they are extremely difficult to change, they do not need to be changed. The literal content of negative thoughts (what your thoughts “say”) is viewed as relatively unimportant. They aren’t that big a deal.

The goal of therapy, then, is to help clients to gain some distance from their thoughts and to not try to do battle with them. There are numerous strategies that can be used to accomplish this change in perspective, and I will focus on them in a later post.

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Anxiety and Safety Behaviors

Posted by Draljerome on January 31, 2010

Safety behaviors and safety objects are important concepts for understanding the cognitive-behavioral treatment for anxiety disorders. A safety behavior is any behavior that serves to keep you “safe” when entering situations in which you feel anxious. For example, if you fear driving over bridges you may be able to manage the trip as long has you drive slowly in the right lane and keep your eyes focused straight ahead. Driving in this manner constitutes a safety behavior. An example of a safety object is always carrying your anxiety medication “just in case.”

Safety behaviors/objects are important because they can interfere with the successful treatment of anxiety. If they remain in effect during exposure treatment, they may prevent the decrease in fear and anxiety that would normally occur. Remember, exposure therapy helps you to learn that the feared object or situation is not dangerous. Repeated exposure should result in an attenuation of your fear response. Safety behaviors/objects interfere with the process of attenuation of response because the lack of negative consequences during exposure may be presumed to be because of the safety behaviors/objects, rather than the fact that the situation is not really dangerous.

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Exposure for Treating Anxiety

Posted by Draljerome on October 3, 2009

A hallmark of cognitive-behavioral treatment for anxiety disorders is exposure. In some ways this is a common sense notion: you must face your fears in order to overcome them. However, there is more to it than just jumping in to face your fear. Both research and clinical practice have contributed to a set of guidelines for maximizing the benefit to be gained from exposure. Some of these guidelines are as follows.

Begin by developing a hierarchy of feared situations. Use a subjective rating of anxiety (0 – 100) for ordering how much anxiety is likely to result from exposure to specific situations. Although it is not really necessary to approach exposure gradually, most clients prefer to do it this way. Begin working up the hierarchy by putting yourself in the situations listed in the hierarchy. When in a situation, keep track of your peak anxiety level (0 – 100) and stay in the situation until your anxiety level decreases by about half. Although the 50% reduction is merely a rule of thumb, it is very important that you let your anxiety level come down and do not flee from the situation because you are anxious. Fleeing (“escape”) is reinforcing, and you will be more likely to flee the next time you are in this situation or are feeling anxious. This happens because fleeing does make you feel better, at least temporarily. When you leave the situation you immediately feel relief. But what happens is that your short-term relief comes at the expense of strengthening your problem with anxiety.

There are several other important aspects of exposure treatment for anxiety disorders, and I will talk about them in future entries.

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Worrying About Worry

Posted by Draljerome on September 9, 2009

Everyone worries.  It is a normal part of the human condition to be concerned about things that might happen in the future, especially if we feel ill-prepared to cope with them.  For some people, though, worry is a way of life and seemingly beyond their control.  Many of these people fit the diagnostic criteria for a mental disorder called generalized anxiety disorder (GAD).  For people with GAD, worry about the future is the predominant aspect of their mental life.  Some people with GAD have just a few specific worries (e.g., finances or health) that are their focus.  Others may worry about a far broader range of things (everything).

Although GAD is a complex problem that develops with contributions from genetics, learning history (from family life, interactions with others, the media, etc.), environment (stressful situations and reactions of others), there is an interesting phenomenon that helps to maintain GAD.  People with GAD worry about worry.  That’s right.  In addition to worrying about things that might occur and how they will manage to cope, people with GAD often get locked into worrying about worry.   And it is not only people with GAD who worry about worry.  This pattern can develop for anyone who has a tendency to worry and “ruminate” about problems and situations.

Psychologist Adrian Wells used the term “metacognition” to describe the process of thinking about thinking, i.e., thinking about your own thoughts.  This term applies well to worrying about worry.  Here is what happens.  You find yourself worrying, maybe worrying a lot.  And then you begin to worry about how much you worry.  “Why am I worrying so much?”  “What is wrong with me?” “Why can’t I get control over my worrying?”  Worry about worrying is then a second level of concern that adds to your original level of distress. There are underlying assumptions that you should not worry, or that your worry is too severe and, furthermore, that you should be able to control your worry.

There are a number of mindfulness-based strategies that can be used to address metacognitive worry. I will address some of these techniques in a future entry.

Dr. Albert Jerome is a Clinical Psychologist who specializes in treating anxiety, depression, and stress disorders. He can be reached at Ashburn Psychological Services (703-723-2999) or draljerome@gmail. com. Visit his website at draljerome.com.

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The Paradox of Panic

Posted by Draljerome on September 8, 2009

Panic attacks are frightening experiences, especially for the uninitiated.   If you don’t understand what is happening, you may fear that you are having a heart attack or stroke, or maybe you are going crazy.  All that you know is that you have to make it stop.  You might end up in the emergency room, or you may ride it out at home and eventually fall asleep from exhaustion.

But after an experience like that you know one thing:  You don’t want a repeat performance.  So you do what you can to prevent another attack.  You begin to monitor signs and symptoms that might portend an attack.  Keep watch over your heart rate; stay away from stressful situations; don’t let your mind wander back to what happened. What can happen is that your focus on watching for symptoms of panic can result in a greater likelihood that you will experience panic.

Imagine that you become sensitive to changes in your heart rate, watching to detect whether any increases might portend a panic attack. Because your heart rate will have natural variation throughout the day, it is likely that you will detect changes. If you then have the thought “oh, no, I might be having a panic attack,” this thought can cause you to become anxious, which can then lead to further increases in heart rate, which can then trigger further anxiety. This, then, is the cycle of panic, where bodily symptoms and cognitive interpretations (thoughts) can work together to create a panic attack.

And therein lies the paradox of panic.  The more that you do to try to prevent panic attacks by focusing on symptoms, the more susceptible you are to having another attack.  If you have several panic attacks, and you become overly focused on avoiding subsequent attacks, you may be on your way to developing panic disorder.   The fact of the matter is that you cannot “control” panic.  If you try to do so, it will end up controlling you.

Attempting to control panic by monitoring symptoms and “fighting” when it looks as if a panic attack is on the way is a losing strategy.   Panic attacks are not dangerous.  Although they can be very uncomfortable, they will not cause heart attacks or strokes.  You won’t go crazy or lose control of your behavior.  Once a panic attack is underway, the best thing to do is to let it run its course.   The more you fight with it and try to battle against the symptoms that occur, the longer it will last and more severe it will seem.  If you let it run its course, it will normally be over in 10  – 15 minutes.

And the best way to avoid developing panic disorder is to accept that you may have some panic attacks and not become overly focused on detecting signs and symptoms of impending attacks and struggling to avoid them from occurring.

Dr. Albert Jerome is a Clinical Psychologist who specializes in treating anxiety, depression, and stress disorders.   He can be reached at Ashburn Psychological Services (703-723-2999) or draljerome@gmail. com.  Visit his website at draljerome.com.

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Thinking about Stress

Posted by Draljerome on August 19, 2009

Life can be stressful.   While the media bombards us with talk of war, recession, and layoffs, we are busy working, raising our children, and caring for elderly parents.   The content of our minds reflects the way that we live, with thoughts rattling around all day and sometimes well into the night.  We review, plan, worry, and obsess, and can end up feeling  stressed and out of control.

So, what can you do to manage your level of stress?  The common wisdom is that you should change how you think:  stop worrying and replace the negative thoughts with positive or more rational thoughts.   Think better and you will feel better.   Right?

This may work for some people, at least in the short-term.  But for most of us, this not a realistic long-term strategy.  Trying to change the content of your thoughts can be a very frustrating experience.  You push a thought away only to have it come back, sometimes stronger.   The realization that your thinking is “out of control” or at least beyond your control, can result in feelings of helplessness.   Why can’t I change this?  What is wrong with me?  Why can’t I control my thinking?

If controlling your thoughts doesn’t work, what can you do?  The solution is to give up the fight, to let go of your efforts to control your thoughts.    Even though you may not be able to change the content of your thoughts, you can change your relationship with your thoughts, the meaning that they hold for you.

Rather than viewing all of your thoughts as being true, valid, and important indicators of who you are and what your world means, try thinking of them as nothing more than habitual patterns that reverberate in your mind.   They are, for the most part, outside of your control.  They just sort of “bubble” up out of nowhere, products of your past history, your experiences, the media, and the world around you.  You can’t control them and you don’t need to control them.  You can accept them for what they are.

Practice taking the perspective that you are separate from the contents of your mind.  A useful metaphor is to think of your thoughts as being like cloud formations in the sky.  You can see how they form and change, but you know that you cannot control them, and you have no reason to try.  They simply are what they are.   Even though your thoughts may not be pleasant, as long as you view them as “just thoughts” and don’t imbue them with any special significance, their power to affect your mood and behavior is greatly reduced.

If you can cultivate this perspective and begin to let go of your need to control your thoughts, you can devote more energy to living the life that you want to live, and you may find that some of the stress and worry in your life will begin to fade away.

Dr. Albert Jerome is a Clinical Psychologist who specializes in treating anxiety, depression, and stress disorders.   He can be reached at Ashburn Psychological Services (703-723-2999) or draljerome@gmail. com.  Visit his website at draljerome.com.

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Posted by Draljerome on August 19, 2009

I am a licensed Clinical Psychologist who specializes in treating anxiety disorders, obsessive-compulsive disorder, depression, and stress disorders.   I will be writing about the treatment of these disorders, as well as a variety of other topics that pertain to psychology, psychotherapy, and related issues.   You can visit my website at draljerome.com.

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