Aviva Psychology Services Blog

Sexual Assault Awareness Month & Pathways to Recovery

Fri, 24 Apr 2026 15:02:00 GMT

Awareness is the first step in recovery from sexual violence.

Sexual violence is a life-altering experience that can impact mental health, physical health, relationships, and day-to-day life. While sexual violence has historically been a taboo topic, society is increasingly open to acknowledging it and supporting survivors. As part of that effort, the United States recognizes the month of April as Sexual Assault Awareness Month (SAAM). In the same spirit, at Aviva Psychology Services, all care provided to clients is trauma-informed, and our team of psychologists includes those who specialize in trauma broadly and sexual trauma specifically.

The longstanding taboo around the topic of sexual violence also means that many people have a limited understanding of what sexual violence is, the impact it can have on a person’s life, and how therapy can help. This article will explore all three of these topics.

What is Sexual Violence?

Sexual violence isn’t one experience; it is a broad category of experiences. Sexual violence is defined as a sexual act that is committed or attempted by another person without the freely-given consent of the victim or against someone who is unable to consent or refuse.

Sexual violence can occur at any age, can happen to people of any gender, and it may be perpetrated by strangers or people we know. Sexual violence can also occur in-person or in online circumstances, when technology facilitates the act of violence. Experiences that are examples of sexual violence include:

Sexual molestation as a child or adult
Rape or attempted rape
Sexual activity that occurs when unable to consent (e.g., sleeping, intoxicated)
Being threatened with unwanted sexual contact
Being coerced or pressured into sexual activity
Nonconsensual sharing of intimate images
Deepfakes and AI-generated sexual images
Indecent exposure
Sexual harassment

Sexual violence is unfortunately very common. In the United States, greater than 50% of women and almost 33% of men report experiencing some form of sexual violence in their lifetime. Sexual violence occurs at higher rates for specific groups, such as for LGBT+ people and for unhoused people.

It is important to note that sexual violence and sexual assault are two distinct terms. Sexual assault also involves nonconsensual sexual acts, but it specifically refers to acts that are named within Federal, state, or tribal law. State laws vary in their definition of sexual assault and related concepts, such as the age at which a person is considered able to consent to sexual activity.

How Can Sexual Violence Impact Our Health?

Sexual violence can impact both our physical and mental health.

For example, survivors of sexual assault frequently experience physical injuries during the act of violence. One study reports that approximately 40% of survivors of rape have injuries like bruises and cuts and that 12% report a sexually transmitted infection as a result of the assault. Some sexual assaults result in pregnancy, and pregnancies that are the result of assault are more likely to be medically complicated. Sexual assault is also a risk factor for difficulty with reproduction and gynecologic problems.

Additionally, research indicates that all forms of sexual violence are associated with physical problems like increased chronic pain, including headaches, migraines, and pelvic pain. Research has found a strong relationship between childhood sexual abuse and serious, chronic physical health conditions. Specifically, survivors of childhood sexual abuse have been found to experience significantly higher rates of high blood pressure, heart disease, thyroid disorders, diabetes, and cancer.

Sexual violence also impacts mental health in many ways. For example, experiencing rape or other forms of sexual violence is strongly associated with developing symptoms of many different mental health conditions. The most common mental health condition developed after sexual violence is depression, followed by sleep disorders and eating disorders. Some survivors of sexual violence also develop symptoms of posttraumatic stress disorder, or PTSD. Research shows that survivors of sexual violence are at high risk of developing low self-esteem, anxiety, persistent feelings of anger, guilt and shame, and thoughts of suicide.

How Can Sexual Violence Impact Our Relationships?

In addition to impracting physical and mental health, experiences of sexual violence can have significant impact on our relationships—and not just our sexual relationships.

Survivors of sexual violence frequently experience difficulties in romantic relationships, friendships, and social interactions in general. These difficulties can be related to persistent feelings of shame, anxiety, or depression, as these emotional experiences sometimes lead to avoiding social settings and living a more isolated life. When this occurs, survivors have limited community to support them, begin to feel more “out of practice” with socializing, and as a result withdraw even further from relationships.

Additionally, many survivors have understandable difficulty with trust, emotional intimacy, and physical intimacy. For example, survivors may believe things like, “If I get close to others, they will take advantage of me.” They may find sexual intimacy triggers strong physical or emotional reactions, such as feelings of panic. These difficulties can make it challenging to initiate or maintain relationships of any kind, but survivors may especially notice these impacts when there is a power dynamic in the relationship, such as between parents and children or employees and supervisors.

How Can Therapy Support Recovery from Sexual Violence?

While there are a multitude of impacts from sexual violence, there are fortunately also a multitide of therapies that can help.

Specifically, there are many evidence-based psychotherapies that have been heavily researched and demonstrated to be safe and effective for survivors of sexual violence. Many of the strongly-supported evidence-based therapies available fall under the umbrella of cognitive behavioral therapy. At its core, cognitive behavioral therapy, often called CBT for short, seeks to help survivors understand the relationship between their thoughts, emotions, and behavior. Because all three are connected, making changes in any one area can impact the others, too.

CBT teaches strategies for enacting changes that can improve our daily lives, even if we can’t change past events (like experiencing sexual violence) and even if we don’t have control over all our circumstances (like whether or not the legal system provided justice related to the sexual violence, society’s tendency to victim blame, etc.). You can read more about CBT here .

There are many different forms of CBT that address specific types of symptoms that may develop after trauma. For example, depression is the most common diagnostic outcome after experiencing sexual violence, and there are many forms of CBT for depression, including traditional forms of CBT like Behavioral Activation and newer therapies like Acceptance and Commitment Therapy.

Health problems like insomnia are common after sexual violence, and CBT for insomina is considered the frontline, gold standard treatment for it. You can read more about CBT for insomnia here . Another common impact of sexual violence is experiences of chronic pain, and CBT for chronic pain (CBT-CP) is also an evidence-based therapy available at Aviva Psychology Services.

While a less common outcome of sexual violence, some survivors do develop PTSD. PTSD has been found to be highly treatable via structured, CBT-based interventions like Cognitive Processing Therapy and Prolonged Exposure Therapy, which are considered the gold standard treatments for PTSD and are available at Aviva Psychology Services. You can read more about PTSD and its treatment here .

How To Begin Your Recovery

If you think you may benefit from therapeutic support after experiencing sexual violence, the first step is getting connected to a provider who has training to assess your symptoms, determine the most accurate mental health diagnoses, and help you build an individualized treatment plan.

At Aviva Psychology Services, we recognize every experience of sexual violence is unique, and so are the needs, preferences, goals, and diagnostic profile. You can get connected with a psychologist with expertise in sexual violence by filling out the Request an Appointment form.

Selected References and Additional Reading:

Basile KC, Smith SG, Chen J, Zwald M. Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women. J Interpers Violence. 2021 Dec;36(23-24):NP12504-NP12520. doi: 10.1177/0886260519900335. Epub 2020 Jan 23. PMID: 31971055; PMCID: PMC7375935.
Irish L, Kobayashi I, Delahanty DL. Long-term physical health consequences of childhood sexual abuse: a meta-analytic review. J Pediatr Psychol. 2010 Jun;35(5):450-61. doi: 10.1093/jpepsy/jsp118. Epub 2009 Dec 18. PMID: 20022919; PMCID: PMC2910944.
McKeon, R. (2024, December 5). Sexual violence can cast a long shadow on health - Harvard Health. Harvard Health. https://www.health.harvard.edu/blog/sexual-violence-can-cast-a-long-shadow-on-health-202412053083‌
American Psychological Association. (2025). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. https://www.apa.org/ptsd-guideline
Norman, S., Hamblen, J., & Schnurr, P. (2023). Overview of Psychotherapy for PTSD. National Center for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/overview_therapy.asp
Wall, D. (2021, March 10). Post Traumatic Stress Disorder (PTSD) | Fact Sheet - ABCT - Association for Behavioral and Cognitive Therapies. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/post-traumatic-stress-disorder/

Anxiety Treatment in Boston: Compassionate, Evidence-Based Care

Fri, 13 Mar 2026 20:36:50 GMT

Anxiety can show up in a myriad of ways. Anxiety is a natural human response to uncertainty and stress, but for many it goes beyond just butterflies in your stomach from time to time. Persistent worry, the kind that doesn’t respond to logical counter arguments, panic attacks that come out of nowhere, or a sense of dread in certain situations are signs of anxiety symptoms that are beyond typical worry that we all experience. For many people, anxiety builds gradually, and it can be hard to know when everyday experiences of normal stress have crossed into something that deserves clinical attention.

Whatever brought you here, one thing is clear: you're looking for answers. Seeking help for an anxiety disorder is one of the most meaningful steps you can take for your mental health and your life.

At Aviva Psychology Services, we provide outpatient anxiety treatment in Boston, Northampton, and online built on evidence-based approaches that actually work. Our team of experienced clinicians offer personalized therapy services for adults experiencing anxiety disorders, from generalized anxiety disorder and panic attacks to social anxiety, OCD, and anxiety tied to major life changes. Learn more about our approach to care and what sets Aviva apart.

Here's what this guide covers:

What anxiety disorders are and why they develop
The types of anxiety we treat at Aviva Psychology Services, including GAD, panic disorder, social anxiety, OCD, and phobias
Our evidence-based approach to anxiety treatment
What therapy services look like at Aviva
How to take the first step toward care

What Is an Anxiety Disorder and How Is It Different from Everyday Stress?

Anxiety is a natural response to uncertainty and stress. When you're facing something challenging, a difficult conversation, a major deadline, or an unexpected change, it's normal to feel some anxiety. Your brain is doing its job: preparing you to respond.

But an anxiety disorder is different. It's when that same alarm system stays activated even when there's no clear threat or responds far out of proportion to the actual situation. The worry becomes difficult to control. Fear starts to interfere with daily life. Avoidance becomes a coping strategy, and over time, the things you avoid tend to multiply.

According to the Anxiety and Depression Association of America , anxiety disorders affect about 19% of adults in the United States each year, making them one of the most common mental health conditions in the country. They are also among the most treatable. With evidence-based treatment, most individuals with anxiety experience significant improvement.

If anxiety has been affecting your daily functioning, your relationships, your work, or your sense of well-being, that's not a personal failing. It's a clinical reality, and it responds well to the right care.

What Causes Anxiety? Understanding Why It Develops

There's no single cause of anxiety disorders, and understanding what causes anxiety in your specific situation is part of what therapy helps you explore. That said, research points to a combination of factors that commonly contribute.

Biological factors play a role, including brain chemistry, genetics, and how your nervous system is wired to respond to threat. People who have a family history of anxiety or mood disorders are more likely to develop one themselves, though this is never a guarantee.

Life experiences shape anxiety significantly. Stressful or traumatic events, chronic stress, significant life changes, or patterns learned early in life can all contribute to how anxiety develops and what keeps it going over time.

Thought and behavior patterns also play a key role in maintaining anxiety. Differentiating anxiety versus an anxiety disorder is often based on the persistence of distress when the stressor is not present. Cognitive patterns, like catastrophic thinking, overestimating danger, and underestimating our ability to cope contribute to the maintenance of anxiety over time.

Equally important is behavioral avoidance. Behavioral avoidance occurs when we steer away from situations that trigger our anxiety. For example, if you had a panic attack at a grocery store, you might not want to go to that grocery store again. Avoiding that store and not having a panic attack reinforces the cognitive distortion that if you go to the store again you will have another panic attack. Behavioral avoidance reinforces the anxiety cycle over time and creates a loop where cognitive distortions create behavioral avoidance and then behavioral avoidance reinforces cognitive distortions.

Understanding your own anxiety, where it comes from, what maintains it, and what makes it better or worse is one of the most useful things that comes out of working with a skilled psychologist. You don't have to figure it out alone.

Anxiety and Related Conditions We Treat at Aviva Psychology Services

Our anxiety care at Aviva Psychology Services is designed to help adults with a wide range of anxiety-related concerns. Whether your experience fits neatly into a diagnostic category or feels more complex and layered, we have psychologists with specialized training to support you.

The types of anxiety and related disorders we treat include:

Generalized Anxiety Disorder (GAD): Persistent, hard-to-control worry across multiple areas of life, work, relationships, health, and finances that interfere with daily functioning and leaves you feeling chronically on edge.

Panic Disorder: Recurrent, unexpected panic attacks paired with ongoing worry about future episodes or significant changes in behavior to avoid them.
Social Anxiety Disorder: Intense fear of being judged, embarrassed, or rejected in social situations. Social anxiety disorder affects an estimated 15 million adults in the US ( Anxiety and Depression Association of America) , making it the second most common anxiety disorder (after specific phobias).
OCD and Related Disorders : Intrusive, unwanted thoughts (obsessions) paired with compulsive behaviors or mental acts intended to reduce distress. While OCD is a separate classification of disorders in the DSM-5, it shares many features with other anxiety disorders and there is often a cross in treatment approaches that work well for OCD and other anxiety related disorders. At Aviva Psychology Services, we use Exposure and Response Prevention, as well as other evidence based treatment approaches to treat OCD.Learn more about OCD treatment at Aviva Psychology Services .

Specific Phobias: A strong, disproportionate fear of a specific object or situation, such as heights, flying, medical procedures, or certain animals, that causes significant distress or avoidance.

Health Anxiety: Excessive worry about having or developing a serious illness, often accompanied by repeated checking, reassurance-seeking, or avoidance.

Anxiety and Depression: Anxiety and related mood disorders frequently co-occur. Many individuals struggling with anxiety also experience symptoms of depression. Our depression therapy in Boston is provided by the same team using the same integrated, evidence-based approach.
Anxiety tied to life changes: Major transitions, relationship shifts, career changes, infertility, or perinatal experiences, can trigger or intensify anxiety. Our perinatal therapy specialty clinic offers specialized support for anxiety during pregnancy and the postpartum period.

Our Approach to Anxiety Treatment at Aviva Psychology

Our approach to treatment is evidence-based, collaborative, and built around you as an individual. We don't use a one-size-fits-all model, because anxiety doesn't work that way, and neither do people.

When you come to Aviva Psychology Services, your psychologist begins by getting to know you: your history, your symptoms, and what matters most to you about your life and your recovery. From there, you and your psychologist work together to create a personalized treatment plan that reflects your specific anxiety disorder, your goals, and the approaches most likely to help.

Our treatment focuses on giving you real, practical tools, not just insight. We want you to leave each session with something you can actually use, and we track your progress over time to make sure the therapy is working. If something isn't helping, we adjust.

We also recognize that seeking help takes courage. We are unequivocally BIPOC and LGBTQIA2S+ affirming. Out psychologists are committed to providing identity-centered, culturally responsive care. Anxiety does not occur in a vacuum; cultural and systemic factors play a role as well.

Evidence-Based Treatment Options: How We Treat Anxiety

At Aviva Psychology Services, our psychologists use evidence-based treatment methods with strong research support. The approaches outlined below reduce anxiety symptoms and improve daily functioning over time.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is the most extensively researched treatment for anxiety disorders and is recognized by the American Psychological Association as an empirically supported, evidence-based treatment . CBT addresses both cognitive and behavioral aspects of anxiety. On the cognitive side, clients learn to identify and evaluate automatic thoughts and threat assessments that tend to overestimate danger and underestimate coping capacity. The focus here is building cognitive skills that are more flexible and reality-based. On the behavioral side, CBT uses gradual exposure to reduce avoidance patterns and safety behaviors that reinforce negative automatic thoughts. CBT is skills-based and goal-oriented, which means you leave sessions with concrete tools you can use between appointments.

Exposure Therapy

Exposure therapy is a core component of CBT and one of the most effective tools for treating anxiety. It involves gradually and systematically approaching feared situations, sensations, or thoughts, rather than avoiding them, in a safe, controlled therapeutic environment. During exposure exercises, the focus is building new learning and letting the brain develop updated expectations about what will happen in the face of a feared event or object. Avoidance is one of the primary factors in the maintenance of anxiety disorders and exposure therapy interrupts that cycle. Your psychologist designs exposure exercises in collaboration with you, always working within your tolerance and at a pace that makes sense for you.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) is part of the third-wave of CBT, with a focus on approaching valued actions rather than working directly with negative thoughts. ACT teaches you to relate to you thoughts differently. To notice them without being controlled by them. You also learn to clarify your values and take meaningful action even when anxiety is present. Many people find ACT especially helpful when anxiety is tied to perfectionism, chronic avoidance, or difficulty identifying what matters most.

ERP for OCD

For OCD and related disorders , Exposure and Response Prevention (ERP) is the gold-standard treatment approach. ERP is a specialized form of exposure therapy that helps individuals reduce compulsive behaviors while tolerating the distress of intrusive thoughts, ultimately breaking the OCD cycle. For some, a combination of medication and ERP is the most effective approach. Our psychologists who treat OCD have specific training in this approach and coordinate with prescribers, if needed

What Our Outpatient Therapy Services Look Like

Aviva Psychology provides outpatient individual therapy for anxiety in Boston from a collaborative, culturally informed and evidence-based perspective. Individual therapy allows you to work one-on-one with your clinician at a pace and depth that fits your needs.

Sessions are typically 53-55minutes and scheduled weekly, especially at the start of treatment. As you make progress and develop more confidence managing anxiety independently, the frequency may shift. Most people begin to notice meaningful changes within the first few months of consistent therapy.

We offer both in-person therapy in Boston and Northampton and telehealth therapy services for clients across Massachusetts. Online therapy is a flexible, accessible option that research shows is comparably effective to in-person care for anxiety disorders, and many people find it easier to access consistently.

When relevant, we also offer relationship and family counseling as part of a broader treatment plan. Anxiety doesn't exist in isolation, it affects relationships, and sometimes involving family members in the therapeutic process is part of what helps most.

How Anxiety Affects Daily Life And What Anxiety Care Can Change

One of the most important things to understand about anxiety disorders is how broadly they affect daily life. Anxiety rarely stays contained to one area, it tends to spread into relationships, work, sleep, physical health, and self-perception.

At work, anxiety can show up as perfectionism, procrastination, difficulty concentrating, or a persistent fear of making mistakes. It can make it hard to take on new challenges, speak up, or feel settled, even when you're objectively performing well.

In relationships, anxiety can create distance. You might withdraw to avoid situations that feel overwhelming, seek constant reassurance, or find it hard to be present because your mind is elsewhere. Anxiety can also intensify conflict or make honest communication feel risky.

Sleep is another area that anxiety affects deeply. Racing thoughts at bedtime, difficulty falling asleep, and waking in the middle of the night with worry are all extremely common among individuals with anxiety disorders, and chronic sleep disruption makes anxiety worse over time.

When anxiety treatment works, these ripple effects improve too. People manage their symptoms more effectively. Daily functioning improves. Relationships feel more connected. There's more room for the things that actually matter to you.

Mental Health Services for Anxiety and Related Conditions at Aviva

Aviva Psychology Services offers more than anxiety therapy. We provide mental health care for the full range of conditions that often co-occur with or complicate anxiety, and our team works collaboratively to make sure each person's treatment reflects their whole picture, not just one diagnosis.

The American Psychological Association recognizes anxiety disorders as highly treatable conditions. When anxiety co-occurs with depression, the feedback loop between avoidance behaviors and negative thoughts can be more entrenched. For individuals experiencing anxiety and depression together, our clinicians are experienced in treating both conditions in an integrated way.

We also offer specialized treatment for anxiety during the family planning, perinatal and postpartum period, through our infertility or perinatal specialty clinics. Our perinatal therapy team brings specific expertise to the particular emotional and relational demands of this life stage.

Our behavioral health specialty clinics also include support for individuals navigating disability & chronic illness or chronic pain , where anxiety is often a significant part of the experience. Living with medical uncertainty is genuinely hard, and our mental health care is designed to meet that reality with both clinical skill and human understanding.

Why Choose Aviva Psychology for Anxiety Treatment in Boston?

There are many places to seek anxiety care in the Boston area. Here's what makes Aviva Psychology different:

Specialized expertise: Our psychologists have deep training in anxiety disorders and the specific treatment methods that work best for them. This isn't generalist mental health treatment, it's specialized anxiety therapy delivered by doctoral-level psychologists who have dedicated their careers to this field.

Evidence-based: We use treatment methods with genuine research support. When we say evidence-based, we mean approaches that have been rigorously studied and consistently shown to help individuals with anxiety.

Personalized from day one: No two people's anxiety looks exactly the same. We create a personalized treatment plan for every client, one that reflects your specific anxiety disorder, your history, your goals, and your life.

A team that communicates: Aviva's psychologists work together, which means you benefit from health care professionals who can consult with one another, refer within the practice, and ensure your care is coordinated.

Compassionate from the start: We know that reaching out for help isn't easy. Our team is committed to making that first step, and every step after it, feel safe, respectful, and genuinely supportive.

What to Expect When You Start Anxiety Treatment at Aviva

Starting therapy can feel like a big unknown, especially if you've never done it before or have had experiences with mental health treatment that didn't quite fit. Here's an honest look at what beginning anxiety treatment at Aviva Psychology looks like.

Your first session is a comprehensive clinical intake, a structured conversation where your psychologist gathers informaiton about your symptoms, history, and what you hope to change. This assessment helps your psychologist develop an accurate diagnostic picture and treatment plan. You don't need to have everything figured out, this assessment is the first step to help with that. From there, you'll collaborate on goals for treatment. Your psychologist will explain their recommended approach and why, answer your questions, and help you understand what the process will look like. You're not a passive recipient of care here, you're an active participant in it.

Most people begin to feel meaningful improvement within the first few months of consistent treatment. Some experience shifts earlier; others take longer, particularly if anxiety has been present for a long time or is more complex. Your psychologist will be honest with you about what to expect and will track progress with you along the way.

Seeking help is not a sign that your anxiety is beyond managing. It's a sign that you're ready to take your mental wellness seriously, and that's exactly the right place to start.

Compassionate Anxiety Treatment: You Don't Have to Keep Managing This Alone

Anxiety is often a solitary experience. You can be surrounded by people who care about you and still feel like no one quite understands what it's like to be inside your own head. That isolation can make anxiety worse, and it's one of the reasons that working with a skilled clinician makes such a difference.

Therapy for anxiety isn't about being told to relax, or learning that your worries are irrational, or pushing yourself into uncomfortable situations without support. It's about having someone in your corner who genuinely understands how anxiety works, and who can help you build a different relationship with it.

If you've been struggling with an anxiety disorder and wondering whether treatment could actually make a difference, we believe it can. Explore our full range of anxiety therapy services in Boston , and reach out when you're ready.

Frequently Asked Questions About Anxiety Treatment

What types of anxiety disorders does Aviva Psychology treat?

We treat generalized anxiety disorder, panic disorder, social anxiety disorder, OCD and related disorders , specific phobias, health anxiety, and anxiety tied to life transitions, including perinatal experiences , chronic illness, relationship changes, and grief. We also frequently treat anxiety and depression together when both are present.

How do I know if my anxiety is serious enough to seek help?

If anxiety is interfering with your daily life, your work, relationships, sleep, or ability to do the things you care about, that's reason enough to reach out. You don't need to be in crisis, and you don't need a formal diagnosis before your first session. Many people wish they had sought help sooner.

What is the most effective treatment for anxiety disorders?

CBT is the most extensively researched and widely supported treatment for anxiety disorders, recognized by the American Psychological Association as an evidence-based treatment . ACT , exposure therapy, and ERP for OCD are also strongly evidence-based. Most people benefit from a combination of these approaches, tailored to their specific situation.

Does Aviva Psychology offer online therapy for anxiety?

Yes. We offer telehealth therapy services for clients across Massachusetts. Online therapy is flexible and accessible, and research shows it is comparably effective to in-person treatment for anxiety disorders. We'll help you decide which format makes the most sense for your situation.

How long does anxiety treatment typically take?

This varies depending on the type of anxiety disorder, its severity, and your personal goals. Many people begin to notice meaningful improvement within 8–16 sessions. Some benefit from shorter-term, focused treatment; others prefer longer-term support. Your psychologist will give you an honest picture of what to expect based on your specific situation.

Does Aviva accept insurance for anxiety treatment?

We work with several insurance plans. We are in-network providers with BCBS and Aetna. We also work with several out of network providers, filing claims for clients. We encourage you to reach out directly to confirm your coverage before your first appointment. If you have questions about costs, our team will help you understand your options clearly and honestly.

Ready to Take the First Step Toward Anxiety Treatment in Boston?

Anxiety is one of the most common mental health challenges people face, and one of the most treatable. The right anxiety care can change how you feel at work, how you show up in your relationships, how well you sleep, and how much space you have for the things that actually matter to you.

At Aviva Psychology Services, we provide outpatient anxiety treatment in Boston that is evidence-based, compassionate, and personalized. Whether you're dealing with a long-standing anxiety disorder or something that has emerged more recently, our team of psychologist is equipped to help you understand what's happening and build real, lasting change.

We're here to help. Contact Aviva Psychology Services today to schedule a consultation and take the first step toward the care you deserve.

What is Cognitive Behavioral Therapy? A Boston Guide to CBT

Wed, 25 Feb 2026 20:18:37 GMT

Cognitive Behavioral Therapy (CBT) is one of the most widely used and researched treatments for a variety of mental health concerns. This evidence-based treatment focuses on the relationship between and impact of thoughts, feelings, and behaviors. CBT is one of the most effective forms of therapy, with evidence supporting it’s effectiveness with treating anxiety, depression, OCD, and trauma-related conditions. For people in Boston seeking mental health support, understanding cognitive behavioral therapy Boston providers offer can help you make informed choices. This article explains what CBT is, how it works, and how we integrate CBT Aviva Psychology Services.

The history of Cognitive Behavioral Therapy, from theory to structured treatment.

Cognitive Behavioral Therapy is based on one key idea: thoughts, feelings, and behaviors are connected. When one changes, the others change too. For example, challenging cognitive distortions, which are negative thoughts about a person, event, etc. can help reduce emotional distress. When we challenge these distortions, it often makes it easier to move towards the thing that made us anxious and potentially change how we think and feel about it over time. This connection is the foundation of CBT and interventions can start at any point on the triangle. CBT was originally developed by psychiatrist Aaron Beck in the 1960s and influenced by the work of psychologist Albert Ellis (who founded Rational Emotive Behavioral Therapy). Dr. Beck focused primarily on the cognitive distortions and created a structured treatment for depression. He believed that our interpretations of events shape our emotions, not the events themselves.

Since the 1960’s, behavioral therapy has integrated with cognitive therapy, and Dr. Judith Beck, Aaron Beck’s daughter, founded the Beck Institute for Cognitive Behavioral Therapy , which continues to be one of the premier research hubs for this approach to mental health treatment. Modern CBT is used in a variety of treatment settings and can help with conditions across the psychological spectrum. It’s a present focused treatment, that involves identifying specific problems and setting clear goals. CBT treatment is full of practical skills that your psychologist teaches you and you begin to use between sessions relatively early in treatment. This structure works well for people who want clear treatment plans. At Aviva, we aim to always meet our clients where they are. We utilize both structured and flexible CBT techniques based on the specific needs and treatment plan of each client.

Common Myths About Cognitive Behavioral Therapy

Several myths about CBT persist despite strong research support. These beliefs create barriers to getting help. They cause harm by discouraging people from seeking effective treatment.

Myth 1: CBT is just positive thinking

This belief minimizes how evidence-based CBT actually is. CBT does not replace negative thoughts with fake positive ones. Research shows CBT teaches realistic thinking based on evidence. You examine thoughts for accuracy, not force optimism. For example, if you think "I will definitely fail this presentation," CBT does not replace it with "I will definitely succeed." Instead, you evaluate the evidence for and against this prediction. You consider other possible outcomes. You develop coping strategies for any result. This realistic approach is different from positive thinking.

Myth 2: CBT ignores emotions

This misconception suggests CBT is cold or dismissive. However, CBT directly addresses how thoughts and emotions relate. Understanding thought patterns helps you manage emotional responses better. CBT recognizes that emotions give important information about your needs. The approach does not suppress feelings. Instead, it helps you understand what triggers specific emotions. You develop skills for managing intense emotions when they arise. Some CBT methods focus specifically on emotional processing.

Myth 3: CBT is a quick fix

This belief creates unrealistic expectations about therapy timelines. Research shows CBT typically takes 12–20 sessions for most concerns. You need ongoing practice between sessions for lasting change. CBT is often shorter than some other therapy types, but it is not instant. Progress requires active work, including practicing skills outside therapy. Some concerns need more time, especially complex or long-standing difficulties. The structured nature of CBT reflects clear treatment targets, not rapid results without effort.

How Cognitive Behavioral Therapy Works

CBT follows a systematic process where you identify, examine, and modify unhelpful thought and behavior patterns. The approach has several connected steps that build throughout treatment.

Identifying Thought Patterns

CBT starts by identifying automatic thoughts . These are immediate mental responses in specific situations; our immediate raw thoughts about a situation (oh that was awful or I always screw that up). These thoughts often follow predictable patterns called cognitive distortions, systematic errors in thinking that skew our perception of reality. The Beck Institute provides a comprehensive worksheet listing common cognitive distortions and examples of how they appear in daily life. For example, all-or-nothing thinking means viewing situations in extremes. You see things as completely good or completely bad completely good or completely bad. Another negative automatic thought or cognitive distortion is catastrophizing, or expecting the worst outcome even when evidence suggests otherwise. Research shows recognizing these patterns is the first step to changing them.

Other common distortions include overgeneralization (when one negative experience becomes a pattern you expect to repeat forever), mental filtering ( focusing only on negative details while ignoring positive information), mind reading ( assuming you know what others think without evidence), and fortune telling (making negative predictions about the future as if they are facts). These distortions happen automatically. However, we can begin to recognise and label these automatic negative thoughts as cognitive distortions. Examining and Testing Thoughts.

Once you identify negative automatic thoughts, you begin labeling and evaluating them. Together with your psychologist, you start to examine evidence supporting and contradicting specific thoughts; you consider alternative explanations and conduct behavioral experiments to test predictions. For example, someone who believes "I cannot handle social situations" might attend a small gathering. They observe what actually happens. Research shows behavioral experiments are especially effective because they provide direct evidence that challenges old assumptions.

During treatment you also evaluate the consequences of maintaining specific thought patterns. Often negative automatic thoughts aren’t totally out of the blue. There can be a little sliver of evidence that these cognitive distortions hold on to. While, a thought may be technically accurate in some narrow way. But it might still be unhelpful if it prevents action or creates unnecessary distress. CBT helps you distinguish between useful thoughts and problematic ones. Cognitive restructuring techniques help you develop more balanced interpretations and move towards behaviors and situations that align with your values and goals.

Building Skills

Beyond examining thoughts, CBT emphasizes skill development. Problem-solving strategies help you break down overwhelming situations into manageable steps. Coping techniques, such as breathing exercises and grounding techniques, provide tools for managing distress in the moment. Behavioral activation involves increasing engagement in valued activities. This is especially important for treating depression. Research shows behavioral activation alone can be as effective as full CBT protocols for some people with depression.

One of the most essential skills in CBT is relapse prevention. Planning for a transition from treatment is an explicit part of skill development and is crucial as treatment nears completion. This involves identifying early warning signs that difficulties may return and developing strategies for managing setbacks. The goal is not to prevent all future difficulties. Instead, you gain skills for managing challenges independently and how to know when to reach out for additional support.

Conditions and Concerns Addressed by Cognitive Behavioral Therapy

Research shows CBT is effective for a wide spectrum of mental health disorders. It has been shown to effectively treat anxiety, depression, obsessive compulsive disorders, PTSD, insomnia, and the impacts of chronic pain.

CBT is effective in treating anxiety, including generalized anxiety disorder, panic disorder, social anxiety, and phobias. Studies suggest 60–80% of people with anxiety disorders improve significantly with CBT . The approach helps you identify anxiety-triggering thoughts and gradually face feared situations through exposure techniques. This is done through developing coping strategies for managing anxiety symptoms, restructuring negative automatic thoughts, and setting up "experiments" to move towards the anxious triggers.

CBT also works for depression. A comprehensive 2 023 meta-analysis of over 400 trials found CBT is as effective as antidepressant medication in the short term, with evidence suggesting even greater effectiveness over time. CBT for depression focuses on identifying and modifying negative thought patterns while increasing engagement in activities that provide pleasure or accomplishment. For severe depression, combining CBT with medication may work best.

For Obsessive-Compulsive Disorder (OCD), a specific form of CBT called Exposure and Response Prevention (ERP) is the gold-standard treatment. Research shows ERP is highly effective for reducing OCD symptoms. At Aviva Psychology, our therapists are trained in ERP. We provide this specialized form of CBT for p eop le experiencing OCD .

CBT is also used for Post-Traumatic Stress Disorder (PTSD), often with exposure-based techniques. For insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) is the first-line treatment. Research suggests it is more effective than sleep medication for long-term outcomes. Aviva Psychology offers a specialized Insomnia Clinic where we provide CBT-I.

Other concerns that may benefit from CBT include chronic pain, relationship difficulties, and adjustment to chronic illness. At Aviva Psychology Services, our Chronic Pain Clinic integrates CBT with clinical health psychology approaches. Our Perinatal Mental Health services incorporate CBT for postpartum depression and anxiety.

Cognitive Behavioral Therapy and Related Approaches

CBT differs from psychodynamic therapy in several ways. Psychodynamic approaches often focus on childhood experiences. CBT aims to briegly understand the childhood events that contribute to present thoughts, but focuses mainly on present concerns and thought patterns. CBT is typically time-limited with specific goals, where psychodynamic therapy is often more open-ended. However, neither approach is inherently superior. The best treatment depends on your preferences, concerns, and goals.

Several therapy approaches build on CBT principles. Dialectical Behavior Therapy (DBT) extends CBT with skills for emotion regulation and distress tolerance. At Aviva Psychology Services, some therapists integrate DBT skills training with CBT when clients benefit from this combination.

Acceptance and Commitment Therapy (ACT) is one of the foundations of the third wave of CBT therapy. ACT incorporates mindfulness and acceptance skills with cognitive and behavioral strategies. Rather than focusing on challenging thoughts directly, ACT emphasizes acceptance of difficult internal experiences and learning to cope and move through these difficult experiences. ACT focuses mainly on behaviors that are aligned with your personal values. Often, thoughts and feelings hold us back from pursuing valued actions. ACT focuses mainly on the valued actions and reducing avoidance of internal experiences that contribute to difficulties and distress.

At Aviva Psychology, therapists may blend CBT with complementary approaches based on your needs and preferences. Treatment is tailored to your circumstances rather than following a rigid protocol. This flexibility allows integration of multiple evidence-based techniques while maintaining the structured nature of CBT. Learn more about our approach to therapy .

What to Expect in Cognitive Behavioral Therapy at Aviva

Initial Consultation

CBT at Aviva Psychology Services begins with an initial consultation. We assess your concerns, goals, and history. Together, you and your psychologist develop a treatment plan and learn about the CBT framework. This treatment planning process helps determine whether CBT is appropriate for your concerns. It also helps you and your psychologist assess therapeutic fit. The American Psychological Association reports that the therapeutic relationship is one of the most important factors in treatment outcomes, regardless of therapy type.

Typical Session Structure

CBT sessions at Aviva Psychology last 53-55 minutes. Sessions typically start with a check-in about your experiences since the last session. You review any between-session practice or assignments. The middle portion focuses on skill-building or application work related to your goals. Sessions end with summarizing key points and assigning practice for the coming week. This structure provides consistency while remaining flexible for emerging concerns.

Timeline and Frequency

Research shows CBT typically involves 12–20 sessions for most concerns. The exact duration varies based on your needs and the complexity of difficulties. Sessions are usually scheduled weekly during initial phases. As skills develop and symptoms improve, sessions may be spaced to every other week. Regular progress evaluation ensures treatment stays aligned with your goals. Adjustments are made when needed in consultation with your psychologist.

Between Sessions

Practice between sessions is crucial in CBT. This may include monitoring thoughts in specific situations. You practice skills introduced in therapy. You conduct behavioral experiments. These assignments are opportunities to apply new learning in real-world contexts. Research shows people who engage in between-session practice improve more than those who only work on skills during therapy sessions.

Aviva-Specific Features

At Aviva Psychology Services, CBT can be conducted via telehealth or in person. Our group practice model allows us to match you with therapists whose specializations align with your needs. Aviva Psychology Services is unequivocally BIPOC and LGBTQIA2S+ affirming. Our therapists provide identity-centered, culturally responsive care. We understand that mental health concerns do not occur in isolation. Identity, culture, and systemic factors influence psychological well-being. Learn more about our approach to anxiety therapy .

Is Cognitive Behavioral Therapy Right for You?

CBT may help if you are seeking evidence-based treatment and prefer structured, goal-oriented approaches. It works well when you are willing to engage in active practice between sessions. The approach works best when you are ready to examine thought patterns and try new behaviors, even when uncomfortable.

However, CBT is not the only effective therapy. It may not be the best fit for everyone. Some people prefer more exploratory or less structured therapy. Others may benefit from approaches that emphasize emotional processing or past experiences. These preferences are valid. There is no single correct path to mental health support.

CBT can be combined with other approaches as needed. Some people benefit from starting with supportive, relationship-focused therapy before transitioning to structured CBT. Others may integrate CBT with medication management. At Aviva Psychology Services, we take a collaborative approach to treatment planning. An initial consultation clarifies whether CBT aligns with your goals and preferences. Treatment can be adjusted based on your response over time.

If you have concerns about homework assignments due to energy limitations, cognitive difficulties, or time constraints, discuss this with your therapist.

Assignments can be modified to be more manageable. Some CBT work can occur primarily within sessions. The goal is to find an approach that works for your circumstances.

Finding a Cognitive Behavioral Therapy Provider in Boston

When seeking a CBT therapist, several factors matter. Training and certification in CBT indicate a provider has received specific education in this approach. Experience with your specific concerns is important. CBT protocols differ across conditions. Cultural competence and identity-affirming practice matter, especially for people from marginalized communities. The therapeutic relationship and sense of trust influence treatment outcomes across all therapy approaches.

At Aviva Psychology Services , our doctoral level clinicians utilize CBT in structured and flexible modalities to treat anxiety disorders , depression , OCD , and PTSD . Additionally, we have specialty clinics for insomnia, chronic pain, chronic illness, and perinatal mental health, all utilizing CBT as a part of the modality of treatment.

Several of our psychologists have received specialized training in evidence-based CBT protocols. This includes Exposure and Response Prevention for OCD and Cognitive Behavioral Therapy for Insomnia. Our group practice model allows thoughtful matching between clients and therapists. Matching is based on clinical needs, identity considerations, and therapeutic style preferences. Meet our team of CBT-trained therapists.

If you want to learn more about CBT at Aviva Psychology, contact us to schedule an initial consultation. The consultation provides an opportunity to discuss your goals and ask questions about our approach. You can determine next steps without any obligation to continue treatment.

Conclusion

Cognitive Behavioral Therapy is an evidence-based approach that helps people understand connections between thoughts, feelings, and behaviors. Research shows CBT works for many mental health concerns, from anxiety and depression to OCD and insomnia. At Aviva Psychology, our CBT-trained therapists provide identity-affirming, culturally responsive care adapted to individual needs.

If you are considering therapy and want to explore whether CBT might be appropriate for your concerns, we are here to help .

What Are Phobias and How Can Therapy Help?

Mon, 09 Feb 2026 17:00:15 GMT

Phobias cause intense fear but are highly treatable.

A fear of flying, a fear of spiders, a fear of elevators... these experiences, or phobias, are commonly dismissed as silly, irrational worries to be ignored or as inevitable genetic experiences to be endured. The truth is phobias are a type of anxiety disorder, and they can be effectively treated with exposure therapy, which is a form of cognitive behavioral therapy (CBT). Many people fully and permanently overcome their phobias with the help of short-term CBT.

Phobias are quite common. Nearly one in ten Americans met criteria for a specific phobia in the last year, and approximately 12.5% of Americans will meet criteria for a specific phobia at some point in their lifetime. Despite how common phobias are, they are poorly understood by many people. In this article, we will explore what phobias are, causes and types of phobias, effective treatment for phobias, and how Aviva Psychology Services can help you overcome phobias.

What are Phobias?

Phobias are a type of anxiety disorder, and there are actually three types. When most people talk about phobias, they generally are referring to what the Diagnostic and Statistical Manual of Mental Illnesses, or DSM-5, calls Specific Phobia.

In this condition, a person feels intense fear about a specific object or situation, and that fearful response persists for at least 6 months. For people with Specific Phobia, the feared object or situation is a consistent challenge—it always or almost always provokes intense fear every time it is encountered.

To be considered a phobic response, the person must experience fear that is out of proportion to the actual danger posed by the situation. Put another way, phobic anxiety is irrational. Feeling fear when an unleashed dog is snarling and advancing on you isn’t a phobic response because this is a genuinely dangerous situation. However, feeling intense fear of all dogs regardless of their behavior or the situation would be considered a phobic response.

Lastly, for Specific Phobia to be present, a person must either actively avoid the feared object or situation or they endure it with intense anxiety. Both of these coping strategies have negative impacts on our lives. When we choose to cope by avoiding, we often give up a lot of freedom of choice, because the phobia chooses for us. When we choose to cope by white-knuckling our way through situations, we often can’t enjoy our lives fully because we are exhausted by an internal battle with our anxiety.

Common Types of Phobias

Phobias can take many forms, as people can develop an intense fear of almost anything. You may have heard some specific terms for certain phobias, such as claustrophobia (the term for fear of enclosed spaces) and arachnophobia (the term for fear of spiders).

In the DSM-5, Specific Phobias are grouped into four common types as well as an “other” category. The categories are as follows:

Animal phobias : These can involve the fear of any type of animal, but some animals are more commonly the subject of a phobia. Some especially common types of animal phobia are fear of spiders, insects, and dogs.
Natural environment phobias : These phobias involve fears of natural phenomena, such as thunderstorms or water, or of certain environments, such as heights.
Blood-injection-injury phobias : These phobias are sometimes called “medical phobias” and involve experiences like fear of needles, surgeries, or invasive medical procedures. People with these phobias often avoid all or most healthcare.
Situational phobias : Many different situations can be the focus of a phobia. Some of the most common examples of situational phobias are fear of flying, elevators, or bridges.
Other phobias : The DSM-5 includes this “catch all” category for phobias that do not fit within the other categories. Examples of phobias that fall into this category are fear of vomiting or fear of choking.

In addition to Specific Phobia, the DSM includes two other types of phobia: social phobia, also called Social Anxiety Disorder, and Agoraphobia.

In Social Anxiety Disorder (social phobia), people experience intense fear of being watched or evaluated by others and have the specific worry that they will appear foolish or be judged negatively. Just like with Specific Phobia, these individuals feel fear that is out of proportion to the actual threat posed by a social situation. And just like those with a Specific Phobia, they respond to their fear by either avoiding social situations entirely or enduring social situations with extreme discomfort.

People with Agoraphobia experience intense fear of being unable to escape or get help when they feel overwhelmed or incapacitated. For some people with Agoraphobia, they specifically worry about what will happen if they have a panic attack. People with Agoraphobia worry that certain situations—like using public transportation, being in crowded or open spaces, waiting in lines, or being alone in public—will result in overwhelm or incapacitation. As a result of this worry, they either avoid these situations or endure them with great anxiety, just like what occurs with social phobia (Social Anxiety Disorder) and Specific Phobia.

Causes of Phobias

When we have difficult experiences, it is human nature for us to ask why. As such, many people who experience phobias are eager to understand the causes of phobias. Research in this area is ongoing. So far, research indicates that phobias likely have both genetic and environmental causes, that some people with phobias have only one of these factors present, and that many people have a combination of these factors present.

When it comes to genetic causes, research is limited and ongoing. However, research so far suggests that there are genetic factors that predispose people to developing phobias. This means we can “inherit” being at higher risk of developing a phobia, but our genetics do not guarantee that we will or won’t develop one during our lifetime. Some research suggests that certain types of phobias, like animal-related and blood-injury-injection phobias, have a higher genetic influence than others.

Regarding environmental causes of phobia, research tells us that some people develop phobias after an especially frightening or even traumatic experience. For example, someone might develop a phobia of dogs after being attacked by a dog or develop a phobia of bridges after a car accident that involved a bridge or similar environment. However, many people develop a phobia without an identifiable experience that was the “origin” of the specific fear.

It is important to note that sometimes people develop other types of disorders after a frightening or traumatic experience, such as posttraumatic stress disorder or obsessive-compulsive disorder. These conditions could develop instead of a phobia or coexist with a phobia. Aviva Psychology Services offers treatment for these conditions, too, and you can read more about PTSD here and read more about OCD treatment here .

Treatments for Phobias

Phobias are highly disruptive, but they are also highly treatable. Broadly speaking, the treatment of choice for phobias is cognitive behavioral therapy (CBT). CBT is a broad category of therapy, and there are well-researched, highly-effective forms of CBT for many different mental health conditions. All forms of CBT involve helping people understand the connection between their thoughts, emotions, and actions.

The most evidence-based form of CBT for phobias involves a technique called exposure therapy. In this type of treatment, a therapist guides a client through a process of strategically and gradually facing fears until the phobia is overcome. This process is very much like training to run a marathon—no one starts by running 26 miles on the first day! Instead, the training process is customized to each runner, builds gradually on their baseline, and eventually builds to the point that they can run the full race.

Similarly, exposure therapy is highly customized to each type of phobia and each unique person who experiences a phobia. For example, someone with a Specific Phobia of dogs may start by looking at cartoon drawings of dogs until the cartoons no longer provoke anxiety, then progress to looking at photographs, then videos, and over time slowly get to the point where they can comfortably be around and even interact with dogs. However, someone who experiences emetophobia, or fear of vomiting, might be doing very different exposure exercises, such as spinning in circles to help overcome the anxiety triggered by nausea-like symptoms.

Types of exposure therapy are also used for the other two types of phobias introduced in this article. Social Anxiety Disorder (social phobia) involves similar gradual exposure to overcome social fears, but also includes working to challenge unhelpful beliefs that are common with social anxiety. Agoraphobia, too, uses gradual exposure to overcome fears, but adds additional therapy to address panic attacks, as they are a very common part of Agoraphobia.

No two courses of exposure therapy for phobia look exactly the same, but they all involve taking a specific, gradual approach to facing fear with the goal of decreasing anxiety while increasing personal freedom. For many people, exposure therapy is a fairly short-term treatment, requiring on average 3-4 months of weekly sessions. Those who are consistent with their at-home exposure assignments tend to recover more quickly, experience more dramatic improvement, and to have more long-lasting results. In fact, for many people, once the course of exposure therapy is completed, the phobia never returns.

Getting Started In Therapy

Starting any kind of therapy may feel intimidating, and beginning therapy to face an intense fear like a phobia may seem especially so. While treatment of phobias requires courage and involves some discomfort, therapy provides a safe, structured way to approach and overcome our phobias and fears.

At Aviva Psychology Services, treatment for phobias will emphasize evidence-based therapeutic strategies and be guided by client needs, preferences, goals, and readiness. Psychologists at Aviva are trained to help you develop a customized treatment plan that allows you to overcome your fears and reclaim your freedom from phobias. You can get connected with a psychologist who has expertise in overcoming phobias by filling out the Request an Appointment form.

Selected References and Additional Reading:

American Psychological Association. (2017). What is exposure therapy? American Psychological Association. Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
‌C.M.H.H. Van Houtem, M.L. Laine, D.I. Boomsma, L. Ligthart, A.J. van Wijk, A. De Jongh, A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears, Journal of Anxiety Disorders, Volume 27, Issue 4, 2013, Pages 379-388, ISSN 0887-6185, https://doi.org/10.1016/j.janxdis.2013.04.007 .
Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php
John Hopkins Medicine. (2019). Phobia s . John Hopkins Medicine; John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias
National Institute of Mental Health. (2020). Specific Phobia. https://www.nimh.nih.gov/health/statistics/specific-phobia
Sawyers C, Ollendick T, Brotman MA, Pine DS, Leibenluft E, Carney DM, Roberson-Nay R, Hettema JM. The genetic and environmental structure of fear and anxiety in juvenile twins. Am J Med Genet B Neuropsychiatr Genet. 2019 Apr;180(3):204-212. doi: 10.1002/ajmg.b.32714. Epub 2019 Feb 1. PMID: 30708402; PMCID: PMC6414251.
Villafuerte S, Burmeister M. Untangling genetic networks of panic, phobia, fear and anxiety. Genome Biol. 2003;4(8):224. doi: 10.1186/gb-2003-4-8-224. Epub 2003 Jul 28. PMID: 12914652; PMCID: PMC193636.
Wall, D. (2021, March 10). Phobias | Fact Sheet. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/phobias/

What is Trauma, What is PTSD, and Can Therapy Help?

Mon, 12 Jan 2026 17:00:26 GMT

Trauma can take many forms. Therapy can help.

Have you survived a life-threatening event and now feel changed as a person? Maybe you’re feeling disconnected from others, disinterested in or angry with the world, or unable to relax. Perhaps it feels like your mind won’t let go of terrible, upsetting memories. These symptoms are common after a traumatic event, and they can also be very disruptive to our everyday life. If any of this sounds familiar to you, know that you are not alone and that psychologists at Aviva Psychology Services are trained to help.

This post will help you evaluate whether a trauma-focused therapy for PTSD may be a good fit for your unique needs and symptoms so you can make an informed decision about your care. You will learn about the clinical definitions of trauma, common impacts of trauma, disorders like PTSD and CPTSD. You will also learn about the available evidence-based treatments for treating trauma, PTSD, and CPTSD.

First, it can be helpful to know that trauma impacts most adults at some point in their lives, and we are biologically hardwired to have a strong emotional and physical reaction to traumatic experiences. After all, a threat to our well-being is a big deal! A big response makes sense, too, and it can help us survive dangerous situations.

However, even a biologically and psychologically normal reaction can be uncomfortable, can be challenging to manage, and can be difficult to recognize as a trauma response. Our reactions to trauma are as unique as each person who survives trauma and as unique as each experience of trauma. Survivors of trauma often feel disconnected from others, even close loved ones, and often worry that they are doomed to experience their symptoms forever. When experiencing symptoms like these, it can be difficult to connect with others, to complete our usual activities, or even to feel like you’re the same person you were before the trauma occurred.

However, there is good news: many people recover naturally from trauma after a few weeks, and for those that experience persistent symptoms, there are safe, effective treatments that can be completed in just a few months of weekly therapy. Whether your symptoms resolve quickly or more slowly, recovery is possible, and you don’t have to accomplish it alone.

What Exactly Is Trauma?

In everyday life, people use the word “trauma” to describe many different types of experiences. For example, they may refer to going through a divorce, experiencing a life-threatening illness, working in a toxic job environment, and being involved in a car accident as traumatic experiences.

However, in the field of trauma psychology, a traumatic experience has a very specific definition: an experience of actual or threatened death, serious injury, or sexual violence. Sometimes we experience trauma directly, such as surviving a house fire or being assaulted. Other times, however, we experience trauma indirectly. For example, we may learn about a loved one being seriously harmed or killed. Some people also experience trauma indirectly as a recurrent part of their job, such as what is experienced by firefighters, military members, or emergency room workers.

Although we may prefer to believe that traumatic experiences are rare, psychological research tells us that most people—about 70% of adults worldwide—will experience trauma at least once in their lifetime, and many people will experience trauma multiple times throughout their life. This is because trauma can take many forms.

Despite what television and movies may lead us to believe, trauma is not limited to extreme settings and specialized careers, such as war experienced by military personnel. Instead, it often takes the form of everyday life events such as car accidents, occupational hazards, natural disasters like fires or hurricanes, violent crime, and abuse within our relationships. Sometimes people experience trauma as a singular event, but trauma often involves recurrent experiences or occurs over prolonged periods of time. Some examples of prolonged trauma experiences are childhood sexual abuse and intimate partner violence.

It is important to note that as a result of societal biases and structures, not everyone is at equal risk of trauma. Trauma is experienced with greater frequency by individuals who have identities that are marginalized by society. For example, women experience higher rates of trauma than men, LGBTQ people experience higher rates of trauma than heterosexual people, and BIPOC people experience higher rates of trauma than white people. Those with multiple marginalized identities are at the highest risk of experiencing trauma and the highest risk of developing trauma-related mental health conditions.

It is also important to acknowledge that difficult life events that do not meet the definition of “trauma” used by clinical science still have real, profound impacts on us. Trauma is a very specific type of experience, and trauma psychology defines it narrowly to help ensure that trauma-focused therapies are only offered to those who will benefit from them, as PTSD therapies can be harmful to those who do not have the specific histories and symptoms they are designed to treat. However, the specific events that meet the clinical definition of "trauma" are not the only type of experience that matters, that can result in a mental health diagnosis, and that may warrant therapy.

For example, a difficult breakup or divorce or unexpected loss of a job could result in depression . The stress associated with chronic illness or a toxic work environment can result in experiences of anxiety and burnout . Dysfunctional, hurtful, or abusive relationships can change how we connect with ourselves or others and warrant therapy related to relationships . Aviva Psychology Services offers treatment for these experiences and more.

How Does Trauma Affect Us?

Experiences of trauma frequently lead to short-term symptoms while our minds and bodies process the experience. For example, a person who survives a car accident may have nightmares about the incident or feel anxious when in a car for a few weeks. This is natural, but when symptoms persist for longer than a month, it may be time to consider a trauma-focused therapy to help resolve symptoms. These symptoms can take many different forms, often depending on the nature of the traumatic experience itself and the survivor’s unique history.

It’s important to recognize that while PTSD is the disorder most people associate with trauma, psychological research tells us that reactions to trauma may take many different forms and can result in many different diagnoses. Moreover, after a traumatic experience, a person may have relatively mild PTSD symptoms but much more severe symptoms of a different disorder.

For example, following a traumatic loss, grief may persist and require therapy, and grief can eventually develop into depression that needs treatment, too. Sometimes survivors of sexual assault develop Obsessive Compulsive Disorder, often involving themes related to contamination and safety. Transportation accidents can result in intense, persistent experiences of fear that take the form of anxiety disorders like phobias . For some people, trauma results in persistent sleep-related symptoms, resulting in a diagnosis of Insomnia. You can schedule an appointment for evaluation and trauma-informed treatment of each of these conditions as Aviva Psychology services.

People who have experienced trauma may experience the aforementioned conditions instead of PTSD or they may have diagnoses in addition to a condition like PTSD. Because trauma can result in so many different symptoms and diagnoses, meeting with a psychologist who is trained in psychological assessment and differential diagnosis is an important first step in recovery, as determining the correct diagnoses will guide you to the most effective treatments.

What is PTSD?

PTSD is diagnosed when a person experiences a specific combination of trauma-related symptoms that begin after a specific kind of traumatic experience.

The specific kind of traumatic experience that can result in a PTSD diagnosis is an event in which a person experienced actual or threatened death, serious injury, or sexual violence. The person may have experienced the trauma personally, been exposed to the trauma of others repeatedly via their job, or may have learned of a close loved one experiencing violence or accidental death. A person may be diagnosed with PTSD following a single experience of trauma, recurrent trauma, or after experiencing multiple, separate types of trauma.

The symptoms of PTSD fall into four categories. PTSD involves intrusive symptoms (like nightmares and strong emotional responses to trauma reminders), avoidance symptoms (like avoiding thinking about the trauma or avoiding situations that are trauma reminders), changes in our thoughts and mood (like strong feelings of guilt or shame or difficulties with trust), and nervous system hyperarousal (like irritability, difficulty concentrating, or being easily startled).

PTSD is only diagnosed if symptoms have persisted for at least a month following the trauma and if the symptoms are causing problems in multiple areas of life, such as at work, in relationships, or at school. How PTSD interferes with daily life looks different for each person, as every survivor of trauma and every traumatic experience is unique. However, some common examples of PTSD-related disruptions are problems with sexual intimacy, isolating and avoiding to the point that our relationships and responsibilities suffer, recurrent conflict with supervisors at work, and trouble tolerating the uncertainty of daily life events.

What is complex PTSD?

If you’ve spent much time reading about mental health online, you’ve probably heard the term “complex PTSD,” which is sometimes abbreviated as CPTSD. This is a clinical term with a very specific definition. Unfortunately, it is frequently misunderstood by the public and even by healthcare providers who do not have advanced training in trauma and advanced understanding of trauma-related research. There are three especially common myths related to “complex PTSD.”

One common myth is that CPTSD means you have an “especially severe or complicated” presentation of PTSD. In reality, both PTSD and CPTSD exist on a spectrum of severity, trauma-related disorders are not necessarily more severe than other disorders, and trauma-related disorders are not necessarily the most severe outcome after a traumatic experience. For example, after trauma, a person could have minimal PTSD symptoms and severe depression.

A second myth is that CPTSD refers to PTSD from repeated or prolonged trauma. In reality, both both PTSD and CPTSD can be related to single-event trauma or from prolonged or multiple traumatic experiences.

A third myth is that CPTSD should not be treated via standard PTSD therapies. In reality, decades of clinical research have clearly indicated that PTSD and CPTSD are most effectively treated with the same forms of psychotherapy. Specifically, both are most effectively treated via specific types of PTSD-focused Cognitive Behavioral Therapy, with the strongest evidence to support Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE).

To accurately understand PTSD and complex PTSD, it is helpful to first know that there are two main systems for diagnosing mental health conditions. One system is called the Diagnostic and Statistical Manual (or DSM) and is used in the United States. The other is called the International Disease Classification (or ICD) and is used by the rest of the world. Both systems are regularly revised and updated to reflect psychological research findings, but the two systems are not always updated at the same time or in the same way.

The term “complex PTSD” was initially proposed by researchers in 1980 to account for trauma-related symptoms that were not included in the narrow definition of PTSD that was in use by both the DSM or ICD systems at that time. The proposed complex PTSD symptoms included experiences like persistent negative emotions, impulsive behaviors, and multiple forms of difficulty in relationships.

The DSM has had multiple revisions since 1980, and it now defines PTSD more broadly, in a manner that includes many of the symptoms originally proposed as “complex PTSD.” The DSM chose to include the proposed CPTSD symptoms in the standard PTSD definition because research indicated the two have significant overlap and respond best to the same treatments. Therefore, the DSM took an inclusive approach that integrates the two diagnoses and includes the proposed "complex PTSD" symptoms within the definition of PTSD.

The ICD has also been updated multiple times since 1980. However, it has not used the same inclusive approach to defining PTSD. The ICD uses a narrow definition of PTSD and lists a separate diagnosis of CPTSD. The separate CPTSD diagnosis requires an individual to meet all the criteria of PTSD and to additionally meet criteria for separate “complex PTSD” symptoms. This approach is more specific and more exclusionary. As a result, some people with significant trauma histories and symptoms fall “between” the ICD’s narrow definitions of PTSD and CPTSD, resulting in neither diagnosis being given. This is especially problematic for healthcare access in the United States, where insurance companies require diagnoses before paying for treatment like therapy.

What treatments are effective for PTSD?

PTSD and CPTSD have been highly researched for decades. As a result, expert psychologists at the American Psychological Association and at the National Center for PTSD have been able to identify which treatments have the most scientific evidence to indicate that they are safe, effective forms of treatment for PTSD and CPTSD.

There are four evidence-based therapies for PTSD available at Aviva Psychology Services: Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE), which are considered frontline, gold standard treatments for PTSD, as well as Written Exposure Therapy (WET) and Skills Training in Affective and Interpersonal Regulation (STAIR), which are also considered evidence-based for PTSD.

How Much Does Treatment Help?

Many survivors of trauma are skeptical that psychotherapy can help them. PTSD symptoms are intense, overwhelming, and can feel impossible to change.

However, there is strong scientific evidence that PTSD is highly treatable and that the gold-standard, frontline treatments of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) are highly effective. In fact, psychological research has demonstrated that they are effective for people of all backgrounds, with all different types of trauma, and regardless of how long ago the trauma occurred or whether the trauma involved a one-time event or a long period of exposure to trauma. Research indicates that most people who complete PE or CPT recover so dramatically that they can no longer be diagnosed with PTSD at the end of treatment. Those who still have the diagnosis often still experience very significant improvements in their daily life.

Yet these research findings do not guarantee dramatic improvement for every individual who completes PTSD treatment. This is because there are important individual factors that influence treatment outcomes. One especially important individual factor is treatment engagement: people who attend therapy sessions consistently and complete therapy homework on a daily basis achieve greater improvement in therapy than those who miss sessions or miss homework assignments. Much like physical exercise, one hour a week is likely to only result in minor changes, but daily work can transform a person’s life entirely. Trauma psychologists at Aviva Psychology Services are trained to help clients engage fully and effectively so that they can get the best possible results in treatment.

Another important factor is individual readiness to commit to the full course of trauma therapy, which is safe and effective but an emotionally intense and time-consuming process. Some clients prefer to start with a trauma-informed treatment like STAIR, which is available at Aviva Psychology Services and designed for those with a traditional CPTSD presentation, to boost coping skills prior to doing a more intensive, trauma-focused therapy like CPT or PE. Other clients may have other conditions, such as anxiety or depression , that they wish to address prior to trauma-focused therapy, so that they have more capacity for the emotionally challenging work of trauma treatment.

Aviva Psychology Services offers an individualized, flexible approach to treatment and a wide range of treatment options and styles to ensure that your readiness is considered thoughtfully and your therapy experience is as helpful as possible.

How Do I Get Started with Trauma Therapy?

If you think you may benefit from trauma-focused therapy, the first step is getting connected to a provider who has training to assess your symptoms, determine the most accurate mental health diagnoses, and help you build an individualized treatment plan. You can get connected with a psychologist with expertise in trauma by filling out the Request an Appointment form.

Selected References and Additional Reading:

American Psychological Association. (2021). Post-traumatic Stress Disorder. https://www.apa.org/topics/ptsd
American Psychological Association. (2025). Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults. https://www.apa.org/ptsd-guideline
National Center for PTSD, Dept of Veteran Affairs. (2022) https://www.ptsd.va.gov/understand/what/complex_ptsd.asp
National Center for PTSD, Dept of Veteran Affairs. (2020). https://www.ptsd.va.gov/professional/treat/txessentials/complex_ptsd_assessment.asp
Norman, S., Hamblen, J., & Schnurr, P. (2023). Overview of Psychotherapy for PTSD. National Center for PTSD. https://www.ptsd.va.gov/professional/treat/txessentials/overview_therapy.asp
Wall, D. (2021, March 10). Post Traumatic Stress Disorder (PTSD) | Fact Sheet - ABCT - Association for Behavioral and Cognitive Therapies. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/post-traumatic-stress-disorder/

Insomnia: A Chronic Problem With Quick Treatment

Mon, 29 Dec 2025 17:00:13 GMT

Insomnia impacts your whole life. CBT-I therapy can help.

A bad night of sleep can make the next day challenging. When poor sleep quality becomes a persistent problem, the effects on our lives aren’t just inconvenient—they’re harmful. In fact, sleep problems are so disruptive to our daily life that one of the top internet searches about insomnia is, “Can insomnia kill you?”

While insomnia is not a direct cause of death, it is associated with increased risk of other life-threatening conditions, such as heart disease, and insomnia can impair our thinking and behavior, increasing risk of dangerous events like car accidents. Fortunately, there is good news: therapy like Cognitive Behavioral Therapy for Insomnia (CBT-I) has strong research support that tells us it is safe and effective, and psychologists at Aviva Psychology Services are trained to provide it. Best of all, CBT-I can help you make big changes quickly—it usually requires only six to eight weeks of therapy!

Why Is Sleep Important?

Sleep is important not only for feeling energized the next day but for our overall physical and mental health. During sleep, our bodies and brains rest and repair themselves, and when this is interrupted, our functioning declines and we can experience profound suffering. After all, there is a reason that prolonged sleep deprivation is considered a form of torture by international law.

Physically, sleep is an important biological process that plays a vital role in our body’s ability to clear toxins, maintain our immune system’s ability to fight disease and develop immunity, and sustain our body’s regulation of temperature and metabolism. Without regular and restful sleep, our body struggles to maintain these vital functions, leaving us more vulnerable to illness and other physical ailments.

Psychologically, sleep is necessary for learning and memory, emotion regulation, concentration, and our ability to tolerate stress. When we are sleep deprived, we are more sensitive to both physical and psychological pain, our reflexes are slowed, and our decision making is impaired. As a result, sleep deprivation makes it difficult for us to complete many daily activities such as work tasks, driving, parenting, self-care tasks like healthy eating and exercise, and navigating complex emotional challenges like conflict with others.

Chronic poor sleep is also associated with a multitude of negative health outcomes, including increased risk of heart disease, Alzheimer’s and other forms of dementia, increased likelihood of developing mental health conditions like depression and anxiety, being at higher risk of suicide, and an overall shorter lifespan.

What is Insomnia?

Insomnia Disorder, colloquially referred to as insomnia, is diagnosed when certain conditions are met. First, a person must have dissatisfaction with their quality of sleep due to difficulty falling asleep, difficulty staying asleep throughout the night, and/or waking too early in the morning and being unable to return to sleep. Second, sleep problems must be disruptive to other aspects of life, such as functioning at work, in school, or in relationships. If symptoms occur at least three nights per week, have persisted for at least three months, and there are no medical conditions or substance use causing the problem, Insomnia Disorder is likely present. Research tells us that insomnia is quite common and impacts up to 30% of adults.

Sleep difficulties often fall into one of three distinct patterns: short-term, persistent, or recurrent.

For some people, sleep problems are short-term, lasting less than three months. This is a common short-term reaction to stressful life events, such as romantic breakups, experiences of trauma, or grieving the loss of a loved one. This type of sleep problem often resolves naturally, and if people with these experiences seek therapy, typically therapy that focuses on stress, depression, grief, or trauma is the best fit, rather than therapy for the sleep problem itself.

For others, however, insomnia is persistent and may require treatment that directly addresses sleep. Chronic insomnia can last for many months or even years without remission, resulting in chronic fatigue and difficulties and radically altered lifestyles. Insomnia can also “come and go” as recurrent episodes of three months with periods of remission between episodes.

What Causes Insomnia?

Insomnia is sometimes categorized as either primary insomnia or secondary insomnia. Primary insomnia means that the insomnia is not being caused by a medical condition, medication side effect, mental health condition, or life circumstance. Simply put, primary insomnia means the problem is only sleeplessness.

However, most people with insomnia experience secondary insomnia. This means that for most people, insomnia is caused by or is occurring at the same time as another condition. For example, secondary insomnia can be related to medical conditions like Long COVID, sleep apnea, asthma, Alzheimer’s disease, or chronic pain. Mental health conditions like depression, anxiety, and PTSD are also associated with insomnia. Hormonal concerns, such as thyroid conditions and menopause, also commonly impair sleep. Many substances can cause sleep problems as a side effect, including prescription medications, recreational drugs, and alcohol.

Insomnia can also be a result of life circumstances. For example, having a new baby results in nighttime parenting duties that make getting a good night of sleep challenging. Another factor can be not having a comfortable place to sleep, such as lacking air conditioning during hot weather or having a bed partner who has their own sleep problems like snoring or restlessness. Stressful life experiences, such as divorce, job loss, trauma, or grief also impact our ability to sleep regularly and restfully.

While anyone can develop insomnia, research tells us that there are certain risk factors. Women are more commonly affected by insomnia than men, with research indicating more than one in four women in the United States have insomnia. The risk of insomnia is also higher for older women than younger women. At this time, researchers aren’t sure why women are at higher risk of insomnia than men, but current theories include hormonal fluctuations associated with menstruation and menopause.

Other risk factors for insomnia include high levels of stress, having a mental health condition like depression, anxiety, or PTSD, and living with chronic illnesses such as sleep apnea, long COVID, chronic pain, or asthma.

What Treatments for Insomnia Are Available?

Broadly speaking, sleep difficulties like insomnia can be treated in two ways: with medication and with therapy. Medications are often highly appealing as a potential quick, easy solution. Unfortunately, research indicates that medications are not ideal for treating insomnia.

This is especially true for over-the-counter medications like antihistamines, some of which can cause significant medical problems such as increased risk of dementia when misused for their sedative effects. Medications commonly prescribed by physicians to help with sleep, such as melatonin, trazodone, and benzodiazepines like xanax or klonopin, have also been found to have limited research support. In fact, they are considered to have “weak evidence against” their use for insomnia, per the 2025 Clinical Practice Guidelines for Insomnia published by the US government. These guidelines are issued routinely, based on large-scale research conducted by national experts, and are considered a leading source of treatment guidance for healthcare providers.

However, the 2025 Clinical Practice Guidelines indicate “strong evidence for” Cognitive Behavioral Therapy for Insomnia (CBT-I). CBT-I is considered an evidence-based therapy, which means there is robust research to support that it is a safe and effective treatment. In fact, it is considered the first-line treatment for both short-term insomnia and chronic insomnia. Most individuals who complete a full course of CBT-I see significant improvement in their quality of sleep.

What Does CBT for Insomnia Involve?

CBT-I is a highly structured approach to therapy that involves completing a specific therapeutic program to improve sleep knowledge, sleep habits, and coping strategies for managing sleep. It is a short-term therapy, often completed in only six to eight weekly sessions. As a form of cognitive behavioral therapy, it focuses on understanding and changing thoughts and behaviors.

In CBT-I, patients are taught about the science of sleep so that they can learn to become their own sleep manager after the therapy concludes. The treatment emphasizes developing healthy sleep habits, such as maintaining a regular sleep and wake time and not spending too much time awake in bed. CBT-I also utilizes relaxation techniques, such as breathing exercises and progressive muscle relaxation, to help patients increase the odds that they will experience efficient sleep. Lastly, CBT-I involves using techniques of sleep restriction and/or sleep compression. These strategies help patients first consolidate their sleep into continuous hours of higher-quality rest, then gradually prolong their duration of sleep.

Completing CBT-I can be challenging, as changing habits and restricting our sleep to “reset” our sleep schedule is an uncomfortable process. However, research tells us that while there is discomfort in this process, the discomfort does not last long and the process is not dangerous. In fact, CBT-I is considered the front-line treatment for insomnia, meaning it’s the best treatment science has developed so far!

How Do I Begin Therapy for Insomnia?

If you are dealing with the disruptive effects of insomnia, rest assured that CBT-I can help you get better rest. CBT-I is a safe, effective treatment that can help you make significant changes in your sleep quality quickly, and psychologists at Aviva Psychology Services are trained to help. You can get connected with a psychologist who has expertise in sleep and insomnia by filling out the Request an Appointment form.

Selected References and Additional Reading:

K.C. Simon, L. Nadel, & J.D. Payne, The functions of sleep: A cognitive neuroscience perspective, Proc. Natl. Acad. Sci. U.S.A. 119 (44) e2201795119, https://doi.org/10.1073/pnas.2201795119
National Institute of Health: National Heart, Lung, and Blood Institute. (2022). Insomnia - what is insomnia? Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/insomnia
Newsom, R. (2024). Cognitive behavioral therapy for insomnia (CBT-I): An Overview. Sleep Foundation. https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
‌U.S. Dept of Health and Human Services, Office on Women’s Health. (2017). A-Z Health Topics: Insomnia. Retrieved from: https://womenshealth.gov/a-z-topics/insomnia
VA/DOD Clinical Practice Guideline. (2024). Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea Work Group Washington, DC: U.S. Government Printing Office. Retrieved from: https://www.healthquality.va.gov/guidelines/CD/insomnia/index.asp
Vgontzas AN; Liao D; Pejovic S; Calhoun S; Karataraki M; Basta M; Fernández-Mendoza J; Bixler EO. Insomnia with short sleep duration and mortality: the Penn State Cohort. SLEEP 2010;33(9):1159-1164.
Wall, D. (2021, March 10). Insomnia | Fact Sheet - ABCT - Association for Behavioral and Cognitive Therapies. ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/insomnia/
Winokur, A. (2015). The Relationship Between Sleep Disturbances and Psychiatric Disorders: Introduction and Overview . Psychiatric Clinics of North America; 38(4): 603-614.
Zhang, B, Wing, Y.K. (2006). Sex differences in insomnia: a meta-analysis. Sleep: 29(1): 85–93.

Boundaries: Myths, Facts, and How Boundaries Support Healthy Relationships

Mon, 15 Dec 2025 17:00:02 GMT

Boundaries are the foundation of healthy relationships.

Boundaries are a buzzword these days, but they are commonly misunderstood. For example, common misconceptions include that boundaries are the same as rules or ultimatums, that boundaries are controlling or selfish, that boundaries are only necessary in difficult or abusive relationships, and that our boundaries can be violated by others. With all this confusion, the tasks of understanding and developing boundaries can seem overwhelming.

In this article, we’ll review several common questions about boundaries so that you can learn what they are, how they support healthy relationships, and how therapy at Aviva Psychology Services can help you develop boundaries that improve your relationships and enrich your life.

What Are Boundaries?

Simply put, boundaries are our personal limitations. We all have limited physical and emotional capacity, and our capacity can vary by situation and change over time. Boundaries are our acknowledgments of our limitations, and boundaries are decisions we make about how to respond to those limitations. Healthy boundaries seek safety and health, and they prioritize safety and health even over other desirable experiences, like comfort and convenience.

Another key aspect of boundaries that they involve behaviors, feelings, and beliefs—but only our own behaviors, feelings, and beliefs! Put another way, boundaries are about us and for us, not about others or for others.

However, boundaries are often communicated to others for their awareness of our needs, goals, values, limitations, and plans. We also may decide we need to develop or share a boundary in response to the behavior of others. But even while the behaviors of others are relevant to our boundaries, we only set boundaries on our own behavior.

Are Boundaries Rules?

No. When we make or enforce a rule, we are telling someone else what to do or not do. For example, saying to someone else, “You aren’t allowed to yell at me,” is a rule because it is about controlling another person’s behavior. When we set boundaries, we are focused only on our own behavior. For example, “I will leave conversations when others yell at me” is a boundary.

Therefore, boundaries are completely different from rules. In fact, they free us from the exhausting, stressful experience of trying to enforce rules. They free us from trying to control other people’s behavior, which in most circumstances is neither possible nor appropriate.

Are Boundaries Ultimatums?

No. Ultimatums and boundaries are different because they have different motivations and different goals.

The goal of an ultimatum is to control another person’s behavior by forcing them to make a decision between changing their behavior in the way we want or experiencing an outcome they don’t want. For example, “If you don’t spend more time with me, I’m going to break up with you” is an ultimatum. In this example, the speaker is trying to pressure the other person to change their behavior to avoid the heartbreak of relationship loss. Ultimatums are motivated by a sense of fear and seek control of others by presenting choices that attempt to coerce others into change. Ultimatums often sound like, “You must do this or else!”

In contrast, the goal of a boundary is to protect your well-being by changing your own behavior when you reach one of your own limitations. An example of a boundary would be, “I will not stay in relationships when I am not treated with care and support.” This is a boundary because it is focused on your own behavior and is not trying to coerce others to change their behavior. Boundaries come from a place of self-awareness, seek health and safety, and they communicate our goals and limitations to ourselves and to others. Boundaries often sound like, “I will do this to meet my personal needs.” Sometimes people will decide to change in response to one of our boundaries, but this is different than an ultimatum that pressures them to change.

Are Boundaries Controlling or Abusive?

No. As explained above, a true boundary is about our own behaviors, and a boundary seeks safety and health. Therefore, a boundary by definition is not a form of control or abuse.

Sometimes people dislike the boundaries we set for ourselves, and they might feel intense, difficult emotions like anger or sadness. While these emotions are unpleasant to experience or to see others experiencing, their presence alone is not an indication of mistreatment. In fact, if our boundaries result in intense emotions for other people, it is often a sign that they have reached one of their own limitations and could benefit from their own boundary setting.

Additionally, sometimes people misuse or weaponize “therapy speech” like boundaries to disguise harmful, controlling, or abusive behavior. For example, someone might say, “My boundary is that you can’t talk about anything I’ve done that upsets you.” Even if they call this a boundary, it’s actually a rule and an example of controlling behavior.

Are Boundaries Selfish?

No, boundaries are not selfish. All humans have limited emotional and physical capacity, and setting boundaries is a way to honor our personal limitations with honesty and clarity of purpose.

This is a necessary form of self-care, but self-care doesn’t always feel luxurious or relaxing. Sometimes self-care is hard work or emotionally challenging, and this may be true when navigating boundaries. This discomfort often comes from unhelpful, inaccurate beliefs. For example, if we believe the myth that “saying no to other people is mean,” then we may worry that our boundaries are unkind.

By knowing our limitations and acknowledging them for ourselves and others, we are able to cultivate an authentic, balanced way of living. This protects our mental and physical health. It also increases the chances that we can engage in our daily activities and relationships in ways that are safe, healthy, and sustainable. In the long run, boundaries help us treat ourselves and others with more compassion and consistency. Nothing could be less selfish than that!

What Should We Do When Boundaries Are Crossed?

To answer this question, we must first remember that boundaries are only about our own behavior. Because our boundaries aren’t about what other people do or don’t do, other people can’t actually violate our boundaries. This can be a very empowering realization because it means our boundaries are not subject to the whims of others. It means that we don’t have to endure the stress of trying to control others. It means that we always have full control of how we set, maintain, and adjust our boundaries. Our boundaries are just that–ours!

However, just because others can’t cross our boundaries doesn’t mean their behavior doesn’t matter. How others treat us is very important, and while boundaries cannot be violated by others, others can certainly violate our consent, endanger our safety, or engage in other highly impactful behavior. In fact, the behavior of others is sometimes what helps us know that we would benefit from setting a boundary. The key thing to remember is that we are only responsible for our own behavior, including how we react to the behavior of others.

For example, you might have shared with your partner that you have a boundary that says, “I will leave conversations when I am yelled at by others.” If your partner then yells at you, they haven’t crossed the boundary, because the boundary is about your behavior (i.e., leaving) not their behavior (i.e., yelling). By yelling at you, they have created an occasion for you to decide if you are going to enforce, adjust, or drop the boundary.

Sometimes the healthiest decision is to maintain the boundary, but the healthiest choice can still be uncomfortable and challenging! For example, if your partner yells at you during a conversation about paying bills, maintaining this boundary might mean leaving the conversation even though you love your partner, even though you wanted a resolution about paying the bills, and even though you anticipate your partner will feel upset if you walk away.

However, sometimes the specific context of a situation means we need to revisit and adjust the boundary. For example, if your partner yells at you while they are in pain from a physical injury, you may decide the healthiest choice is to help them with their injury rather than leave the conversation. In this way, boundaries can be flexible and adjusted to specific situations, changing life circumstances, your own changing capacity, or new information about a person or situation.

Other times, we may want to maintain the boundary, but it is not a safe or accessible option. For example, if you are the passenger in a moving vehicle and your partner is yelling at you while driving, there may not be a safe way to immediately leave the conversation. You may instead choose to take a different action, such as using a de-escalation strategy, to help you stay safe while traveling. Once you are safe, you can revisit whether it is time to maintain the boundary by leaving and/or whether you would like to develop new boundaries.

What Happens If Our Boundaries are Unhealthy?

The idea of “healthy boundaries” simply means that we have boundaries that accurately reflect our needs and limitations and that effectively help us maintain safety and achieve our goals. This often requires boundaries with nuance, specificity, clarity, and flexibility. When we have “unhealthy boundaries,” it typically means our boundaries are either too rigid or too loose.

When our boundaries are highly rigid, we hold others at a distance. This can have some appeal, such as feeling independent and feeling insulated from the stress of conflict with others. However, we may also experience difficulties from this style of boundary. Common issues are feeling isolated and lonely, not having adequate support from others during times of stress, feeling unable to connect meaningfully with others, having difficulty collaborating and compromising with others, feeling unable to understand the emotions and experiences of others, and getting feedback that we seem cold, aloof, or distant.

When our boundaries are extremely loose, we become enmeshed with others. This has some appealing aspects, such as feeling “in sync” with others and never feeling alone. However, this style of boundary can also cause problems. Common difficulties are losing our distinct sense of self, finding it difficult to say “no” to others, oversharing personal information, frequent or intense feelings of jealousy, chronic worry about being abandoned, feeling dependent on others for validation or emotional stability, being controlling of others, difficulty making decisions independently, and engaging in people-pleasing behavior.

With boundaries that are too rigid or too loose, we ultimately face the same outcome: our needs are not met in safe, healthy, sustainable ways, and our relationships suffer.

How Do We Set Healthy Boundaries?

Setting boundaries involves using several skills that are “ingredients” to healthy boundaries. You don’t need to be a master of these skills to start setting boundaries, but strengthening these skills will help you set boundaries with less difficulty, more confidence, and with healthier outcomes for yourself and for others.

To set boundaries effectively, we must first be aware of our experiences. Being aware of our internal experiences (like emotions and sensations) as well as external experiences (like life events or the actions of others) is often called mindfulness. Developing mindful awareness is key for developing healthy boundaries because boundaries are reflections of our capacity. To honor our capacity with healthy boundaries, we must first be aware of our experiences, needs, wants, and limitations. Regular mindfulness practice can help build our self-awareness over time.

A closely-related ability is called radical acceptance, which involves fully acknowledging and processing our experiences, even when our experiences are difficult, upsetting, or unwanted. Radical acceptance involves making space for our experiences rather than avoiding them or controlling them. This is crucial for boundary setting, as healthy boundaries often involve accepting some difficult realities. For example, healthy boundaries require us to accept that we cannot control the behavior of others or that we may benefit from saying no to something that we want. Being able to accept our authentic experience, even when it is challenging, allows us to develop boundaries that truly address our need for sustainable safety, rather than get swept up in our natural but sometimes unhelpful desire for comfort or convenience.

Another related and important skill for boundary development is called distress tolerance. Distress tolerance is our ability to effectively manage difficult emotions. Difficult emotions are an inevitable part of life, and they’re also very likely to be involved in situations where we need a boundary to protect our capacity. Distress tolerance skills are like muscles we can build to help us carry heavy emotions. Having robust distress tolerance skills helps us maintain clarity of purpose and make effective choices while managing our boundaries.

Can Therapy Help Build Healthy Boundaries?

While reading this article may have helped you understand what boundaries are and why they’re important for healthy relationships, it may have also led to another realization: boundaries are complicated!

Learning to set, maintain, and adjust boundaries can seem overwhelming. As explained above, there are many separate skills–like mindfulness, radical acceptance, and distress tolerance–that are key for effective, healthy boundaries. Developing boundaries and maintaining them under stress also takes time and practice. Learning any new skills requires patience, self-compassion, and courage. And there’s good news: you don’t have to do all of this on your own!

Psychologists at Aviva Psychology Services are trained to help you develop healthy boundaries that improve relationships and enrich your life. You can get connected with a psychologist who has expertise in healthy relationship dynamics by filling out the Request an Appointment form.

Selected References and Additional Reading

Davis, K. (2025). Who Deserves Your Love. Simon and Schuster.
Drescher, A. (2024). Simply Psychology. Relationships: Boundaries vs Rules. https://www.simplypsychology.org/boundaries-vs-rules.html
‌Linehan, M. M. (2015). DBT Skills Training Manual (2nd ed.). Guilford Publications.
‌Lopez, A. H. (2025). DBT Workbook for BPD: A 12-Week DBT Program for Emotional Balance, Distress Tolerance, and Relationship Harmony. Owubooks.
Nash, J. (2018, January 5). How to Set Healthy Boundaries & Build Positive Relationships. PositivePsychology.com. https://positivepsychology.com/great-self-care-setting-healthy-boundaries
What is Mindfulness?. DBT Mindfulness: Exercises, Videos and Worksheets. https://dialecticalbehaviortherapy.com/mindfulness/

Exposure and Response Prevention (ERP): A Powerful Tool for Managing OCD and Anxiety

Mon, 08 Dec 2025 22:11:02 GMT

You can reclaim your life from OCD and anxiety with ERP therapy.

If you’ve ever struggled with intrusive thoughts, anxiety, or compulsive behaviors, you may have come across ERP—short for Exposure and Response Prevention.

ERP is widely regarded as the gold standard for treating OCD and is increasingly being used to treat other anxiety-related conditions. This article provides an overview of ERP, including what it is, how it works, who it helps, and what to expect from the process.

What is Exposure and Response Prevention (ERP)?

Exposure and Response Prevention is a specific type of Cognitive Behavioral Therapy (CBT) designed to help individuals confront their fears rather than avoid them, resist them, or neutralize them with rituals or compulsions. It has two main components:

Exposure : Gradually and intentionally facing the things that cause fear or discomfort. Imaginary exposures include thoughts, mental images, and stories. In vivo exposures include real-life situations and experiences. Interoceptive exposures include physical sensations.
Response Prevention : Refraining from performing the compulsive behavior or mental ritual typically used to reduce the distress associated with the obsession.

Compulsive behaviors can include tapping, washing, checking, asking for reassurance, or doing things a particular way. Compulsive behaviors can also include avoiding doing things including avoiding touching doorknobs, driving, and talking.

Mental rituals can include silent counting, replaying memories, comparing, and mantras.

By repeatedly facing fears and resisting compulsions, the brain learns that the anxiety decreases on its own and that feared outcomes are less likely or not as catastrophic as once believed.

The Science Behind ERP

Anxiety and OCD often work cyclically. We experience a trigger, which cues an obsession or intrusive thought. If our brain interprets the trigger or thought as threatening, our threat-response system (also known as the sympathetic nervous system or fight or flight ) activates. The threat-response system can lead to emotional and physical distress, including symptoms like increased heart rate.

We might attempt to reduce the threat to alleviate our distress. Sometimes that means solving the problem, avoiding the problem, or some other action or mental act that leads to short-term relief. The relief that we feel convinces us that the threat was real and the compulsion or avoidance was necessary. The relief reinforces future anxiety, which drives more avoidance and compulsions, and the cycle continues.

Unfortunately, we don’t actually have the ability to control whether bad things happen. We cannot control the future - bad things may or may not happen, no matter how careful and controlled we try to be. In addition, avoiding discomfort makes our worlds smaller and doesn’t give us opportunities to feel brave and resilient. While we are getting pushed around by our fears and trying to keep ourselves safe and comfortable, we miss out on the beautiful parts of life that require some uncertainty, discomfort, and effort. We also miss out on learning that we can do hard things, learn, and grow. We gain confidence by persevering through tough times.

“We can choose courage or we can choose comfort, but we can't have both. Not at the same time.”

-Brené Brown

ERP interrupts the anxiety cycle by giving us tools and experience to build motivation to face our fears. ERP helps us to stop doing things that bring us temporary relief and fuel more anxiety. By accepting short-term uncertainty and discomfort, we can get more comfortable with being uncomfortable and uncertain.

ERP is rooted in the principles of behavioral psychology, particularly the concept of habituation. Habituation refers to the natural decrease in anxiety that occurs when a person is exposed to a feared stimulus over time without engaging in avoidance or compulsions. This retrains the brain to respond more appropriately to anxiety triggers - we learn through experience that we can survive it and we don’t need to be as afraid of it. It’s like the difference between watching a scary movie alone in the dark for the first time versus watching a scary movie with the lights on for the tenth time. It’s just not as scary after you’ve done it several times without hiding from it.

Research consistently shows that ERP is one of the most effective treatments for OCD, with success rates as high as 60% to 80% when done correctly and consistently. Brain imaging studies have even shown structural and functional changes in the brains of people who undergo ERP, indicating long-term benefits.

Conditions Treated with ERP

While ERP is most commonly associated with OCD, it is also effective for a range of anxiety disorders and related conditions, including:

Social Anxiety Disorder
Panic Disorder
Generalized Anxiety Disorder (GAD)
Specific Phobias
Health Anxiety (Hypochondria)
Body Dysmorphic Disorder (BDD)
Post-Traumatic Stress Disorder (PTSD), in some cases

ERP can be tailored to a wide variety of OCD subtypes. Some common themes include:

Contamination OCD : Fear of germs, illness, or dirt
Harm OCD : Fear of causing harm to oneself or others
Sexual or Religious OCD : Intrusive taboo thoughts
Checking OCD : Repeatedly checking appliances, doors, or personal mistakes
Symmetry and Ordering OCD : Needing things to be “just right”
Scrupulosity : Religious or moral obsessions
Relationship OCD: Obsessive doubts about relationships

Each theme may involve different triggers and compulsions, but the underlying treatment principle remains the same: exposure to the feared thought or situation, followed by response prevention.

The ERP Process: What to Expect

Assessment and Planning A therapist will begin with a detailed assessment to understand the individual’s specific fears, obsessions, and compulsions. This helps create a personalized ERP plan.
Building Motivation The individual and therapist will work together to clarify and build the client’s motivation to engage with ERP. Because ERP includes facing fears and feeling uncomfortable, it’s important for the client to have a clear idea of what they really care about.
Creating a Fear Hierarchy Together with the therapist, the individual will list their feared situations and rank them from least to most anxiety-provoking. This is called a fear hierarchy, and individuals and therapists use them to choose exposures. Usually, exposures begin with situations in the middle of the fear hierarchy.
Gradual Exposure The individual begins confronting their fears in real-life or imaginal situations with the therapist. This can involve touching a doorknob without washing hands, imagining a distressing thought, breathing through a straw to experience shortness of breath that often comes with anxiety, or resisting the urge to check something.
Response Prevention During and after exposure, the individual resists performing any compulsions. This is challenging but essential for the therapy to work.
Repetition and Practice Exposures are repeated frequently until the anxiety subsides. Over time, new exposures are faced, and the individual works their way around the hierarchy.
Maintenance and Relapse Prevention Once significant progress is made, the focus shifts to maintaining gains and developing strategies to prevent relapse.

Challenges and Misconceptions

ERP is highly effective, but it is not always easy. Some common challenges include:

Initial Increase in Anxiety : Facing fears head-on can temporarily raise anxiety levels. It can help to think of this as a transition phase: change is often hard! It’s like when we want a more satisfying relationship or job - we need to do the hard work of acknowledging the problem and then persevering through the changes to get what we really want.
Avoidance or Resistance : It’s common to want to avoid exposures or give in to compulsions. Of course you might not WANT to do the hard thing or feel the uncomfortable feeling. The therapist and client can work together to build motivation by remembering how life could be better without OCD in control.
Misunderstanding the Process : Some people fear that ERP is about forcing them into extreme situations too quickly. In reality, ERP is gradual and collaborative. Consent and choice is a crucial part of the process.

Misconceptions can deter people from trying ERP. For instance, it’s not about ignoring fears but confronting them with support. It also doesn’t require 100% certainty or perfection; rather, it teaches tolerance of uncertainty.

The Role of the Therapist

A skilled ERP therapist plays a critical role in guiding the process, providing support, and ensuring that exposures are done correctly and safely. They help tailor the approach to the individual's needs and adjust the plan as therapy progresses.

A key to ERP is personal motivation. Therapists can help clients stay engaged and motivated during exposures by answering these questions.

What would life look like without this issue?
Why does this matter to you?
What is anxiety and OCD keeping from you?
Why would you do this hard thing and keep going?
What do you have to gain from doing this?

Therapists can help you to become your own cheerleader and coach by encouraging yourself through the exposures.

“I can do hard things.”
“I can feel uncomfortable and still be okay.”
“I am resilient.”
“I believe in myself.”
“I am stronger than my anxiety/OCD.”
“I’m being brave!”

Your therapist may encourage you to write or record your own helpful reminders and encouragement. These personalized phrases can be used to support you through the discomfort that may come from resisting compulsions.

Other Possible Benefits from ERP

In addition to reducing the severity and frequency of OCD and anxiety symptoms over time, ERP can help us in other areas of life. If we embrace the “I can do hard things” mindset, we may have an easier time being open to new experiences, letting go of control, and coping with unexpected situations. Some clients who engage with ERP find that they become less perfectionistic and controlling, even though that was not what initially brought them to therapy.

Self-Help and Digital Tools

While working with a therapist is ideal, some people begin with self-help resources or use digital tools to complement therapy. These include:

Books : "Freedom from Obsessive Compulsive Disorder" by Jonathan Grayson, or "The OCD Workbook" by Bruce Hyman.
Apps and websites : NOCD, WorryTree, and anxieties.com
Social Media: @ocddoodles

Conclusion: Reclaiming Life Through ERP

Exposure and Response Prevention is more than just a treatment; it is a transformative process that empowers individuals to reclaim their lives from the grip of anxiety and OCD. While it can be challenging, the results are often life-changing. With commitment, support, and the right guidance, ERP helps people confront what they fear most and discover that they can handle it—often with greater strength than they ever imagined. The path may not be easy, but it is one grounded in hope, resilience, and proven success.

You can begin your path to recovery at Aviva Psychology Services by filling out the Request an Appointment form. Our admin team will contact you quickly to arrange scheduling.

References

Abramowitz, J. S. (2009). The family guide to getting over OCD: Reclaim your life and help your loved one . The Guilford Press.

Foa, E. B., Yadin, E., & Lichner, T. K. (2012). Exposure and response (ritual) prevention for obsessive-compulsive disorder: Therapist guide (2nd ed.). Oxford University Press.

Grayson, J. (2014). Freedom from obsessive compulsive disorder: A personalized recovery program for living with uncertainty (2nd ed.). Berkley Books.

Hyman, B. M., & Pedrick, C. (2010). The OCD workbook: Your guide to breaking free from obsessive-compulsive disorder (3rd ed.). New Harbinger Publications.

Kozak, M. J., & Foa, E. B. (1997). Mastery of obsessive-compulsive disorder: A cognitive-behavioral approach—Therapist guide. Oxford University Press .

National Institute of Mental Health. (n.d.). Obsessive-Compulsive Disorder . https://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd

Narrative Therapy: How Your Story Shapes Your Life

Fri, 21 Nov 2025 19:55:41 GMT

Narrative Therapy: How Your Story Shapes Your Life

The decision to enter therapy can be fraught with apprehension and ambivalence. Many of the clients I meet with will tell me they’ve agonized for quite some time before making their decision to seek out a therapist.

Why? They were worried about being judged, misunderstood, and having their struggles pathologized. It is a common fear associated with traditional therapy approaches that often emphasize the “What is wrong with you?” approach to treatment. We know this increases stigma around mental health services, and further marginalizes those seeking support when they view themselves as “less than” for needing help. Therapists can unintentionally contribute to this structural stigma by continuing to place themselves as “experts” while disempowering clients from accessing agency in their own healing. What can be done about this dynamic?

Narrative Therapy is an approach that offers clients an opportunity to reflect on how their lived experiences have shaped their world view and understanding of themselves. One of the benefits of using a narrative therapy approach is its deeply collaborative nature. The idea behind this modality of treatment is to get at the client’s “story.” In other terms, what is the version of themselves and the world around them that they carry in personal narratives. Narrative Therapy posits that the individual’s story shapes their thoughts, feelings, and actions. By getting insight into the themes and patterns present in their life story, clients begin to see themselves as experts in their own right. They then can take ownership to revise and re-author the aspects of their stories that are outdated, unhelpful, and at times harmful to their health, personal growth, career development, and relationships.

Where to begin?

In my first appointment with clients, I will ask them what their goals are for therapy. Most of the time, the answers I get actually tell me everything about what clients identify as “problems” that are getting in the way of their goals. This is the beginning of understanding a client’s problem-saturated narrative . Many of the themes listed here will repeat across clients of different ages, genders, ethnicities, and socio-economic markers. The most common “problem-areas” I have encountered in my clinical practice include:

“I am not good enough:” someone will hold self-critical views that highlight their inadequacies and mistakes, while minimizing their strengths and accomplishments
“I am too much:” someone will be hypervigilant to their perceived flaws and attempt to present themselves in social situations as amenable, agreeable, and “easy-going”
“I am falling behind:” someone will hold rigid beliefs around needing to achieve certain milestones of adulthood based on an impersonal socio-cultural “timeline,” even if that deviates from their personal goals
“I am smart but lazy:” someone will focus on what they have failed to achieve, minimize their efforts, and downplay their wins
“I am not smart but I work hard:” someone will overly rely on effort, often to the point of burn out and minimize their built-in strengths and attributes
“I am difficult to love:” someone will assume their difficulties in interpersonal relationships are caused by their fixed flaws and negatives traits
“I am a fraud and will be found out:” someone who has achieved some degree of success will experience fear that they have “tricked” their way into achievements (personal and professional) and are at risk of “losing everything” if others were to know them deeply
“I am bad and deserve mistreatment:” someone will convince themselves that being hurt by others is justified based on a core belief that their “badness” is inherent
“I have no control over what happens to me:” someone will place the “cause” of all their problems and challenges outside of their control, contributing to a sense of helplessness to change their circumstances
“I am to blame for everything that happens to me:” someone will place self-blame at the center of their problem-saturated narrative, removing the influence of their socio-cultural-historical context and other situations outside of their control
“I am broken and unlovable:” someone will mistake their painful experiences with the essence of who they are and believe their past traumas make them unworthy of love and belonging

It is not hard to imagine that anyone walking around with this never-ending “problem” list about themselves would experience emotional distress, relationship difficulties, and low self-esteem. Their life story has been skewed to highlight areas of difficulty, pain, and struggle, while strengths, virtues, and achievements have been diminished or completely erased from conscious awareness. Examining the problem-saturated narrative is the first step to taking ownership and practicing cognitive flexibility to ask: “What am I missing in my story?”

Revision Work and Deconstructing the Dominant Narrative

Using a narrative therapy approach allows me to join clients in the revision of their problem-saturated narrative. This leads to the active work of creating an alternative narrative , to remove the limiting-beliefs clients hold about themselves and the world around them. This process is also known as “re-authoring.”

One strategy I will explore with clients is the notion of deconstructing the dominant narrative. This allows for clients to experience ownership and agency, without becoming stuck in self-blame and shame-induced critical thinking. Here are some examples of what is explored in this stage of therapy:

Personal History: exploring what challenges the client has faced and their resilience, perseverance, and courage in moments of overcoming struggle
Social Context: naming aspects of the client’s identity which have been marginalized due to structural stigma, such as discrimination based on racial identity, gender, religious affiliation, sexuality, and documentation status.
Personal Choice: working collaboratively to examine choices available to clients to improve their quality of life that have previously been overlooked or ignored due to fears, insecurities, and socio-historical barriers present in the problem-saturated narrative

Revision Work and Externalizing the Problem

Many clients have learned to internalize their mental health symptoms, to the degree that they have developed an association between their problems and their identity. This has become common vernacular in our everyday lives. Most of us hear others and ourselves say the following:

“I am depressed and down all the time”
“I am so anxious. I live in constant worry”
“I am so OCD that I fixate on every little problem”

Statements like this create a blending between the problem someone is experiencing (depression, anxiety, OCD) and who they ARE. By working to place the problem outside of the client–that is, externalizing the problem –we are better able to establish a healthy separation between someone’s sense of self and how they experience their symptoms. This approach allows clients to experience enough psychological distance from an identified “problem” in order to experience themselves as existing separate from and independent of the issue they are facing. Here are some examples of how I have used this with clients over the years:

Externalize the Diagnosis: reframing clinical diagnoses, such as anxiety disorder, depressive disorder, panic disorder into experiences outside of the client (e.g., “The Depression” vs “You are depressed”), to avoid placing the problem inside the client
Discover the Influence: working with the notion that the problem exists outside of the client, using questions to better understand how the problem attempts to “influence” the client (e.g., “How does The OCD get in the way of your self trust?”)
Begin to Strategize: once the problem exists outside of the person, working together and brainstorming ways to reduce the problem’s influence (e.g., “Do you think The Anxiety has any weaknesses? Are there ways we can try to outsmart its influence over you?”)
Notice the Wins: place emphasis on the client’s efforts to resist the influence of the problem, and use curiosity to explore how these wins are possible (e.g., “Even with The Depression hanging heavy on your back, you still made it to your cousin’s event. How were you able to do that?”)

Benefits to Narrative Therapy

There are many benefits to using a Narrative Therapy approach. Some of these include:

New Possibilities: encouraging clients to examine their expertise and knowledge from their lived experience can facilitate hopefulness in taking action steps for change.
Collaboration: therapists and clients work together, and are building an alliance against the identified problem. This can decrease the stigma associated with mental health care by humanizing the client and reducing the power-imbalance in the therapy relationship.
Reducing Blame & Shame: when clients increase their sense of agency and ownership over their lives, they can become less vulnerable to paralysis and overwhelm from shame and self-blame. They can be responsible for making changes without fearing that accepting accountability makes them weak or at fault.

If you would like to learn more about Narrative Therapy, we encourage you to reach out to our practice. You can get connected with a psychologist who has expertise in narrative therapy by filling out the Request an Appointment form.

Reference:

White, Michael (2004) Narrative Practice and the Unpacking of Identity Conclusions. Dulwich Centre Publications

https://dulwichcentre.com.au/wp-content/uploads/2020/09/Unpacking-Identity-Conclusions.pdf

Navigating the Storm: Treating Postpartum Anxiety with CBT, EFT, and ACT

Fri, 07 Nov 2025 20:09:39 GMT

Postpartum anxiety is real. So is effective treatment.

Let’s get one thing out of the way: postpartum anxiety is real. It’s not just “new parent stress.” It’s not just “hormones.” And it’s definitely not something you should feel ashamed of.

If you’re reading this because you—or someone you love—is in the thick of it, please take a breath. You’re not alone, and you’re not broken. What you’re feeling is valid. And more importantly, there are proven, compassionate ways to feel better.

In this post, we’re going to talk about three powerful therapeutic approaches that can help reduce postpartum anxiety: Cognitive Behavioral Therapy (CBT), Emotionally Focused Therapy (EFT), and Acceptance and Commitment Therapy (ACT). These aren’t magic cures, but they are well-researched, meaningful paths forward—tools to help you feel more grounded, connected, and whole again.

What Is Postpartum Anxiety?

Most people have heard of postpartum depression, but postpartum anxiety (PPA) is often misunderstood or completely overlooked. It affects an estimated 1 in 7 mothers and 1 in 10 dads , though that number may be higher due to underreporting.

Postpartum anxiety can look like:

Constant worry that something bad will happen to your baby
Intrusive thoughts that are scary or disturbing
Difficulty sleeping—even when your baby is asleep
Feeling on edge, irritable, or panicked
A racing heart, upset stomach, or a sense of dread
Feeling disconnected from your partner, your baby, or yourself

It’s overwhelming, disorienting, and isolating. And yet, many new moms and dads suffer in silence because they’re afraid of being judged—or worse, seen as unfit mothers.

But here’s the truth: you can love your baby and still feel anxious. Those two things can exist side by side. And they often do.

Why Therapy for Postpartum Anxiety Works

Therapy gives you a safe space to unpack what’s going on inside. It’s not about being “fixed”—it’s about being heard , understood , and supported as you navigate the postpartum period, one of the biggest transitions of your life.

Let’s explore how CBT, EFT, and ACT each offer unique ways of helping moms heal from postpartum anxiety.

1. Cognitive Behavioral Therapy (CBT): Challenging the Storm of Thoughts

CBT is often the first-line treatment for anxiety —and with good reason. It’s practical, structured, and rooted in the idea that our thoughts, feelings, and behaviors are interconnected .

What CBT for Postpartum Anxiety Looks Like

Imagine you’re constantly thinking, “If I fall asleep, something bad will happen to my baby.” That thought triggers anxiety, which leads to you staying up all night checking on your baby. You’re exhausted the next day, which feeds more anxiety—and the cycle continues.

CBT helps by breaking this cycle. It teaches you to:

Identify distorted thoughts (e.g., catastrophizing, all-or-nothing thinking)
Challenge those thoughts with evidence-based reasoning
Replace them with more balanced, realistic ones

CBT also focuses on behavioral changes , like gradually reducing safety behaviors (e.g., checking the baby monitor every five minutes) and learning relaxation techniques .

Why It Helps

Many people with postpartum anxiety feel trapped in a loop of “what ifs.” CBT helps you step back and ask, “Is this thought helpful? Is it even true?” Over time, it empowers you to rewrite your internal narrative—to stop being your own harshest critic and start becoming your own ally.

2. Emotionally Focused Therapy (EFT): Healing Through Connection

While CBT focuses on thoughts and behaviors, Emotionally Focused Therapy (EFT) centers on your emotional world —especially your attachment to others.

EFT was originally developed for couples, but its principles are just as powerful for individuals, especially mothers and fathers navigating postpartum anxiety. It’s based on the understanding that emotional bonding is essential to our sense of safety .

What EFT Looks Like

Postpartum anxiety often brings with it a flood of difficult emotions: guilt, shame, fear, sadness. EFT helps you:

Explore and name these emotions without judgment
Understand the deeper needs behind those emotions (e.g., “I need to feel safe” or “I need to know I’m not alone”)
Strengthen emotional connections with loved ones and yourself

In sessions, you may revisit key emotional experiences—maybe the birth didn’t go as planned, or maybe you feel unseen in your relationship. A skilled EFT therapist will guide you through these vulnerable places with warmth and compassion.

Why It Helps

EFT is deeply validating. It doesn’t rush to “fix” you. It says, “Of course you feel this way. Let’s sit with it together.” When you're able to feel your feelings (instead of fighting them), and when you can share those feelings safely with someone who cares—healing happens.

3. Acceptance and Commitment Therapy (ACT): Making Space for the Hard Stuff

ACT is a newer form of therapy that blends mindfulness, values, and behavioral change. At its core, ACT teaches you how to accept what’s out of your control , while committing to actions that align with your values.

Unlike CBT, ACT doesn’t ask you to change your thoughts. Instead, it teaches you to relate to them differently.

What ACT Looks Like

Let’s say you have an intrusive thought: “I’m a terrible mother.” ACT doesn’t argue with that thought. It says, “Okay, that thought showed up. Now what do you want to do next?”

ACT helps you:

Notice your thoughts and feelings without getting hooked by them
Practice mindfulness and present-moment awareness
Clarify your values (e.g., love, connection, courage)
Take small steps toward those values—even when anxiety is present

One key ACT tool is defusion —the practice of unhooking from painful thoughts. For example, instead of saying, “I’m failing,” you might learn to say, “I’m having the thought that I’m failing.” That little shift can create a lot of breathing room.

Why It Helps

Postpartum anxiety often brings a sense of being stuck—like you’re frozen in fear or drowning in shame. ACT reminds you that you can feel anxiety and still choose your path . It doesn't promise to make hard feelings disappear, but it does offer the tools to carry them with more grace.

Putting It All Together: A Compassionate Path Forward

You don’t have to choose just one of these therapies. Many therapists, including several at Aviva Psychology Services, integrate elements of CBT, EFT, and ACT depending on your unique needs. Some parents respond well to CBT’s structured approach. Others need the deep emotional work of EFT or the mindful acceptance of ACT.

The beauty of therapy is that it’s not one-size-fits-all . It’s tailored. It’s relational. It meets you where you are.

And most of all, it’s a process . Healing doesn’t happen overnight. There will be steps forward and steps back. But with the right support, you will begin to feel more like yourself again—maybe even a fuller, more compassionate version of yourself than before.

You Are Not Alone

If you’re struggling with postpartum anxiety, please know:

You are not a bad mother or father.
You are not weak.
You are not alone.

There is help, and there is hope.

Therapy isn’t about getting rid of anxiety forever. It’s about learning how to live with it, respond to it, and move forward anyway . Whether through CBT, EFT, ACT, or a blend of all three, there is a path through this. And on that path, there are people ready to walk with you.

So if you’ve been waiting for a sign to reach out, this is it. Talk to a therapist. Talk to your partner. Talk to your doctor. Talk to someone.

You don’t have to do this alone.

Resources

Aviva Psychology Services : Our dedicated team of psychologists are trained to provide services like CBT, EFT, and ACT for postpartum anxiety. You can initiate services with Aviva by filling out the Request an Appointment form.
Postpartum Support International (PSI) : PSI offers free helplines, therapist directories, and online support groups

You are worthy of care. You are allowed to struggle. You are allowed to heal.

From one human to another: hang in there. You’re doing better than you think.

Grief: Myths, Facts, and Getting Support While Mourning

Fri, 17 Oct 2025 20:13:52 GMT

Therapy can support your mental health during mourning

What is Grief?

Loss is a universal human experience. Grief is the natural response to a devastating loss, such as death of a loved one, loss of a relationship, or more complex, subtle forms of loss such as the loss of abilities or identities. Even though it is a natural process, grief can feel overwhelming, confusing, or intolerable, and it’s commonly misunderstood. For example, people may believe that grief is the same thing as sadness, that grief is supposed to look a certain way, that grief is just another word for depression, or that grief should only last a certain amount of time. These are all myths!

Natural And Without “Normal”

All humans are subject to various stressful experiences in life, and the loss of a loved one is especially impactful. Grief, which is also called bereavement, is a natural but painful process that occurs after we experience the stressor of a loss. Grief is so impactful that most people experience both psychological and physiological symptoms—grief affects our entire body!

For example, during a typical grieving process, people are likely to experience at least some symptoms that we might associate with anxiety or depression, such as sadness, lack of interest in things we typically enjoy, feeling “stuck” in worried thoughts, and difficulty concentrating. Some people may develop enough symptoms to be diagnosed with an anxiety or mood disorder, but many people experiencing grief have a separate, unique experience of bereavement rather than clinical anxiety or clinical depression.

These psychological symptoms may be accompanied by physiological changes, such as an increase in physical pain like headaches, decreased appetite, increased fatigue, and increased digestive issues. Research has even shown that during grief, our immune system is weakened, making us more vulnerable to illness and less able to heal from sickness or injuries. The degree to which grief manifests as physical symptoms varies widely by person and by each experience of grief.

Grief also varies significantly by culture. For example, some cultures speak very openly about the circumstances of a loved one’s death and their feelings about it, but in other cultures, such details may be seen as deeply private and inappropriate to share with others. Some cultures have very formal or subdued funeral traditions. Others may mourn out loud, with wailing or crying or shaking. Some cultures have lively celebrations of life, such as the public musical processions seen in the second line parades of New Orleans. What is “normal” in grief is highly dependent on cultural variables.

Lastly, grief varies by context, much of which is specific to an individual, resulting in a large variability in grief responses even among members of the same culture or same family. We experience each loss differently, and our experience is shaped by important contextual details like the relationship we had with who we lost, our age, their age, whether the loss was expected or unexpected, and what degree of control we did or didn’t have in the circumstances. Factors like our religious or spiritual beliefs and the amount of social support we have are highly influential. Our own health, both physical and mental, is also part of the context of our grief response. With all of these variables, there simply isn’t a “one size fits all” when it comes to grief.

Grief Stages and Grief Cycles

You may have heard that there are “stages” of grief. This idea, called the Kübler-Ross model, originally proposed five distinct “stages” of grief, anticipated to occur in a particular order. WE now understand that these stages more commonly happen as a cycle of phases rather than a linear progression. This change in language reflects increased clinical research about grief, which has revealed an important truth: grief does not happen in neatly organized, sequential stages.

Instead, grief is a process that is constantly in flux. The Kübler-Ross model can be useful for understanding some common reactions to a loss, which include periods of denial, anger, bargaining, depression, and acceptance. However, not every person who experiences grief will experience each of those phases, the phases do not occur in a fixed sequence, and grieving people often return to previous stages multiple times, “cycling” through them in a way unique to each individual.

For those who experience the denial phase, feelings of numbness and shock are common. In this phase, people may also experience a sense of unreality, feeling as though the loss is a dream, happening to someone else, or never happened at all. Sometimes people in this phase worry they are secretly unloving or broken, and that is why they feel numb instead of sad. However, this reaction is common and a result of the shock of a profound loss, and it means nothing about their character, morality, or the relationship they had with our lost loved one.

The phases of anger and depression often involve waves of intense emotions, sometimes triggered by specific experiences and sometimes feeling like they came “out of nowhere.” For many people in these phases, the emotions are disruptive to daily life. Sometimes the anger and depression of these phases is interrupted by sudden bursts of excitement or joy, which may in turn feel confusing or even shameful. However, rapid and intense mood swings, including emotions like happiness, are a common experience in grief.

The bargaining phase of grief is often characterized by intense feelings of hopelessness or helplessness, leading those grieving to desperately try to find a way out of their suffering. In this phase, people may be consumed by “what if?” questions or “if only” wishes. This painful experience often leads us to try to negotiate with the grief. For example, we may try to make agreements or compromises with ourselves or a higher power, hoping to feel less pain.

The acceptance phase involves coming to terms with the reality of our loss. It does not mean liking, approving, or wanting the loss. Instead, in this phase we have made space for the loss, including the painful emotions involved, and acknowledge rather than wrestle with the loss. In this phase, we have a sense of forward momentum in life rather than a sense of being stuck in grief.

When Grief Gets Stuck: Prolonged Grief Disorder

There is no one right or normal way to grieve. However, grief should involve a progression from more intense emotional distress toward a sense of adjustment and decreased emotional intensity. Sometimes this doesn’t happen, and this is called Prolonged Grief Disorder. Other names for this experience included “complicated grief” and “complicated bereavement.”

Prolonged Grief Disorder occurs when there are significant difficulties with grief, which are not explained by variables like culture or context, and which persist a year or more after the loss. Prolonged Grief Disorder involves intense longing for the deceased person and/or being intensely preoccupied with thoughts and memories of them. In this disorder, the longing and preoccupation becomes consuming, disruptive, and interferes with daily life.

People with prolonged grief may feel that they have lost part of themselves. There may be intense emotional pain, like anger and despair, or there may be persistent emotional numbing that makes happiness and satisfaction feel impossible. It’s common for those experiencing prolonged grief to significantly change their daily lives in an effort to avoid reminders of the loss. Frequently, they struggle to resume daily life. They may find that working and connecting with loved ones is difficult because of distractibility and preoccupation with the loss. They may experience intense loneliness or even have thoughts that life is meaningless.

While many people recover from grief on their own, Prolonged Grief Disorder indicates that a barrier to natural recovery is present. People with Prolonged Grief Disorder are also more likely to meet criteria for other mental health conditions, such as depression or anxiety. As such, therapy can be especially helpful for processing both the loss and addressing any co-existing mental health symptoms.

When Grief Gets Overlooked: Disenfranchised Grief

It is important to acknowledge that not all grief is about the death of a loved one. We can also grieve the loss of relationships, occupations, and identities. For example, we may grieve when there is a significant change in family dynamics. We may grieve for our home when it is lost, such as through a house fire or as a result of displacement from natural disasters or political unrest. We may grieve the loss of physical or mental abilities due to illness, injury, or age. We may grieve the loss of our "old self" after a traumatic event.

One term for these other types of grief is “disenfranchised grief.” This term refers to a loss that is not openly acknowledged by society, is stigmatized in some way, and/or is commonly misunderstood or minimized by others.

These losses can be just as significant and disruptive as the grief we feel after the loss of a loved one, but often we feel that we are not entitled to grieve them in the same way. The truth is that these experiences matter. They can result in grief cycles just like those that follow the death of a loved one. Moreover, these experiences may be especially difficult to understand and process on our own—after all, we typically don’t get the structure and support of a funeral, FMLA, or friends and family "checking on us" for these types of losses—making therapy an especially helpful option.

How Therapy Can Help with Grief

Grief often feels like a journey: long, winding, full of unexpected highs and lows, twists and turns, and long, dark stretches. It can feel intensely lonely and like the road goes on forever, with no light on the horizon. Therapy can help navigate this journey in several ways.

One way therapy can help is by providing a supportive space to process grief—no matter how messy it feels, or how intense the emotions, or how illogical the thoughts. We often have intense self-judgements about the “right way to grieve” or how we “should feel.” Therapy can help those grieving pivot from habits of self-judgement, which often prolong suffering, to building practices self-compassion, which promote healing.

Therapy can also help by identifying ways that attempts to cope with grief may be creating or maintaining problems rather than helping resolve them. One common way this occurs is a coping style of avoidance. It makes sense to want to avoid things that feel painful, and this can sometimes be very healthy. However, avoidance can sometimes go too far. For example, sometimes when grieving, people try to remove reminders of the loss. They may get rid of objects that remind us of the loss, avoid people associated with it, or give up hobbies and other valued activities. This temporarily decreases pain, but it also blocks the ability to process the loss and move forward from it. Therapy can help identify coping strategies that help create long-term healing, not just a temporary decrease of discomfort.

Loss is a disruptive and disorienting experience—sometimes even a destructive or traumatic one. In the wake of such an event, we can feel lost or as if our life has no sense of meaning or satisfaction. Therapy can help us rediscover our personal values and redefine ourselves and our goals, even after the difficult experience of loss. Whether coping with changed circumstances, relationships, or identity, therapy can help those who are grieving discover ways to build a values-consistent, meaningful life with enduring richness and value, even in times of great pain.

How Do I Begin Grief Therapy?

If you are dealing with the pain of a loss, you don’t have to go through it alone. Whether you are dealing with a typical grief process or experiencing more prolonged, complicated bereavement, therapy can be a source of support and growth. You can get connected with a psychologist who has expertise in grief and bereavement by filling out the Request an Appointment form.

Selected References and Additional Reading:

Bereavement | Fact Sheet. (2021, March 4). ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/bereavement/
‌Cardoza, K., & Schneider, C. M. (2021, June 14). The Importance Of Mourning Losses (Even When They Seem Small): Life Kit. NPR.org. https://www.npr.org/2021/06/02/1002446604
Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2010). Do CBT-based interventions alleviate distress following bereavement? A review of the current evidence. International Journal of Cognitive Therapy, 3(1), 77-93.
Complicated Grief Fact Sheet. (2021, March 4). ABCT - Association for Behavioral and Cognitive Therapies. https://www.abct.org/fact-sheets/complicated-grief/
Fisher, J. (2023, December 12). 5 stages of grief: Coping with the loss of a loved one. Harvard Health; Harvard Health Publishing. https://www.health.harvard.edu/mind-and-mood/5-stages-of-grief-coping-with-the-loss-of-a-loved-one
‌Kosminsky, P. (2017). CBT for grief: Clearing cognitive obstacles to healing from loss. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 35(1), 26-37.
‌Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. New York, Scribner.

Can Therapy Help with Long COVID?

Fri, 03 Oct 2025 18:13:18 GMT

Long COVID can impact all aspects of life. How do you cope?

COVID-19 changed the world in many ways. One of those ways is that all human beings now live in a world with ongoing risk of developing persistent, disruptive, and sometimes intensely disabling post-infection symptoms. These symptoms are sometimes called “Long COVID.” Long COVID has significant impacts on mental health, and mental health interventions like therapy can help.

Long COVID: The Myths and The Facts

Long COVID is also called Post-COVID Conditions (PCC), long-haul COVID, and post-acute sequelae of COVID-19 (PASC). It is the subject of ongoing scientific research, news coverage about its disabling impact on both children and adults, political conversations about public health, and social media discourse.

Long COVID myths based in ableist and anti-scientific biases are pervasive. Common myths include that Long COVID is “all in your head,” “caused by vaccines,” or an “excuse to be lazy.” These beliefs cause harm to public health and create hurtful stigma for those who are experiencing Long COVID. In reality, post-viral conditions are well-documented by decades of scientific research and research is progressing and helping us understand Long COVID a little more every day.

So far, we know that Long COVID involves the development of new, persistent, and/or recurring symptoms after a COVID infection. Long COVID is a condition that impacts multiple body systems and can involve a variety of respiratory, neurological, cardiac, and psychological symptoms. These symptoms can be mild and manageable or entirely debilitating, and research so far cannot fully predict or explain these outcomes. However, research does indicate that Long COVID can occur after any COVID infection of any severity. In fact, most people who develop Long COVID do so after a mild COVID infection, and Long COVID can develop even after a totally asymptomatic infection. This means some people with Long COVID never even knew they had COVID in the first place.

The discovery that Long COVID is a possible outcome after a COVID infection of any severity also means that Long COVID is more common than scientists first thought. Research indicates there is a 10-30% chance of a person developing Long COVID after a COVID infection. The more times a person is infected, the more likely they are to eventually develop Long COVID.

One complicated, ongoing question in the research is this: who is most at risk of developing Long COVID? The research in this area has evolved significantly in the last five years. For example, the early pandemic belief that children are especially resilient and low-risk for Long COVID has been debunked, and some initial studies reporting this have even been retracted due to rampant errors.

Other research has identified groups of people are at higher risk of developing Long COVID. So far, we know that the more times a person gets COVID, the more likely they are to develop Long COVID, which can also be dramatically worsened by additional infections. We also know that many marginalized groups, such as trans people, BIPOC people, elderly people, and women are at higher risk of Long COVID. Preexisting disabilities and medical conditions, such as asthma, cancer, heart problems, and autoimmune conditions also result in higher risk. Having certain mental health conditions, such as depression, anxiety, stress, and ADHD have also been found to increase risk of Long COVID by as much as 45%. Another important consideration is occupation: people such as healthcare workers and teachers are at higher risk of Long COVID due to repeated exposure to illness at work.

How Long COVID Impacts Mental Health

You may be wondering how therapy is relevant for a medical condition like Long COVID. While society often thinks of our physical symptoms as separate from our psychological experiences, this simply isn’t true. Physical symptoms have psychological impacts, psychological symptoms have physical impacts, and living with complex medical diagnoses is often an emotionally challenging and life-changing experience.

As described above, Long COVID symptoms may manifest in many different types of medical symptoms, and Long COVID most commonly occurs after mild infections. As a result, developing Long COVID may feel like it happened “out of nowhere,” which can cause emotional turmoil. Additionally, Long COVID patients may experience a complicated, prolonged medical mystery involving life-threatening or life-changing symptoms that could be unpredictable, recurrent, or permanent. These experiences are distressing, disruptive, and sometimes even traumatic. The psychological impacts can be profound and may include an increase in stress, anxiety, depression, or PTSD symptoms.

Following the psychologically difficult experience of developing Long COVID, living with the condition presents both medical and psychological challenges. As described above, research increasingly indicates that Long COVID is common, but the condition continues to be highly stigmatized, even among medical professionals. As such, living with Long COVID can be a deeply isolating experience. Many people with Long COVID are unaware, undiagnosed, or hide their symptoms due to stigma, internalized ableism, or difficulty grieving their changed health status. Moreover, the unpredictable nature of Long COVID and the few available treatment options can lead to feelings of anxiety, depression, and even thoughts of suicide.

Long COVID can also impact mental health by exacerbating existing mental health conditions and mimicking the development of new mental health conditions. For example, as noted above, ADHD is one risk factor for developing Long COVID. Long COVID commonly involves difficulties with concentration and brain fog, which can worsen existing ADHD or cause people to wonder if they’ve developed ADHD or had it all along but didn’t realize it. This has been discussed as one possible factor driving the current rise in people seeking ADHD evaluations.

Research into Long COVID increasingly suggests that it is not only that the experience of living with Long COVID can result in experiences like anxiety and depression, but that the condition itself may cause brain and mind-related symptoms. Research indicates about 90% of those hospitalized with COVID and 25% of people who did not require hospitalization during a COVID infection will go on to develop brain or mind-related symptoms like depression, anxiety, sleep problems, headaches, or chronic fatigue. While researchers are still investigating the cause, so far it is believed this may be happening because the COVID virus causes brain inflammation and changes in metabolism in the brain, which in turn creates psychological changes.

How Therapy Can Help

The impacts of Long COVID can be daunting, especially given that there is no cure for Long COVID at this time. However, therapy holds great promise to help those experiencing Long COVID and those who want to make adaptive changes to reduce their risk and protect their well-being.

While Long COVID is a new phenomenon and medical science will need time to understand it and develop specific treatments for it, there are already existing therapies for many Long COVID related concerns. Because these therapies have been around for decades, we already know they can improve the lives of those who experience difficulties related to medical conditions. For example, psychological interventions like therapy have been used successfully with people experiencing cancer, traumatic brain injuries, autoimmune disorders, genetic conditions, and other post-viral illnesses. They can help with Long COVID, too.

For example, at Aviva Psychology Services, there are multiple well-established forms of psychotherapy available that address anxiety , depression , grief , and trauma . These therapies can dramatically reduce symptoms and dramatically improve quality of life regardless of the underlying origin of the symptoms. Treating these conditions, even while Long COVID persists, can improve quality of life in meaningful ways.

Aviva Psychological Services is also home to multiple psychologists who specialize in clinical health psychology. In the area of clinical health psychology, there are robust interventions available to help address many common Long COVID experiences such as chronic pain, executive dysfunction, chronic fatigue, brain fog, and insomnia. Clinical health psychologists also specialize in helping people make adaptive changes to protect their health. For example, they can provide support for implementing lifestyle changes such as clean air practices to reduce risk of airborne illness, guide you through developing self-care strategies after mental and physical abilities are altered by disability, and can help you navigate the stress of occupational or relationship changes necessitated by health conditions.

Some psychologists at Aviva Psychology Services specialize in working with chronically ill and disability communities. These providers have expertise in helping people manage experiences of ableism and discrimination, the stress of managing illness and disability, grieving losses associated with health status, the ripple effects of changes in our work and personal lives, and navigating changes in identity. Working with these psychologists can help those with Long COVID develop rich, meaningful lives even in the face of extremely difficult circumstances.

One particular benefit of mental health services for Long COVID is that unlike much medical care, which requires in-person visits for evaluations and procedures, therapy can be conducted via telehealth in the form of video and/or telephone appointments. This can be helpful in multiple ways. For example, Long COVID is frequently an energy-limiting condition and often makes travel logistically complicated. Additionally, having Long COVID means that exposure to and contracting additional illnesses, including but not limited to additional COVID infections, are more dangerous. Sitting in public waiting rooms or therapy offices can therefore be a significant health risk for medically-vulnerable people, and teletherapy provides a safer, more accessible option.

Whether your Long COVID related therapy targets a specific mental health condition like depression, explores disability-related experiences like ableism, or happens in-person or via telehealth, there is one universal truth: you deserve and can build a rich, meaningful life even while living with Long COVID.

How To Get Connected to Care

If you’ve been feeling overwhelmed by managing Long COVID symptoms, therapy can help you manage your stress. Chronic illness is complicated, and so is learning to manage its impact on your health and the complex changes that unfold in our daily lives when we develop a chronic or disruptive health condition. Living with a stigmatized chronic illness is often uniquely challenging, but you don’t have to face it alone.

Psychologists at Aviva Psychology Services are trained to help. The first step in getting connected to therapy is filling out the Request an Appointment form. Our dedicated admin team will be in contact promptly to help you get connected to a provider.

Selected References and Additional Reading

CDC. (2025, July 24). Long COVID Basics. Long COVID. https://www.cdc.gov/long-covid/about/index.html
Centers for Disease Control and Prevention (2024). People with Certain Medical Conditions and COVID-19 Risk Factors. https://www.cdc.gov/covid/risk-factors/index.html
Center for Infectious Disease Research and Policy (CIDRAP). (2025, April 23). https://www.cidrap.umn.edu/covid-19/studies-detail-high-rates-long-covid-among-healthcare-dental-workers
Amani Al-Oraibi, Woolf, K., Naidu, J., Nellums, L. B., Pan, D., Sze, S., Tarrant, C., Martin, C. A., Mayuri Gogoi, Nazareth, J., Pip Divall, Dempsey, B., Lamb, D., & Manish Pareek. (2025). Global prevalence of long COVID and its most common symptoms among healthcare workers: a systematic review and meta-analysis. BMJ Public Health, 3(1), e000269–e000269. https://doi.org/10.1136/bmjph-2023-000269
Yale Medicine. (n.d.). Long COVID (Post-COVID Conditions, PCC). https://www.yalemedicine.org/conditions/long-covid-post-covid-conditions-pcc
Leitner, B. (2024, June 10). Depression and Anxiety in Long COVID: Why Interdisciplinary Treatment Is Needed. Yale Medicine. https://www.yalemedicine.org/news/depression-and-anxiety-in-long-covid-why-interdisciplinary-treatment-is-needed
Murdoch, B. (2024, October 18). Long COVID Is Harming Too Many Kids. Scientific American. https://www.scientificamerican.com/article/long-covid-is-harming-too-many-kids /
‌Williamson, L. (2023, August 17). Understanding the link between long COVID and mental health conditions. https://www.heart.org/en/news/2023/08/17/understanding-the-link-between-long-covid-and-mental-health-conditions
‌‌Bourmistrova, N. W., Solomon, T., Braude, P., Strawbridge, R., & Carter, B. (2022). Long-term effects of COVID-19 on mental health: A systematic review. Journal of Affective Disorders, 299(299), 118–125. https://doi.org/10.1016/j.jad.2021.11.031
Engelmann, P., Reinke, M., Stein, C., Salzmann, S., Löwe, B., Toussaint, A., & Shedden-Mora, M. (2024). Psychological factors associated with Long COVID: a systematic review and meta-analysis. EClinicalMedicine, 74, 102756. https://doi.org/10.1016/j.eclinm.2024.102756
Patients with Long COVID Face Significant Mental Health Challenges | Patient Care. (n.d.). Weillcornell.org. https://weillcornell.org/news/patients-with-long-covid-face-significant-mental-health-challenges
Overview of the Impacts of Long COVID on Behavioral Health Overview of the Impacts of Long COVID on Behavioral Health Acknowledgments. (n.d.). Retrieved February 14, 2025, from https://library.samhsa.gov/sites/default/files/pep23-01-00-001.pdf
Communications, N. R. H. C. S. (2022, September 7). Depression, anxiety may escalate chances of long COVID, says study. Harvard Gazette. https://news.harvard.edu/gazette/story/2022/09/depression-anxiety-may-escalate-chances-of-long-covid-says-study/
The Sick Times - Chronicling the Long Covid crisis. https://thesicktimes.org/

How to Find the Right Psychologist in Boston, Massachusestts

Sun, 20 Apr 2025 23:14:57 GMT

Looking for the right therapist can be daunting – it might take a few tries to find a great match, but once you do, it can be transformative. Finding a psychologist who meets your needs can feel particularly overwhelming. In large cities like Boston, the options can be difficult to navigate.

With realistic expectations and patience (sometimes a lot of it) you can soon be on your way to building a meaningful and supportive therapy relationship.

So, let’s dive into how to find a fitting therapist:

1. Know What You’re Looking For

Before you start Googling “how to find a therapist” or "best therapists in Boston," it’s important to get clear on your needs. Ask yourself the following questions:

What are you struggling with? Are you dealing with anxiety, depression, or relationship struggles?
What kind of feedback do you want? Are you looking for someone active who will give homework and direction, or someone who is more insight oriented and allows you to drive the process?
Are you looking to learn new skills, explore your history and its impact, become more effective in relationships, better understand your feelings, and/or gain relief from specific symptoms?

The better you understand your own goals, the easier it’ll be to find a therapist who can support you in achieving them.

This self-awareness isn’t just helpful – it’s crucial. According to a study published in Psychotherapy (2014) , clients who have a clear understanding of their needs and goals are more likely to achieve positive outcomes from therapy. It’s about aligning your needs with the therapist's expertise.

In the world of psychotherapy there is a spectrum of theories and training approaches that psychologists pull from. They range from behavioral therapy, which is highly active and skills based, to psychodynamic therapy, which is more insight oriented and focuses on understanding the past to improve the present.

Different concerns and personality styles have different needs and desires related to fitting therapists. For example, if you’re struggling with an anxiety disorder, like Generalized Anxiety Disorder (GAD) or Obsessive Compulsive Disorder (OCD), evidence based behavioral therapy treatments like Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), or Acceptance and Commitment Therapy (ACT) have been shown to be the most effective for symptom relief and management.

On the other hand, if you’re struggling in relationships or understanding behavioral patterns, psychodynamic therapy may be a better fit. Whatever your situation, identifying what you need is your first step toward finding the right therapist.

2. Start with Referrals and Recommendations

One of the best ways to find a therapist is by asking people you trust for recommendations. Many have had positive experiences with therapists, and sharing recommendations can help you get started.

If you feel uncomfortable asking your friends or family directly, you can always start by browsing online platforms. Reading a therapist's profile and website can give you a good "gut sense."

If you’re in Boston, Aviva Psychology Services offers a free 20 minute consultation to assess fit and has a large team of psychologists with many specialties, including anxiety, mood disorders, PTSD, grief, relationship challenges, and insomnia. Every potential client has a call with our intake team to get a better sense of your needs and what you are looking for. We then match you with a best fit therapist on our team. Once matched, the assessment doesn't end there. We actively encourage your therapist and you to assess needs, discuss them directly, and assess fit in the first 2-4 sessions. Truly assessing fit takes some time, but at Aviva, we aim to provide as much information as we can along the way so that you are empowered to find the best fit for your needs.

3. Consider Their Specializations and Approach

As mentioned earlier, there is a spectrum of approaches and therapeutic styles. As you assess your needs, think about the areas of expertise and treatment approaches that may match what you are looking for. At Aviva Psychology Services our therapists can work with a variety of clients, but each have an area of expertise. On our team we have psychologists with expertise in anxiety , depression , grief , infertility and perinatal support , relationship issues trauma & PTSD . If you are clear on an area of expertise you are looking for, whether it's at Aviva or somewhere else, letting your provider know the expertise you are seeking will help them realistically assess if the fit is right for you.

Most therapists have conditions and areas of expertise related to the problems that they work best with. They also have training in specific therapeutic or treatment approaches that inform how they work with a given problem. Some treatment approaches are tied to specific problems, like Cognitive Behavioral Therapy for Insomnia (CBT-I) and others are more general and have empirical support for helping with a variety of presenting concerns. At Aviva, the main models of care across our team include Acceptance and Commitment Therapy (ACT) , Cognitive Behavioral Therapy (CBT), Internal Family Systems (IFS) , Psychodynamic Therapy , and Relational Cultural Theory .

You can read more detail in the links above, but to here is a brief overview of each:

Acceptance and Commitment Therapy (ACT) is a mindfulness-based approach that encourages acceptance of uncomfortable thoughts and feelings while focusing on behaviors that move you towards clarifying and taking action on personal values.

Cognitive Behavioral Therapy (CBT) is a practical, solution-focused approach that helps individuals identify and change negative thought patterns and behaviors. The link between thoughts, feelings, and behaviors is examined and behavioral strategies are used to work on disrupting the automatic thought patterns that cause distress or unwanted behaviors.

Internal Family Systems (IFS) is an evidence-based, strength-focused approach that helps clients identify parts of themselves that get in the way of their natural sense of confidence, clarity, and calm.

Psychodynamic Therapy is a deeper, more introspective approach that explores past experiences to understand current behaviors and address relational stuck points.

Relational-cultural theory (RCT) is a strengths-based model of psychotherapy that proposes all humans are healthiest in connection. RCT helps clients understand their suffering, which often stems from disconnection and isolation. RCT aims to uncover this and help clients move towards “mutually growth-fostering relationships," which are built on mutual empathy, acceptance and authenticity, and that empower both people in the relationship.

These are just a few examples of therapeutic approaches. It’s important to find a therapist whose style and approach resonate with you. A study from the American Psychological Association (2017) found that therapy works best when the client resonates and feels comfortable with the therapist's expertise and theoretical approach.

4. Location and Accessibility Matter

When you’re asking yourself how to find a therapist in Boston, it’s also worth considering logistics. Where is the therapist’s office located? Is it convenient for you? What are their billing and practice policies?

If you live in the suburbs of Boston, for example, getting into the city for a therapy session can become a hassle or barrier to consistent care. Telehealth may be a more appealing option and, if so, this would become an important part of your search criteria.

Another practical consideration is the therapist’s hours. Do they offer sessions at times that work for you? What is their reschedule and/or cancellation policy? Finding a fitting therapist means finding one that fits with your schedule and lifestyle.

If you’re in the Boston area, you may find it helpful to look for practices that offer both in-person and online therapy sessions. Having the flexibility to choose between virtual and face-to-face meetings can make it easier to prioritize your mental health, even during busy times, attend consistently, and avoid frequent cancellations. Consistency in therapy is a primary predictor of positive outcomes.

At Aviva, we aim to provide potential clients with as much information about our availability, logistics, fees, cancelation policies, and clinician hours. This is a vital part of our informed consent process in the 20-minute phone consultation with our intake team.

5. Verify Insurance Coverage

One of the trickiest aspects of finding a therapist can be navigating insurance coverage. In Boston, like many large cities, a majority of providers are private pay only. Mid-size and larger practices, like Aviva often have the ability to work with insurance companies because of their size and ability to pool resources.

In Massachusetts and in most of the US, health insurance plans are required to cover mental health services at the same rate as medical services. However, this varies widely by plan. K nowing your plan specifics is important for you to be able to estimate your costs for therapy. The easiest way to check if a therapist accepts your insurance is by calling your insurance company or checking their website.

At Aviva, we are in-network with Blue Cross Blue Shield and Aetna. We also file claims for clients with Harvard Pilgrim and Cigna who have plans that cover out of network services. Before your first session, every client is given an estimate of costs based on their particular plan. While insurance companies ultimately dictate coverage and rates for providers who bill insurance, we aim to give as much information as we can so clients can make informed choices.

6. Trust yourself & Assert your Needs

One of the best ways to find a therapist is to trust your instincts. Your first few sessions, called intake sessions, are focused on gathering a lot of information. For some, these sessions can feel relieving; when you are finally able to get it all out. For others, it can be an intense process to go through your whole history. Everyone responds a little differently to starting therapy, but it’s completely okay if you don’t feel an instant connection.

After your first session, ask yourself: Do I feel understood? Did the therapist seem empathetic and attentive? Did they offer helpful feedback? If you're unsure about fit, which is common after the first session, giving feedback can be an important part of the relationship developing process.

Feedback on the therapeutic relationship is welcome and important. Especially at Aviva, we welcome feedback as an opportunity for clarifying needs and furthering connection. Even if that feedback and exploration leads to learning that you and your therapist are not a perfect fit, giving this feedback can often help guide you towards what might be more fitting. As therapists we know that we have particular styles, theoretical frameworks, and areas of expertise. Being a great fit for one person does not mean we are a great fit for all. Our goal at Aviva is to make sure your needs are met and with a diverse team, we can often help find a fit within or outside Aviva with this feedback.

7. BE WILLING TO BE HONEST & HAVE REALISTIC EXPECTATIONS

A study published in the Journal of Counseling Psychology (2016 ) found that the therapeutic alliance – the bond between therapist and client – is one of the most significant factors in determining the success of therapy, so take your time, trust your gut, and do "the work" to find a fitting therapist. Remember to ask yourself, "what am I doing to get my needs met in this process?" and "have I made my needs and concerns known directly?" If you haven't done those things, that's likely part of your essential work before any therapy space can be effective. If you are doing those things, but still not making progress towards your goals, you can trust that this is not the right fit and keep your search going.

In some ways working with a therapist is like any other relationship-- it takes effort, time, patience, vulnerability, honesty and courage to build a healthy and productive relationship. What a wonderful place to practice these skills!

Final Thoughts

Although finding the right therapist in Boston is certainly a process, it doesn’t have to be a stressful or overwhelming one. By understanding and asserting your needs, having realistic expectations, asking for recommendations, and researching therapists’ qualifications and specialties, you’ll be well on your way to finding the support you need.

At Aviva, we aim to have a relational and informative intake process for all clients at our practice. Using this framework, we aim to assess needs (to the best of your knowledge at the time - and not knowing is totally ok! That might be your starting point) and match you with a therapist who can best meet those needs. It's an evolving process and we hope to support you on your therapeutic journey from beginning to end.

faqs

1. How do I know if a therapist is the right fit for me?

The therapeutic relationship is built on trust and connection, which takes time and effort to build. Remember that a successful therapy relationship is co-created. With this in mind, remember to ask yourself, "what am I doing to get my needs met in this process?" and "have I made my needs and concerns known directly?" If you haven't done those things, that's likely part of your essential work before any therapy space can be effective. If you are doing those things, but still not making progress towards your goals, you can trust that this is not the right fit and keep your search going. A combination of "your gut" and "your work" will guide you well. Pay attention to both as you explore fit.

2. How can I find a therapist who accepts my insurance?

Finding a therapist who accepts your insurance can be challenging. Especially in a city like Boston where hospital systems make directories look fuller than they are. The best start is to contact your insurance provider directly and get a list of in-network providers. Be mindful that around city centers (like Downtown Boston), there are many providers that are a part of large hospital systems (like Mass General) and may or may not be directly accessible like a private practitioner.

The other option is to contact the therapist/practice directly. Remember to inquire about both in and out of network benefit mental health coverage with your specific insurance plan for any therapist you are interested in seeing. This will help give you a realistic sense of your coverage and responsibility. If the arrangement is not sustainable, keep your search going and narrow it down to in-network providers only.

3. Can therapy be done online or does it have to be in person?

Yes, many therapists offer both in-person and online therapy. Online therapy has become increasingly popular, especially after the pandemic, and it provides the flexibility to attend sessions from the comfort of your home. This option is particularly helpful for those with busy schedules or for those who live farther from therapy offices. Be sure to ask your therapist if online sessions are available to fit your needs and remember that you must be in the state that the provider is licensed in during the time of the session.