Anxiety is a normal reaction to stress. Mild levels of anxiety can be beneficial - it can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness and involve excessive fear or anxiety. People with generalized anxiety disorder (GAD) have trouble controlling their worry. When they think of different areas of their lives — health, work, family, friends — they often imagine what could go wrong. They often struggle with excessive rumination, perfectionism, or avoidance of activities that might otherwise enhance their lives.

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Chronic pain, or pain lasting three or more months or beyond expected healing time, is an epidemic currently affecting over 100 million American adults. The International Association for the Study of Pain (IASP) defines pain as an “unpleasant sensory and emotional experience.” What this means is that pain is both physical and emotional 100 percent of the time. While it seems obvious that pain is produced by the body, in fact it is produced by the brain. Our emotions and physical pain share real estate in the brain, and this is the reason that psychological techniques such as Cognitive Behavioral Therapy or Pain Reprocessing Therapy are gold-standard treatments for all types of chronic pain.

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Obsessive compulsive disorder (OCD) is a mental health disorder that occurs when a person gets caught in a cycle of obsessions and compulsions. Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings. Compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease distress. Common obsessions include: fear of contamination and contagion; fear of being responsible for something bad happening; worry about perfectionism, worry about committing violent, sexual, or sacrilegious acts; excessive concern about morality, or intense discomfort about things not being in their proper place or order. You can learn more about OCD here.

Pain Reprocessing Therapy (PRT) is a system of psychological techniques that retrains the brain to interpret and respond to signals from the body properly, subsequently breaking the cycle of chronic pain. Pain Reprocessing Therapy has five main components: 1) education about the brain origins and reversibility of pain, 2) gathering and reinforcing personalized evidence for the brain origins and reversibility of pain, 3) attending to and appraising pain sensations through a lens of safety, 4) addressing other emotional threats, and 5) gravitating to positive feelings and sensations. Here is a NYT article on PRT as well as more iformation here.

Chronic pelvic pain is pain in the area below the belly button and between the hips - there can be myriad causes including endometriosis, vulvodynia, IBS, pr painful sex, or sometimes the cause is unknown. Treatment that addresses both the physical and psychological symptoms results in the best outcomes for long-term improvement of pelvic pain.

Often dealing with pelvic pain can leave individuals feeling helpless, and this stress and frustration can often present in their symptoms. This leads to an ongoing cycle of pain: the feeling of pelvic pain leads to an increase in stress, worry, or depression, which then leads to an increase in pain symptoms, which in turn leads to further stress and frustration.

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Perfectionism refers to setting extremely high expectations for oneself and others, and being overly self-critical and evaluative in thoughts and actions. This can involve having trouble moving on from mistakes or perceived shortcomings. Perfectionism can also result in behaviors such as procrastination, trouble delegating tasks, and worry about failure.

Symptoms of perfectionism can include:

Setting overly high standards for oneself: Individuals with perfectionism often set unrealistic standards for themselves, which can be difficult to meet.

Being overly critical of oneself: Individuals with perfectionism are often self-critical and have a hard time accepting normal mistakes or imperfections in their own work or behavior.

Procrastination: Perfectionism can lead to procrastination, as individuals may put off starting a task because they are afraid they will not be able to do it perfectly.

Difficulty completing tasks: Perfectionism can make it difficult to finish tasks because they are always seeking to make them perfect, which can lead to feeling overwhelmed, anxious, and stressed.

Fear of failure: Perfectionism often goes along with a fear of failure.

Difficulty accepting compliments or positive feedback: Individuals with perfectionism may have a hard time accepting compliments or positive feedback.

Difficulty delegating tasks: Perfectionists may have a hard time trusting others to do tasks correctly.

Difficulty relaxing or engaging in leisure activities: Perfectionism can make it difficult for individuals to relax or engage in leisure activities.

Cognitive behavioral therapy for insomnia (CBT-I) is a first-line treatment of insomnia. The focus is on addressing the three factors that contribute to the persistence of insomnia: 1. Conditioned arousal 2. Identifying and eliminating habits that were developed in an effort to improve sleep but have become ineffective 3. Reducing sleep-related worry and other sources of heightened arousal. In CBT-I, the therapist identifies the most relevant targets for behavior changes, and helps patients overcome obstacles to making the necessary and often difficult changes in sleep-related behaviors. This means that individual patients can concentrate their energy on changes that are most likely to produce improvements in their sleep. CBT-I is highly effective for treatment of insomnia disorders.