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Advanced Behavioral Health, LLP
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Dr. Shinar appears on the Dr. Oz Show.

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Trichotillomania (Hair Pulling Disorder) Blog
Have you ever gotten so frustrated that you've grabbed a chunk of hair and thought, "Ugh ! I want to tear my hair out!" How about finding yourself twirling your hair, picking at your nails or skin, or biting your cheek while sitting through a boring lecture? Most of us can relate to how strong emotions can lead to unwanted behaviors. But imagine being so out of control that you actually create your own bald spots or pick away at your skin or fingers until they are raw and bleeding. Unfortunately, some people have an extremely difficult time controlling these types of body-focused repetitive behaviors (BFRBs). They get stuck in these compulsions, finding these acts to be hypnotically self-soothing. The highly sensory experience of hair pulling, skin picking and nail biting can masterfully disarm any logical thought process about their harmful consequences. 

The ritualistic act of pulling one's hair out in an attempt to alleviate a physical or emotional discomfort is an impulse control disorder known as Trichotillomania. Some people pull hairs that look or feel out of place in order to achieve a sense of symmetry. They favor the short ones, coarse ones or ones that feel "just right" for pulling. Sometimes people pull to distract themselves from emotional discomfort (anxiety, boredom, anger, fatigue, etc) since the pulling is experienced as a temporary respite. The soothing properties that accompany this habit reinforce the hair pulling problem and make it very challenging to stop. 

Compulsive skin picking, known clinically as dermatillomania, is another type of impulse control disorder whose motivations parallel those of Trichotillomania. The desire for smooth skin, the satisfaction of removing a bump that doesn't look or feel like it belongs, and the short-term mental escape that it offers creates a similar hard to break cycle as hair pulling. 

Nail biting, lip picking, hair twirling, and hair splitting are further examples of impulse control problems. Habit Reversal Training is a highly effective CBT technique that teaches people how to better manage the urge to engage in these body-focused repetitive behaviors and, ultimately, how to find more effective ways to eliminate these destructive habits. 
Contact Advanced Behavioral Health in Midtown Manhattan to schedule an appointment with one of our specialists.

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Our Social Anxiety Success Stories

Our Social Anxiety Success Stories

A 43 year old Union Representative who was recently promoted to Vice President presented with a fear of public speaking that significantly impacted him at staff meetings in which he was expected to speak in front of over one hundred people.   He made up excuses to not attend the last three meetings and it caused him to become increasingly concerned with his job stability.  He reported having heart palpitations and debilitating anxiety twenty-four hours before he was expected to present and spent excessive amounts of time planning his escape.  After a handful of sessions which included relaxation therapy, role-playing, cognitive restructuring and planned exposure exercises, he was able to effectively deliver his presentations in front of large audiences.  He was extremely pleased with his progress and recognized that he was a talented speaker who actually enjoyed the process now that he was able to manage his anxiety.  He graduated after ten sessions. 
A 47 year old Vice President of a large corporation arrived to treatment complaining of extremely debilitating panic symptoms when he is expected to lead groups and present to the president of his company.  He feared being humiliated in front of others and was hyperaware of the pressures to perform well.  He was considered to be a leader and a top person in his field and was terrified of people witnessing his nervousness.  When speaking in front of others, he experienced chest tightening, shortness of breath, feeling of impending disaster, tremors, a lump in his throat and a loss of control.   After three sessions, he reported feeling marked improvement in his physical symptoms of anxiety as well as the negative self-dialogue.  He now looks forward to team meetings and feels confident in his ability to deliver a speech with a calm demeanor.
A 28 year old graduate student was experiencing increasing social anxiety in her Masters in Education program when she was expected to speak or present in class.  She was in the process of applying to doctoral programs but was concerned that her social anxiety would hinder her from moving forward in her professional path and disable her at her interviews.  Within 6 CBT sessions, her anxiety was at an extremely manageable level and she felt confident in her ability to conduct herself in the classroom and at her upcoming interviews.
A 35 year old trial attorney was able to perform at an optimal level while pleading a case in front of a judge and jury, but experienced intense anxiety at a bar or party scenario. Her social limitations prevented her from meeting new friends, dating with the hope of finding more appealing partners, and attending work-related social functions that could have elevated her career path.  After 6 months of weekly CBT sessions, her level of social-related anxiety diminished dramatically.  She was going to bars and parties in the Hamptons and meeting men through online dating and speed dating opportunities.  She eventually met a new romantic partner whom she continues to date today, five years after beginning treatment.  
A 30 year old IT executive spent most of his life avoiding social contact and immersing himself in his career, one in which involved interacting solely with computers instead of people.  He had only one short term dating experience and a few fairweather friends.  Upon entering treatment, we developed a hierarchy of social activities ranging from least to most anxiety provoking.  He learned the biological and cognitive mechanisms responsible for his social anxiety and was encouraged to engage in activities he had avoided most of his life.  We began with less threatening situations such as asking strangers for directions and making eye contact and small talk with doormen and colleagues.  He graduated up to meetup.com social events, speed dating parties, and online dating.  After 4 months of treatment, he began dating three women at once and attending work-related networking events.  He now has one serious girlfriend and looks forward to more social exposure with larger groups and more challenging situations.
A 27 year old woman working in finance presented with a specific social anxiety limited only to job interviews.  She was stuck at a job she didn't like due to a chronic avoidance of the face to face interview process.  She feared  being humliated in front of her interviewer by stammering, sweating profusely, or possibly even passing out during the interview.  CBT techniques including relaxation therapy, role-playing, and cognitive restructuring to reduce her symptoms and increase her confidence and self esteem.  Within 2 months, she had lined up 5 potential job leads, each with several rounds of interviews.  After multiple rounds of individual and group interviews, she received two offers from her top choices and began her new dream job soon thereafter.

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