• Lisa Feldman

    Exposure Coach

    Does anxiety get in the way of school, social opportunities and family functioning? It doesn't have to -- exposure therapy can help you master your anxiety and fear by confronting the real-life situations you avoid.

  • What is exposure therapy?

     

    Over a quarter of the people in the United States will have an anxiety disorder sometime during their lifetime. Exposure therapy is the treatment of choice for anxiety disorders. Unfortunately, only a small percentage of people receive this treatment.

     

    “We know from our research and work with pediatric patients that exposure therapy is a highly effective behavioral treatment for anxiety and OCD, but it is very challenging for kids and families to practice those skills on their own,” - Jennifer Freeman, Ph.D., director of research and training at the Pediatric Anxiety Research Center at Bradley/Hasbro Children’s Hospital, Brown University

     

    Exposure therapy is the process of facing feared situations, places or objects, gradually and repeatedly over time, until anxiety lessens. It is normal to want to avoid the things you fear. However, avoidance prevents you from learning that the things you fear may not be as dangerous as you think.

     

    "Exposure work is most powerful when significant repetition occurs in multiple real-life settings in order to generalize skills and mastery." - Stéfane Bouchard, Ph.D., University of Quebec

     

    "Evidence shows that the therapy is more effective in real settings. When we go out of the office we see more gains – kids make more progress. They feel more confident and motivated to keep doing the exposures elsewhere." - Dr. Jerry Bubrick, Ph.D., The Child Mind Institute

     

     

     

    What does an exposure coach do?

     

    As an exposure coach I expose my clients to the things at home and in the community that trigger their anxiety. I then coach them to tolerate the anxiety without avoiding, escaping, and using safety behaviors. Kaplan & Tolin (2011) explain that safety behaviors refer to unnecessary actions individuals take to feel better or to prevent feared catastrophes. Left unchecked, safety behaviors can undermine the process of exposure therapy by teaching the client a rule of conditional safety (e.g., “The only way to be safe during a panic attack is to have my medication with me”) rather than a rule of unconditional safety (e.g. “Panic attacks will not harm me, regardless of whether I am carrying my medication”). After the exposure, I report my observations to my client's therapist so the treatment plan can be tailored and expanded to meet the treatment goals.

     

     

     

    What can you learn from exposures?

     

    Exposure therapy is designed to treat anxiety that is maintained over time due to avoidance. Exposure counteracts avoidance when individuals incrementally and repeatedly confront their core fears. Through exposure therapy, people can learn that:

    • What they fear is not actually dangerous or harmful
    • Many of their feared negative outcomes are unlikely to happen
    • If negative outcomes do occur, they are unlikely to be catastrophic
    • Anxious feelings can be tolerated and will decrease over time
    • They are competent and can cope effectively with stressful situations
    Many individuals with anxiety disorders such as panic disorder, specific phobias and social anxiety lack confidence in their ability to confront stressful situations effectively. When my clients have a chance to test the validity of their negative beliefs, they discover they are more capable than they had previously thought. They realize they are able to accomplish difficult tasks and effectively deal with the challenges of life.

  • "Lisa Feldman is ideally suited to serve as an exposure coach as she combines her firsthand life experience as a parent/consumer with her training and knowledge about anxiety and exposure therapies. Lisa successfully balances the dialectic of empathically validating the individual's anxiety and urge to avoid while firmly encouraging the individual to carry out the exposures. She's a special human being who gets it and is a great asset to any therapeutic program that calls for exposure therapy."

     

    -Alec L. Miller, PsyD
    Clinical Director and Co-Founder
    Cognitive & Behavioral Consultants of Manhattan and Westchester

     

    "We are so grateful for Lisa's support. We had tried therapy in the past but it did not prepare us for real-life experiences. We are thrilled to see such progress in a short amount of time and, most importantly, our son is so pleased as well. Our son described having a breakthrough. It’s the first time we've heard him speak so optimistically about the future. Thank you Lisa!"

     

    -Parent of a Teenager

  • Common traps parents fall into

     

    Family support is critical to an individual’s treatment. Parental and family involvement can lead to more positive outcomes, however, even well-meaning parents may unknowingly engage in behaviors that maintain or increase their child's anxiety.

     

    According to psychologists, Abramowitz, Deacon, and Whiteside (2012), family members can become extremely involved with their loved one’s anxiety symptoms, and may inadvertently participate in safety behaviors that facilitate avoidance. These actions are referred to as accommodation. In a 2013 study in the Journal Depression and Anxiety involving 75 parents of anxious children, more than 97 percent reported resorting to accommodations. Parental accommodation is any parental behavior that attempts to reduce a child’s exposure to distressing situations that are, in fact, safe or age appropriate.


    Working with a trained exposure coach facilitates completion of exposure assignments correctly, diffusing tension and allowing the family dynamic to remain positive.

  • Explaining exposure therapy to children

     

    When we are scared, we often try really hard to stay far away from the things we are afraid of. If we are afraid of bees, we might avoid parks and playgrounds. If we are afraid of getting an answer wrong in class, we might not raise our hand. If we are afraid of being away from our parents, we might not want to spend time with a babysitter. When we avoid the things we are afraid of, we might feel relieved in that moment, but it actually makes those things seem even bigger and scarier over time. We don’t give ourselves a chance to learn that we can handle these situations. We don’t learn that the things we fear are not as bad as we have built them up to be in our minds (Raggi, Samson, Felton, Lofffredo, & Berghorst, 2018).

     

    In order to beat our fears, we must slowly get used to what we are afraid of by gradually approaching, instead of avoiding, those things. We will do this in small steps that will help you feel more confident and stronger as we go. You may decide that the things you fear aren’t so bad after all. You may realize you feel scared but nothing terrible happens. You might feel proud that you handled it and didn’t run away (Raggi et al., 2018).

  • Exposure coaching

    step by step

     

    In order for clients to be willing to face their fears, they must believe they can trust their exposure coach to provide them with effective support. To achieve this, I:

    • Review and help implement exposures on the hierarchy developed by the client's licensed therapist. The number and length of sessions will vary depending on their hierarchy, with most sessions lasting approximately 60-90 minutes
    • Spend the first session getting to know the client and building trust
    • Plan ahead so the exposure goes as smoothly as possible. This may include scouting an appropriate location and making special arrangements in advance
    • Obtain and record a baseline SUDS level (subjective units of distress scale – a scale of 0 to 10 for measuring the subjective intensity of distress experienced) before and after each exposure
    • Record feared outcomes
    • Look out for use of safety behaviors
    • Ask the client if their feared outcome occurred and discuss what they learned from the exposure
    • Review the next exposure task assigned by their therapist
    • Share my recorded observations with the client’s family and therapist

  • About Lisa

     

    My background

     

    My passion for mental health issues is long standing. More than ten years ago, I led a committee for the Edgemont School District to implement a district wide social emotional learning program. I have completed the Linehan Institute’s “Foundations in Exposure Therapy” training. I have also completed a CBT Foundational training with renowned expert, Dr. Lata McGinn, as well as a DBT skills training with Dr. Chad Brice. I am certified in Youth Mental Health First Aid by the National Council for Community Behavioral Healthcare; I am a member of the New York City Cognitive Behavioral Therapy Association, as well as a member of The Association for Behavioral and Cognitive Therapies. I use the skills I’ve acquired through all of these avenues in my coaching practice to guide interactions with parents and children struggling with anxiety.


    Prior to focusing full-time on exposure coaching, I owned an award-winning graphic design firm for more than 20 years after graduating with a BFA from Washington University in St. Louis.

     

    In my free time, my dog Trapper and I enjoy our visits to Ronald McDonald House as a certified therapy dog team for the Good Dog Foundation. See Trapper below, at his therapy dog graduation.

     

     

    My story

     

    I am passionate about helping those struggling with anxiety. My exposure coaching practice grew out of my family’s personal search for someone to implement exposure homework with our son in between his therapy sessions. We realized that working with a third party could help diffuse tension and allow our family dynamic to remain positive.

     

    Unfortunately, after an extensive search we found that few psychologists could offer meaningful patient time out of the office, and that more intense exposure therapy often involved multi-week programs usually away from home. I was inspired to become trained in exposure therapy to offer families an option where children could maintain their routines at home and get the support they need.

     

    I have found that my personal experiences contribute to the strong connections I form with the families in my practice. I know firsthand how difficult it can be for a family to have a child who struggles with anxiety.

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  • I offer a complementary phone consultation to answer your questions and to discuss whether my services may be helpful for you.

    lisa@feldman.net

    914-844-5418

    Scarsdale, New York

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