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Monday, March 12, 2018

Intensive Cognitive-Behavioral Therapy (CBT) for Anxiety

By: Ryan Ruth Conway, Psy.D.
Clinical Psychologist, NESCA

Deciding to enroll your child in mental health treatment is a big step in and of itself. Before initiating the process, there is often a trial and error period of interventions to improve the situation, whether at home or in school, and then coming to terms with the fact that they might not be enough to sufficiently address your child’s needs. Finding the right therapy and therapist match for your child can also prove challenging. Not only are there numerous therapeutic approaches available, but there are also varying levels of care depending on the severity of your child’s symptoms and amount of support he or she requires. This ranges from once weekly outpatient therapy to day treatment programs to inpatient hospitalizations for more acute psychiatric issues that may require crisis stabilization (i.e., suicidality, self-harm, etc.)

One type of treatment that has garnered considerable empirical support for treating youth anxiety and depression (conditions we regularly treat at NESCA) is Cognitive-Behavioral Therapy (CBT). CBT focuses on the intersection between our thoughts, emotions, bodily sensations and behaviors. The goal of CBT is to better manage overall emotional distress and reduce physiological symptoms by changing negative thoughts or unhelpful thinking patterns, ineffective coping strategies, and maladaptive behaviors that might be reinforcing uncomfortable feelings. CBT aims to teach children and their parents new, adaptive coping skills while providing opportunities both in and between sessions to practice these skills. CBT is a short-term, targeted treatment that promotes “approach” behaviors (as opposed to “avoidance”) through “exposures,” or exercises designed to practice facing fears gradually, in a safe environment. CBT might also include learning mindfulness, emotion regulation, and distress tolerance; techniques that have been shown to enhance treatment outcomes.

While some youth make progress in meeting with a therapist once per week, others benefit from a condensed, “intensive” format where they receive CBT treatment daily and over a shorter period of time. The accelerated nature of these types of programs, offered in both outpatient and hospital-based settings, allows for quicker acquisition of strategies, substantial exposure practice, and generalization of newly learned skills to other settings in a child’s life. Think of it as a crash-course in CBT.

You may want to consider an intensive therapy program for your child if:
  • Your child’s symptoms are greatly interfering with his or her life, such as attending school or school performance, family life, and friendships.
  • Your child has tried different therapies in the past but there has been minimal carryover from session to session and/or you haven’t noticed much progress overall.
  • Your child is experiencing distress but other commitments during the school year have hindered attending therapy on a consistent basis, making school breaks or the summer an ideal time to work on it.
At NESCA, we are pleased to offer a highly specialized and immersive therapy experience through our 2-Week Summer Intensive CBT Program for anxiety. We work with children and adolescents who present with all types of anxiety, including generalized anxiety, separation anxiety, social anxiety, specific fears (e.g., dog phobia, vomit phobia, etc.) and obsessive-compulsive disorder (OCD).

What does NESCA’s 2-Week Summer Intensive Program consist of?
  • Intake evaluation – A meeting is held with the child and parents to gain a comprehensive understanding of the child, provide an assessment of symptoms and discuss goals for treatment, all of which will inform the treatment plan.
  • 1:1 therapy sessions – Individual CBT therapy sessions with the child or teen are conducted 5 days/week for 90 minutes. Homework will also be assigned between therapy sessions to reinforce skills learned.
  • Parent involvement – Parent participation is vital in treating childhood anxiety. Parent sessions are held 5 days/week for 30 minutes. During these meetings, parents will be educated about their child’s anxiety, receive progress updates and also acquire tools to better support their child. Parents might also be asked to help children practice the new skills they are learning.
  • Discharge planning – Families will be assisted in determining follow up support that will be helpful in order to maintain treatment gains.
  • Treatment summary – Following the conclusion of the program, families will receive a written summary that reviews the course of treatment, progress made and discharge recommendations.
There are circumstances in which the frequency, duration and/or structure of the program can be modified to best fit your child’s needs.

For more information about NESCA’s Summer Intensive CBT Program or to find out if the program is appropriate for your child, please contact Dr. Ryan Ruth Conway at (617) 658-9831 or rconway@nesca-newton.com.

About the Author:

Dr. Ryan Ruth Conway is a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy (CBT), behavioral interventions, and other evidence-based treatments for children, adolescents and young adults who struggle with mood and anxiety disorders as well as behavioral challenges. She also has extensive experience conducting parent training with caregivers of children who present with disruptive behaviors and Attention-Deficit/Hyperactivity Disorder. Dr. Conway has been trained in a variety of evidence-based treatments, including Parent-Child Interaction Therapy (PCIT), Dialectical Behavior Therapy (DBT), and Exposure with Response Prevention (ERP). Dr. Conway conducts individual and group therapy at NESCA utilizing an individualized approach and tailoring treatments to meet each client’s unique needs and goals. Dr. Conway has a passion for working collaboratively with families and other professionals. She is available for school consultations and provides a collaborative approach for students who engage in school refusal. 

Tuesday, March 6, 2018

AANE, NESCA, and MGH Aspire Partnering for Conference on April 7th!

I Am Who I Am: Asperger Syndrome and Building Self-Esteem

According to Dr. Tony Attwood and Autism Hangout founder Craig Evans, poor self-esteem is one of the most common and debilitating problems experienced by people with Asperger/Autism profiles. This interactive conference, featuring keynote speaker Sarah Hendrickx, Nomi Kaim, and a diverse group of presenters on the autism spectrum, will be a chance for professionals, adults, and family members to examine this topic in depth. We invite you to participate in this important discussion which aims to uncover strategies and tools for those on the spectrum to improve their feelings of self-worth.

Date: Sat, April 7, 2018
Time: 9 AM - 3:30 PM
Location: Newton-Wellesley Hospital (NWH), 2014 Washington Street, Newton, MA

Learn More



Hosted by AANE in partnership with NESCA and MGH Aspire
Price for Attendee: $50 *
Additional Attendee: $50*

* Thanks to a generous grant from the Belmont Savings Bank Foundation, AANE is able to offer half-price tickets, for $50 each, to all attendees.

Monday, March 5, 2018

Mindfulness In Schools

By: Ann-Noelle McCowan, MS, RYT
Therapeutic Yoga Instructor, NESCA

Open Google and type in Mindfulness in Schools and you are presented with a buffet of resources. What was once seen as an alternative idea has become mainstreamed. But what is Mindfulness and why is it something that deserves a place in schools?

Mindfulness was originally developed as part of the 8 Fold Path of Buddhism. With mindfulness your attention would be turned inward and also impact your relationship with the world through mindful actions and behaviors.  Now it is scientifically studied and found in locations like professional locker rooms, jails and hospitals to fortune 500 companies like Nike, Google and Apple. Advancements in brain imaging show that a regular mindfulness practice creates increased activity in the areas of the brain associated with working memory, executive function, emotional regulation, perspective taking and empathy, with decreases in the areas of the brain associated with depression, PTSD and stress (correlated with a decrease in amygdala size).

Mindfulness’ increased popularity may be due to the fact that it is an adaptable, take with you anywhere antidote to a society that is increasingly fast paced and technology focused. In a global world it helps us feel both connected to ourselves and grounded where we are. More adults and kids are feeling stressed, anxious and depressed, and mindfulness can help soothe our worries without negative side affects.

Schools are responsible for teaching children skills and information across many content areas, yet how often are children taught the best way to pay attention, or how to use attention?  Attention is the lens through which all of our experiences are filtered through, yet it is rarely directly and specifically taught! Mindfulness is at its core simply focusing on a single thing at time, in a particular way, without evaluation. It is an invaluable life skill for helping children be successful students as well as happy well adjusted and connected children. An informal survey of my colleagues and friends found that yoga and mindfulness is being adapted to various school settings.  From class transitions that begin with listening bells, rounds of belly breathing before assessments, calming scented oils on cotton balls in the nurse's’ office,  books clubs with teachers, introductions to mindfulness apps in health class and  mindfulness or yoga activities and clubs.  mindfulness is staking its place in schools. 

When introducing mindfulness in classrooms and schools the following steps help outline ways to weave mindfulness into classrooms and schools.

1. Learn More. 

Starting with this blog post the internet is full of articles and videos to explore.
     How Meditation Can Reshape Our Brains: Sara Lazar at TEDxCambridge 2011
     Kids getting lessons in mindfulness in school - Today's Parent

2. Model Mindfulness and Practice Yourself. 

You can’t teach what you don’t know. Practicing mindfulness will help you be aware of your own reactions if at first your students are squirmy or resistant. Keep in mind that students may not use the words you expect to describe their experience, listen for what is behind their words.

3. In an age appropriate way, explain how mindfulness is beneficial for them. 

My teens love learning about how their brain works and that mindfulness is a form of training for their brain. 

Some videos for younger  kids:

4. Teach about the monkey or animal mind. 

Children of all ages enjoy the practice of noticing how many places their thoughts go and how quickly thoughts connect to others. There are fantastic books for younger kids such as Moody Cow Meditates and  Mindful Monkey, Happy Panda.  Teens understand how if walk into class and see their friend laugh with a peer after a glance towards them their thoughts immediately race.... “ “what did I do” ...“ they are mad”...“I’m not going to have a partner for this project”... “ there goes my secrets, begin the rumors”... “I’ll be left out of the weekend plans” … “I’ll be alone forever”.  Teach them to acknowledge the chatter but not get caught in it.

5. Start small. 

Begin with 1-3 minutes at the start of class directing kids to feel their seat in their seat, their feet on the floor, their hands on their lap and intentionally take 5-10 long inhales and exhales. Other ideas:

  • Practice silent snack one day a week, take a mindful walk as a class and have them focus on their senses and record it in their own journal ( words or visuals) when back in the classroom. Create a mindful space in a corner of your room with coloring books, pencils, cushions as a safe break place.
  • For kids it may be hard to focus on a single item at a time, so use manipulatives. A Hoberman Sphere, Pinwheels or feathers to demonstrate breath.  Build Worry Jars, adapt Chutes and Ladders or other familiar games with mindful exercises. Use one of the many Yoga Card Decks. 

6. There’s an App for this!

Ironic perhaps to use technology but most kids love technology and it offers choice and control. Try  “Calm.com”, “Stop, Breathe and Think”, “Smiling Mind” or the “Insight Meditation Timer” (after medications my kids love to check out the world map and see all the locations where people are meditating!).  Try a classroom program such as http://www.innerexplorer.org/

7. Be consistent.

Greater benefits and habits are created when mindfulness is done repeatedly. Colleagues who practice mindfulness daily, even for a few minutes notice the impact is greater than if  done sporadically. 

Mindfulness is good for us and our children and has a natural place in our schools. Benefits abound like enhanced attention, self-regulation, social competence, as well as greater kindness and compassion. After I have practiced mindfulness with my students or clients they look different, calmer and relaxed and ask for it again. I too notice the rest of my day feels more manageable and my smile is broader. Enjoy adding mindfulness to your classroom or express your hope to your child’s teacher or school leaders that mindfulness be a part of your child’s school experience. 

Thursday, March 1, 2018

Continuing Education Opportunity: Late, Lost, and Anxious! – Technology to Support Executive Function

An exciting continuing education opportunity for psychologists, occupational therapists, speech-language pathologists, educators and related professionals!!!


Angela M. Currie, Ph.D., Pediatric Neuropsychologist at NESCA
Heather Gray, M.S., CCC-SLP, ATP, Gray Consulting and Therapy
Jennifer Stylianos, M.S., OTR/L, Gray Consulting and Therapy

About the Workshop:

Students nowadays are confronting significantly greater levels of stress and anxiety than ever before. Often times, this stress occurs alongside executive function and attentional difficulties that make it difficult for the student to manage increasing academic demands. In this workshop, we will discuss how executive function, attention, and stress intersect and ultimately impact a student’s academic motivation. We will then discuss assistive technology as a tool to support these challenges, addressing how to identify appropriate supports and how to develop an effective plan for their implementation. 

At the conclusion of this workshop, participants will be able to:
  • Define and understand executive function as a complex set of self-regulation skills 
  • Understand how attention and anxiety intersect with executive function, resulting in motivation 
  • Identify 3 factors necessary to effectively implement an assistive technology plan 
  • Describe key features of assistive technology needed for executive functioning 
4.5 continuing education credits or professional development units will be offered for this workshop.

When and Where: 

May 17th, 2018 9:00am – 2:30pm
Brookstone Park, Derry, NH


Registration is $119 and includes continental breakfast and lunch. Registration deadline in May 11th. Please register by calling or emailing Stephanie MacInnis at 603-818-8526 or smacinnis@nesca-newton.com.

Cancellation Policy: 

Cancellations received prior to May 10th will receive full refund. Cancellations received after that date will not be refunded.

This event is Co-Sponsored by Neuropsychology & Education Services for Children & Adolescents (NESCA). NESCA is approved by the American Psychological Association to sponsor continuing education for psychologists. These credits are also accepted by the State Board of Mental Health Practice for all NH licensees. NESCA maintains responsibility for the program and its content.