Q&A with Dr. eisenhauer

how are you different from other psychologists?

While other psychologists often have general practices, I focus my practice exclusively on anxiety and anxiety-related disorders.  I use research-based techniques and offer prolonged sessions that may include virtual reality technology and going out into the real world (e.g., to practice riding elevators). Very few psychologists in San Antonio have practices that are structured to allow for the types of prolonged interventions that I am able to offer.  Additionally, I am the only licensed psychologist in San Antonio certified to treat Trichotillomania and Excoriation Disorder and am also one of just a handful of psychologists in San Antonio who uses Cognitive Behavioral Therapy for Insomnia (CBT-i) to treat Sleep Onset and Sleep Maintenance Insomnias.

My friends call me a "worry wart." Does this mean I have an anxiety disorder?

People who find it difficult to manage their worry and experience significant emotional distress and/or social or occupational impairment because of their worrying may be considered to have an anxiety disorder.  Anxiety is so common that it is often thought of as the common cold of psychology.  Anxiety is treatable.  Even if your anxiety doesn't rise to the level of a 'disorder,' you may still benefit from a few meetings with me.

I think I have depression and anxiety.  Can we still work together?

We can absolutely work together.  Depression and anxiety frequently co-occur, and the two diagnoses share several overlapping symptoms.  Furthermore, CBT has been shown to be an effective treatment for both anxiety and depression.

How is cognitive-behavioral therapy different from other therapies?

First, Cognitive behavior therapy (CBT) is a practical, goal-oriented therapy. Unlike traditional therapy, CBT is directly focused on the problem(s) you identify in order to help you reach your goals as efficiently as possible.  Second, CBT has been shown in hundreds of research studies to be effective for anxiety, depression, OCD, panic disorder, sleep problems and many other issues.  Third, CBT is a structured form of therapy with homework assigned between sessions in order to help you learn to be your own therapist. Every session follows an agenda including mood update, homework review, session topics, new homework and feedback.  Fourth, CBT is active and experiential.  In CBT, you will learn techniques to change your thinking and behaviors in order to gain new confidence and coping skills. You will engage in exercises such as learning to identify and respond more effectively to unhelpful thoughts, engaging in roles plays and exposures to avoided situations, and completing behavioral experiments between sessions.

COGNITIVE-BEHAVIORAL THERAPY SEEMS SO SIMPLE.  CAN IT REALLY BE EFFECTIVE?

I asked this question to Dr. Aaron Beck, a psychiatrist who is world-renowned as the father of Cognitive Therapy.  His response was this: "Penicillin is simple, and it works."  I appreciated his quippy response, but beyond that, extensive research clearly demonstrates that Cognitive-Behavioral Therapy is a robust treatment for many psychological disorders.  Further, my clinical experience dating back to 1999 has shown me that CBT is a highly effective treatment.

You talk about exposure a lot.  Why is exposure so important?

Exposure is a key intervention for many of the conditions I treat (e.g., Social Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, Specific Phobias, Illness Anxiety Disorder, and Perfectionism). A hallmark of many anxiety disorders is avoidance.  When we think of things that make us anxious (e.g., meeting new people, flying on a plane), we realize that we tend to avoid those things (e.g., we may decline an invitation to a social event or may drive to our destination rather than flying).  Avoidance is an incredibly common response to anxiety. However, avoidance backfires in two ways: It reinforces anxiety and it prevents new learning experiences that can teach people that they are able to handle situations like social gatherings and airplanes.  On the other hand, exposure creates an opportunity for a new type of learning experience that is very powerful in changing reducing anxiety.

I get why exposure is necessary, but I'm a little scared by the idea. How do we proceed?

We will spend time addressing your thoughts about exposure and will work collaboratively throughout the process.  Together, we will construct a hierarchy related to your fear (e.g., of germs) and will work on easier items (e.g., touching a pencil from my desk that has been handled by strangers) before progressing to more challenging items (e.g., touching a public door handle).  I will never ask you to do something that I would not do myself, and I will model each exposure for you before you try it.  We will work at your pace.

How do you treat Trichotillomania and Excoriation Disorder?

I use the Comprehensive Behavioral (ComB) model, a focused adaptation of Habit Reversal Therapy, to assess and treat Trichotillomania, Excoriation Disorder, and other Body-Focused Repetitive Behaviors. Basically, we do a very thorough assessment of the conditions that precede your pulling/picking; the specific rituals you use while you pull/pick; and the thoughts you have about your skin, hair, and pulling/picking behavior. We then work collaboratively to choose cognitive and behavioral interventions that target key areas this assessment revealed.

I experience my anxiety physically-- racing heart, feeling weak in my limbs, etc.  how can you help me?

Many people are so distressed by the physical symptoms that accompany their anxiety (e.g., heart racing, shortness of breath, feelings of unreality) that they avoid certain situations for fear of experiencing these uncomfortable symptoms.  It is also common for people to misinterpret normal, mild physical sensations in a way that intensifies feelings of anxiety and panic. For example, before giving a speech, most people feel a small flutter in their chest. A person who interprets this flutter as excitement or a benign case of jitters will have a different experience than a person who interprets this flutter as a sign of a heart attack or incapacitating stage fright.

When patients report distressing physical sensations of anxiety, I use interoceptive exposure, an evidence-based method for gradually exposing patients to their feared physical sensations in a controlled environment.  Together, we will assess which physical exercises (e.g., breathing through a straw to feel shortness of breath) produce symptoms most similar to your anxiety or panic symptoms.  We will then practice experiencing these symptoms in session so that you learn that they are not dangerous or intolerable.  Most patients report that in-session interoceptive exposure is significantly helpful, ultimately giving them a "been there, done that" perspective so that when their heart begins to flutter (e.g., before giving a speech), they know that they are able to tolerate the mild discomfort and re-orient to the task at hand.

How long will we work together?

The length of our work together depends on a number of things, including the nature of your concerns and your commitment to practicing new strategies outside of session.  Generally, I like to see a new patient weekly for 4-8 weeks to gain some therapeutic traction before introducing a conversation about transitioning to every other week. Many patients feel that they have achieved their goals within 10-20 sessions, but will often schedule booster sessions every 3-6 months to maintain their therapeutic gains.

Do you offer counseling for couples, families, and kids?

I do not see couples, families, or patients under the age of 18.  

Do you prescribe medication?

As a licensed psychologist, I am unable to prescribe medication.  Many of the conditions I treat may be effectively treated without medication.  Indeed, outcome research often suggests that the longest-term gains in therapy are due to cognitive and behavioral interventions rather than medication.  That being said, however, medication can be a useful adjunct to psychotherapy at times.  I know a number of psychiatrists in San Antonio and am happy to provide referral information as needed.  If you are currently taking medication, I will ask you to sign a release of information so that I am able to collaborate with your psychiatrist in providing the most effective care possible.