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Obsessive Compulsive Foundation Newsletter
*****For the latest interview with The Obsessive Compulsive Foundation and Dr. Robin Zasio and Jeff Bell, Author of Rewind, Replay, Repeat: A Memoir of Obsessive Compulsive Disorder visit: http://www.ocfoundation.org/UserFiles/File/ITP_Interviews/Zasio_Bell_Anxiety_Treatment_Center_2007.pdf
2006 interview with Dr. Robin Zasio about the Newly Opened Anxiety Treatment Center, Inc.
Newsletter: When did The Anxiety Treatment Center open?
Dr. Zasio: The Anxiety Treatment Center opened on November 28, 2005.
Newsletter: What types of disorders will you be treating at the Anxiety Treatment Center?
Dr. Zasio: We treat OCD, Social Phobia, Panic Disorder, Posttraumatic Stress Disorder, Generalized Anxiety Disorder, Specific Phobias, Body Dysmorphic Disorder, Hypochondriasis, Trichotillomania, Separation Anxiety Disorder, and Hoarding.
Newsletter: What types of therapy will you be offering people with OCD who come to you seeking treatment? Are you using cognitive behavioral therapy (CBT)?
Dr. Zasio: We utilize Exposure and Ritual Prevention (ERP) techniques, which are based in Cognitive-Behavioral Therapy (CBT).
Newsletter: Will you be offering different levels of treatment intensity at the Center?
Dr. Zasio: Yes. In addition to our daily Intensive Treatment Program, we offer individual, group, and family therapy.We also offer aftercare and family support groups.
Newsletter: Can you describe your Intensive Treatment Program for our readers?
Dr. Zasio: Our Intensive Treatment Program is offered Monday through Friday from 9:00 am to 1:00 pm. We treat children, adolescents, and adults. We begin daily with a check-in group where individuals share homework progress, difficulties they may be experiencing, and their victories. Staff then begins to work one on one with individuals teaching and applying ERP therapy. With their therapy they will receive information about the causes of anxiety disorders; social skills and assertiveness training; relaxation training and stress management; family therapy and consultation; psychopharmacological consultation and psychological testing as needed; collaboration with community mental health professionals; and relapse prevention. We complete each day with a wrap-up group where individuals discuss their day as well as their homework assignments.
Newsletter: Can you describe how you introduce your patients to ERP?
Dr. Zasio: First, we set up an evaluation to get information about the individual’s condition and symptomatology. Once this information is obtained, we feel it is extremely important to provide education about causes of their symptoms by including a detailed discussion of the chemical and environmental aspects influencing their condition. This validates why they are having such a difficult time and cannot stop obsessing or compulsing on their own. We then discuss how ERP therapy will desensitize them to their fears, change the neurochemistry in their brain, and promote a reduction in anxiety.
Newsletter: Do you have a set therapy regimen that you use with patients who have OCD? What is it?
Dr. Zasio: Once the evaluation has been completed, the next step is to have the individual complete various questionnaires and assessments, and we continue to obtain information regarding their condition. Next, we develop a hierarchy of triggers and find a starting point at which to begin exposure. For each individual it will be different depending on his/her level of anxiety and fears. We have individuals rate their anxiety level with each trigger on a scale of 1-10 and determine their first exposure based on an anxiety level of four or less. We then begin the exposure and work our way through their hierarchy. Because of the systematic desensitization, individuals can control their treatment and move to the next trigger situation when they are ready. This is very empowering for them.
Newsletter: Is there anything that you feel is unique about your program?
Dr. Zasio: Yes. Our Day Treatment Program operates out of a residential home setting. The philosophy behind this setting is the understanding that many people who seek treatment are getting “stuck” in their homes. Therefore, practicing and changing behaviors in a simulated home environment significantly increases a person’s ability to generalize and replicate what s/he is learning to his/her home environment.
Newsletter: Do you use antiobsessional medication such as SSRI’s in treating people with OCD? Under what circumstances do you use medication? Who prescribes it? Do you have a psychiatrist available to prescribe and monitor medications?
Dr. Zasio: Once an individual seeks treatment, we ask if s/he is taking medications and if so we consult with his/her treating psychiatrist. If s/he is pleased with his/her current medication regimen, typically no changes are made. If the patient is not taking medication and would like to attempt treatment without medication, then we go forward with the program. If s/he is not taking medications, and would like to be evaluated (or his/her symptoms are such that we encourage him/her to consider medications), we refer him/her to our staff psychiatrist Dr. Carlos Solis, M.D. Dr. Solis will then make a recommendation which often includes SSRI’s.
Newsletter: Do you require your patients to go off their medication in order to participate in your treatment program?
Dr. Zasio: No. We recognize that the combination of medication and therapy tends to yield an overall positive treatment outcome.
Newsletter: Are your treatment programs time-limited or does your treatment period vary based on the patient’s needs and the intensity of his/her OCD?
Dr. Zasio: Although we try to estimate during the evaluation process how long an individual can expect to be in therapy, we tell patients that length of treatment depends on the individual him/herself. We explain that the more a patient can practice his/her exposure exercises, the more rapid s/he will experience a reduction in anxiety as a result of desensitization. In general, most individuals can expect to be enrolled in our Intensive Treatment Program from five to seven weeks.
Newsletter: Will you design a treatment program to fit a patient’s availability and needs?
Dr. Zasio: Yes. We will obtain information about a patient’s condition and symptoms in the evaluation process and discuss our recommendations. For some, the Intensive Treatment Program will not be an option due to occupational, vocational, or familial responsibilities. Therefore, we will work to develop a treatment program based on their availability (i.e., individual therapy one or more times per week and/or group therapy). For others, they can enter directly into our Intensive Treatment Program. For individuals who are not able to leave their home due to severe anxiety we will make home visits, and in many cases, we do assisted exposure in the community. For example, if someone is avoiding places due to contamination, we help guide her/him with this exposure when he or she is ready. If another is struggling with social anxiety, we can help her/him to enter into situations that previously were difficult.
Newsletter: What if someone has made some progress through your Intensive Treatment Program, but still has not gotten well enough at the end of the five to seven weeks to end treatment, will you allow the patient to continue treatment?
Dr. Zasio: Yes. Each individual admitted into our program participates in their treatment plan, which includes length of stay. Each week we monitor their progress and assess their needs. If it appears as though an individual needs to stay longer we discuss this with him/her and determine how much longer.
Newsletter: Do you include Relapse Prevention in your treatment program?
Dr. Zasio: Relapse Prevention techniques are taught in the early stages of therapy to allow adequate time to practice these tools. In our Intensive Treatment Program, we offer a weekly relapse prevention group in which we discuss topics, such as minimizing avoidance and reassurance to facilitate exposure. Once taught, the relapse prevention techniques are reviewed regularly.
Newsletter: After a patient finishes your Intensive Treatment Program, do they continue on a less intensive basis?
Dr. Zasio: Typically, yes. The only circumstances which might prevent them from being able to follow up in our center would be those traveling from out of town. In these circumstances, we offer telephone sessions to support the patient’s gains. If individuals are returning to a therapist with whom they are already established, we consult with the therapist as needed. Otherwise, most will follow up with individual therapy and/or group therapy at the Center.
Newsletter: If a patient who finished your Intensive Treatment Program has a relapse, can she/he come back for a “tune-up” treatment?
Dr. Zasio: Yes, in fact we discuss this prior to discharge. Most individuals will taper down to a less intensive therapy, such as, individual or group. However, if they chose not to, we always let them know they can return should they need us in the future. Letting clients know that we are there for them in the future provides them with tremendous relief and comfort.
Newsletter: Can patients be hospitalized in your program at your Center? Are there any hospitals nearby at which someone can be an inpatient while being treated at The Anxiety Treatment Center?
Dr. Zasio: Our program offers outpatient treatment services only. Most local inpatient hospitals do not allow their patients to leave for extended periods of time during the day. Since we are the only Intensive Treatment Program located in Northern California specifically for OCD, most people come directly to our program. If they have a medical or other condition that requires inpatient hospitalization, we recommend that they stabilize that condition first and then enter into our program.
Newsletter: If patients can’t be hospitalized, how do you handle patients who live outside a daily commuting distance? Are there hotels or a Ronald McDonald House near your clinic? Is there any discount people will be given by local hotels?
Dr. Zasio: A large percentage of individuals who enter into our treatment program reside out of town. Because of this, we have complied a list of hotels nearby where individuals can stay for extended periods of time. Many of these hotels offer kitchenettes and/or suites at weekly at discounted rates. Currently we are working to expand our program by providing housing for those traveling from out of town that will be within walking distance to our program.
Newsletter: How long have you been treating patients with OCD?
Dr. Zasio: I have been working in the mental health field for the past 18 years, and specializing in treatment for OCD and anxiety spectrum disorders for the past 8 years.
Newsletter: Where did you get your doctorate and what kind of training did you have that prepared you for treating OCD?
Dr. Zasio: I received my doctorate from the California School of Professional Psychology located in Alameda, CA. My training in OCD treatment began with Dr. Paul Munford, Ph.D., when he opened an OCD treatment program in a local psychiatric hospital. I trained with him daily, often times working weekends for the first few years. Slowly I began to develop my own caseload and within three years we developed The Anxiety Treatment Center of Northern California which is now closed. I am now the owner and director of The Anxiety Treatment Center and supervise interns who are learning to treat OCD and related anxiety conditions.
Newsletter: Do you involve the family members or friends of your patients in the treatment? How? Are there support groups available for family members and friends?
Dr. Zasio: Yes. We recommend family meetings once per week. This helps to include them in the treatment process, identify how they can be a support, provide an opportunity for loved ones to express their concerns, and receive support themselves. We also offer a support group for family members every other week.
Newsletter: Do you teach family members to be ERP coaches for the patients in your program?
Dr. Zasio: Yes, however, this is done on a case by case basis. In many cases, individuals want to feel empowered to do the exposure on their own; and in others, they will require help. In the latter case, we provide ERP training to the family members, teaching them how to gently guide the exposure exercises. Often we will practice this in session to help trouble shoot and answer questions for clarification.
Newsletter: Are there free support groups available in your area for people with OCD?
Dr. Zasio: There is one held every two weeks at The Sutter Center for Psychiatry located approximately two miles from The Anxiety Treatment Center.
Newsletter: Will private insurance pay for your CBT treatment? What about Medicare or Medicaid?
Dr. Zasio: Yes. It is common that insurance companies will pay for this specialized treatment. The California parity law established in the year 2000 has been instrumental in facilitating this process. And, because we are the only program located in Northern California providing intensive treatment services, many insurance companies contract with us to provide coverage. We do not accept Medicare or Medicaid.
Newsletter: How can someone get in touch with you to talk about your programs?
Dr. Zasio: They can contact me directly by calling The Anxiety Treatment Center at (916) 366-0647 or email me at drrobin@sierrabg.com. They can also visit our website at http://www.anxietytreatmentexperts.com/. If they would like to write to us, our address is 8980 Alderson Avenue, Sacramento, CA 95826, and the fax number is (916) 487-4408.
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