Autism Spectrum Disorder Evaluation Program
RCBM offers a Comprehensive Autism Spectrum Disorder (ASD) Evaluation for individuals two years of age and older.
Screening:Initially, patients will be scheduled for an intake with one of our clinicans, after which they will be scheduled for a 2-3 hour screening session examining the patient’s symptoms of ASD, ADHD, Anxiety, Mood, Personality Characteristics, Cognitive Abilities, etc. As there is significant overlap in symptoms between ASD and other psychiatric disorders, this screening step allows RCBM to feel confident that the correct diagnosis is being pursued, and that any co-occurring conditions are being identified.. This step also allows us to ensure that pursuit of a full ASD evaluation is warranted.
After the screening session, patients will meet with their primary clinician at RCBM in order to review the results of the screening. If the clinician believes that the screening results may be indicative of ASD, the patient will be referred for our full ASD evaluation with one of our trained psychologists- this step is necessary in order to establish a formal medical diagnosis of ASD.
ASD Evaluation:The ASD evaluation entails one to two 1-hour sessions, depending on the age of the patient.
The Following assessments are administered as part of our ASD Evaluation
Autism Diagnostic Interview-Revised (ADI-R ):Is an interview administered by the clinician to a parent or caretaker who is familiar with the developmental history and current behavior of the patient.
Autism Diagnostic Observation Schedule- Second Edition (ADOS-2):Is a semi-structured, standardized assessment of communication, social interaction, play/imaginative use of materials, and restricted and repetitive behaviors for individuals who have been referred because of possible autism spectrum disorders. The ADOS-2 offers standard activities designed to elicit behaviors that are directly relevant to the diagnosis of ASD at different developmental levels and chronological ages.
Upon completion of the full evaluation, a report will be created and reviewed with the patient and their family. A copy of the report will be provided to the school upon request and with written consent.
Screening is covered under some, but not all insurance plans. RCBM is unable to bill insurance for the full ASD evaluation at this time. For additional information or to schedule an initial intake appointment for this evaluation, please call 248-608-8800.
The Following PDF provides our ASE Handout:
Academic and Cognitive Evaluations for Learning Disorder or Intellectaul Disability
RCBM offers Academic and Cognitive evaluations for both children, adolescent and adult individuals. This program is designed to assess individuals for Learning Disorders, Intellectual Disabilities, Cognitive Strengths/Weaknesses, and any co-morbidities.
Screening:Initially, patients will be scheduled for an intake with one of our clinicians, after which they will be scheduled for a 3-hour comprehensive screening assessing for Academic Skills, Cognitive Skills, Attention, Anxiety, Mood, etc. This screening session allows us to ensure that we are pinpointing the exact cause of one’s academic difficulties, which can be due not only to the experience of a Learning Disorder, but also to Inattention, Anxiety, etc. Additionally, this screening session allows us to better focus our Academic/Cognitive Evaluations such that we only assess the pertinent academic and/or cognitive areas as part of this evaluation.
After the screening session, patients will meet with their primary clinician at RCBM in order to review the results of the screening. If the clinician believes that the screening results may be indicative of a Learning Disorder or Intellectual Disability, the patient will be referred for our full Academic/Cognitive evaluation with one of our psychologists - this step is necessary in order to establish a formal medical diagnosis of Learning Disorder/Intellectual Disability.
Academic/Cognitive Evaluation: The Academic/Cognitive Impairment evaluation can take anywhere from 1 to 6 hours to complete, depending on the academic areas being assessed, and whether a cognitive assessment is being requested. Psychologists administering this evaluation have training in both school and counseling psychology, and consequently have an understanding of the school system and assessment services utilized in the schools. The Following Assessments are administered as part of our Adademic/Cognitive Evaluations:
Ø Woodcock Johnson IV- Tests of Academic Achievement:Is an individually administered assessment that allows for the objective assessment of one’s reading, writing, and math skills.
Ø Woodcock Johnson IV- Tests of Cognitive Abilities:Is an individually administered assessment that allows for the objective assessment of one’s cognitive abilities, including verbal reasoning, fluid reasoning, working memory, processing speed, etc. This assessment also produces an I.Q. score.
Upon completion of the full evaluation, a report will be created and reviewed with the patient and their family. A copy of the report will be provided to the school upon request and with written consent.
Screening is covered under some but not all insurance plans. RCBM is unable to bill insurance for the full Academic/Cognitive evaluation at this time.
Note: If your child demonstrates an academic need (meaning grades of D or lower in one or all academic areas), your school is required (upon your request) to review your child’s academic history in order to determine whether an academic assessment is warranted for your child. If they feel it is warranted, the school will conduct a comprehensive evaluation free of charge in order to determine whether your child necessitates an Individualized Education Plan (IEP) or a 504 Plan. Clinicians at RCBM can act as your advocate, helping you to receive the pertinent testing for your child at their school.
If you would like Academic/Cognitive testing to be conducted at RCBM, we can conduct these evaluations in order to provide a medical diagnosis for a Learning Disorder or Intellectual Disability, or to provide a second opinion. For additional information or to schedule an intake appointment for this evaluation, please call 248-608-8800.
Below is a PDF version of our Academic/Cognitive Evaluation Handout:
Adult Weight Management Program
According to the CDC, more than 32.7% of U.S. adults are overweight and 37.9% are obese. Overweight and obesity can cause or be caused by mental health symptoms. RCBM offers a comprehensive approach to weight management, offering medical and behavioral strategies to address weight concerns. Each patient has a treatment plan tailored to his needs and preferences.
-Your prescriber can explore medication options to address underlying cravings and decrease hunger, including:
In addition, you and your prescriber can discuss whether any of your existing medications could be contributing to weight concerns
-Your therapist will work with you to:
-Identify triggers to unhealthy eating (wrong food choices or over-eating)
-Assess underlying mental health issues contributing to weight issues
-Explore maladaptive habits and replace them with healthy ones
-Involve family members (when appropriate) who can help support you as you work toward your goals
-Help to pave the way for sustained lifestyle changes.
-Bariatric surgery evaluations: Most doctors who perform bariatric surgery require a psychiatric evaluation to ensure that the patient is ready to make and sustain the lifestyle changes to support a bariatric surgery. RCBM clinicians can conduct these evaluations and provide a report to the referring physician.
We look forward to assisting you on your weight loss journey!
Attention Deficit Hyperactivity Disorder (ADHD) Treatment
A major emphasis of The Rochester Center for Behavioral Medicine is the identification and treatment of Attention Deficit Hyperactivity Disorder throughout the life span. We offer comprehensive screening and evaluation of this particular disorder. Screening is done through thorough psychiatric interview and the use of collateral history and symptom checklists. When needed, neuropsychological testing is available.
ADHD is a highly prevalent disorder. It affects between 6% and 10% of the American population. ADHD is a disorder of attention, concentration, hyperactivity and impulsivity. This activity persists through the life cycle. RCBM is dedicated to the treatment of children, adolescents, and adults with ADHD.
ADHD directly impacts individuals and their family. Students with ADHD often struggle in school, academically and socially. They have a high rates of school failure and struggle with other mental health conditions.The struggle with ADHD does not end in adolescence. Adults with ADHD report problems with distractability, attention, and impulsivity. They are much more likely than the rest of the population to suffer from anxiety and depression. Many report difficulties with insomnia or oversleeping. They have higher levels of persistent anxiety and depression. Studies reveal that adults with ADHD have difficulty throughout their lives with their job, schooling, interpersonal relationships and overall well-being.
RCBM is committed to accurately and fully diagnosing ADHD. We believe that each individual should be carefully evaluated. Our patients obtain a full diagnostic interview where we can ascertain the full history and the current concerns. If after this intake we believe that further evaluation is warranted, we will arrange for psychological testing. The psychological testing process takes approximately two and a half to three hours to complete. It is conducted by specially trained RCBM psychometricians. The testing allows us to precisely diagnose the type of ADHD you have (ADHD combined type, ADHD predominantly inattentive type, ADHD predominantly hyperactive impulsive type).
Furthermore, we can diagnose other conditions that commonly co-occur with ADHD. These include depression, anxiety, post-traumatic stress disorder, panic disorder, learning disabilities, sleep disorders, and substance-use disorders.
Once the testing is completed, our psychiatrist or one of our nurse practitioners will review your findings, combining the initial diagnostic intake with the psychological screening. A treatment plan will be developed, which usually includes medications and ADHD coaching or therapy.
ADHD coaching can be an important part of comprehensive treatment program for individuals with ADHD. ADHD coaches educate clients regarding this disorder. They reframe negative beliefs, identify individual learning styles, and develop systems and strategies to overcome strategies. Individuals with ADHD struggle with time management, organization, impulsivity, and procrastination. Coaching offers individualized and action-oriented approaches to combat these issues. Coaches are focused on developing productive habits and systems that lead to more productive lives. Several of the RCBM therapists are particularly focused on ADHD coaching. At times, coaching can be conducted on the phone, although different insurance coverage applies.
Sometimes medications are useful for ADHD. The Rochester Center for Behavioral Medicine prescribes many different medications, and will work with you to develop a medication treatment plan that works for you. RCBM staff have been involved in many clinical protocols. Many of the medications currently available for the treatment of ADHD have been tested through clinical trials at the Rochester Center for Behavioral Medicine. A list of the commonly used AD/HD medications can be found on the medications page.
Binge Eating Disorder Program
Binge Eating Disorder is a common disorder characterized by:
-Eating an extremely large amount of food within a 2-hour period (a binge) at least once a week on average for at least 3 months.
-Feeling unable to control how much you eat during a binge.
-Feeling very unhappy about binging.
If you have Binge Eating Disorder, you also have three (or more) of the following symptoms:
You eat more quickly than normal during a binge.
You eat until you are painfully full.
You binge eat when you are not hungry, to reduce stress or to comfort yourself.
You eat alone because you are embarrassed about how much food you eat.
You feel upset, guilty, or depressed after binge eating.
(from WebMD and DSM-5):
Binge Eating Disorder is thought to effect 2-5% of the population.
Dr. Young and his staff have been involved in researching this disorder for several years and have conducted clinical trials for treatment. Dr. Young and RCBM are members of the Binge Eating Disorder Association (BEDA).
In January 2015, the FDA announced that Vyvanse, lisdexamfetamine dimesylate, has been approved for the treatment of binge eating disorder. Vyvanse has been shown to decrease the number of binge episodes. Patients treated with Vyvanse reported improved quality of life. If you have concerns about binge eating disorder, the Rochester Center for Behavioral Medicine has developed a comprehensive program integrating medications and behavioral treatment. We emphasize accurate diagnosis, appropriate medications, and individualized exercise and nutritional recommendations. The program is led by Joel L Young, MD and Melissa Oleshansky, PhD.
CBT-I (Cognitive-Behavioral Therapy for Insomnia)
Over 50% of adults report difficulty sleeping, half of which suffer with chronic sleep difficulty. We now know that medications are not the only solution to insomnia and that it is possible to successfully treat insomnia using cognitive-behavioral therapy (CBT). CBT has been endorsed by the National Institutes of Health as an effective method for treating insomnia. Research on CBT shows the following:
* 75% of insomnia patients experience significantly improved sleep
* The majority become normal sleepers
* 85- 90% reduce or eliminate sleeping pills
CBT achieves these results because it is based on the idea that insomnia is treated effectively by addressing the underlying causes of insomnia- thoughts and behaviors- which are learned and can be unlearned.
Techniques taught in CBT include:
* changing sleep thoughts and behaviors
* lifestyle habits that improve sleep
* relaxation techniques
WHO WOULD BENEFIT
* individuals with problems falling asleep or waking during the night
* individuals who wish to reduce or eliminate sleep medications
CBT for insomnia includes:
* an initial individual assessment
* five individual treatment sessions over a six week period
CBT is covered by most insurance companies but coverage cannot be guaranteed.
Cognitive Behavioral Therapy
The Rochester Center for Behavioral Medicine uses Cognitive Behavioral Therapy (CBT) for the treatment of anxiety and depressive disorders. Our specialist is Mindy Layne Young, J.D., M.S.W., C.S.W., trained at the University of Michigan Anxiety Disorders Clinic. This therapy combines behavioral exposure therapy along with cognitive restructuring to help enable the patient to confront avoidances, correct negative automatic thoughts, and return to optimal functioning.
CBT is particularly effective for the Anxiety Disorder spectrum, such as Panic Disorder, Post Traumatic Stress Disorder, Obsessive Compulsive Disorder, Social Anxiety Disorder and Specific Phobias. The hallmark of CBT is the patient’s role in learning and practicing skills outside the session, to maximize the therapeutic benefit of this therapy. In mood disorders, the patient will learn coping skills to master tasks often thought too arduous for the depressed patient. The use of CBT with or without medication management is addressed, and the ultimate decision is made between the patient and the RCBM Professional.
Comprehensive Psychiatric Evaluation & Second Opinions
The Rochester Center for Behavioral Medicine offers independent psychiatric examinations. This can be helpful in challenging cases where a new diagnostic perspective is necessary.
Examinations are performed regularly by RCBM Medical Director, Joel L. Young, MD. Often other RCBM services such as psychological testing or the Dementia and Cognitive Evaluation Program are helpful in the diagnostic process. If treatment is needed, a myriad of services are available at RCBM such as Individual therapy, Marital and Conjoint therapy or Cognitive Behavioral Therapy. Contact RCBM at 248-608-8800 to set up an evaluation.
Dementia / Cognitive Evaluations
For some patients, it is important to assess cognitive functions such as memory, recall, alertness and overall aptitude. This is formally done via neuropsychological and psychological testing.
This type of testing can be ordered following medical illness such as stroke or other brain based diseases such as Parkinson's Disease or Multiple Sclerosis. It is also used to characterize childhood developmental illness such as autism or Asperger’s Syndrome. Psychological testing is also ordered to evaluate dementia. Dementia is the diminution in cognition and memory. It is associated with the aging process. The most common type of dementia is of the Alzheimer's Type. These are important diagnoses to make early on. Some dementias are reversible if caught early. For other types, such as Alzheimer’s and vascular dementias, newer cognitive enhancing medications are available which can improve functioning and prolong quality of life.
Fibromyalgia and Chronic Fatigue Syndrome (Systemic Exertion Intolerance Disease) Treatment Program
What is Chronic Fatigue Syndrome*?
*Please note that, effective February 2015, Chronic Fatigue Syndrome has been renamed as Systemic Exertion Intolerance Disease*
A few short decades ago, people afflicted with constant exhaustion had no word for their suffering, and might even have been labeled as “crazy.” We now know that a disparate group of exhaustion-related symptoms are the result of a disorder called chronic fatigue syndrome. The diagnosis is still not well-understood, though, and many people with chronic fatigue syndrome spend years seeking the right medical care.
In some countries, chronic fatigue syndrome is known as myalgic encephalopathy, leading some practitioners to refer to the disorder as CFS/ME. No matter what you call it, though, CFS/ME can be debilitating, even undermining a sufferer's ability to work. The hallmark symptom of the disorder is chronic fatigue that is not well-explained by another condition.
What Causes Chronic Fatigue Syndrome?
For a long period of time, the Rochester Center has treated individuals with ADHD. This has led us to the observation that a number of individuals with ADHD (inattentive type) develop chronic fatigue and chronic pain. Oftentimes, by detecting whether ADHD exists, treatments for ADHD can address chronic fatigue. Dr. Young and the Rochester Center have published extensively on this issue.
What Are the Symptoms of Chronic Fatigue Syndrome?
Chronic fatigue syndrome is a diagnosis of exclusion. This means that there is no direct test for the condition. Instead, doctors diagnose CFS by testing for other conditions, excluding those conditions, and then evaluating symptoms. Consequently, you can help speed your diagnosis by keeping an accurate log of your symptoms. A symptom log can also help you determine whether any lifestyle choices or environmental issues – such as stress – affect your symptoms.
Symptoms of chronic fatigue syndrome include:
· Ongoing fatigue that is not better explained by a medical condition or insufficient sleep. Fatigue from exercise and other strenuous activities may last 24 hours or more.
· Difficulties with concentration, memory, or thinking.
· Enlarged lymph nodes, particularly in the neck or under your arms.
· Muscle pain that is not better explained by muscle strain or injury.
· Joint pain not caused by another medical condition.
· Chronic headaches or sore throats.
· Feeling unrefreshed and exhausted even after a good night's sleep.
Note that not all patients with CFS experience all of these symptoms, and the symptoms you experience may change with time.
How The Rochester Center for Behavioral Medicine Can Help
Our medical team specializes in chronic fatigue syndrome, and has been at the cutting edge of new treatment developments. We regularly conduct CFS research, and we take the suffering of CFS patients seriously. We'll listen to you, carefully evaluate your needs, then find ways to improve your current symptoms. Individuals experiencing excessive fatigue will undergo a comprehensive evaluation to identify any underlying disorders, such as anxiety, depression and AD/HD. Our approach is holistic, incorporating several treatment options, including:
· The use of psychoactive medications to help you deal with the stress and pain of CFS and comorbid conditions. Many patients with the disorder experience anxiety, depression, or sleep disturbances.
· Helping you adopt lifestyle choices that can improve your symptoms. If you find making lifestyle changes difficult, we can counsel you about how to move past common roadblocks. We'll also work with your family to help them help you.
· Aiding you in the development of coping skills that can improve the way you feel every day.
· Investigating your symptoms and monitoring you for changes in your condition.
We're here to help you whenever you're ready. While there may not yet be a cure for CFS, there are many treatment options. Let us help you find something that works for you. Contact us today.
What is Fibromyalgia?
Fibromyalgia is a relatively new diagnosis, but has likely affected people for thousands of years. It remains poorly understood, partially because doctors have historically attributed the disorder to psychological problems. We now know that fibromyalgia is a real disease that afflicts between two and eight percent of the population. As many as 90 percent of people affected by the disorder are women, though doctors don't yet know why this is.
The disorder is a musculoskeletal disease characterized by widespread pain throughout the body. The pain is often localized at specific tender points primarily located along the upper body, but people afflicted with the condition can experience pain just about anywhere. The pain ranges from mild to debilitating, but it tends to get worse over time. For some people with the condition, symptoms start after a physical trauma, such as a fall or car accident. For others, symptoms come on slowly and get worse over time, and a few people with fibromyalgia experience a sudden and acute onset of symptoms.
What Causes Fibromyalgia?
The Rochester Center for Behavioral Medicine has been focused on the identification treatment of ADHD and related diagnoses for many years. Dr. Young has written about the natural history of ADHD. Many individuals with inattentive ADHD develop symptoms of chronic fatigue and Fibromyalgia. Often, this is a missing link in the treatment of Fibromyalgia. Evidence suggests that treating the underlying ADHD can help to reduce fatigue and pain.
Symptoms of Fibromyalgia
Fibromyalgia is a diagnosis of exclusion. This means that there's no single medical test that can test for the condition. Instead, doctors evaluate patient symptoms and rule out other possible causes before diagnosing the patient with fibromyalgia. Many patients find that logging their symptoms over time helps them communicate clearly with their doctors. This practice can also help you determine whether any lifestyle choices or environmental issues trigger symptoms. Common symptoms of fibromyalgia include:
· Pain throughout the body. If the pain is concentrated at specific points, this strongly suggests fibromyalgia. Even without these tender points, though, a doctor may diagnose fibromyalgia if the pain is a dull ache, gets worse over time, and has no other physiological cause – such as muscle injuries or rheumatoid arthritis.
· Fatigue. People with fibromyalgia may also deal with chronic fatigue. The pain may keep you up at night, or you may have trouble sleeping. Some people with the disorder also report a sudden depletion in their energy levels.
· “Fibro fog” is a change in cognitive abilities due to the disorder. Some people with fibromyalgia feel foggy or confused, like they're living in a dream state. If you have trouble remembering information or concentrating, be sure to note this at your doctor's appointment.
· Frequent headaches or gastrointestinal disturbances.
· Skin problems. Some people with the disorder report skin pain and itching. Others experience skin problems such as eczema or dry, scaly skin.
How The Rochester Center for Behavioral Medicine Can Help
The Rochester Center for Behavioral Medicine specializes in fibromyalgia, and we know the destruction this disease can cause. We'll listen to you and take your pain seriously, focusing on what you need – not what we think you should want. Our approach is holistic, embracing both lifestyle changes and appropriate medical care. Our doctors and therapists are fibromyalgia specialists who can help you with the following challenges:
· Developing psychological coping skills that can help you manage your pain, communicate with friends and family about your disorder, and gain the motivation you need to implement healthy lifestyle choices.
· Embracing lifestyle choices, such as exercise and a healthy sleep schedule, that can help you feel better. We work with you to cut through obstacles that make healthy lifestyle choices challenging, and we can help you tailor a plan that works with your lifestyle and personality.
· Prescribing psychoactive medications where appropriate. If your fibromyalgia leaves you feeling anxious or depressed, the right medication can make a world of difference. Many of the medications use to treat ADHD, anxiety and depression are helpful in our patients with Fibromyalgia.
***Please note that the Rochester center does not use opium medications in treatment of chronic nonterminal pain conditions.
We're standing by to help you when you need it, and we know that there's a solution for every problem – no matter how daunting things might feel right now. Contact us today.
If you would like to learn about possible participation in a clinical trial for Fibromyalgia, please contact one of our clinical coordinators, Lori Niewiarowski at email@example.com or (248) 608-8800 x 249.
Grief/Loss/Coping with Illness Issues
Sudden loss of a loved one from a heart attack, stroke, homicide, suicide or accident, often presents many issues for those left behind. People who experience loss from divorce, chronic or terminal illness face a different type of grieving. There are also differences in how adults, children, men and women experience grief and loss.
RCBM clinicians are well-trained in helping individuals through the grieving process, whether grieving the loss of a loved one or coping with their own terminal illness. Some of the therapeutic interventions used at RCBM include techniques in relaxation, cognitive restructuring, stress management, goal setting, learning new coping skills, improving communication skills with loved ones as well as with medical personnel, and referral to community support groups. Each case is looked at individually and the type of loss is taken into consideration when a treatment plan is created. RCBM also offers the services of our Psychiatrist and Nurse Practitioners who can evaluate patients who may need medication as an adjunct to their therapy.
Individual psychotherapy is an approach in which all therapists at Rochester Center are trained in. Individuals receive assistance in addressing issues related to self, family, school and work. Clients who chose to participate in individual therapy work together with their therapist to gain insight and increase coping skills in order to improve general mental health.
At the Rochester Center for Behavioral Medicine (RCBM) the therapists work closely with the Psychiatrist and Nurse Practitioners in a therapeutic team approach. This provides a broader viewpoint of existing mental health issues. When deemed necessary by the mental health professionals at RCBM (in conjunction with the patient), Psychiatric evaluations, medication reviews, group therapy, family or marital counseling may be undertaken. The professionals at RCBM also encourage clients to take an active role in participating in their therapy. They may provide psychoeducation through the use of videos, bibliotherapy and opportunities to attend seminars pertaining to individual mental health issues. Please click on the "Meet our Professionals" link to view the background information and related interests of a particular therapist.
Individuals in the LGBT (Lesbian, Gay, Bisexual, Transgender) community often face a unique set of issues including stigma, discrimination and societal inequalities. The Rochester Center offers a supportive and affirmative environment to help provide individuals, families, and couples with comprehensive treatment and care.
Gender Identity and expression
The coming out process
Career problems/workplace issues
Marital & Conjoint Therapy
RCBM offers marital and conjoint therapy sessions. Professionals at RCBM first carefully evaluate each member of the couple to ensure that no other condition is interfering with the marital or familial relationship. From there, individuals are brought together to begin conjoint therapy. Important steps in therapy include: reducing blaming and negativity within the couple or family; creating common goals toward which individuals can work (both and independently and together); and developing and implementing plans in order to accomplish these goals.
The therapist may help the couple or family with: communication skills; coping techniques; patterns of interaction; and any other important areas of stress. Further, therapists will help the individuals to generalize the skills they have learned in therapy so they are able to apply these techniques to any future difficulties that may arise. RCBM therapists are highly flexible and willing to adjust the process of therapy in order to best meet the needs of each couple and family. Confidentiality is priority at RCBM, and the therapists work hard to ensure the privacy of everyone involved. If you are interested in becoming involved in marital or family therapy, please contact us at (248) 608-8800 to set up an appointment.
Mind and body medicine focuses on the connections of the brain to the body and how our emotions, verbalizations, behaviors, and spirituality directly affect our health and well-being. It is a cognitive and behavioral therapeutic practice that enhances our awareness of our thoughts and actions in order to improve our level of self-esteem and self-confidence in order to live the life we want.
Mind and body medicine often utilizes specific therapies such as individual and group psychotherapy, yoga and stress management techniques, progressive muscle relaxation, and hypnosis. There have been a number of clinical studies that indicate these alternative therapies can help patients cope and manage pain, minimize stress and anxiety, and gain an overall sense of control over one’s mind and body.
Obsessive Compulsive Disorder is an anxiety disorder which involves both obsessions (thoughts, images, or impulses that occur over and over again) and compulsions (acts that a person repeatedly performs in an attempt to make the obsession go away). The brain seems to get “stuck” on a thought or urge and cannot shake it. Individuals with OCD often have the sense that if that “obsession” continues without them taking part in any compulsions, the anxiety will become intolerable.
Cognitive Behavioral Therapy (CBT) is an empirically-validated therapeutic intervention that is often used to help individuals with OCD to manage their symptoms. CBT is a concrete, proactive and goal-oriented therapeutic style. With the help of a trained therapist, individuals with OCD can learn to control and even alleviate their obsessions and compulsions. Individuals will also learn coping strategies such as relaxation exercises and ways to challenge distorted thinking in an effort to reduce anxiety. Psychotropic medications may also be a part of the treatment plan for the individual with Obsessive-Compulsive Disorder.
Non-medical use of opiates is dramatically increasing the U.S. Opiates include prescription drugs such as Vicodin and Oxycontin, as well as street drugs like heroin. A U.S. Government report released in 2005 states that prescription opiates are now the second most commonly abused drugs, after marijuana. Heroin use is also increasing among young people in their late teens to early twenties. Abuse of and dependence on opiates interferes significantly with work, relationships, and education.
Here at RCBM, we offer a collaborative approach to treating opiate-related struggles. Individuals with opiate addiction or dependence are evaluated and treated for other psychiatric problems which may be contributing to their opiate use. Suboxone is a medication used to aid in the cessation of opiate use while controlling withdrawal symptoms. Suboxone may be prescribed as a part of the treatment plan. Individuals on Suboxone are required to take part in counseling. Outside resources such as Narcotics Anonymous are also provided for additional support.
The Rochester Center for Behavioral Medicine is dedicated to improve the quality of life experience for our clients. We combine the treatment modalities of cognitive-behavioral & supportive psychotherapies with medication to help people lead happier, more productive lives.
RCBM offers a comprehensive program of individual, group and conjoint therapies across all areas of psychiatry and psychology. RCBM is strongly committed to a “biopsychosocial” approach to mental health conditions. We try to understand the biological basis of an individual’s affliction, the psychological conflicts that might arise from it or give rise to it, and the sociological or community context of one’s life. Our staff is composed of individuals with strengths in these areas.
Educating our patients about innovative treatment options and cutting edge research on mental health conditions is vital to our treatment approach. We join our patients in a collaborative effort so that they make informed educated choices for themselves. We attempt to educate through dialogue, referral to patient advocacy groups, and distribution of educational material and videos.
RCBM offers services to children, adolescents, adults and seniors coping with anxiety, depression, ADHD, learning disabilities, work related issues, stress and family and marital issues among other conditions.
Outpatient Alcohol and Addictions Treatment Program
At the Rochester Center for Behavioral Medicine, we offer an innovative multidisciplinary treatment approach to recovery. Our program has been developed through years of experience working with addicted clients. In addition, we have utilized many exciting new discoveries in the field of neurobiology.
Recent discoveries in the field of addiction science have expanded our understanding of addictions and their impact upon the human brain. We have combined our years of experience with cutting edge discoveries in neuroscience in order to provide highly effective treatment for our patients. Research has shown that the combination of medication and therapy has proven most efficacious in treating mental health conditions. This is the model that we utilize at RCBM. Substance Abuse & the Law Our advice to you: Take control of your addiction Do not wait for the legal system to make treatment mandatory; acknowledge responsibility and voluntarily seek treatment Take your addiction seriously. It is a life threatening problem. But remember there is hope. . . We can help by: Communicating with your attorney & the court system, at your request Ordering laboratory alcohol and drug tests Providing psychiatric consultation Offering individualized and family counseling When appropriate, utilizing cutting edge medications specially developed to help people with alcohol and substance addictions. Understanding Addictions Our knowledge about addictions has rapidly grown. Research into the fields of genetics and neuroscience has produced encouraging new medications, including: Campral™ -- to help control cravings Vivitrol™ -- a new injectable medication with 30 days of coverage Antabuse™ -- a powerful deterrent to drinking Suboxone™--a medication for the treatment of opioid dependence Chantix™—a medication used to aid in smoking cessation Other medications to decrease impulsive choices that can lead to relapse Did you know that . . . Many people with addictions also have undiagnosed and untreated mental health conditions such as: Depression Anxiety ADHD and Learning Problems Insomnia Identifying and treating these symptoms can strengthen the recovery process. Please contact us at: (248) 608-8800 to schedule an appointment or find out more information.
It is not uncommon for RCBM clinicians to be faced with overwhelmed parents, many of whom have attempted to implement a variety of parenting techniques but have not found success. These failed attempts can lead to feelings of hopelessness and helplessness for these parents, which often exacerbate the problematic dynamics in the household.
The key elements include consistency and remaining calm, both of which can be difficult during stressful parenting situations. Here at RCBM, our therapists take into consideration the age of the child, the presenting concerns, and the family dynamics in order to tailor-make a treatment plan. Often, therapists will use a combination of techniques to meet their needs. These may include education about special considerations for their child as well as exploration and practicing of parenting techniques. Work with the child alone, the caregivers alone, and the family together are all integral parts of the treatment plan.
Post-traumatic Stress Disorder Treatment
Post-traumatic Stress Disorder is an anxiety disorder which occurs after a person has personally experienced or witnessed a dangerous and life-threatening event. Individuals who are at risk for developing PTSD include but are not limited to: Soldiers who have been in combat, survivors or witnesses of violent crimes (including rape, kidnapping, robbery, etc.), individuals who have lived through a natural disaster, survivors of accidents or grave illness.
These events can cause lasting psychological symptoms, including the following (taken from the National Institute for Mental Health Website--www.nimh.nih.gov): 1) Re-experiencing symptoms: Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating Bad dreams Frightening thoughts. 2) Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience Feeling emotionally numb Feeling strong guilt, depression, or worry Losing interest in activities that were enjoyable in the past Having trouble remembering the dangerous event. Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. 3) Hyperarousal symptoms: Being easily startled Feeling tense or “on edge” Having difficulty sleeping, and/or having angry outbursts. Hyperarousal symptoms may make it hard to do daily tasks, such as sleeping, eating, or concentrating. At the Rochester Center for Behavioral Medicine, PTSD is treated with a combination of cognitive-behavioral therapy and medications (when necessary). This effective approach can help individuals with PTSD to identify situations that trigger their “fight or flight” response. Using the cognitive-behavioral techniques of flooding and systematic desensitization, the therapist and patient can work together to safely reintroduce situations that have become too anxiety-provoking for the patient. Over time, irritability, flashbacks and nightmares will subside and the patient is able to return to their pre-trauma functionality. Treating PTSD is a rewarding experience for our clinicians, as long-term success is highly achievable and patient transformation is astounding to watch.
Program for Sexual Health
Concerns such as low libido and erectile dysfunction can create frustration, self-esteem issues, relationship challenges and even depression. These sexual difficulties can be due to a physiological issue, a side effect of a medication, or the result of an underlying psychiatric disorder. Whatever the root cause, RCBM clinicians are committed to helping our adult patients achieve optimal sexual health in a sensitive, confidential environment. Treatments may include relationship therapy to help partners improve underlying issues that are impacting their sexual relations, individual counseling to deal with factors inhibiting sexual health, and medications. Often, a combination of medications and therapy is most effective.
For several years, erectile dysfunction medications such as Viagra, Levitra and Cialis have been used to improve sexual functioning in men. Now women have a medication option as well. Addyi is an FDA-approved medication for the treatment of low sexual desire in women. Feel free to speak with your prescriber if you wish to learn more.
Pseudobulbar Affect Program
The Rochester Center for Behavioral Medicine maintains the Pseudobulbar Affect Program. This condition, also known as PBA, is characterized by mood swings-- notably tearfulness or laughter that are often uncontrollable and can be incongruent with their actual emotional state. Newer drugs and therapies have been developed to treat this condition, and the Rochester Center for Behavioral Medicine offers these interventions.
The clinic is staffed by Marie McMahon, M.S.W., our lead clinician on geriatric issues. Jaime Saal, M.A., L.P.C., also administers the program. Medical support comes from Joel L. Young, M.D. and Carol Rembor, M.S., A.P.R.N., B.C. For further information, please contact (248) 608-8800.
Psychiatric Forensic Services
Joel L. Young, M.D. is a board certified forensic psychiatrist. Dr. Young has testified in many criminal and civil court cases and has offered testimony as an expert witness.
The Rochester Center for Behavioral Medicine utilizes a team approach (with Dr. Young as primary clinician) in offering the following forensic services: Comprehensive custody evaluations. Geriatric/Competency Evaluations. AD/HD and other Psychiatric Issues in the Workplace. Employment Discrimination. Custody and Divorce Disputes.
Psychological Testing for Accomodations
RCBM offers evaluations in order for one to seek accommodations for college (e.g. extended time) as well as standardized testing (SAT, ACT, LSAT, MCAT, and GRE). For college accomodations testing, we ask that you please provide documentation outlining the testing requirements stipulated by your college/university, as each univeristy is different in terms of their testing requirements. For standardized testing accomodations, we provide the testing evaluation stipulated by each testing agency. Please see the following links for additional information regarding what each testing agency requires: ACT; SAT; MCAT; LSAT; ETS assessments. If you are interested in pursuing an accommodations evaluation, please call our office to schedule a one-hour intake session with one of our testing clinicians, who will conduct an intake interview and compile necessary background information. Then, you will be scheduled for a 3-hour testing session. If more time is needed to complete the evaluation after the initial testing session, a second testing session will be scheduled, with the length of this session depending on the time needed to complete the evaluation. Results will vary depending on the needs of each individual. Although we are performing the assessments required by one's college/the pertinent testing agency, the ultimate decision is at their discretion.
Please note that accommodations testing services provided at RCBM are not covered by insurance, and the price varies based on the length of testing.
If you have any questions regarding our Accommodations Evaluations, feel free to call our Center, and one of our testing clinicians would be happy to speak with you.
RCBMetrics: Diagnostic Screening
The Rochester Center for Behavioral Medicine is committed to accurate diagnosis. We believe that before an appropriate treatment is implemented (either medications, therapy, or both), it is imperative to identify the extent and severity of the mental health issue that you have.
Diagnostic screening often plays a vital role in this process. We have developed RCBMetrics, a protocol designed to help us help you. RCBMetrics uses a variety of standardized psychological and educational testing batteries and rating scales. The evaluation process typically takes two to three hours and it is conducted by an RCBM psychometricians under the supervision of Joel Young, M.D. RCBMetrics uses software-based and pen and paper assessments.
RCBMetrics quantifies the extent of many conditions, including anxiety disorders, depression, AD/HD and its various subtypes, substance use disorders, eating disorders, and personality disorders. The program assesses for cognitive impairments and personality style. Other aspects of RCBMetrics can assess and offer guidance about careers.
RCBMetrics is particularly useful for the evaluation of the various subtypes of ADHD. In addition, RCBM assesses for comorbidities. Comorbidities occur in 25% to 45% of individuals with ADHD. Common ADHD comorbidities include anxiety disorders, depression, and learning disorders. Input from teachers and family is also factored into final report. Once RCBMetrics is completed, a full report is generated. Your RCBM clinician will meet with you to review therapies and develop a comprehensive treatment plan, including medications, psychotherapy, and/or coaching.
Diagnostic screening done outside of RCBM may be considered sufficient, provided that the testing has been done recently and includes assessment of the following conditions:
-Depression (including an assessment of suicidality)
-AD/HD (Objective testing is required, including assessment of processing speed, psychomotor speed, executive function, complex attention and cognitive flexibility).
-Autism Spectrum Disorders
The Rochester Center for Behavioral Medicine works with children, parents and schools to provide a comprehensive and integrated treatment program. Children and teenagers spend the majority of their day in the school setting, and their relationships and behaviors in the school setting are often critical pieces of the diagnostic and treatment puzzle. Your child’s therapist or doctor will contact the school to ensure that treatment plans and goals are aligned and well-coordinated.
Navigating the educational system to advocate for your child can be overwhelming. RCBM can assist your family in getting answers to the follow types of questions: How do I know if my child is eligible for an Individualized Education Plan (IEP) or a 504 Plan for my child? When and how do I suggest this to my child’s school? What type of accommodations will teachers make without an official plan? Clinicians at the Rochester Center for Behavioral Medicine are well-versed in these issues and can help your family work through this process.
Social Phobia, also known as Social Anxiety Disorder, is characterized by marked and persistent fear of situations in which one must perform or interact socially with or in front of others. A person with social phobia fears situations in which he or she is exposed to new situations or people and worries about behaving in a way that he/she might be judged by others as foolish, unacceptable, inappropriate, or inadequate.
When a socially phobic individual is exposed to these situations, he or she feels anxious, both physiologically and emotionally. This disorder causes a negative impact on the individual’s social, academic and/or occupational functioning. Treatment for social phobia focuses on helping the patient to explore and identify possible triggers to their social anxiety, how this anxiety manifests itself, and work on coping skills and tools they can acquire to help overcome their phobias. Furthermore, treatment interventions for social phobia may include individual, family, and group therapy. Cognitive-behavioral therapeutic techniques are often utilized, along with relaxation techniques and psychotropic treatment (if appropriate).
RCBM professionals are pleased to offer phone or video-call sessions for individuals who are unable to attend in-office appointments. At this time, most insurance companies do not offer coverage for these visits. In these cases, phone appointments would represent an out-of-pocket expense.
Please note that new evaluations cannot be conducted over the phone.
Trichotillomania is a disorder characterized by the pulling of hair for non-cosmetic purposes, which can often result in significant hair loss. Hair is typically pulled from eyebrows, eyelashes, scalp, beard and pubic area, though hair from other parts of the body may be pulled as well.
Individuals with Trichotillomania may also play with, bite, nibble or chew the hair. If ingested, this may cause a serious condition in need of medical attention. It is not uncommon for people with this disorder to engage in other damaging behaviors such as nail-biting or skin-picking. It appears that significant emotional experiences or feelings can trigger hair pulling. Anxiety, depression, stress, anger, and tension may increase the urge to pull. However, hair pulling may also occur when the individual is inactive and subdued; while reading, watching television, doing homework or even lying in bed. Here at RCBM, we fully evaluate individuals suffering from Trichotillomania to assess the disorder and determine if any conditions result from or contribute to the pulling of hair. In addition, we assess the impact on social functioning, academic environment and family relationships. Often times, we work with the family utilizing a cognitive-behavioral approach. This consists of putting together a treatment plan focusing on triggers associated with the pulling (thoughts and feelings – physical and emotional) and the situations in which the pulling occurs. We meet with the patient and family regularly to determine progress and discuss the factors contributing to the pulling/picking behaviors. It is not uncommon for clinicians to ask patients with Trichotillomania to complete activities outside of the therapy session, such as journal writing, progress calendars, worksheets, and creating barriers like wearing band-aids/gloves or hats/scarves.
Women’s Mental Health and Wellness
Research consistently shows that women suffer from mental illness at a higher rate than do men. This is likely due to a combination of the unique stresses women face—such as the pressure to conform to an unrealistic beauty standard or to be a perfect mother—as well as factors such as hormonal shifts.
We work with women of all ages to combat mental illness and manage challenging mental health symptoms. We understand that mental health concerns—whether they be relationship issues or serious depression—rarely derive from a single cause. Instead, we treat the whole woman, looking at the complex interplay of biology, life history, environment, nutrition, and much more.
Infertility and Pregnancy Loss
Though both men and women often aspire to be parents, women are taught from an early age that motherhood is a special, and perhaps mandatory, calling. For this reason, infertility can directly affect a woman's self-esteem and overall mental health. Moreover, the complex biological changes associated with treating infertility can wreak havoc on a woman's hormones, making an already difficult time even more stressful.
Women who struggle with pregnancy loss are often hesitant to seek help. There is still stigma associated with miscarriage, and well-meaning loved ones may inadvertently say hurtful things. Your partner might not feel as connected to the baby as you did, and the sudden hormonal shift associated with a pregnancy loss can compound these challenges. We work with women to navigate the pain associated with infertility and pregnancy loss, to talk to their partners about their pain, to regain a sense of identity after pregnancy loss, and to move forward with confidence no matter what the outcome of fertility treatments may be.
Food and Eating Issues
Women face enormous pressure to be thin, and to meet society's ever-shifting standard of attractiveness. The result is that 90% of people with eating disorders are women. Though anorexia and bulimia tend to get the most attention in the media, some eating disorders cause their sufferers to eat more, not less—notably binge eating disorder.
Eating issues can make you feel terrible about yourself. They also assault your health, and can even contribute to additional problems, such as diabetes, infertility, and anxiety. We work with you to help you establish a healthy relationship with food, achieve a healthy weight, and ignore the near-constant pressure you may feel to conform to an unreasonable beauty standard.
Trauma and Abuse
Trauma is a common experience among women. As many as 1 in 4 women has been raped, and 1 in 3 has experienced intimate partner violence. This type of interpersonal trauma can have far-reaching effects on your self-esteem, relationships, and sense of safety. Women who have experience trauma may develop symptoms of post-traumatic stress disorder (PTSD), or adopt unhealthy coping mechanisms, such as drinking or refusing to leave the house.
We work with you to help you understand how your trauma has affected your life and sense of self. We never push you to talk about something you're not ready to address. Instead, we move slowly and deliberately, helping you feel safe to discuss the pain you have faced.
Prenatal and Postpartum Depression
Pregnancy is a life-altering event that spurs a whirlwind of changes in your body—weight gain, strange medical symptoms such as swelling and high blood pressure, a sense that your body is no longer fully your own, the challenges and triumphs of birth, and so much more. It's no wonder that so many women experience depression either during or immediately after pregnancy.
Hormonal shifts play a significant role in pregnancy-related mental health issues, but hormones are not the sole culprit. Women are more vulnerable to pregnancy-related mental illness if they feel unsupported, have a history of trauma, struggle with financial issues, experience health problems during or after pregnancy, or do not receive adequate assistance to tend to their own health.
We work with you to tease apart the various causes of your depression. We don't write you off as just another case of hormones gone awry. Instead, we'll craft a comprehensive plan to help you get back to being yourself, so you can enjoy motherhood and find a sense of meaning in bonding with your baby.
Transitioning Into Motherhood
There is perhaps no more profound life change than the transition to motherhood. Suddenly you are responsible for caring for a small person. Many women find that the burdens of motherhood fall primarily to them, thanks to generations of gender norms. And women without partners may feel completely alone. From navigating breastfeeding to coping with the stress of a screaming infant, and from managing the mixed emotions of transitioning back to work to rediscovering who you are separate from your identity as a parent, we can help you make the transition to motherhood a smooth one.
From an early age, women are taught to prize their relationships. Relationships make us human, enrich our lives, and offer support through the challenges of life. Too often, though, relationships themselves become the source of life's worst challenges. Infidelity, divorce, breakups, abuse, and relationship conflict can overwhelm even the strongest women, leaving them wondering how to cope.
We can work with you and your partner to get your relationship back on track. Even if your relationship is ending or your partner is unwilling to seek counseling, though, we can hep. A few sessions offer you clarity, a renewed sense of hope, and a deeper faith in your ability to resolve the problems in your relationship—or to move onto a relationship that works better for you.
Mental Health Disorders
Women experience mental illness as a significantly higher rate than men. Doctors don't fully understand why, but the unique pressures of being a woman coupled with the many hormonal shifts women face throughout their lives are likely culprits. Depression, anxiety, obsessive-compulsive disorder, and similar issues are common, but highly treatable. We partner with you to find solutions, both medical and lifestyle-based, that fit into your life and comport with your values.
Amanda Moar Kerbawy, PhD, LLP
Amber Barber, BA
Ashley Ceresnie, PhD, LLP
Benjamin Young, BS BA
Courtney Keeler, BS
Jillian Fortain, PhD, LLP
Kathy Egan, LMSW LMSW
Lindsey Brenz, BA
Simon Levinson, MA, tLLP MA, tLLP