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Specialized Programs at CUCARD

CUCARD's mission is to provide mental health services with the strongest scientific support for providing relief from disability and distress. Our clinicians may recommend that certain individuals and/or families participate in one of our specialized programs.

Please click the links below to learn more.

The CALM Program: Treatment for Early Childhood Anxiety Disorders

The CALM Program (Coaching Approach behavior and Leading by Modeling) developed by Anne Marie Albano, Ph.D., Jonathan Comer, Ph.D., and Anthony Puliafico, Ph.D., is an evidence-based cognitive-behavioral treatment used to address anxiety disorders in young children ages 2-7.

The CALM Program is a modification of Parent-Child Interaction Therapy (PCIT; Eyberg, 2010; McNeil & Hembree-Kigin, 2011) and also builds on the treatment PCIT-SAD treatment for separation anxiety in young children developed by Donna Pincus, Ph.D., and colleagues (Choate et al., 2005; Pincus et al., 2005, 2010). The CALM Program addresses the needs of young children presenting with separation anxiety disorder, social anxiety disorder, generalized anxiety disorder, and/or specific phobias.

The CALM Program is delivered using a behavioral parent training approach, and the therapist meets weekly with both the child and their parents. During these sessions, the therapist teaches parents specific skills to encourage and reward their child’s “brave behavior.” The CALM Program is unique in that the therapist also provides individualized, in-the-moment parent coaching to assist parents in using these skills during interactions with their anxious child. Through this program, the parents become key agents of change in supporting their child in developing coping skills and mastery over their anxiety. Length of treatment varies, but typically families in our program participate in 12-16 weekly 45-minute treatment sessions.

Treatment goals include:

  • Providing parents with directive and specific skills for encouraging their child’s brave
  • behavior and decreasing their child’s anxious behavior  
  • Providing opportunities for children to practice coping with anxiety-provoking situations in a gradual, supportive manner
  • Decreasing child and parent distress during anxiety-provoking situations
  • Strengthening a positive, mutually rewarding parent-child relationship

ADHD and Behavioral Disorders

The Program for ADHD & Behavioral Disorders at CUCARD offers a multi-modal treatment approach for children, comprised of a combination of a comprehensive diagnostic evaluation, parent training, school consultation, medication consultation, and cognitive behavioral therapy.

Comprehensive Diagnostic Evaluations
Children with behavioral disorders often present with underlying disorders that can be identified with specialized and comprehensive diagnostic evaluations. Our expert diagnosticians gather pertinent information in an effort to arrive at the most accurate diagnosis that will guide the most effective evidence-based treatments.

Parent Training
Parent Training programs have been shown through research to be the most effective treatments for child behavioral disorders. Parents learn specific skills on how to respond to their children in an effective manner, including:

  • attending to appropriate behavior and ignoring negative behavior
  • using positive reinforcements
  • giving effective commands
  • using effective and consistent mild consequences for misbehavior

We offer the following parent training interventions:

Parent-Child Interaction Therapy (PCIT)
PCIT is a gold-standard treatment for young children with disruptive behaviors. PCIT provides parents with live coaching to adapt their parenting skills.

More Information about Parent-Child Interaction Therapy (PCIT)

Parent-Child Interaction Therapy (PCIT) is a specialized therapy program designed to treat young children with behavior problems, such as defiance, aggression, or tantrums. PCIT involves working with parents and their young children to learn more effective ways of positively interacting, improve child compliance, and reduce disruptive behavior.

What separates PCIT from other forms of child treatment is the active coaching component. While other forms of treatment involve education and instruction regarding effective parenting techniques, in PCIT parents practice these skills while receiving live, active coaching by their PCIT therapist.

PCIT is conducted in two phases. During the first phase, Child-Directed Interactions, parents learn and then subsequently practice play therapy skills which are designed to enhance the parent-child relationship, improve child social skills, and encourage good behavior, while simultaneously cultivating parent attention as a powerful reward. The second phase, Parent-Directed Interactions, involves learning and practicing structured and effective techniques for disciplining child misbehavior. During this phase, parents learn how to give commands, use time-out as an effective punishment, and enforce the rules of their home.

PCIT is often a short-term treatment, with some families requiring as few as 12 treatment sessions. Numerous research studies have shown strong evidence supporting PCIT as an effective and efficient treatment for children with disruptive behavior, with child behavior improvement remaining long after treatment has ended.

At CUCARD, we also offer the CALM program, an adaptation of PCIT for families with young, anxious children ages 3 to 8 years of age. The Coaching Approach behavior and Leading through Modeling program was developed by CUCARD staff and is appropriate for families with children presenting with separation anxiety, extreme shyness and social anxiety, fears of specific situations (e.g., the dark, animals, doctors, clowns), selective mutism (refusal to speak outside of the home), and other anxiety conditions.

Parent Management Training (PMT)
PMT is an evidence-based treatment for disruptive and explosive children ages 3-14. PMT can be offered in individual and group session formats.

More Information about Parent Management Training

Parent Management Training (PMT) is an evidence-based treatment for disruptive, non-compliant, aggressive, and oppositional children between the ages of 3-14. It teaches parents specific behavioral skills designed to increase appropriate behaviors and reduce negative behaviors in disruptive children. Research shows that when these steps are applied, it results in improved behavioral compliance, arguing, tantrums, and parent-child interaction.

PMT is a skill-based treatment that gives parents concrete tools to deal more effectively with their disruptive child. Each PMT session focuses on teaching a new skill that parents can utilize toward their children right away. Time is spent during each session discussing why coercive parenting methods are ineffective, explaining how PMT skills work, and then actually practicing these skills in session.

What are the specific skills taught?

  • Explanation of why children misbehave
  • Increasing special time with your child
  • Increasing parental attention to positive behavior
  • Using effective commands to increase compliance
  • Using positive reinforcements (privileges, point charts) to increase compliance
  • Using consistent consequences for inappropriate behavior
  • How to ignore misbehavior and attend to appropriate behavior
  • How to improve school behaviors
  • Extending consequences to other behaviors
  • How to handle more severe, infrequent behaviors
  • How to compromise with your child
  • Managing child behavior in public situations
  • Predicting triggers and preventing future problems
  • Booster sessions and follow-up meetings

Length of treatment depend on several factors. Some parents experiencing mild non-compliance with their children can see significant improvements within 10 sessions. Parents whose children present with more significant non-compliance and aggression tend to require longer treatment. The decision to end PMT will be made collaboratively with the therapist and parents when the parents feel comfortable with implementing the skills consistently and the child’s behavior has improved.

It is important to note that parents are the primary focus in treatment in PMT. This means that, although we may try to incorporate your child during specific sessions, your child does not necessarily have to be seen during the course of treatment. In fact, research shows that PMT can be just as effective without the child ever being present as if he or she is routinely involved in sessions. The decision to include your child in treatment in addition to PMT will be discussed between parents and the therapist.

School Teacher Behavioral Consultation
Given that children with behavioral disorders often exhibit symptoms in school, it is at times necessary to target these behaviors directly. Our team consults directly with teachers to offer effective behavior management skills, including a positive behavior system.

Cognitive Behavioral Therapy
CBT for children with anger, impulsive aggression, and other disruptive behaviors, when combined with parent training, can produce long- term improvement, especially for children over 8 years of age. In CBT, greater emphasis is placed on teaching the child skills to cope with his/her emotions more appropriately. Typical skills taught in CBT to reduce anger are:

  • emotional recognition
  • body-calming techniques
  • perspective-taking skills
  • changing distorted thinking about anger-provoking situations
  • developing problem-solving skills

What Would Treatment Look Like for Your Child?

  • Step 1: Parents and child are seen by an experienced clinician for a comprehensive diagnostic intake evaluation.
  • Step 2: The intake clinician will meet with the family to discuss diagnostic impressions, explain how the child’s problems have been impacting functioning, and thoroughly discuss treatment plans.
  • Step 3: Start treatment. Specific type and duration of treatment depends on the severity of the child’s condition and over time, their response to the treatment provided. Research has shown that children with disruptive behaviors can show significant improvement within 10-15 weeks. The treating clinician will set goals and monitor progress with you to make ongoing decisions about your child’s care.

Launching Emerging Adults Program (LEAP): Helping Young Adults Thrive

Throughout CUCARD’s history, Dr. Albano and her team have focused not just on reducing symptoms of anxiety and depression, but also helping patients develop skills needed to succeed in life. With the generous support of our donors, CUCARD has developed “LEAP: The Launching Emerging Adults Program". This new treatment expands on traditional cognitive-behavioral exposure therapy by integrating skills needed to help the millennial generation thrive in adulthood. The LEAP program is designed for families struggling with “failure to launch” issues including transition from high school to college, work and career problems, family conflict, limitations in friendships and romantic relationships, and limited independence. Through the LEAP program, we assist parents in letting go of their emerging adult while they take on the challenges of growing into independence.

In 2013, the LEAP model became the cornerstone psychological treatment of the New York Presbyterian Hospital's Youth Anxiety Center (YAC), a new, landmark collaborative program that focuses on the unique needs of young adults with anxiety and related disorders.

Intensive Cognitive Behavior Therapy for Anxiety Disorders

CUCARD provides personalized, intensive therapy programs for individuals suffering with anxiety disorders. Intensive treatment begins with a thorough evaluation of the presenting problem and development of goals and the intensive treatment plan. Sessions are often longer than typical (e.g., 90 minutes to 120 minutes each) and usually scheduled to occur several times per day and occurring on several days during a week. We offer intensive for specific phobias, panic disorder with or without agoraphobia, and obsessive-compulsive disorder.

Intensive CBT includes:

  • Education about anxiety disorders and CBT
  • Training in appropriate somatic management and mindfulness techniques to address anxiety-related bodily sensations
  • Development of skills to cope with self-defeating thinking styles
  • Engaging in specially designed behavioral exposures to anxiety provoking stimuli both in clinic as well as in the environment

We welcome active collaboration with current care providers and appropriate family members in defining goals and objectives.

Cognitive Behavioral Group Therapy

CUCARD provides cognitive behavioral group therapy for anxiety disorders. During group treatment, patients typically participate in small groups of 5-7 people for 90-minute sessions. Groups are mixed gender and are available for a variety of ages including adolescents, college students, young adults, and adults. Each group is short term, often lasting for 12-16 weeks. Group treatment is available for a variety of anxiety disorders including social phobia, generalized anxiety disorder, separation anxiety, panic disorder, and obsessive-compulsive disorder.

Groups include a variety of cognitive behavioral therapy principles including:

  • Psychoeducation about anxiety disorders
  • Training in relaxation techniques to manage anxiety-related bodily sensations
  • Development of skills to cope with anxious thoughts
  • Completing behavioral exposures to anxiety provoking stimuli both in clinic as well as outside in neighboring areas
  • Development of problem solving skills
  • Development of social skills

"The Coping Cat" Program

The Coping Cat Program, developed by Philip C. Kendall, Ph.D., is an evidence-based cognitive behavioral treatment used to treat Generalized Anxiety Disorder, Separation Anxiety Disorder, and Social Phobia in youth ages seven and older.

Typically, children meet with the therapist individually on a weekly basis. Parents also attend separate parent sessions at different times during the course of treatment. The therapist, child, and parent collaborate in therapy to help the child develop coping skills and mastery over their anxiety.

Treatment goals include helping children learn to recognize when they are anxious, to monitor their nervous thoughts and feelings, and learn relaxation and problem-solving skills to cope with anxiety. These skills directly address the escape or avoidance of anxiety-provoking situations that underlies the anxiety disorder. Finally, children are provided opportunities to practice their anxiety management skills in challenging situations, a process known as "exposure", in order to foster confidence and new coping habits. What are the skills taught in the Coping Cat program?

Children who participate in the Coping Cat Program learn how to:

  • Identify and label their anxious feelings
  • Use relaxation techniques to calm anxious arousal
  • Identify their anxious thoughts and develop coping thoughts that are more adaptive and proactive
  • Use appropriate problem solving skills
  • Self-monitor and reward their own efforts at coping to become increasingly effective in managing anxiety
  • Practice coping with anxiety-provoking situations in a step-like manner, both in the clinic and through home-based assignments
Individual Coping Cat Treatment

Treatment sessions are generally held weekly. Parents are involved as collaborators in treatment.

Group Coping Cat Treatment

The Coping Cat program is also conducted in group format. Groups meet weekly with children of similar ages.

Several of our CUCARD clinicians were trained directly by Philip C. Kendall, PhD, at Temple University. Our staff members are experts in the delivery of this evidenced-based treatment program, which we are very proud to offer to children and adolescents with separation anxiety, social anxiety, and generalized anxiety disorders.

School Refusal Intensive Services

School refusal behavior is defined as a child or adolescent's refusal to attend classes or difficulty remaining in school for an entire day. Children often refuse school due to strong feelings of anxiety, such as fears of separating from their parents or caregivers or fear of negative evaluation by others, or due to feelings of depression or sadness that may or may not be linked to a specific stressor or event.

The School Refusal Program offers an accelerated treatment program for children and adolescents who are struggling to attend school consistently due to anxiety. The School Refusal Program begins with a clinical psychologist interviewing the child and parents in order to determine the nature of the child's problems. Next, depending on the history of the child's problem with the school, a review of the child's school records as well as a consultation with the child's school may occur. Next, our staff psychologist will consult with the school refusal clinical team to review all of the information together and make the determination as to whether the School Refusal Program would be appropriate for the child and family as a treatment option. At times, referrals for neuropsychological or psychoeducational evaluation may be requested, if there is a suspicion of a specific learning issue affecting the child's ability to attend school comfortably.

Treatment is tailored to match the child's specific needs, with the immediate goal of returning the child to school as quickly as possible. Youth will attend weekly individual therapy sessions targeting consistent school attendance. Depending on the child's concerns, individual treatment may involve gradual exposure to feared situations, skills training, anxiety management training, or behavioral activation to combat depression. Parents are also involved in sessions as necessary to learn strategies for supporting their child’s progress.
In CUCARD Westchester’s School Refusal Program, parents attend weekly parenting workshops to learn the tools and behavior management skills necessary to facilitate their child’s school attendance. The program offers also additional support to families including school consultation, school visits, and individual case support. Clinicians are available “on-call” to provide phone coaching to families on school mornings (7:00 a.m. – 9:00 a.m.), and participating youth are able to complete schoolwork in the clinic with guidance from CUCARD Westchester staff if they are unable to attend school on any given day.

Psychopharmacology Consultation and Management

Medication is used as first-line and adjunctive evidence-based treatment for anxiety, depressive and mood disorders. Research studies in children and adolescents, as well as adults, have shown that for some disorders the combination of medication and CBT is the most effective treatment. The Columbia University Clinic for Anxiety and Related Disorders (CUCARD) provides medication consultation, management, and expert second opinion evaluations.

Virtual Reality for Social Anxiety and the Transition to College

CUCARD has partnered with a technology startup company, Headset Health, to develop a novel immersive virtual reality (VR) program. Our program, among the first of its kind, was designed for use with adolescents and emerging adults struggling with social anxiety and/or the transition the college. Our virtual scenarios allow for skill-building and exposure to a range of anxiety-provoking situations that are otherwise challenging to recreate in the clinic.

Current VR scenarios include:

  • Dorm room: meeting your roommate, asserting needs with your roommate
  • Classroom: giving a speech, asking your professor for an extension
  • Party: introducing yourself to new people, dealing with peer pressure

Skills targeted include:

  • Assertiveness
  • Public speaking
  • Social skills

CUCARD clinicians are currently using VR during both the assessment and treatment process, in both individual and group formats. Our VR scenarios are customizable, allowing for variation in difficulty level and overall experience. Thus, patients and therapists can work together to tailor the virtual experience based on current skill level, degree of anxiety, and/or current treatment goals.

While we are one of the first clinics in the area to use VR for social anxiety and college transition issues, virtual reality-based exposure therapy has been extensively researched and found to be beneficial for a range of anxiety disorders, including:

  • Fear of flying (e.g., Rothbaum, Hodges, Smith, Lee, & Price, 2000)
  • Fear of heights (e.g., Emmelkamp et al., 2002)
  • Fear of spiders (e.g, Garcia-Palacios et al., 2002)
  • Public speaking anxiety (e.g., Anderson et al., 2013; Wallach, Safir, & Bar-Zvi, 2009)

For more information, please contact Dr. Lauren Hoffman at 212-342-0969.