Agoraphobia

Agoraphobia is an anxiety about being in places or situations from which the escape may be difficult or embarrassing (i.e., travelling in a car or a bus, crossing a bridge, being outside the home, being in a crowd, being in enclosed place, standing in line, etc.) In many cases, the person suffering from agoraphobia tries to avoid the feared situations or endures them with great distress. In severe forms, a person may become completely home bound. 

The treatment of choice of agoraphobia is Cognitive Behavioural Therapy (CBT). Treatment includes identifying and, if needed, modifying the thoughts that underlie and drive the person's fear. Additionally, it involves gradual step-by-step exposure to feared situations with the purpose of helping the person unlearn the conditioned fearful response. 

Most people with agoraphobia have other psychological conditions such as panic disorder, phobias, social anxiety, etc. It is very important to establish the correct diagnosis as it will guide the treatment. 


Anxiety

Everybody feels anxious sometimes. We feel anxious when we are scared or think something bad or dangerous may happen. Anxiety is a normal, even helpful and adaptive emotion. It allows us to deal effectively with danger. At times, however, anxiety may become overwhelming and negatively affect our functioning in daily life. We may start avoiding things that make us anxious, or deal with things differently than we normally would. It is important to deal with unhelpful anxiety that might have gotten in the way you live your life. 

Cognitive Behavioural Therapy (CBT) is the evidence-based treatment for anxiety. Using CBT tools, your therapist will guide you in learning helpful strategies for managing your anxiety. You will learn what anxiety is and how to recognize and interpret its signs. In therapy, the unhelpful thoughts that make you anxious and keep your anxiety going will be explored, challenged and modified. Additionally, you and your therapist will identify the behaviours that may contribute to your anxiety, and work of gradually changing them. 

You can stop anxiety from controlling your life! 

To learn more about various aspects of anxiety, check out recent posts on our blog.



Adjustment Disorders

Life changes, such as an illness, going away to school, marriage, divorce, unemployment, new job, being involved in a car accident, etc., cause stress. In most cases, people adjust to those events within a few months. In some cases, however, the emotional (anxiety, depression, worry, tension, stress), behavioural (impaired functioning at home, at work or socially), or physical symptoms do not go away even several months after the occurrence of the stressor. It is important to seek therapy to address those symptoms before they become chronic. 

The treatment of adjustment disorders usually involves assessing the person's problem-solving and coping skills, as well as encouraging and supporting more effective coping. Relaxation techniques and lifestyle changes are often addressed in therapy. Treatment includes helping the person to gain perspective through addressing possible cognitive errors, reevaluating his or her role in the situation, and coming up with specific steps in dealing with the stressor and moving on. 


Anger

Has your life, or the lives of people around you, been negatively affected by your anger? Have you regretted some of the decisions made in anger? Are you ready to make some positive changes in your life and to learn to express your anger in a non-destructive way? 

Together, we can examine in depth what triggers you, how some of our thinking patterns may contribute to anger, and which ways of expressing your anger may lead to undesirable outcomes. With the help of cognitive and behavioural strategies (CBT), we will work on re-examining unhelpful assumptions, modifying the ways anger is expressed, taking a step back from the "tornado" of anger, and greatly reducing conflicts and stress in your life. 

Intense and overwhelming anger may be a symptoms of several psychiatric disorders, such as Borderline Personality Disorder (BPD), Post-Traumatic Stress Disorder (PTSD), one of the mood disorders (Depression, Bipolar Disorder), Oppositional Defiant Disorder, etc. It is, therefore, crucial to see a professional who will be able to establish a differential diagnosis as in those cases different therapeutic strategies will be useful in addition to CBT. For example, Dialectical Behavioural Therapy (DBT) is usually helpful to individuals with Borderline Personality Disorder. In case of a mood disorder, it is important to treat Depression or Bipolar Disorder, which may be the root cause of angry and irritable mood. 

Working in therapy to address your anger is not easy. It requires perseverance and hard work. But it is well worth it of anger is currently getting in the ay of important things in your life. Anger is an important emotion that can play a positive role in your life if you learn to understand it, manage it, and use it appropriately. 


Cognitive Behavioural Therapy (CBT)

Cognitive-Behavioural Therapy (CBT) is a goal-oriented approach that addresses problems related to the interactions between our thinking, feelings, and behaviour. This is an evidence-based treatment that has been proved to be effective in dealing with various emotional disorders, as well as daily life challenges. 

CBT-trained clinician will work with you helping you to not only resolve your problems, but also learn the various effective CBT strategies so that you can become "your own therapist." Those strategies include goal setting, identifying and changing distorted thinking, modifying beliefs, challenging "rules for living", developing a "Fear Ladder", conducting behavioural experiments, addressing and changing behaviour, relapse prevention and learning to relate to others in healthier ways. 


Depression

Do you sometimes feel hopeless and helpless? Have you lost interest in things you used to enjoy? Do you believe that nothing will ever work out? Do you criticize yourself and feel that you just can't do the things that are expected of you? Please do not despair. Those are symptoms of depression and are not a reflection of the reality. 

Cognitive Behavioural Therapy (CBT) has been proven to effectively relieve the symptoms of depression. Through scientifically proven tools, such as behavioral activation, challenging unhelpful cognitions, and practicing mindful awareness, you can change the way you think, feel and behave. 

It is important to seek treatment for depression as early as possible as depression is a self-limiting condition that often takes a persistent and recurring course if left untreated. It affects people on cognitive, emotional, physiological, motivational, and behavioural levels. 

In treatment you will learn techniques that will help you overcome your depression. We will work collaboratively in therapy on reclaiming your life one step at a time. 
 


Dialectical Behaviour Therapy (DBT)

Dialectical Behaviour Therapy (DBT) has been shown to be effective in working with people suffering from intense emotional misery. Such individuals tend to feel things deeper, more intensely, and for longer time than other people. They react excessively to relatively low levels of stress and it takes them longer to return to normal after the stressful situation passed. Such emotionally vulnerable people find it hard to change their thoughts and behaviours without first learning to accept themselves, including their thoughts and feelings. DBT helps people balance acceptance and change. 

DBT is a form of behavioural therapy that focuses on teaching people specific skills that help them cope with distressing emotions. It includes mindfulness, distress tolerance (crisis survival and reality acceptance), interpersonal effectiveness, and emotion regulation skills.


Eating Disorders

Eating Disorders are characterized by disturbed eating or eating-related behaviours. Frequently, a person with an eating disorder is preoccupied with their weight or with food. The three main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. 

Some people exhibit more subtle signs and symptoms of disordered eating that do not meet the full criteria for any of the eating disorders, but are, nevertheless, a cause for serious concern. 

Many people with eating disorders are scared to seek treatment because they are afraid that they will have to gain weight. Others are afraid to give up their eating behaviours that provide emotional comfort and/or a sense of control. The adverse psychological, physical, and social consequences of eating disorders, however, are profound. Eating disorders are usually a sign of a bigger emotional problem and are real, treatable medical illnesses. 

Treatment of eating disorders usually includes Cognitive Behavioural (CBT) strategies, such as addressing over-evaluation of shape and weight, as well as unhelpful weight-control behaviours (dietary restraints and restrictions, binging, purging, etc.), restoring adequate nutrition, bringing weight to a healthy level, and relapse prevention. It is important to understand that in many cases, other psychological issues, and interpersonal relationship difficulties contribute to disordered eating. Those issues need to be identified and addressed in therapy with the goal of developing healthier ways of dealing with them. 


Emetophobia

Emetophobia is an intense irrational fear of vomiting. Most sufferers of emetophobia fear vomiting themselves, while some fear seeing someone else vomit. The standard treatment for emetophobia, as any anxiety disorder, is Cognitive-Behavioural Therapy (CBT), which involves cognitive restructuring and gradual exposure to feared stimuli. This treatment does not require that the individual actually vomit. The person learns to stop avoiding situations, objects and activities that they fear might lead to vomiting. 

Emetophobics frequently suffer from agoraphobia and ritualistic behaviour that may look like OCD. They may wash their hands until raw for fear of germs from an illness that may make them vomit. They may fear seeing someone vomit or catching germs so much that they will not leave the house. Many emetophobics have a variety of rituals to keep from vomiting or to reassure themselves that they are not sick (i.e., obsessive temperature-taking), or superstitions about numbers and dates (especially the date they last vomited). It is, therefore, important to see a therapist who has an understanding of this disorder and is able to provide differential diagnosis and create an appropriate treatment plan. 


Excoriation (Skin-Picking Disorder)

Skin-Picking Disorder is characterized by frequent and intense picking of skin resulting in bleeding, sores and scars, in spite of recurrent attempts to stop. This is often done in an attempt to remove small irregularities or perceived imperfections, but individuals may pick at healthy skin as well. The most common picked sites are the face, arms and hands; however, in some cases multiple body sites are picked. People usually use their fingernails to pick, but often tweezers and other instruments may be used. Skin picking frequently starts as a regular grooming behaviour (everyone picks their skin at times), but it may change into a highly disturbing and embarrassing condition. The majority of skin-pickers are women, and this disorder often starts in adolescence. 

Unfortunately, many people with skin-picking disorder are reluctant to seek help because of embarrassment and shame. It is important, however, to see a psychologist that is knowledgeable in treating excoriation, as even though skin picking intensity frequently fluctuates, it rarely remits completely. Some of the treatments of choice for excoriation are Habit Reversal Training, Stimulus Control, and Cognitive Behavioural Therapy (CBT). 

In treatment, you will increase your awareness of this habit by identifying the emotional, social and other consequences of picking, and whether your picking is usually preceded by a feeling or by a thought. Your therapist will then help you develop a new behaviour (a competing response) that would compete with your picking. You will be then guided in consistently implementing that response.


Generalized Anxiety Disorder (GAD)

GAD is characterized by excessive worry and anxiety about a number of events and activities, when the person finds it difficult to control the worry. The anxiety and worry are usually associated with restlessness, feeling keyed up, being easily fatigued, difficulty concentrating, irritability, muscle tension or sleep disturbance. 

In addition to worrying, individuals with GAD often perceive worry as impossible to control and harmful. At the same time, however, they may view worry process as important for preparing for the future and for the unforeseen circumstances. The problem is that in any case, excessive worry negatively affects their ability to concentrate, make decisions and solve problems. 

Another set of thoughts that is characteristic to people with GAD is their difficulty tolerating the uncertainty, which leads to their continuous exhausting attempts to try and (over)plan for the future. 

Cognitive Behavioural Therapy (CBT) is the treatment of choice for this disorder. In treatment, the patient's thinking patterns are carefully examined and addressed. Beliefs that lead to excessive worry, as well as beliefs about the process of worry are re-evaluated. A great deal of time is devoted to increasing the tolerance for ambiguous situations. An emphasis is put on problem solving, as opposed to unproductive worry. 

To learn more about various aspects of anxiety, check out recent posts on our blog.


Healthy Lifestyle Counseling

We all know that to achieve better quality of life we need to make healthier diet choices, get regular exercise, manage stress well and create an organized calming environment at our homes. There is a great deal of information around; however, it can sometimes be overwhelming. How do we re-organize our homes and our lives? 

At the coaching sessions, we will help you formulate your long-term and short-term goals and motivate and support you in changing your daily habits and routines. Whether you have a specific goal (e.g., organize your week so that you have healthy home-cooked meals, develop and stick to an exercise routine, or make a shift to using non-toxic products in your home), or a broader goal of making healthy changes in many areas of your life - we are here to guide and support you! 
 


Health Anxiety

Illness Anxiety involves a preoccupation with fear of having a serious disorder or a belief that one has a serious disorder. This usually causes great distress. It is treated using Cognitive Behavioural Therapy. One of the main goals of treatment is to identify the thoughts and behaviours that keep the anxiety going, and to gradually modify and eliminate them. 

To learn more about various aspects of anxiety, check out recent posts on our blog.


Life Coaching

Life Coaching is an action-oriented approach. Its objective is to help people achieve their personal goals and fulfill their potential through establishing longt-term, short-term and immediate goals, increasing motivation, and removing emotional and psychological obstacles. In the course of the life-coaching sessions, all the areas of the person's life that could benefit from improvement will be addressed: personal and family life, career, parenting, productivity, health and lifestyle choices, daily organizational strategies, etc. 


Low Self-Esteem

A person with low self-esteem usually evaluates himself or herself in a negative way. If you have low self-esteem you may find it difficult to accept yourself the way you are. You may feel inferior or inadequate in some way. You may frequently doubt yourself and feel undeserving of the good things in life. Such beliefs undoubtedly negatively affect many areas of your life such as your career, relationships, mood, self-care, and physical and emotional health. 

Why do people have low self-esteem? Low self-esteem is usually the result of life experiences. Most of the time, those experiences happened early on in life. Among the common experiences contributing to the development of low self-esteem are inability to meet your parents' high standards, lack of warmth and empathy in the family, being bullied, a sense of non-belonging to your peer group, feeling "different", "odd" or excluded. 

There are several strategies of dealing with low self-esteem. In our clinic, the first treatment of choice is often CBT (Cognitive Behavioural Therapy). We will address the self-esteem on three levels: your deeply rooted views of yourself, your self-imposed rules for dealing with everyday life situations, and your automatic, knee-jerk reactions to situations that trigger those deeply rooted beliefs. 

In time, you will develop a more balanced reaction to everyday stresses, a more positive perception of yourself, and a sense of self-acceptance.


Mindfulness

Mindfulness is the state of acknowledging what is happening in the present moment and accepting it as it is, without judging or evaluating it. 

Our every moment is usually filled with thoughts - assessing, judging, worrying, regretting, protesting. We ruminate about the past and worry about the future. There is little space left for attending to the present moment as it is. That way, we identify with our thoughts and don't see ourselves as separate from them. Our thoughts become our reality, and we become slaves to the thoughts that are rapidly generated by our brain and interpreted by our mind. 

If, however, you stop and attend to the present as an observer, without identifying with the thoughts and the judgement, you develop a capacity to observe what your mind is doing. That way, you gradually learn to mindfully respond to situations and thoughts, as opposed to being mindlessly reactive to them. 

There are two main approaches to developing mindfulness - formal meditation practice and informal mindfulness of the moment practice. 

Meditation teaches you to attend to present moment by bringing your awareness back gently from external and internal distraction. It requires allocating some time in your day, starting with a few minutes, to quietly sit and breathe, while acknowledging your thoughts, feelings and physical reactions, but not engaging with them. 

The informal practice involves disengaging from your reactive thoughts as you go about your day. This does not mean that your mind needs to be "clear of the thoughts" and does not involve thought stopping. It just means acknowledging the thoughts, accepting them as they are, and continuing to attend to the present moment. 

By becoming mindful, we develop an an ability for conscious living, being in touch with yourself, and seeing things as they are.


Obsessive-Compulsive Disorder

This disorder includes either obsessions (intrusive recurrent thoughts and impulses that cause distress) or compulsions (repetitive behaviours or mental acts that the person is driven to perform in order to reduce the anxiety caused by the obsession). In most cases, both obsessions and compulsions are present. 

Many people assume that OCD is related to excessive hand-washing and a need to keep everything in order. In reality, however, OCD can take numerous forms, such as: 
 

  • Compulsive checking. Repeatedly checking and re-checking doors, locks, stove, iron, etc. The checking can also be health-related. Checking temporarily reduces anxiety brought by the obsessive thoughts about pending disaster, but this relief is short-lived - the anxiety always returns with a vengeance.

  • Washing and cleaning. The constant washing, cleaning, and sanitizing is related to obsessions about contamination by germs, viruses, dirt, chemicals, air pollution and other potentially harmful substances.

  • Hoarding. Collecting insignificant items and having difficulty letting go of things that other people would consider junk.

  • Ordering, repeating, and symmetry. Arranging and re-arranging things until it feels "just right."

  • Scrupulosity. Obsessions about offending God, or violating religious, moral, or ethical principles.

  • Primary obsessional OCD (Pure O). In this case, there are hardly any visible rituals present. The obsessions can be about violence, harm to self or others, or they can be of sexual nature. Even though this form of OCD is frequently called "Pure O" over the internet, in most cases, people do engage in numerous mental rituals, such as trying to suppress or "neutralize" the thoughts or performing invisible mental rituals - praying, counting, checking, or repeating a lucky/positive phrase.


OCD is treated by Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP), which have been proven to be the golden standard of treatment of this disorder. 

Check out our blog posts on OCD for more insight.


Panic Attacks

A Panic Attack is a discrete period of intense fear or discomfort that develops abruptly and unexpectedly and reaches a peak within approximately ten minutes. It could include the following symptoms: palpitations or pounding heart, sweating, trembling, shortness of breath, feeling of choking chest pain, nausea or abdominal distress, feeling of derealization or depersonalization, fear of losing control or going crazy, fear of dying, numbing or tingling, and chills or hot flashes. Sometimes they feel like heart attacks. 


Panic Disorder

Panic Disorder is characterized by recurrent unexpected Panic Attacks. At least one of the attacks has been followed by a month or more of persistent concern about having another attack, worry about the consequences of the attack, or a change in behaviour related to the attacks. It can often be accompanied by Agoraphobia. Cognitive Behavioural Therapy (CBT) is a very effective specialized treatment of Panic Disorder. 


Parenting Issues

These days we are bombarded with advice about parenting. There are books about parenting from every theoretical perspective and personal point of view imaginable. There are articles on the internet, heated discussions on Facebook and parents' forums, and advice from well-meaning relatives and friends. The advice is often conflicting. You will be told that a child will develop more secure attachment if she sleeps in her parents' bed, and you will be told that it is imperative that the child is trained to sleep in her own bed early on. You will read about the importance of emphasizing academic achievement, and you will then read in a different source that it is more important to develop emotional intelligence. Time-out or time-in? Attachment parenting or clear boundaries? Daycare or nanny? Public or private school? Or maybe French Immersion? 

In addition to conflicting general parenting advice, parents often struggle with the issues of discipline, relationships between family members, conflicts and rivalry among siblings, as well as fears, anxieties and other psychological problems in children and teens. 

Our approach to parenting is no-nonsense hands-on advice geared to your particular child and your specific family situation. What works for one child may be contraindicated for another. After thoroughly assessing the history and the current situation, we will discuss specific strategies to address the issue. This may include behaviour modification strategies, communication tools, advice on modifying daily routine and schedule, or a referral to a specialist. As all our services are either provided or supervised by a Clinical Psychologist, a careful assessment will be conducted to rule out a psychological health problem.


Phobias

A Phobia is a persistent excessive and unreasonable fear of a specific object or situation. This disorder is usually accompanied by either avoiding the object or situation, or enduring it with intense distress. The most common phobias include: animal type, natural environment type (e.g., heights, storms), blood-injection-injury type, and situational type (e.g., elevators). 
CBT provides an effective evidenced-based treatment for Phobias, specifically exposure-based treatment. 


Psychologist

Psychologists are regulated health professionals and are required to meet rigorous education, training and supervision requirements. 

Unlike many other mental health professionals (social workers, psychotherapists, family therapists, and counselors), psychologists can perform the controlled act of making an accurate diagnosis, which is crucial for effective treatment of numerous psychological health problems. This is a very important distinction as in order to develop an appropriate treatment plan, it is imperative to first conduct a careful assessment, to rule out possible psychological disorders, and to establish a diagnosis which will guide the treatment. 

All the services at Turning Point are provided under a supervision of a Registered Psychologist and a certified member of the College of Psychologists of Ontario (CPO). Ms. Anna Prudovski, the Clinical Director of Turning Point, has over 15 years of experience practicing in various settings, such as hospitals, community agencies, and in private practice. She is trained and qualified to assess, diagnose, treat, and prevent various psychological conditions in children, adolescents and adults. In addition to being registered with CPO, she is a certified Diplomate and the Credentialing Committee Member of the Academy of Cognitive Therapy (ACT) and a Founding Member of the Canadian Association of Cognitive Behavioural Therapists (CACBT). 


Productivity and time management

Do you go through life with a feeling that you just never get things done? Do you have difficulty staying in the moment when you spend time with your family or try to relax? Have you tried implementing strategies, such as daily "To Do" lists and setting priorities, only to find yourself re-writing the lists all over again, not accomplishing much and feeling frustrated? 

Our lives today are busier than ever. It is difficult or impossible to keep everything we need to do in our mind, and we end up living with constant anxiety that we may miss something important that needs to be done. There are simple and effective ways of managing your complex daily tasks and commitments - both at work and at home. In our sessions we will talk about tools that will help you approach your current and future commitments with calm and clear mind, without feeling overwhelmed and frustrated. 


Psychotherapy

In psychotherapy, patients work toward achieving their goals, overcoming obstacles to growth, developing an in-depth self-understanding, and making changes in their lives through a therapeutic relationship with the therapist. Whether you seek therapy to treat a psychological disorder, to improve interpersonal relationships or overcome fears, anger, low mood or other issues, - our ultimate goal is to help you, through therapy, to achieve a greater sense of well being. Psychotherapy is an exciting journey toward self-realization. It involves an ongoing dialogue, collaboration, and examining your feelings, thoughts and behaviour through a variety of therapeutic tools. 


Unfortunately, a great deal of marriages ends up in divorce. About 40% of Canadian families will face a divorce before reaching a 30 year wedding anniversary. Separation and divorce bring with them stress, uncertainty, anxiety, anger, and a wide range of other emotions, which are often overwhelming and confusing. 

If you are preparing to separate, or are in the process of separation and divorce, you may have a lot of questions. How to deal with your spouse? How and when to tell the children about the breakup? What are the different approaches to the children of different ages in this situation? 

You may think that those dilemmas end when the divorce is finalized. However, new issues then come up. How to co-parent your children with your former spouse? How to organize holidays or special occasions? How to help your children deal with your or your ex-spouse's new relationship or remarriage? How to avoid mistakes when blending two families? How to be a stepparent? 

In the last few years, an increasing number of parents seek professional advice on how to handle this life transition in the best way. A therapist with the knowledge of the issues of separation and divorce, as well as an understanding of developmental milestones that affect each child's potential response to the separation, can be a great source of support and guidance during this difficult period. 


Social Anxiety Disorder

Social Anxiety involves a fear of social or performance situations. The person is worried that his or her behaviour will be embarrassing or humiliating. There are numerous strategies of dealing with Social Anxiety. They include cognitive therapy, behavioural experiments, exposure, and social skills training. 

To learn more about various aspects of anxiety, check out recent posts on our blog.


Solution-Focused Therapy

In Solution-Focused Therapy clients are encouraged to focus on their strengths and to identify solutions. The solutions may be new, or the ones that already worked in the past. This is typically a very brief form of therapy, sometimes requiring only a few sessions. 


Stress Management

Everyone at times experiences stress and anxiety. It is important, however, to seek help if you feel that stress and anxiety overwhelm you to the point of negatively affecting your quality of life. Long-term, chronic stress can be harmful to your physical and mental health. Among common stressors are major life events and transitions, such as marriage, pregnancy, a birth of a child, changing jobs or losing a job, experiencing losses, and many others. In addition to those major life events, routine everyday stresses, such as competitive environment at work or school, conflicts with peers and family members, financial pressures, and health concerns, also contribute to elevated stress levels. 

Why is it that people react so differently to stress-provoking events? The answer to that question is complex, as a person's response to stress depends on their core beliefs about the world, themselves and others, which directly affect their perceptions, thoughts and actions in stressful situations. The availability of social support system may also play a part. Our perception is our reality, and, therefore, it determines whether we see our daily events as a threat or as a challenge on our way to success. 

Working with a psychologist to uncover those core beliefs that guide our perception will allow you to have a better understanding of your reaction to stressful events and to develop more adaptive ways of coping. 


Supervision and Consultations

We offer clinical supervision and consultations for providers of psychotherapy. At our supervision sessions we will discuss clinical issues arising in therapy, therapeutic content and process, counter transference, as well as therapeutic approaches and modalities. 

Additionally, as a Certified Diplomate of the Academy of Cognitive Therapy (ACT) and a Founding Member of the Canadian Association of Cognitive and Behavioural Therapies (CACBT), Anna Prudovski, M.A., C.Psych., provides specific training and supervision in Cognitive Behavioral Therapy (CBT) at introductory, intermediate and advanced levels. 

The supervision is eligible for Clinical Supervision Hours as defined by the College of Registered Psychotherapists of Ontario (CRPO) - both prior to and after the proclamation of the Psychotherapy Act.


Trichotillomania (Hair-Pulling)

Trichotillomania (Hair Pulling, TTM, trich) is characterized by recurrent pulling of hair, resulting in hair loss, in spite of repeated attempts to stop. Hair may be pulled from scalp, eyelashes, eyebrows, pubic area, underarms, and other parts of the body. The treatment of choice for the Hair-Pulling Disorder is Cognitive Behavioural Therapy (CBT), specifically - Habit-Reversal Training, and the Comprehensive Model for Behavioral Treatment of Trichotillomania.