Tory Tomassetti

New Year No Fear

January 24, 2024 by Tory Tomassetti

New Year, No Fear

Twenty-twenty-three was a big year for most of us

– it marked a return to a version of life that resembled our time before the Covid-19 pandemic. Many of us returned to the office, resumed travel, and rarely thought of the consequences of doing routine activities like dining indoors or going to a movie theatre.

Twenty-twenty-three was also a record year at my practice. Not only did I return to in-person work at my Union Square office, but I treated a record number of phobias using both the single session phobia format and the more traditional multisession phobia format.

Most people who call me to inquire about phobia treatment have been dealing with their phobia for many years. They have either suffered through encounters with their phobic stimulus or they have gone to great lengths to avoid it.

This year, I met with people who have:

avoided air travel, even though they wanted to see close relatives
avoided traveling for vacations due to fear of encountering certain animals
delayed essential medical treatments due to fear of needles, blood draws, and dental interventions
spent hours on the ferry or thousands on taxis instead of taking the subway
avoided important appointments due to fear of elevators
avoided restaurants, bars, and social gatherings due to fear of vomit

and many more!

In each case, I worked closely with my client to develop a highly individualized treatment plan to cure their phobia. I went on “field trips” to find mice, rats, cats, tarantulas, elevators, and laboratories for bloodwork/vaccines. I spent hours riding subways, going through tunnels, and accompanying my clients wherever they were too fearful to venture alone. I even brought one of my own cats to the office as my assistant for a client with a lifelong fear of felines!

New this year: virtual reality

During the past year, I also began using virtual reality in some of my phobia treatment sessions. Using the latest VR headset technology, I was able to introduce another level of nuance for clients with certain phobias. The virtual reality allowed clients to “encounter” certain stimuli in a manner that felt more real than watching a video, but more approachable than say, holding a rodent in their own hand. After being comfortable with a stimulus using VR, my clients were ready to move up their exposure hierarchy and confront the “live” version of their feared stimulus.

Phobias are one of my favorite things to treat because my clients are always exhilarated after overcoming their fear. They are usually very surprised at the end of a long phobia session and are eager to phone a friend or family member to tell them about their success. Often, they ask for a photo as proof that they “did the thing,” so they can show their loved ones evidence of their incredible feat.

In 2024, I hope to continue providing this short term treatment to people with phobias of all kinds. I am ready to tackle both the “common” phobias like heights, airplanes, and needles, as well as those less frequently discussed phobias, such as specific insects, animals, or medical procedures.

Not sure if I can treat your phobia? Contact me for a consultation to see if phobia treatment is the right option for you.

Cognitive Behavioral Therapy for Insomnia: Getting Out of Your Head

April 8, 2022 by Tory Tomassetti

Cognitive Behavioral Therapy for Insomnia: Getting Out of Your Head

You snooze, you lose? Not so much. Sleep dissatisfaction is one of the most prevalent complaints in medical and mental health settings (Ferrie et al., 2011). More than just feeling groggy after a late night out, insomnia is a serious concern for those who aren’t achieving the quantity or quality of sleep they need.

Sleep is essential for our health and has been shown to benefit emotional regulation, physical performance, cognitive processes (e.g., attention, memory, and processing speed), as well as one’s ability to effectively cope with daily stressors (Ellenbogen, 2005 & Vyazovskiy, 2015). Sleep deprivation can lead to significant difficulties with attention, concentration, memory, and decision-making. Not getting enough sleep, or getting low quality sleep, can result in mood disturbances (think irritability, anxiety, and depression), poor physical coordination, and slowed reaction time.

If you are one of millions of people who have difficulty initiating or maintaining sleep, you know that poor sleep is a recipe for disaster when combined with everyday life stress. Your mental health, interpersonal functioning, occupational, and academic performance all suffer when you’re not getting the right amount of z’s. So, what’s keeping you up at night? Science (and experience) tells us that sleep can be negatively impacted by physical discomfort, unhelpful or intrusive thoughts, and distressing emotions.

Everyday life stressors can lead to physical tension, which for some, leads to difficulties relaxing their bodies at night when they get into bed. For those with anxiety, the peace and quiet at bedtime is often interrupted by worries, memories of embarrassing moments, or other obsessive rumination. Similarly, when an individual experiences emotional distress, while it is often “convenient” to push the emotions aside during the day in attempt to check off the to-do list, at night, those emotions can come to the surface and disturb one’s ability to sleep peacefully. And sleeping too much, not enough, or waking earlier than desired in the morning are all common symptoms of depression.

Even in the absence of a diagnosable mental health disorder such as anxiety or depression, poor quality sleep can significantly interfere with your life at home, work, or during leisure. In fact, some of the happiest events in life can lead to poor sleep. Planning a wedding? Welcoming a new baby into your life? Starting a new job? Looking forward to retirement? Changes in your routine and anticipation of exciting life events can get in the way of our sleep and make enjoying those events more difficult.

If you have been experiencing sleep difficulties for more than a few weeks, you may benefit from getting out of your head and into your therapist’s (virtual) office. Cognitive behavioral therapy for insomnia (CBT-I) is a short-term, evidenced-based treatment that Dr. Tomassetti employs to assist her clients in acquiring optimal sleep health. CBT-I has been identified as the first-line intervention for chronic insomnia, with research demonstrating its benefits are superior when compared to individuals being treated with pharmacotherapy (i.e., sleep medications) (Jacobs et al., 2004). Dr. Tomassetti will help you identify sleep habits that would benefit from enhancement to improve your sleep and will assist you in individualizing your bedtime routine by considering your sleep hygiene in the context of your specific environment, preferences, and resources.

Like all CBT approaches, CBT-I begins with assessment and education. Dr. Tomassetti believes it is her job to make YOU your own therapist. To that end, she will teach you effective strategies to employ during the day and prior to bed to promote optimal sleep. Through CBT-I, you will learn a variety of sleep interventions that have been designed in the context of sleep studies and shown to decrease the time it takes to fall asleep, decrease the number of nighttime awakenings, and improve the overall quality of one’s sleep (Newson & Dimitriu, 2020 & Trauer et al., 2015).

CBT-I is highly individualized to meet your needs, and has been proven effective for people of all ages from adolescence to older adulthood (De Bruin et al., 2015 & Irwin, Cole, & Nicassio, 2006). So, whether you are the person planning that three-week trip abroad, or the one ruminating on the embarrassing thing you did five years ago, Dr. Tomassetti will design your treatment accordingly. If you cannot seem to relax physically at night, Dr. Tomassetti will equip you with evidence-based relaxation strategies to soothe your body and mind at night. If it is rumination, worry, or problem-solving the moment your head hits the pillow, then CBT-I will likely include cognitive techniques to help you achieve the inner tranquility you need to drift off at night. If it is the intensity of emotions that prevents you from falling into a peaceful sleep, then Dr. Tomassetti will help you identify emotion regulation strategies to employ throughout the day and at bedtime to address this concern.

Whether you are experiencing temporary life stressors, chronic heightened anxiety, or some other unknown cause of sleep disturbance, CBT-I may be just what you need to get your sleep back on track. Call Dr. Tomassetti today to discuss treatment options and see if CBT-I is the right approach for you.

References

De Bruin, E. J., Bögels, S. M., Oort, F. J., & Meijer, A. M. (2015). Efficacy of Cognitive Behavioral Therapy for Insomnia in Adolescents: A Randomized Controlled Trial with Internet Therapy, Group Therapy and A Waiting List Condition. Sleep, 38(12), 1913–1926. https://doi.org/10.5665/sleep.5240
Ellenbogen, J. M. (2005). Cognitive benefits of sleep and their loss due to sleep deprivation. Neurology, 64(7), 25-27.
Ferrie, J. E., Kumari, M., Salo, P., Singh-Manoux, A., & Kivimäki, M. (2011). Sleep epidemiology—a rapidly growing field. International Journal of Epidemiology, 40(6). 1431–1437.
Irwin, M. R., Cole, J. C., Nicassio, P. M. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25(1). 3–14.
Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: A randomized controlled trial and direct comparison. Arch Internal Medicine, 164(17). 1888–1896. doi:10.1001/archinte.164.17.1888
Newsom, R. & Dimitriu, A. (2020). Cognitive behavioral therapy for insomnia (CBT-I). Sleep foundation.
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of internal medicine, 163(3), 191–204. https://doi.org/10.7326/M14-2841
Vyazovskiy V. V. (2015). Sleep, recovery, and metaregulation: explaining the benefits of sleep. Nature and science of sleep, 7, 171–184. https://doi.org/10.2147/NSS.S54036

Call Dr. Tory Tomassetti today!

Single-Session Phobia Treatment: Client Success Story

November 15, 2021 by Tory Tomassetti

Single-Session Phobia Treatment: Client Success Story

“I am forever grateful for the time I spent in treatment with Dr. Tomassetti, and wish I would have pursued single session phobia treatment sooner!”

By definition, phobias are something that we do our best to avoid. People with phobias will go to great lengths to minimize contact with the object of their fear. Afraid of snakes? Forget that day trip to hike around the Hudson River. Terrified of vomit? You’ll just have to miss that party. Fear of flying? It’s only road trips for you!

Levity aside, intense fears can cause significant distress. Prior to treatment, some of my clients have been unable to attend even the most important family events due to fear of flying, or have postponed necessary medical treatment due to fear of blood or injections. Women have reported to me that they have even delayed pregnancy due to intense fear of nausea and vomiting.

As a high-energy person, I enjoy getting down to business and getting things done in an efficient manner. The best way to get over a fear is to face it. Although single session phobia treatment is evidence-based, it is not offered by many psychologists. For these reasons, I’ve dedicated a part of my practice to single session phobia treatment: the most efficient way to overcome phobic avoidance. This intensive option is favored by clients who are motivated to just get it over with as quickly as possible. With a motivated and confident professional guiding you, almost everyone can overcome their phobia.

If you are considering this one-session option, check out this blog to hear one client’s perspective on the process. *Published with permission, certain details have been edited for clarity and to protect the client’s anonymity.

client success story!

“When I first heard of ‘Single Session Phobia Treatment,’ I thought it was too good to be true. Surely, I wouldn’t be able to address my fear of needles in ONE session. I decided to at least meet with Dr. Tomassetti for an intake appointment. When I did, she explained the rationale for treatment, including a summary of the evidence in support of this treatment, her success with other clients like me, and a description of the structure of the single session versus the longer format treatment. She explained all of this in such a way that it made sense to me, so I thought ‘why not?’ Dr. Tomassetti had a warm and inviting demeanor, which I found comforting, as I thought about the discomfort I would likely experience while soon facing my fear. She also managed to make me laugh during the intake, so I took that as another sign that I found the right fit.

At the start of the exposure session, Dr. Tomassetti guided me through the development of a “hierarchy.” The hierarchy is a list of things that I felt afraid of – everything from just thinking about needles to watching videos of people getting injections to getting an injection or blood draw myself! We used something called “SUDS” to describe how scary each item was to me. After we finished making this list, we started with something low on the list, which was simply talking about needles. Slowly, we proceeded to watching videos of nurses handling needles and eventually of sticking a patient. Next, Dr. Tomassetti presented an actual needle, and I observed as she stuck herself with the small needle. After watching Dr. Tomassetti handle the needle, I was given the opportunity to handle a clean needle myself. Dr. Tomassetti was so hands on with this process, that she even presented a dummy used for training nurses, giving me the opportunity to observe her performing a “blood draw” and allowing me to actually stick the dummy with the needle myself! If you had asked me a day before this session if I could have done any of this, I would have said “no way!” Dr. Tomassetti was exceptionally professional and invested in my success. She had various props ready and available to foster my victory!

With each additional step in my hierarchy, I was being exposed, and at the same time desensitized to my fears surrounding needles. Every few steps, we would take a quick break to breathe, stretch, and process what was happening. At the end of each hour, I was shocked at how much I had accomplished. I was now mindlessly holding a capped needle while having a conversation about where I might get my first flu shot ever.

Through the process, Dr. Tomassetti also helped me with challenging my fears and restructuring my thoughts to be more accurate and helpful. She equipped me with behavioral strategies so that I could gain greater control over my physiological sensations. For example, she taught me breathing strategies that allowed me to regulate not only my breathing, but even my heart rate. She also taught me how to eliminate the possibility of passing out by teaching me how to position my body into a squat position and wrap my arms around my legs. So, while the point of this single session was to expose myself to my long-held fear so that I could debunk the irrational beliefs I adopted, Dr. Tomassetti also taught me a variety of coping skills that I have since found useful in other contexts as well.

All of this culminated in Dr. Tomassetti accompanying me to the doctor’s office so that I could have my blood drawn – something I had been avoiding for years. Engaging in this single session phobia treatment with Dr. Tomassetti was probably one of the most empowering ways I could have spent six hours. Successfully allowing my blood to be drawn, without passing out, felt incredibly freeing. I am forever grateful for the time I spent in treatment with Dr. Tomassetti, and wish I would have pursued single session phobia treatment sooner!”

Contact Dr. Tory Tomassetti today!

If you are considering phobia treatment, contact me to talk about the best form of treatment for you. While not all phobias are well-suited for a one-session format, examples of phobias that would be a good fit include: needle/injection phobia, bodily fluid phobias, insect/animal phobias, and dental phobias. While phobia treatment can sound intimidating, I will be with you each step of the way- I’ll hold the snake, ride the elevator, look over the edge of a tall building, or even handle simulated bodily fluids to foster a supportive environment that is conducive to successful completion of treatment.

Negotiating Your Return to the Office

July 17, 2021 by Tory Tomassetti

Negotiating Your Return to the Office

Undoubtedly, the COVID-19 pandemic has drastically altered the workforce for millions of individuals. In fact, data demonstrates that the workplace may never return to pre-pandemic operations for most organizations (Gartner, 2020). Following mandated work from home orders, employees were required to quickly shift their work routines and habits, while expected to maintain efficiency from their kitchen tables. Turns out, for many individuals this wasn’t an issue, as nationwide productivity rates increased for a variety of workplaces (Curran, 2021; McKendrick, 2021).

This is good news, since in the United States, a staggering 58% of the workforce is now comprised of remote workers (Steward, 2021) compared to just 30% in the pre-pandemic workforce (Gartner, 2020)! Despite the intensity of the pandemic decreasing, the U.S. workforce will forever be impacted, and many workers are likely to experience a workweek that may include at least a few hours back at the kitchen table as hybrid work schedules become a more viable option.

Working remotely has its perks! 83% of workers report being more productive in their work when completing it remotely, and 75% of remote-working individuals report feeling less distracted when working remotely (O’Donnellan, 2021). Additionally, remote workers are found to engage in activities which maintain their physical wellness 10% more than non-remote workers (O’Donnellan, 2021).

For many people, however, one of the greatest benefits of remote work is related to the work-life balance it offers. By having more flexibility during their workdays/weeks, individuals are better able to attend to the needs of their loved ones, engage in hobbies, or even engage in self-care more freely.

As more offices begin decreasing remote work hours, some employees may feel worried about losing the autonomy and work-life balance they have grown accustomed to. In fact, the mandated work from home orders during the pandemic may have highlighted or reinforced some work-related values that previously did not seem possible (e.g., the value of flexible work hours or a condensed workweek). If this is the case, the thought of returning to the office may stir up angst for some or leave individuals feeling trapped or helpless. In other words, while going back to the office may be exciting for certain workers, it could result in anxiety for others if they believe their values may no longer be fulfilled.

Re-entering the workplace does not mean one must completely sacrifice their values and repress their yearnings for greater work-related flexibility. On the contrary, learning to navigate the post-pandemic workforce may mean that voicing one’s needs is more important than ever to maintain optimal mental wellness following an exceptionally trying season. Here are four tips to keep in mind as you re-enter the workspace and learn to advocate for yourself:

Identify and define your values. Research shows that when we live more in-line with our values, we experience improved mental health and are more satisfied with our quality of life (Brasfield, 2020). Knowing your values can help prioritize your requests when it comes time to negotiate with your employer.

Effectively communicate your needs to your employer. Assertive communication (as opposed to passive, aggressive, or passive-aggressive) will be exceptionally important as you voice your needs and make your requests known. Respect is a major feature of assertive communication: you not only respect yourself by attempting to live a value-oriented life, but you are also respecting others (e.g., your supervisors, colleagues, etc.) in the requests you make. To promote effective communication, consider the following:

Remain solution-focused, rather than problem-focused while presenting your requests.

Ask yourself, “What’s in it for the organization?” In other words, when communicating your needs, be sure to be other-focused and not overly me-focused.

Use “I statements” to ensure you’re taking responsibility for your words and to decrease the likelihood of the other party becoming defensive.

Use data to support your requests (this will also help you to honestly evaluate whether your request is reasonable).

Tip: Try combining the tips above, resulting in something like the following, “I would like to propose an idea that would not only allow me to live in-line with my values, but would also support the values and goals of the organization. I feel respected and appreciated as an employee when given the opportunity to complete (X work task) from my home office. Feeling valued like this really motivates me to want to go above and beyond for the company in the following ways ______. Additionally, during the work from home mandate, as you can see from the data, I completed 15% more of (aforementioned work task) compared to when I’m in the office. This 15% equated to $X of increased profit for the organization. Thus, I would like to request to work remotely while completing (aforementioned work task).”

Having made your request, keep in mind, compromise is essential. Not every request will be granted, and that’s okay. If you have identified a value and believe it may not be met in your 9 to 5 job, consider how you may meet those values in other areas of your life, such as hobbies, social engagements, community organizations, or volunteer work.

In conclusion, the workforce has changed in lieu of the COVID-19 pandemic, and it is likely to continue to change. Hopefully, most changes will benefit not only the employer, but also the employee. With that being said, adults spend much of their waking hours at work, so learning how to make your needs known through assertively and respectfully advocating for yourself will be a crucial part of navigating the altered workplace. Doing so effectively will allow the worker to live a value-oriented lifestyle, which will not only benefit their own mental health, but will also benefit the organization they work for.

Fun and Safe Projects to Do During the Pandemic

December 28, 2020 by Tory Tomassetti

Fun and Safe Projects to Do During the Pandemic

The year 2020 is coming to a close, but the winter is just beginning.

After nine months of days that blurred into nights, sacrifices in nearly every domain of functioning, and general malaise, we will now enter a period of coldness that can be difficult to cope with even under the best of circumstances.

Those familiar with seasonal affective disorder may be particularly concerned about entering wintertime during a pandemic.

Indeed, many of the things I’ve been suggesting to my clients over the past several months have revolved around outdoor activities: picnics, exercise, foliage-seeing, park-exploring, and stargazing.

Here in the northeast, these activities are less feasible when temperatures drop below freezing.

So what can we do to keep up our spirits? How can we fend off seasonal blues with the pandemic still raging?

Self-Care, Netflix Binge, or a New Hobby?

Many of us have received the messaging that we should accomplish something with all of this extra downtime. Whether it’s learning a language, knitting a sweater, or becoming proficient in at-home facials and binge-watching Netflix, there is no dearth of advice on how to “best” take care of oneself.

But which is it? Is it best to be productive? Or is self-care the name of the game?

Rather than thinking about it as productivity versus relaxation, think of your winter plan as a commitment goal, a project.

Get a project. Commit to it. Having something to work towards and look forward to will give you a sense of purpose.

Whether it’s finishing a classic book that you never read in high school, or trying every bath bomb on the market is much less important than whether you feel as though you are committed to a task. (Commitment is a component of the personality trait called hardiness, which has been shown to have protective benefits against various forms of stress.)

Here are just a few pandemic project ideas to commit to. Tell me yours in the comments!

Read a book that’s been on your shelf for a while
Take an online woodworking class
Complete a lengthy docuseries on a topic about which you’re uninformed
Re-watch the entire series of a television program from your youth
Learn to make a complicated dish and practice it repeatedly
Design a website
Start an indoor herb garden
Write and mail letters to friends
Draw, color, or paint
Teach your pet a new trick

Explore and Experiment

Call Dr. Tory Tomasetti today!

How to Commute When You’re Working From Home

September 8, 2020 by Tory Tomassetti

How to Commute When You’re Working From Home

Working from home isn’t all bad–think of all the time you’re saving by skipping the schlep on public transportation or by car, the decrease in dry cleaning bills, the increase in everyday foot comfort. In different times, I might write a blog about how to make the most of your commute- -catching up on morning emails, listening to your favorite music, or simply decompressing after a long day.

Early in the pandemic, I noticed that many of my clients were having difficulty sleeping through the night. While I frequently treat people with insomnia, the sleep distress that my clients were describing seemed due to other factors. As I examined the correlates, there was one glaring similarity: the people with the most difficulty sleeping were those who had a more drastic change in their commute. That is, these were people who went from having a lengthy train or subway ride to/from the office, and now were “commuting” from the bed to the couch.

As the weeks progressed, more and more of my clients began to experience restlessness, irritation, anxiety, and depression–particularly in the hours after work each day. I began encouraging all of my clients–not just those with sleep impairment–to start “commuting” to and from the “office.”

So how does one commute while working from home?

Each morning, do your usual routine as though you were going into the office: wake up, shower, get dressed, grab your keys, and go! In this case, “go” means to leave the house or apartment. If you typically walk to work or the train, take a few laps around the block before returning to your abode. If you typically drive to work, start the engine and drive for a few minutes. Your “commute” does not have to be as long as your typical commute–ten or fifteen minutes will do. When you get to the “office,” turn on your computer, grab your coffee, and get to work.

At the end of the day, do the same thing. Shut down your computer, clean up your work station, and leave the house for another commute. When you return home, change out of your work clothes and transition into “home mode.”

What is the purpose of this commute?

Rituals and routine provide clues and cues to our brain. We make associations between certain activities/spaces/people and particular feelings/actions. You might, for example, associate your living room with watching television. You might associate the setting sun with dinner time. Ideally, you associate your bed with sleep. By marking your day with a commute in the morning and evening, you are signaling to your brain the difference between non-work mode and work mode. When most of us are spending more than 20 hours per day at home, anything we can do to help distinguish between work and play is valuable.

If you’re feeling restless, sluggish, or generally ill-at-ease at home, try incorporating a morning and evening commute into your daily routine.