Zachary Kilgore, LCSW
Therapy for OCD, Anxiety, & BFRBs
Therapy Services
CBT | ERP | ComB | Intensive
Cognitive Behavior Therapy
Cognitive Behavior Therapy (CBT) is widely regarded as the gold standard treatment for anxiety disorders, including OCD, panic disorder, social anxiety, generalized anxiety, and phobias. Backed by decades of research, CBT is one of the most effective and evidence-based approaches for treating a wide range of mental health concerns.
CBT is based on the idea that our thoughts, feelings, and behaviors are closely connected. When we get caught in unhelpful thought patterns, they can fuel painful emotions and behaviors that keep us stuck in a cycle of anxiety.
In CBT, you’ll learn to:
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Identify and challenge unhelpful or distorted thought patterns
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Develop healthier, more balanced ways of thinking
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Practice new coping strategies and behaviors that reduce anxiety and improve daily functioning
CBT is collaborative, practical, and skills-focused. The goal is not only to reduce symptoms in the short term but also to equip you with lifelong tools to manage stress, anxiety, and other challenges.
Exposure and Response Prevention
Exposure and Response Prevention (ERP) is a highly effective, evidence-based therapy and the gold standard treatment for Obsessive-Compulsive Disorder (OCD). ERP works by helping you face feared thoughts, images, or situations (exposure) in a gradual, structured way while resisting the urge to perform compulsive behaviors (response prevention).​ By repeatedly confronting anxiety-provoking situations without performing compulsions, you learn that the distress naturally decreases over time and that feared outcomes are unlikely to happen. This process breaks the cycle of obsessions and compulsions, reducing the need for rituals and avoidance behaviors, and helping you regain confidence and control over daily life.
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ERP is collaborative and tailored to your unique fears, providing practical strategies to manage anxiety both in and outside of therapy. Over time, it empowers you to face triggers with less distress and greater independence.
Comprehensive Behavioral Treatment
Comprehensive Behavioral (ComB) Treatment is a leading evidence-based approach for Body-Focused Repetitive Behaviors (BFRBs), such as hair pulling and skin picking. Unlike a “one-size-fits-all” model, ComB is highly individualized, targeting the specific factors that contribute to each person’s behaviors.
ComB is based on the understanding that BFRBs are maintained by multiple influences. During treatment, we assess five domains that can drive these behaviors:
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Sensory: Physical sensations (e.g., texture of hair or skin)
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Cognitive: Thoughts, beliefs, or images linked to the behavior
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Affective: Emotional states such as stress, anxiety, or boredom
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Motoric: Automatic movements/patterns that trigger the behavior
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Place/Environmental: Specific settings, times, or contexts where the behavior occurs
By identifying which domains are most relevant, treatment is tailored with targeted strategies—such as habit reversal skills, stimulus control techniques, cognitive restructuring, and emotion regulation tools.
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Habit Reversal Training (HRT) is the most well-established behavioral treatment for BFRBs. Developed in the 1970s and supported by decades of research, HRT remains a core evidence-based intervention. HRT typically includes the following components:
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Awareness Training: Increasing recognition of urges, triggers, and situations that lead to the behavior.
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Competing Response Training: Learning and practicing alternative behaviors that are physically incompatible with the repetitive behavior.
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Stimulus Control: Modifying environmental factors to reduce opportunities and triggers.
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Motivation and Generalization: Strengthening commitment to change, involving support systems when appropriate, and applying skills across settings.
HRT is often delivered on its own or integrated into ComB, which provides an even more individualized approach. Together, these methods offer effective strategies to reduce BFRB symptoms and improve overall functioning.
Intensive Therapy
Intensive therapy is a focused, short-term approach designed to help individuals make significant progress in overcoming anxiety disorders, OCD, or related challenges. Unlike traditional weekly therapy, intensive therapy involves multiple sessions per week, up to daily sessions, over a condensed period. This structure allows for concentrated practice of strategies that directly target fears, avoidance, and compulsive behaviors. Exposure-based Cognitive Behavior Therapy (CBT), including Exposure and Response Prevention (ERP), forms the core of the program. Sessions typically last around 60 minutes each day for three weeks, with some sessions extending to 90 minutes depending on individual needs.
Intensive therapy is especially helpful for individuals whose anxiety or OCD symptoms are severe, have not improved sufficiently with weekly therapy, or who are seeking faster progress. It can also be ideal for those with a unique opportunity to dedicate concentrated time to therapy, such as a child during a school break or anyone whose symptoms are significantly disrupting daily life.