Obsessive-Compulsive (OCD) Psychiatrists in Westford, MA

Photo of Shailaja Emani, MD, Psychiatrist
Shailaja Emani
Psychiatrist, MD
Verified Verified
1 Endorsed
Westford, MA 01886  (Online Only)
She has knowledge on a broad spectrum of psychopathology, but some of her specific clinical interests include anxiety/depressive disorders, OCD, tic disorders, ASD, ADHD, psychosis and trauma/stress related disorders.
Dr. Shailaja Emani is a board certified psychiatrist passionate about providing holistic, comprehensive, and evidence based psychiatric care. She has a wide variety of experience treating children, adolescents, and adults across treatment settings and complexity levels.
She has knowledge on a broad spectrum of psychopathology, but some of her specific clinical interests include anxiety/depressive disorders, OCD, tic disorders, ASD, ADHD, psychosis and trauma/stress related disorders.
Dr. Shailaja Emani is a board certified psychiatrist passionate about providing holistic, comprehensive, and evidence based psychiatric care. She has a wide variety of experience treating children, adolescents, and adults across treatment settings and complexity levels.
(339) 500-6853 View (339) 500-6853
Photo of Regina Macharia, PMHNP, Psychiatric Nurse Practitioner
Regina Macharia
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
1 Endorsed
Westford, MA 01886  (Online Only)
Regina is a Board Certified Psychiatric Nurse Practitioner with multiple years of experience as a nurse in community psychiatric care. She believes in individualized client care that is holistic and is vested in promoting self-care, and lifestyle changes (sleep hygiene, exercise, nutrition, stress management) in concert with a variety of psychotherapy and pharmacological modalities.
Regina is a Board Certified Psychiatric Nurse Practitioner with multiple years of experience as a nurse in community psychiatric care. She believes in individualized client care that is holistic and is vested in promoting self-care, and lifestyle changes (sleep hygiene, exercise, nutrition, stress management) in concert with a variety of psychotherapy and pharmacological modalities.
(508) 841-5132 View (508) 841-5132
Photo of Cecilia Sky Ryll, APRN, DNP, PMHNP, Psychiatric Nurse Practitioner
Cecilia Sky Ryll
Psychiatric Nurse Practitioner, APRN, DNP, PMHNP
Verified Verified
Westford, MA 01886
I am a board certified psychiatric and mental health nurse practitioner with experience in evaluating and treating anxiety disorders, depression, various mood disorders such as bipolar, PTSD, neurocognitive and psychotic disorders. I graduated from the University of New Hampshire with a post-master certificate in psychiatry and mental health. Prior to this I earned my MSN with specialization in women’s health and then my Doctor of Nursing Practice from Frontier University, and worked as a women’s health nurse practitioner and a primary care provider for women. My niche is focusing on issues involving both areas.
I am a board certified psychiatric and mental health nurse practitioner with experience in evaluating and treating anxiety disorders, depression, various mood disorders such as bipolar, PTSD, neurocognitive and psychotic disorders. I graduated from the University of New Hampshire with a post-master certificate in psychiatry and mental health. Prior to this I earned my MSN with specialization in women’s health and then my Doctor of Nursing Practice from Frontier University, and worked as a women’s health nurse practitioner and a primary care provider for women. My niche is focusing on issues involving both areas.
(508) 625-7434 View (508) 625-7434
Photo of Meredith Hogarty, PMHNPBC, MSW, Psychiatric Nurse Practitioner
Meredith Hogarty
Psychiatric Nurse Practitioner, PMHNPBC, MSW
Verified Verified
1 Endorsed
Westford, MA 01886  (Online Only)
Do you feel like you are not making progress with therapy or lifestyle modifications alone? Do you feel exhausted, overwhelmed, frustrated, misunderstood or unheard when it comes to your mental health? Do you believe that you are not on the right medication or experiencing unwanted side effects? I use a collaborative approach to managing your medications, where you feel heard, respected, and understood. We will carefully select and monitor medications tailored to address your unique needs and symptoms so that we can find the right balance between effectively managing your condition and minimizing any unwanted side effects.
Do you feel like you are not making progress with therapy or lifestyle modifications alone? Do you feel exhausted, overwhelmed, frustrated, misunderstood or unheard when it comes to your mental health? Do you believe that you are not on the right medication or experiencing unwanted side effects? I use a collaborative approach to managing your medications, where you feel heard, respected, and understood. We will carefully select and monitor medications tailored to address your unique needs and symptoms so that we can find the right balance between effectively managing your condition and minimizing any unwanted side effects.
(978) 561-2325 View (978) 561-2325
Photo of Stella Macharia, PHMNP, Psychiatric Nurse Practitioner
Stella Macharia
Psychiatric Nurse Practitioner, PHMNP
Verified Verified
Westford, MA 01886  (Online Only)
I am a dually certified Psychiatric Mental Health and Family Nurse Practitioner and I have extensive psychiatric nursing experience having worked in inpatient, homecare and outpatient settings. I have experience in Anxiety disorders, Bipolar disorders, Mood disorders, Psychotic disorders and other mental illness. I work with 13+ and I take pride in providing high-quality patient care.
I am a dually certified Psychiatric Mental Health and Family Nurse Practitioner and I have extensive psychiatric nursing experience having worked in inpatient, homecare and outpatient settings. I have experience in Anxiety disorders, Bipolar disorders, Mood disorders, Psychotic disorders and other mental illness. I work with 13+ and I take pride in providing high-quality patient care.
(508) 978-6074 View (508) 978-6074
Photo of James Quackenbush, MSN, APRN, PMHNP-, BC, Psychiatric Nurse Practitioner
James Quackenbush
Psychiatric Nurse Practitioner, MSN, APRN, PMHNP-, BC
Verified Verified
2 Endorsed
Westford, MA 01886
Please note: At this time, I am primarily virtual but offer intermittent in-person appointments. I am based in Southern NH and Greater Boston, MA. I received my nurse practitioner education at Rivier University and completed clinical training at McLean Hospital, in Belmont, MA. My personal and professional goals include bridging the gaps that exist in our healthcare system to ensure everyone has adequate access and good mental health care, reducing stigma so that people are more inclined to ask for help, and providing a treatment plan where both you and I work together to ensure your needs are met.
Please note: At this time, I am primarily virtual but offer intermittent in-person appointments. I am based in Southern NH and Greater Boston, MA. I received my nurse practitioner education at Rivier University and completed clinical training at McLean Hospital, in Belmont, MA. My personal and professional goals include bridging the gaps that exist in our healthcare system to ensure everyone has adequate access and good mental health care, reducing stigma so that people are more inclined to ask for help, and providing a treatment plan where both you and I work together to ensure your needs are met.
(617) 982-3184 View (617) 982-3184
Photo of Salma Trainor, APRN, MSN, PMHNP, -BC, Psychiatric Nurse Practitioner
Salma Trainor
Psychiatric Nurse Practitioner, APRN, MSN, PMHNP, -BC
Verified Verified
1 Endorsed
Westford, MA 01886
Welcome to Birch Grove Mental Health! I am a Board Certified Psychiatric Nurse Practitioner with a strong passion and desire to help patients feel better by improving sleep, decreasing anxiety and improving mood. I use a combination of medication management and psychotherapy to achieve your goals as we target symptoms that may be disruptive to your life. I take great care with every patient I treat to ensure they feel heard, respected and understood. I work with you to get through a difficult time or to maintain a current regimen that perhaps is working well.
Welcome to Birch Grove Mental Health! I am a Board Certified Psychiatric Nurse Practitioner with a strong passion and desire to help patients feel better by improving sleep, decreasing anxiety and improving mood. I use a combination of medication management and psychotherapy to achieve your goals as we target symptoms that may be disruptive to your life. I take great care with every patient I treat to ensure they feel heard, respected and understood. I work with you to get through a difficult time or to maintain a current regimen that perhaps is working well.
(617) 600-4506 View (617) 600-4506
Photo of Danielle Cogliano, NP, PMHCNS, Psychiatric Nurse Practitioner
Danielle Cogliano
Psychiatric Nurse Practitioner, NP, PMHCNS
Verified Verified
1 Endorsed
Westford, MA 01886
Accepting state of MA. clients only. Please visit my website at Oasisbehavioral.com and fill out the new patient Depression, fear, and anxiety are some of the most common and uncomfortable emotions that we can experience at some point in our lives. My focus is to help my patients heal, energize, and become aware of their inner strengths in order to move forward to where they want to be in life. This is achieved by providing a neutral safe space, listening to your concerns, and customizing a treatment plan. Often this involves medication management, although I always take a holistic approach to my practice, treating the whole person.
Accepting state of MA. clients only. Please visit my website at Oasisbehavioral.com and fill out the new patient Depression, fear, and anxiety are some of the most common and uncomfortable emotions that we can experience at some point in our lives. My focus is to help my patients heal, energize, and become aware of their inner strengths in order to move forward to where they want to be in life. This is achieved by providing a neutral safe space, listening to your concerns, and customizing a treatment plan. Often this involves medication management, although I always take a holistic approach to my practice, treating the whole person.
(351) 888-1916 View (351) 888-1916
Photo of Holistic Behavioral Health Services Llc - Holistic Behavioral Health Services LLC , MSN, PMHNP, BC, Psychiatric Nurse Practitioner
Holistic Behavioral Health Services LLC
Psychiatric Nurse Practitioner, MSN, PMHNP, BC
Verified Verified
Westford, MA 01886
Holistic Behavioral Health Services provides both outpatient and tele-psychiatry mental health services in Dracut and surrounding areas. Tele-psychiatry services are provided in the comfort of your home using a computer/ a phone. We accepting new patients. Evening and weekend hours are available to those busy during office hours. Board certified psychiatric mental health nurse practitioner with training and experience across the lifespan in outpatient settings.
Holistic Behavioral Health Services provides both outpatient and tele-psychiatry mental health services in Dracut and surrounding areas. Tele-psychiatry services are provided in the comfort of your home using a computer/ a phone. We accepting new patients. Evening and weekend hours are available to those busy during office hours. Board certified psychiatric mental health nurse practitioner with training and experience across the lifespan in outpatient settings.
(978) 693-5001 View (978) 693-5001
Photo of Louisa Martin, PMHCNS-, BC, Psychiatric Nurse Practitioner
Louisa Martin
Psychiatric Nurse Practitioner, PMHCNS-, BC
Verified Verified
1 Endorsed
Westford, MA 01886
Through active listening and thoughtful questioning I aim to deliver high quality compassionate care. As an adult psychiatric clinical nurse specialist I am focused on person centered holistic care. I have over 20 years of experience treating psychiatric disorders including anxiety, depression and ADD. I earned my BSN and MSN at the University of Pennsylvania in 2002 and have worked at both inpatient and outpatient setting. I provide psychiatric medication prescriptions and medication management. I also offer ADHD testing and treatment. I do not provide psychotherapy. I treat ages 18 and above.
Through active listening and thoughtful questioning I aim to deliver high quality compassionate care. As an adult psychiatric clinical nurse specialist I am focused on person centered holistic care. I have over 20 years of experience treating psychiatric disorders including anxiety, depression and ADD. I earned my BSN and MSN at the University of Pennsylvania in 2002 and have worked at both inpatient and outpatient setting. I provide psychiatric medication prescriptions and medication management. I also offer ADHD testing and treatment. I do not provide psychotherapy. I treat ages 18 and above.
(978) 515-6622 View (978) 515-6622

More Psychiatrists Nearby

Photo of Mayumi Okuda Benavides, MD, Psychiatrist
Mayumi Okuda Benavides
Psychiatrist, MD
Verified Verified
Concord, MA 01742
As an internationally recognized expert in the treatment of anxiety (social anxiety, obsessive compulsive disorder, generalized anxiety, panic disorder) and mood disorders (depression, bipolar disorder), and trauma (Post-Traumatic Stress Disorder), I bring years of experience working with patients from around the world.
I want to congratulate you on taking the first steps towards self-improvement. You’ve tried everything: therapy, mindfulness, lifestyle changes, but are still struggling. I understand that making that first appointment can often be one of the biggest hurdles. As your psychiatrist, I will work closely with you every step of the way to determine the best treatment that is tailored specifically to your personal needs.
As an internationally recognized expert in the treatment of anxiety (social anxiety, obsessive compulsive disorder, generalized anxiety, panic disorder) and mood disorders (depression, bipolar disorder), and trauma (Post-Traumatic Stress Disorder), I bring years of experience working with patients from around the world.
I want to congratulate you on taking the first steps towards self-improvement. You’ve tried everything: therapy, mindfulness, lifestyle changes, but are still struggling. I understand that making that first appointment can often be one of the biggest hurdles. As your psychiatrist, I will work closely with you every step of the way to determine the best treatment that is tailored specifically to your personal needs.
(978) 643-5182 View (978) 643-5182
Photo of Yu Wang - Seaside Psychservices, Psychiatric Nurse Practitioner
Seaside Psychservices
Psychiatric Nurse Practitioner
Verified Verified
Lowell, MA 01851  (Online Only)
Dr. Wang, DNP, is the owner and founder of the Seaside Psychservices outpatient clinic. She specializes in treating anxiety, depression, ADHD, PTSD, OCD, and bipolar. She emphasizes building a trusting relationship, incorporates comprehensive assessments and tailors pharmacological treatment plans for the unique needs of each individual.
Dr. Wang, DNP, is the owner and founder of the Seaside Psychservices outpatient clinic. She specializes in treating anxiety, depression, ADHD, PTSD, OCD, and bipolar. She emphasizes building a trusting relationship, incorporates comprehensive assessments and tailors pharmacological treatment plans for the unique needs of each individual.
(857) 371-7003 View (857) 371-7003
Photo of Nina Abelowitz, ANP-BC, PMHNP, Psychiatric Nurse Practitioner
Nina Abelowitz
Psychiatric Nurse Practitioner, ANP-BC, PMHNP
Verified Verified
1 Endorsed
Concord, MA 01742
I specialize in oncologic diagnoses, anxiety, ADHD, OCD, Bipolar disorder and depression.
I'm OPEN to new clients! I'm a Nurse Practitioner with fourteen years of experience. I have cared for patients in primary care, oncology and psychiatry throughout the Boston and South Florida area.
I specialize in oncologic diagnoses, anxiety, ADHD, OCD, Bipolar disorder and depression.
I'm OPEN to new clients! I'm a Nurse Practitioner with fourteen years of experience. I have cared for patients in primary care, oncology and psychiatry throughout the Boston and South Florida area.
(978) 625-9708 View (978) 625-9708
Photo of Mark Strecker, MD, Psychiatrist
Mark Strecker
Psychiatrist, MD
Verified Verified
Concord, MA 01742
I specialize in the treatment of ADHD, depression, obsessive-compulsive disorder and other anxiety disorders across the life span.
How do we learn to understand and trust what our feelings are saying to us? What makes it possible to change entrenched ways of coping that are not working? My focus in therapy is to help patients deepen their personal relationships and find their work more rewarding; medication can sometimes help alleviate symptoms that interfere with achieving these goals. By providing a safe and supportive environment for the patient's search for self-understanding, and listening closely to what is being said and not said, I collaborate with the patient in finding creative and pragmatic ways to overcome obstacles to change.
I specialize in the treatment of ADHD, depression, obsessive-compulsive disorder and other anxiety disorders across the life span.
How do we learn to understand and trust what our feelings are saying to us? What makes it possible to change entrenched ways of coping that are not working? My focus in therapy is to help patients deepen their personal relationships and find their work more rewarding; medication can sometimes help alleviate symptoms that interfere with achieving these goals. By providing a safe and supportive environment for the patient's search for self-understanding, and listening closely to what is being said and not said, I collaborate with the patient in finding creative and pragmatic ways to overcome obstacles to change.
(781) 996-3478 View (781) 996-3478
Photo of Eustache Marie, PMHNP, BC, Psychiatric Nurse Practitioner
Eustache Marie
Psychiatric Nurse Practitioner, PMHNP, BC
Verified Verified
1 Endorsed
Lowell, MA 01850
Welcome and thank you for visiting my profile. I am a Board Certified Psych Nurse Practitioner with great experience in the field. I provide diagnostic assessments and medication management to patients across the lifespan using holistic approach. I have experience working with adult and children(14+) with a variety of mental health needs. I have a primary clinical interest in anxiety, depression, ADHD, bipolar disorder, OCD and Pre and/or Postpartum related mood disorders.
Welcome and thank you for visiting my profile. I am a Board Certified Psych Nurse Practitioner with great experience in the field. I provide diagnostic assessments and medication management to patients across the lifespan using holistic approach. I have experience working with adult and children(14+) with a variety of mental health needs. I have a primary clinical interest in anxiety, depression, ADHD, bipolar disorder, OCD and Pre and/or Postpartum related mood disorders.
(781) 287-8722 View (781) 287-8722
Photo of Mercy K Micheni, MSN, PMHNP, Psychiatric Nurse Practitioner
Mercy K Micheni
Psychiatric Nurse Practitioner, MSN, PMHNP
Verified Verified
Lowell, MA 01852  (Online Only)
Throughout my career, I have worked with a diverse population of patients, including those with Mood disorders, Anxiety disorders, Psychotic disorders, Substance Abuse Issues, Autism, ADHD, OCD, Insomnia, Trauma, and PTSD.
I am currently accepting new clients, struggling to manage their symptoms and want expert guidance and support in their treatment. Those looking for a compassionate and understanding healthcare provider who can help them navigate their mental health challenges. Their needs may include a comprehensive psychiatric assessment, medication management, psychotherapy, and support in developing coping skills and strategies to manage their symptoms. Benefit from education about their diagnosis, treatment options, and self-care practices with primary goal to achieve a sense of well-being, stability and live a meaningful life.
Throughout my career, I have worked with a diverse population of patients, including those with Mood disorders, Anxiety disorders, Psychotic disorders, Substance Abuse Issues, Autism, ADHD, OCD, Insomnia, Trauma, and PTSD.
I am currently accepting new clients, struggling to manage their symptoms and want expert guidance and support in their treatment. Those looking for a compassionate and understanding healthcare provider who can help them navigate their mental health challenges. Their needs may include a comprehensive psychiatric assessment, medication management, psychotherapy, and support in developing coping skills and strategies to manage their symptoms. Benefit from education about their diagnosis, treatment options, and self-care practices with primary goal to achieve a sense of well-being, stability and live a meaningful life.
(781) 805-3480 View (781) 805-3480
Photo of Amanda Rose Sullivan, DNP, PMHNP, Psychiatric Nurse Practitioner
Amanda Rose Sullivan
Psychiatric Nurse Practitioner, DNP, PMHNP
Verified Verified
2 Endorsed
Tyngsborough, MA 01879
Waitlist for new clients
I’m a doctorally prepared psychiatric nurse practitioner, and treat many mental health conditions including depression, anxiety, attention deficit disorder, trauma, addictions, obsessive compulsive disorder, and many more including chronic illnesses and complex grief.
Reaching out for help can be scary, and in recognition of this, I strive to provide care in a warm, welcoming, and safe environment. I believe a relationship with mutual respect and trust is a requirement for effective psychiatric care. Being honest, transparent, and “real” with patients is the bedrock of this relationship, and I approach care with this mindset. I’m non-judgmental, relaxed, and will always treat you with compassion and dignity. I use a collaborative approach, and believe that you must be involved in decision-making for your treatment to be effective.
I’m a doctorally prepared psychiatric nurse practitioner, and treat many mental health conditions including depression, anxiety, attention deficit disorder, trauma, addictions, obsessive compulsive disorder, and many more including chronic illnesses and complex grief.
Reaching out for help can be scary, and in recognition of this, I strive to provide care in a warm, welcoming, and safe environment. I believe a relationship with mutual respect and trust is a requirement for effective psychiatric care. Being honest, transparent, and “real” with patients is the bedrock of this relationship, and I approach care with this mindset. I’m non-judgmental, relaxed, and will always treat you with compassion and dignity. I use a collaborative approach, and believe that you must be involved in decision-making for your treatment to be effective.
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Photo of Maria Thompson, DNP, PMHNP-B, Psychiatric Nurse Practitioner
Maria Thompson
Psychiatric Nurse Practitioner, DNP, PMHNP-B
Verified Verified
Harvard, MA 01451
Hi there, I'm Maria! Do you feel pulled in a million directions, unable to fit it in? Are you struggling to keep up with your relationships, work and health? Is it hard to be kind to yourself? Whether you're dealing with overwhelm, relationship issues or cycles of anxiety and depression, Insomnia, bipolar disorders, substance abuse, Obsessive Compulsive Disorders, Schizophrenia/Psychosis, ADHD, and others I'm here to help. One of my passions is creating Healing communities- my nurse residency capstone involved creating the inpatient psychiatric family mental health recovery group; main objective was to provide psychoeducation.
Hi there, I'm Maria! Do you feel pulled in a million directions, unable to fit it in? Are you struggling to keep up with your relationships, work and health? Is it hard to be kind to yourself? Whether you're dealing with overwhelm, relationship issues or cycles of anxiety and depression, Insomnia, bipolar disorders, substance abuse, Obsessive Compulsive Disorders, Schizophrenia/Psychosis, ADHD, and others I'm here to help. One of my passions is creating Healing communities- my nurse residency capstone involved creating the inpatient psychiatric family mental health recovery group; main objective was to provide psychoeducation.
(617) 397-4895 View (617) 397-4895
Photo of Israel Egeruo, PMHNP, Psychiatric Nurse Practitioner
Israel Egeruo
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
Lowell, MA 01852
Israel C. Egeruo, PMHNP, brings a wealth of experience and compassion to his practice as a psychiatric nurse practitioner. With a background spanning over a decade in mental health counseling and nursing, Dr. Egeruo is dedicated to providing personalized care to individuals struggling with anxiety, depression, and mood disorders. His ideal client is someone seeking empathetic psychiatric care, valuing a holistic approach that integrates therapy and medication for optimal treatment outcomes.
Israel C. Egeruo, PMHNP, brings a wealth of experience and compassion to his practice as a psychiatric nurse practitioner. With a background spanning over a decade in mental health counseling and nursing, Dr. Egeruo is dedicated to providing personalized care to individuals struggling with anxiety, depression, and mood disorders. His ideal client is someone seeking empathetic psychiatric care, valuing a holistic approach that integrates therapy and medication for optimal treatment outcomes.
(857) 314-2004 View (857) 314-2004
Photo of Michelle McCarthy, APN, MSN, PMHNP, Psychiatric Nurse Practitioner
Michelle McCarthy
Psychiatric Nurse Practitioner, APN, MSN, PMHNP
Verified Verified
Concord, MA 01742
Michelle is passionate about delivering care to individuals suffering from anxiety, substance use, and depression. Client motivation and dedication are key to utilizing the tools provided during our sessions including medication management, implementing lifestyle interventions, and therapy to help develop and implement a successful treatment plan. Relief of the client's suffering in dealing with their mental health issues and striving for an improvement in their quality of life is key to treatment.
Michelle is passionate about delivering care to individuals suffering from anxiety, substance use, and depression. Client motivation and dedication are key to utilizing the tools provided during our sessions including medication management, implementing lifestyle interventions, and therapy to help develop and implement a successful treatment plan. Relief of the client's suffering in dealing with their mental health issues and striving for an improvement in their quality of life is key to treatment.
(339) 217-8237 View (339) 217-8237
Obsessive-Compulsive (OCD) Psychiatrists

How long does OCD treatment take?

Obsessive-Compulsive Disorder (OCD) is often treated on a weekly or twice-weekly schedule, depending on symptom severity and the client’s preferences. Some clients may start to see a noticeable improvement in symptoms in as little as six weeks, but it’s also possible, especially in more severe cases, for treatment to take several months to a year before significant progress is made.

What happens if OCD is not treated?

Some people with OCD, especially those with mild symptoms, may find that they are able to adapt reasonably well to life with the condition, even if their symptoms never resolve completely. However, many people, particularly those whose symptoms are severe at the outset, find that their obsessions and compulsions grow more intrusive with time, making it harder to maintain relationships, hold down a job, or navigate the world successfully.

Are there medications for OCD?

Medication can be used to treat OCD. The class of drugs most often prescribed are selective serotonin reuptake inhibitors, or SSRIs, which include fluvoxamine (under the brand name Luvox), fluoxetine (Prozac), and sertraline (Zoloft), among others. In cases of treatment-resistant OCD, other classes of medication, such as tricyclic antidepressants or atypical antipsychotics, may be prescribed. Medication is frequently used in conjunction with therapy.

Can OCD come back after treatment?

Yes. Major life transitions, periods of stress, or other factors can cause symptoms to return or, if they were never fully eradicated, to ramp back up in intensity. For some, these relapses are brief and do not require additional treatment; identifying specific triggers and practicing the skills learned in therapy can help speed their course. For others, returning to therapy for a brief period can help address the underlying stress and strengthen coping mechanisms.