Email: mzivor@gmail.com
Tel: 0546195737
DR MICHAEL ZIVOR
Clinical Psychologists | CBT Specialist
Introduction
Dr. Michael Zivor is a Clinical Psychologist and CBT specialist, trained and specialised at Oxford University. He is a practicing psychologist, lecturer, supervisor and trainer. Dr. Zivor has a private clinic based in Tel Aviv, Zichron Yaakov and North West London. He also works as a highly specialised Psychologist in the psychology department of NWL Trust, treating post Covid -19 patients. Dr. Zivor works with adults, families, children and adolescents, and specialises in the area of Cognitive Behavioural Therapy. Dr. Zivor has been a practicing Psychologist for 20 years, and having trained and work in South Africa, Israel and the UK, he has rich experience working with people from different cultures and from various religious backgrounds.
ABOUT CBT
Cognitive Behavioural Therapy (CBT) is a talking therapy which has been shown to effectively treat a range of emotional and physical conditions, particularly anxiety and depression and is used in the treatment of adults, adolescents and young children. CBT is a short term therapy, which is based on the concept that the way we think about a situation influences how we act, and the way we act in turn impacts how we think and feel. CBT therapists work together with the client to recognize and breakdown negative patterns of thoughts and actions, and provide the client with the tools to implement new, healthier patterns to improve day to day living.
EMDR
הוכח כטיפול יעיל בפוסט טראומה . בשנים האחרונות שיטת טיפול זו EMDR טיפול
הורחבה לטיפול בחרדות, כאב, הפרעה טורדנית כפייתית ובפוביות. לרוב זהו טיפול קצר וממוקד. ד״ר מיכאל זיו אור משלב טכניקה זו עם הטיפול הקוגניטיבי התנהגותי לפי צרכי המטופלים
ANXIETY DISORDERS
Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe.
Everyone has feelings of anxiety at some point in their life – for example, you may feel worried and anxious about sitting an exam, or having a medical test or job interview. During times like these, feeling anxious can be perfectly normal.
However, some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.
Anxiety is the main symptom of several conditions, including:
- panic disorder
- phobias – such as agoraphobia or claustrophobia
- post-traumatic stress disorder (PTSD)
-social anxiety disorder (social phobia)
People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. As soon as one anxious thought is resolved, another may appear about a different issue.
GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include:
- feeling restless or worried
- having trouble concentrating or sleeping
- dizziness or heart palpitations.
With treatment, many people are able to control their anxiety levels. However, some treatments may need to be continued for a long time and there may be periods when your symptoms worsen.
For more information please contact me directly.
DEPRESSION
Most people go through periods of feeling down, but when you're depressed you feel persistently sad for weeks or months, rather than just a few days.
Some people think depression is trivial and not a genuine health condition. They're wrong – it is a real illness with real symptoms. Depression isn't a sign of weakness or something you can "snap out of" by "pulling yourself together".
The good news is that with the right treatment and support, most people with depression can make a full recovery.
Depression affects people in different ways and can cause a wide variety of symptoms.
They range from lasting feelings of unhappiness and hopelessness, to losing interest in the things you used to enjoy and feeling very tearful. Many people with depression also have symptoms of anxiety.
There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and various aches and pains.
The symptoms of depression range from mild to severe. At its mildest, you may simply feel persistently low in spirit, while severe depression can make you feel suicidal, that life is no longer worth living.
Most people experience feelings of stress, unhappiness or anxiety during difficult times. A low mood may improve after a short period of time, rather than being a sign of depression.
Treatment for depression can involve a combination of lifestyle changes, talking therapies and medication. Your recommended treatment will be based on whether you have mild, moderate or severe depression.
If you have mild depression, your doctor may suggest waiting to see whether it improves on its own, while monitoring your progress. This is known as "watchful waiting". They may also suggest lifestyle measures such as exercise and self-help groups.
Talking therapies, such as cognitive behavioural therapy (CBT), are often used for mild depression that isn't improving or moderate depression. Antidepressants are also sometimes prescribed.
For moderate to severe depression, a combination of talking therapy and antidepressants is often recommended. If you have severe depression, you may be referred to a specialist mental health team for intensive specialist talking treatments and prescribed medication.
OBSESSIVE COMPULSIVE DISORDER
Obsessive compulsive disorder (OCD) is a common mental health condition in which a person has obsessive thoughts and compulsive behaviours.
It affects men, women and children and can develop at any age. Some people develop the condition early, often around puberty, but it typically develops during early adulthood.
OCD can be distressing and significantly interfere with your life, but treatment can help you keep it under control.
If you have OCD, you'll usually experience frequent obsessive thoughts and compulsive behaviours.
An obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease.
A compulsion is a repetitive behaviour or mental act that you feel you need to carry out to try to temporarily relieve the unpleasant feelings brought on by the obsessive thought.
For example, someone with an obsessive fear of their house being burgled may feel they need to check all the windows and doors are locked several times before they can leave the house.
Here are some effective treatments for OCD that can help reduce the impact the condition has on your life.
The main treatments are:
1. Psychological therapy – usually a special type of cognitive behavioural therapy (CBT) that helps you face your fears and obsessive thoughts without "putting them right" with compulsions
2. Medication – usually a type of antidepressant medication called selective serotonin re-uptake inhibitors (SSRIs) that can help by altering the balance of chemicals in your brain
3. CBT will usually have an effect quite quickly. It can take several months before you notice the effects of treatment with SSRIs, but most people will eventually benefit.
LOW SELF ESTEEM
We all have times when we lack confidence and don’t feel good about ourselves.
But when low self-esteem becomes a long-term problem, it can have a harmful effect on our mental health and our lives.
Self-esteem is the opinion we have of ourselves. When we have healthy self-esteem, we tend to feel positive about ourselves and about life in general. It makes us able to deal with life’s ups and downs better.
When our self-esteem is low, we tend to see ourselves and our life in a more negative and critical light. We also feel less able to take on the challenges life throws at us.
Low self-esteem often begins in childhood. Teachers, friends, siblings, parents, and even the media give us lots of messages – both positive and negative. But for some reason, the message that you are not good enough sticks.
You may have found it difficult to live up to other people’s expectations of you, or to your own expectations.
Stress and difficult life events, such as serious illness or a bereavement, can have a negative effect on self-esteem. Personality can also play a part. Some of us are simply more prone to negative thinking, while others set impossibly high standards for themselves.
The problem with thinking we’re no good is that we start to behave as if it’s true. “Low self-esteem often changes people’s behaviour in ways that act to confirm the person isn’t able to do things or isn’t very good,” says Chris Williams, Professor of Psychosocial Psychiatry at the University of Glasgow.
If you have low self-esteem or confidence, you may hide yourself away from social situations, stop trying new things and avoid things you find challenging.
“In the short term, avoiding challenging and difficult situations makes you feel a lot safer,” says Professor Williams. “In the longer term, this avoidance can actually backfire because it reinforces your underlying doubts and fears. It teaches you the unhelpful rule that the only way to cope is by avoiding things.”
Living with low self-esteem can harm your mental health, leading to problems such as depression and anxiety. You may also develop unhelpful habits, such as smoking and drinking too much, as a way of coping.
SELECTIVE MUTISM
Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they don't see very often.
It usually starts during childhood and, left untreated, can persist into adulthood.
A child or adult with selective mutism doesn't refuse or choose not to speak, they're literally unable to speak.
The expectation to talk to certain people triggers a freeze response with feelings of panic, rather like a bad case of stage fright, and talking is impossible.
In time, the person will learn to anticipate the situations that provoke this distressing reaction and do all they can to avoid them.
However, people with selective mutism are able to speak freely to certain people, such as close family and friends, when nobody else is around to trigger the freeze response.
Selective mutism affects about 1 in 140 young children. It's more common in girls and children who are learning a second language, such as those who've recently migrated from their country of birth.
Selective mutism usually starts in early childhood, between the ages of two and four. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.
The main warning sign is the marked contrast in the child's ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they're expected to talk to someone who's outside their comfort zone.
They may avoid eye contact and appear:
- nervous, uneasy or socially awkward
- rude, disinterested or sulky
- clingy
- shy and withdrawn
- stiff, tense or poorly co-ordinated
- stubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents.
More confident children with selective mutism can use gestures to communicate – for example, they may nod for "yes" or shake their head for "no".
But more severely affected children tend to avoid any form of communication – spoken, written or gestured.
Some children may manage to respond with a word or two, or they may speak in an altered voice, such as a whisper.
Few people see the child or young person as they really are – a sensitive, thoughtful individual who's chatty, outgoing and fun-loving when relaxed and unaffected by their selective mutism.
With appropriate handling and treatment, most children are able to overcome selective mutism.
But the older they are when the condition is diagnosed, the longer it will take.
The effectiveness of treatment will depend on:
-how long the person has had selective mutism
-whether or not they have additional communication or learning difficulties or anxieties
-the co-operation of everyone involved with their education and family life
CBT is designed to work towards and reinforce desired behaviours while replacing bad habits with good ones.
Rather than examining a person's past or their thoughts, it concentrates on helping combat current difficulties using a gradual step-by-step approach to help conquer fears.
Health Anxiety & Managing Long Covid-19
Health Anxiety can be a debilitating condition. At times people are unable to stop and think about their medical situation whether they have been diagnosed or not with a physical medical diagnosis. Health Anxiety can manifest with intrusive thoughts. ongoing unnecessary medical checks, , reading and researching medical information, avoiding living life to the full. CBT is the treatment of choice for health anxiety and include the use of techniques and strategies aiming to reduce the level of anxiety and associated depression
Mindfulness Training
Over the last 20 years mindfulness training receive a lot of attention due to an ongoing research that demonstrated the effectiveness of mindfulness practice on mental health. Mindfulness training has shown good results in decreasing the chance of re-experiencing depressive episodes, decreased levels of anxiety and and stress , improved immune response and overall reported quality of life. Incorporating mindfulness practice with CBT if a common practice these days
Panic Attacks
Panic attacks are common, up to 35% of of the population experience panic attacks at some stage in their life. At times panic attacks continue and require specialised assessment and treatment.
The fear of having another panic attacks and the tendency to avoid normal day to day activities can be extremely challenging. CBT is the most recommended therapy fo panic attacks. Therapy include finding together the triggers leading to the attacks, and practicing ways to decrease the attacks and to reduce avoiding behaviours. CBT for panic attacks at times can be a short therapy.
Child & Adolescent Therapy
Michael areas of speciality include:
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Obsessive Compulsive Disorder
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Social Phobia
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Sleeping difficulties
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Fears, Phobias and Generalised Anxiety
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Depression
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Ticks D.O
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Trichotillomania & Skin Picking
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Low Self Esteem
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Selective Mutism
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Screen Addiction
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Anger Problems
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Health Anxiety and Coping with medical conditions
Cognitive behavioural therapy with children and adolescents aims to be focused and short-term. The treatment includes the utilisation of evidence based techniques in which the the child is encourage to practice during and in-between sessions. Therapy include an initial assessment session with the parents and generally , it is important that parents will take an active role throughout the therapeutic process. Sometimes, therapy include parents guidance where we will discuss alternative and helpful ways of responding to your child aiming to assist him/her in managing his/ her difficulties.
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Exam Anxiety
Exam anxiety has become a common problem in recent years. Sometimes an exam anxiety will be manifested in a specific subject and at times it can be more generalised. Cognitive behavioral therapy is considered the most effective treatment for this problem. Sometimes it is necessary to discuss the problem with the school or college and to try and integrate a systemic effort to assist the student to achieve his best. Therapy includes providing tools for balanced thinking, relaxation exercises, weakening perfectionist beliefs, working with guided imagination and more. In many cases , a focused CBT is short-term and sometimes
Phobias
Phobia are usually an uncontrollable and intense lasting fear of certain objects or situations. This fear can be so overwhelming that a person may go to great lengths to avoid the source of his fear. The treatment in phobias usually includes a joint understanding of the specific fear. We will find your coping strategies and will work through better ways to cope with the fear. Therapy includes a discussion on useful techniques to deal with the fear. The most common techniques for overcoming specific phobias is gradual exposure (in a slow and controlled manner). Often therapy included imaginal exposure and at times the use of cognitive techniques and relaxation exercised is considered . In most cases therapy can last between 6-10 sessions. CBT for kids who struggle with specific phobias include the cooperation of the child’s parents throughout therapy.
Insomnia and other Sleep difficulties
According to the NHS, the most recommended treatment for insomnia for adults and children is CBTi. CBTi is a straightforward focused therapy aiming to assist you to change your habits, thoughts and behaviours around sleep. After an initial assessment we will discover the patterns which disturb your sleep. Therapy include specific interventions such as : sleep hygiene, challenging automatic thoughts around sleep, stimulus control , relaxations and meditations . CBT can be short as up to 10 sessions.
Emotional Regulation
Emotional regulation is our ability to modulate our emotion in order to adapt and meet the requirements of our surroundings. Some people find it hard to regulate their emotions in stressful situations and that can lead to upsetting experience with others. CBT focused on identifying specific triggers and pattens and learning new ways of coping in these. At times, therapy can last for several months, however, from the onset you will learn adaptive coping strategies. When relevant, therapy include a joint effort incorporating partners or family members. Common techniques and strategies are learning to appraise situations in a proportional way, developing adaptive behavioural responses, improving theory of mind (how others perceive the situations), identifying problematic relationship patterns, relating past experiences to the way you relate to others, decreasing a tendency for overthinking and more.
Anger Management
We all get angry from time to time however, some individuals find themselves reacting with rage and experience a sense of lack of control which can lead to further distress.
Tantrums and anger outbursts often damage our relationships and the way people perceive us. Individuals who struggle with anger management can also end up suffering from health issues such as high blood pressure, headaches, heart problems, skin disorders and digestive problems. After an initial assessment therapy aims at identifying common triggers , finding helpful ways to express negative emotions, working on communication skills, training how to rethink your immediate reactions and more.
Chronic Pain
Immediate and fleeting pain is a familiar experience, however, sometimes we face chronic pain for which medical treatment has limit in what it can offer . The way one response to his or her pain and the way one put his or her attention on his or her pain has a significant impact on pain experience. Pain is a subjective phenomena and this subjective experience can cause an unnecessarily emotional struggle.
As part of cognitive behavioural therapy, we will make a joint effort to help you to live a full life despite your ongoing pain and try to move away from putting life on hold. Research demonstrate that our mood and appraisal towards pain impact our level of pain. Together we will understand the consequences and effects of your chronic pain, we will learn ways to manage your pain through adopting appropriate responses, learning relaxation exercises and mindfulness, regulate weekly behaviors in order to prevent overexertion of your body. We will also explore the way your pain or medical condition change the way you think about yourself and your life .
Burnout/Life Challenges and Crisis
Life in its full brings with it ongoing change, transitions and challenges. As strange as it may sound, even positive life events such as: marriage, new job and relocation to a new place can bring with it feelings of apprehension, fear and even low mood. At times we have to deal with complex experiences such as: layoffs, divorces, financial or medical crises. These experiences often take a mental toll on us and force us to find new ways of coping. In the last few years the notion of
Burnout has become more noted and diagnosed as a real mental condition which require professional help. Burnout can also manifest itself in various physiological symptoms such as fatigue, headaches, pains, sleep problems and more. Therapy in all of these instances will focus on identifying what possibly lead to your current state and what maintains your situation . Therapy focuses on conceptualising old and new ways of coping and trying various strategies to assist you maintain a healthy life balance.
From my experience when people face life challenges therapy may last over couple of months. After an initial assessment we will make therapeutic plan and goals and will initially assess how long therapy may last.
Sport Perfomance
My love for physical activity has led me to connect with clients ( children , adolescents and adults) who train and compete in amateur and professional sport. When clients come for focused CBT on sport performance we initially identify clear therapeutic goals and work together to achieve them. CBT in sport performance include the use of positive self talk, guided imagery, re-appraisal challenging mental self talk, emotional regulation, improving mental recovery time, relaxation and mindfulness techniques and more.
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לונג קוביד
עד כ 10% מהאנשים שחלו בקורונה סובלים עדיין מסנדרום המכונה לונג קוביד. סנדרום זה כולל מגוון רחב של תסמינים כגון: עייפות , הפרעות בזכרון ובריכוז( בריין פוג), כאבים, תסמיני גסטרו, שיעול ,קוצר נשימה ועוד. ד״ר מיכאל זיו אור עובד כפסיכולוג מומחה וכחוקר באחת המחלקות היחידות בעולם המטפלות בחולים אלו. על ידי שילוב טכניקות סיביטי ישנה אפשרות להקלה בתסמינים ולשיפור באיכות החיים. הטיפול יכול להנתן בזום , בטיפול פרטני או בטיפול קבוצתי בו תוכלו לשוחח ולהכיר אנשים אחרים המתמודדים עם בעיה זו.