Dr. Wiesel is an Assistant Professor of Psychology and the Director of the Psychiatry Resident CBT Training Program at the Icahn School of Medicine. She is also an Assistant Professor of Psychology in Psychiatry at Weill Cornell Medical College.
Dr. Wiesel specializes in anxiety disorders, BDD, OCD and related disorders. Dr. Wiesel uses strategies from cognitive behavioral therapy (CBT), including exposure and response prevention (ERP), mindfulness and acceptance-based therapies and dialectical behavior therapy (DBT) to help people manage their symptoms.
Key Highlights
Today, Dwellingright founder, Miriam Rapaport-Hindin, sat down with Dr. Tali Wiesel to chat about life as a psychologist, neurodiverse thinking, and the challenges that the neurodiverse community faces when it comes to being organized.
Key takeaways:
Feeling overwhelmed is normal and sometimes you just need to break tasks up into small bite-sized steps so you can get through things one by one.
If you have trouble managing time, one tip that can help is to make sure to always wear a watch and time how long it actually takes for you to do daily tasks so you can properly plan ahead.
Cognitive behavioral therapy is useful for working with anxiety and depressive disorders. It’s an evidence-based approach that looks at the way in which you think, which impacts the way you respond behaviorally to situations and how that impacts the way you feel.
Interested in reading more? Let's get into the interview below 👏🏽
The Interview
Miriam: Can you tell us a bit about the work that you do as a psychologist?
Tali: I mostly see adults and older teens with anxiety disorders, such as generalized anxiety, OCD and related disorders including, body dysmorphia, skin picking, hair pulling, panic disorder - all of the anxiety disorders really.
Oftentimes if somebody with anxiety is not in control and it's kind of snowballed, you'll see depression with that too. So, I treat that as well.
The modality that I use to treat these patients is a combination approach.
The main approach I take is cognitive behavioral therapy. It’s an evidence-based approach that looks at the way in which you think, which impacts the way in which you respond behaviorally to situations and how that impacts the way you feel. All of these things are connected to each other. If you change one, it's going to impact the other.
I focus a lot of time on the behavioral approach, and then on cognitive restructuring. So I work on how we can shift the way in which you think, as this can change the way you behave and the way you feel.
Another way in which I treat people is through something called acceptance and commitment therapy (ACT), which is changing your relationship with your thoughts.
Instead of struggling against these thoughts, it’s more about taking an approach of mindful observation. Noticing these thoughts, feelings, and sensations without any sort of judgment.
The best way I could describe it is if, for example, you're in quicksand, right? A lot of people who struggle with anxiety or depression, thrash about. But when you thrash about, you sink deeper into that quicksand. So, the best way to get out of that quicksand is to just float, to do nothing. But that's not the impulse. The impulse is to struggle. So, what we try to do is to get you to float, which is to relinquish control.
Something important to note is that the ways in which we often try to control the way we think, is by engaging in compulsions and rumination, which is a behavior. We don't typically think about rumination as a behavior. We tend to think about it as if ‘I'm just thinking’. But thinking and sitting and waiting is a behavior and can be addressed with behavioral therapy tools.
And finally, I also use exposure and response prevention (ERP) and dialectical behavioral therapy (DBT), which consists of different things, including, mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills.
Miriam: So, why did you choose to become a psychologist?
Tali: The honest answer is that my dad is an oncologist and he worked at the Cleveland Clinic where I grew up and I loved going to work with him. I especially loved talking to his patients. I became very interested in the human side of cancer.
When I got to college, I volunteered a lot at Memorial Sloan Kettering Cancer Center. I went there every Sunday and really liked it. It was the highlight of college for me.
I then got an internship while I was in college to volunteer in the psychiatry and behavioral sciences department there and started doing research, and then I applied to psychology graduate school because I was just really interested in it.
Miriam: At Dwellingright we’re really focused on the neurodiverse community and how we can make people’s lives a lot easier. What would you say are the most common challenges that you see your patients facing, especially in the realm of executive functioning?
Tali: It's a really good question because I think for each person the struggle is so unique, and especially when it comes to executive functioning.
I've seen people that go to a really dark place when they've been struggling with these issues for such a long time. This is especially true when you're an adult facing these issues and you haven't had proper treatment. Some patients develop a sense that things aren't really going to change, an overwhelmed "I-don't-know-how-to-manage-this" approach and a sense of helplessness.
I've had older adults, even in their fifties and beyond, come to treatment with an approach of 'I don't really know what I'm going to get out of this, but I might as well just give this a shot'. And they really, really struggle with letting go of the mindset they had before that nothing can help them. Getting them engaged in treatment takes a little bit of time. Moving past this mental hurdle and into the "doing" part of the work, is a really a big step in the process for them.
Another piece of this is getting motivated. Motivation is really a big challenge for many.
And then another big aspect is feeling very overwhelmed and not knowing what to do. Often you see people avoid tasks because their very anxiety inducing and overwhelming. And their mental narrative turns into something like ‘How am I ever going to get this done? I don't have the skills to do this, and I can't. I just can't.’
And lastly, another piece of the puzzle is that people procrastinate on important (and less important) tasks because of poor time management skills.
These are, generally speaking, the really big pieces that I've seen many people struggle with.
Miriam: How would you explain the general issue of executive functioning challenges to those that may not be diagnosed with something specific and are wondering if this is an issue they face and can seek help on?
Tali: It's important to understand that there are many different challenges and many different solutions when it comes to executive function difficulties. Executive functioning is an umbrella term for so many different issues.
So, if you think about executive functioning, it consists of your ability to self-regulate, to hold information in your short-term memory, to think through decisions and to make good choices.
It's also your ability to keep yourself organized and on task. Being able to motivate yourself to do something. Being able to plan ahead. Being able to manage your time. Being able to organize and process information.
Yet another aspect is being able to learn from your mistakes and think about consequences, thinking through things in advance of taking action, not being super impulsive and being able to regulate your moods.
It's so many different things.
Miriam: What are some solutions that you propose to your patients to deal with these challenges?
Tali: There is a whole world of potential solutions, but I can give you some examples of certain recommendations I make.
Generally speaking, there are certain books that I recommend to patients. There are also tips and tricks that I go over with them that are tailored to managing their personal symptoms. Here are some tips I share with my patients.
One thing I would say is that if you're feeling overwhelmed by a task and that the task is too big and you're having trouble getting started - that means the task is too big and that means the first step is too large.
You need to break that task up into many different subtasks.
So, for instance, I have so much laundry that I need to do. And of course, I’m dreading doing all of it. To help deal with approaching this task, we can decide today to tackle just two loads. That’s step one. And it doesn’t all have to be done in one day. As long as we can break it up into really manageable steps.
Another big thing that hinders people from getting things done is how they estimate how much time the task that they need to do takes. Sometimes people who have ADD/ADHD or are in the neurodiverse community really struggle with having a good sense of time. Many people decide that wearing a watch doesn’t seem to do much.
Wear a watch. Get a watch and wear it all the time. Start to time yourself on average on how long it takes you to get your tasks and life chores done. For example, how long does it take you to make your lunch? How long does it take you to eat your breakfast? How long does it take you to get yourself out the door in the morning? How long does it take you to shower at night? How long does your commute take? How long does it take you to drive to certain places that you're typically driving to in, you know, rush hour or whatever?'
Find out how long it takes you to do your average everyday tasks. And then you need to add some buffer time. Say, fifteen minutes.
A lot of people really underestimate what they can get done in ten minutes.
No, it really doesn't take you five minutes to get dressed. It takes you twenty five! To remedy that you can adopt small new habits. For example, get your clothes out the night before so you're not going off track timewise in the morning.
Another tip that I work on with my patients is setting reminders for themselves. If you have a recurring event every week, like a therapy session every Monday at 3 PM, put that in your phone and make an alarm that goes off 15 minutes before and then again 10 minutes before and then again five minutes before. This way, you can't forget and you're not going to be late.
So, breaking things down into smaller tasks, wearing a watch, estimating how long it's going to take you, scheduling those tasks in, and setting reminders as needed, are key things that you can do.
To sum up, back to our laundry example - if that's a task that might be too overwhelming to get done in one day, break it up into two days, schedule a realistic timeframe into each day to do some of it and then put an alarm (or 10, if that's what you need!) on your phone.
Miriam: Tali, I absolutely loved chatting with you! I would love to have you back for another discussion later on so that we can explore some of these issues further. Thank you so much for your time and insights!
If you're interested in finding out more about Dr. Wiesel's work, you can find her here.
Dr. Wiesel completed her Ph.D. in clinical psychology at Ferkauf Graduate School of Psychology, Yeshiva University. She completed her internship training at Weill Cornell Medical College/New York-Presbyterian Hospital in New York City and her postdoctoral fellowship at Northwell’s Zucker-Hillside Hospital. Dr. Wiesel is an expert in CBT and a certified Diplomate of the Academy of Cognitive and Behavioral Therapies, the international credentialing body of CBT. She is licensed in New York and New Jersey.
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