Ask Dr. Ruja — Psychiatry & CBT Q&A

Psychiatrists are medical doctors (MBBS, MD) who diagnose conditions, prescribe medication, and also provide psychotherapy. Psychologists and counselors provide talk therapy only and cannot prescribe. Dr. Ruja Shrestha (NMC 19766) is a Consultant Psychiatrist — she evaluates whether medication, therapy such as CBT, or a combination fits your presentation, and can adjust the plan over time with single-doctor continuity at the clinic.

Cognitive Behavioral Therapy targets the thought–feeling–behavior loop. You learn to identify automatic anxious thoughts, test them against evidence (cognitive restructuring), and gradually reduce avoidance through behavioral activation and exposure. Dr. Ruja uses structured CBT with practice between sessions — for anxiety disorders this is a first-line, evidence-based treatment, often combined with medication when severity warrants it.

The first visit is a structured conversation — your concerns, symptom timeline, sleep, mood, functioning, medical history, current medications, and what you want to change. There is no forced disclosure and no automatic prescription. Dr. Ruja explains the working assessment, options (therapy, medication, both, or watchful waiting), and next steps so you leave with a clear plan rather than uncertainty.

Not necessarily. Duration depends on the condition, episode history, and response. Some people use medication for a defined period alongside therapy and taper under supervision; recurrent or severe conditions may justify longer treatment. Dr. Ruja reviews medication regularly — benefits, side effects, and when reduction is reasonable — decisions are made together, not imposed.

Yes — exposure and response prevention (ERP), a CBT protocol, is the first-line treatment for OCD. It involves gradual, supported exposure to triggers while resisting the compulsive response, weakening the obsession–compulsion cycle over time. Medication (usually an SSRI) is added for moderate-severe OCD or when ERP alone is insufficient. Dr. Ruja plans ERP paced to what you can sustain.

Not always — but persistent insomnia, early waking, or oversleeping can be a symptom of depression, anxiety, bipolar illness, or medication/substance effects, and it also worsens those conditions. Evaluation at the clinic separates primary insomnia from sleep disturbance driven by mood or anxiety so the right target is treated — sometimes CBT-I, sometimes treating the underlying condition.

For most people, appropriately chosen psychiatric medication is safe long-term, but it should be monitored — periodic review of benefit, side effects, weight, sleep, and (for some medications) blood tests. Risks differ by drug and person. Dr. Ruja discusses expected benefits and known risks transparently before starting, and reviews regularly rather than prescribing indefinitely without follow-up.

Listen without minimizing, avoid 'just think positive,' encourage a professional evaluation, and help with practical steps (booking, accompanying, medication routines). Take talk of self-harm or hopelessness seriously and seek urgent help. At the clinic, Dr. Ruja can see the patient directly and, with consent, involve family in the plan — family awareness is often what gets someone through the door.

When stress stops being situational — persistent low mood or anxiety for weeks, sleep and appetite changes, loss of interest, irritability affecting work or relationships, panic symptoms, or coping through alcohol/substances. Early evaluation is easier than waiting for a crisis. Dr. Ruja distinguishes adjustment reactions from conditions needing structured treatment like CBT or medication.

Evidence-based trauma care is paced and safety-first — stabilization skills come before trauma processing, and you control the pace. Avoidance maintains symptoms; structured, gradual work reduces them. Dr. Ruja uses trauma-informed CBT and, where indicated, exposure-based approaches for PTSD and trauma-related conditions — no forced retelling, and medication is considered when symptoms like hyperarousal or depression co-occur.