Welcome!
My name is Nikole Krueger, LMSW, and I am a licensed clinical social worker with 15 years of experience working with people from all walks of life. I love brain science and learning different approaches to help people get back to living fulfilling lives, even when their brains aren’t the most cooperative.
My Story
My journey with therapy began when I was 9 years old and was diagnosed with sudden-onset OCD. I was blessed to be diagnosed and begin treatment right after my symptoms began, which is sadly not the norm for OCD sufferers. I went through extensive exposure and response prevention treatment, and while I did not particularly enjoy it, I am extremely grateful for it and credit it with saving my life. It made “normalcy” possible.
When I got to college, I knew I wanted a career where I could help others, with one big caveat: I didn’t ever want to be a therapist, and definitely not an OCD therapist. It felt too close to my own experience, too painful. In time, I came to see that my past was a gift to be used to bless others, not something to bury.
When I went through an extended period of grief several years ago, gardening became my go-to coping skill. It wasn’t the pretty pictures of gardening you see of stylish women in expensive gardening gloves planting flowers. It was me, sweaty with bare hands and dirt in my nails, ripping out my landscaping and starting from scratch; uprooting everything I didn’t want and taking out my grief on the earth. Only then could I start fresh and plant new things. When I see the blooms each year now I smile, but also remember the pain that led to my love of gardening.
It is my hope that by seeing an example of someone who has made it through the storm, you will find hope that you don’t have to live with OCD in the driver’s seat; you can heal and grow and thrive.
“Your story is unique from mine, but I hope someday you too can look back and say, 'I was stuck for a while, but I didn’t stay stuck. I had courage to do the hard things required to grow.'
— Nikole
What is OCD?
Obsessive Compulsive Disorder is a serious mental health disorder that is estimated to affect 1 in 40 people over their lifetime. While symptoms can begin at any age, two common peak times of diagnosis are late childhood (ages 9-12) and late teens to young adulthood.
OCD can take on many different themes that tend to wax and wane over time. Some common themes include obsessions about contamination, harm/violence, responsibility, faith, morality, sexuality, perfectionism, relationships, health, and existence, although there are no limits to the topics OCD will latch onto! Common compulsions include washing, checking, repeating, mental rituals, seeking reassurance, doing rituals until they feel “just right,” and avoiding situations that could trigger obsessions. Compulsions only temporarily relieve distress before the intrusive thoughts return and the compulsion must be performed again. OCD is like a monkey in a jungle. It may jump to a new tree (theme), but it operates following the same pattern of obsessions and compulsions. It’s the same monkey, just on a different tree!
My Specialty & Passion
The themes OCD latches onto cause significant distress because they are excessive, illogical, or in contradiction with a person’s closely held values, beliefs, or personality. For example, someone of strong faith may have obsessions about God not being real or doing something that could offend God or send them to hell. Someone who is empathetic and cares about others might obsess about whether they are secretly a pedophile without knowing it or whether they might kill their family in their sleep. Someone who finds comfort in routines and order might create excessive rules for themselves about what times they can or cannot begin or end activities or how many times they need to repeat a motion to prevent a terrible consequence from occurring. People with OCD may know that their compulsions are irrational, but they still feel compelled to do them.
As a clinician with lived experience of the disorder, there is nothing I love more than helping my clients realize that their OCD thoughts are just OCD thoughts - they don’t mean anything or speak to some deep hidden terrible truth about them. I particularly enjoy working with young adults with religious scrupulosity or other shame-inducing fears.
Unwanted, intrusive thoughts, images, or impulses that are”sticky” in nature are obsessions.
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Compulsions are physical or mental acts done with the purpose of neutralizing the distress caused by the obsession.
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While everyone experiences obsessions or compulsions sometimes, a diagnosis of the disorder is only given if the symptoms consume more than an hour per day, cause significant distress, or interfere in daily activities.
What I Offer
I am trained in two evidence-based treatments for OCD: Exposure and Response Prevention (ERP) and Inference-Based Cognitive Behavioral Therapy (I-CBT). Research shows that each of these therapies brings about significant improvement in symptoms for about two-thirds of people with OCD. I am also trained in Comprehensive Behavioral Intervention for Tics (CBIT) and Habit Reversal Training (HRT) for Body-Focused Repetitive Behaviors.
Exposure and Response Prevention (ERP) Therapy
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ERP is a behavioral therapy – we change your behaviors, which in turn changes your thoughts and feelings. A phrase to describe ERP’s treatment approach is “what you resist persists,” so if we want OCD to leave you alone, you must counter-intuitively let the distressing thoughts be there rather than trying to chase them away.
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In ERP, we will expose you to the things that trigger your obsessions and bring you distress in a controlled environment, and then we will have you resist the urge to do a compulsion and instead sit with that distress while it fades away over time.
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Ultimately, you’ll learn that you can tolerate uncomfortable feelings related to your obsessions, and your brain will learn to no longer see intrusive thoughts, images, or urges as a threat, thereby reducing your distress.
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More information about ERP can be found here.
Comprehensive Behavioral Intervention for Tics (CBIT)
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CBIT, or Comprehensive Behavioral Intervention for Tics, is a structured therapy that combines habit-reversal training and other behavioral techniques to help individuals manage and reduce tic symptoms.
CBIT is not a cure for tics, but it is a management strategy that can significantly improve quality of life for over half the people who underwent treatment in studies.
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In CBIT, I will teach you strategies to become more aware of your urges to tic, guide you in choosing a competing response you can use when you feel those urges, and help you implement strategies to reduce the likelihood your tics will be triggered in daily activities.
In a typical CBIT session, you will learn to recognize tic triggers, practice competing responses, and develop strategies to manage tics effectively.
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Comprehensive Behavioral Intervention for Tics (CBIT) works because it addresses the behavioral and neurological components involved in tic disorders. The therapy focuses on increasing awareness of tics and teaching individuals competing responses that are incompatible with the tic movement or sound. By doing so, CBIT trains the brain to interrupt the automatic tic behavior.
The effectiveness of CBIT lies in its ability to modify the premonitory urge—the uncomfortable sensation that often precedes a tic—helping individuals to manage or reduce these urges through behavioral strategies. This intervention also incorporates relaxation techniques and functional analysis, which identifies triggers or situations that exacerbate tics, enabling patients to develop coping mechanisms.
Additionally, CBIT’s structured, repetitive approach promotes neuroplasticity, encouraging the brain to form new pathways that diminish tic severity over time. Because it empowers individuals with self-regulation skills rather than relying solely on medication, CBIT offers a sustainable and evidence-based treatment for reducing tic frequency and improving quality of life.
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More information about CBIT can be found here.
Inference-based Cognitive Behavioral Therapy (I-CBT)
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I-CBT (Inference-based Cognitive Behavioral Therapy) views obsessions as inferences or doubts that occur due to faulty reasoning, distrust of the senses, and vulnerable self themes. This results in the person with OCD treating abstract possibilities without any direct relevance to the here-and- now as actual probabilities that need to be taken seriously. OCD creates this confusion through clever tricks and cheats that are part of the reasoning story behind the obsessional doubt, which can make the unreal feel very real.
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In I-CBT, I will teach you to trust your senses to overcome the tricks of OCD, rather than teaching you to tolerate discomfort. A phrase to describe I-CBT’s treatment approach is “be where your feet are,” so if we want OCD to leave you alone, you must re-engage with your senses in the present moment rather than getting sucked into thought spirals about possibilities.
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Once you disengage from OCD’s story, you won’t need to do your compulsions anymore; they become irrelevant. In this type of therapy, we change your thoughts, which in turn changes your feelings and behaviors.
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More information about I-CBT can be found here.
Habit Reversal Training (HRT) Therapy
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HRT (Habit Reversal Training) therapy is a behavioral therapy used to treat body-focused repetitive behaviors like skin picking or hair pulling and is very similar to CBIT. Simply put, HRT helps you recognize and change unwanted behaviors.
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I will teach you strategies to become more aware of your urges to pick or pull, guide you in choosing a competing response you can use when you feel those urges, and help you identify strategies to reduce the likelihood that environmental stimuli will trigger your desire to pick or pull. We will also address beliefs that may contribute to the undesired behavior.
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Habit reversal training works by increasing awareness of the unwanted behavior and teaching individuals alternative, competing responses to replace it. This structured approach helps break automatic patterns by encouraging conscious control, reducing the frequency of the habit over time through consistent practice and reinforcement.
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More information about HRT can be found here.