Chronic Pain Psychiatrists in New York, NY

Photo of Shanthi Mogali, Psychiatrist in New York, NY
Shanthi Mogali
Psychiatrist, MD
Verified Verified
New York, NY 10001
My goal in practice is to work together with each patient to develop a customized plan that will address their needs. I am a strong believer in psychotherapy and have experience in individual, group, couple and family therapy. However, when therapy has not provided adequate relief, medication management is always available. I will collaborate with patients to find the best treatment. I am also on faculty at Columbia University/ NYSPI and actively involved in research (specific areas include opioid dependence, pain and complicated grief). This experience allows me to integrate up to date treatment in my practice.
My goal in practice is to work together with each patient to develop a customized plan that will address their needs. I am a strong believer in psychotherapy and have experience in individual, group, couple and family therapy. However, when therapy has not provided adequate relief, medication management is always available. I will collaborate with patients to find the best treatment. I am also on faculty at Columbia University/ NYSPI and actively involved in research (specific areas include opioid dependence, pain and complicated grief). This experience allows me to integrate up to date treatment in my practice.
(646) 480-6303 View (646) 480-6303
Photo of Seth Resnick, Psychiatrist in New York, NY
Seth Resnick
Psychiatrist, MD, DFAPA, FASAM
Verified Verified
New York, NY 10024
His experience in Pain Medicine and Palliative Care subsumes a unique background informing his capacity to help those suffering symptoms physically and psychologically bound.
In his private practice, Dr. Resnick specializes in psychodynamic psychotherapy and psychopharmacology for adults, focusing on young professionals, dealing with issues related to loss, phase-of-life and role change, and associated anxiety and emotional disturbances.
His experience in Pain Medicine and Palliative Care subsumes a unique background informing his capacity to help those suffering symptoms physically and psychologically bound.
In his private practice, Dr. Resnick specializes in psychodynamic psychotherapy and psychopharmacology for adults, focusing on young professionals, dealing with issues related to loss, phase-of-life and role change, and associated anxiety and emotional disturbances.
(646) 679-5304 View (646) 679-5304
Photo of Dr. Jena Simon, Psychiatric Nurse Practitioner in New York, NY
Dr. Jena Simon
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
New York, NY 10003
Jena M. Simon, DNP, is a Double Board-Certified nurse practitioner specializing in psychiatric mental health and family health. After graduating from Columbia University in 2010 as a Family and Oncology Nurse Practitioner, Dr. Simon worked in New York City at a large tertiary medical center caring for adults with sickle cell disease. In this role, she became attuned to the needs of people living with chronic illness and chronic pain.
Jena M. Simon, DNP, is a Double Board-Certified nurse practitioner specializing in psychiatric mental health and family health. After graduating from Columbia University in 2010 as a Family and Oncology Nurse Practitioner, Dr. Simon worked in New York City at a large tertiary medical center caring for adults with sickle cell disease. In this role, she became attuned to the needs of people living with chronic illness and chronic pain.
(347) 967-5203 View (347) 967-5203
Photo of Noam Koenigsberg, Psychiatrist in New York, NY
Noam Koenigsberg
Psychiatrist, MD
Verified Verified
New York, NY 10025  (Online Only)
Awards and Publications: ASAM Essentials of Addiction Medicine Second Edition, Chapter 98 Comorbid Pain And Addiction.
I am a board certified psychiatrist with a telepsychiatric practice seeing patients in Florida and NY. I am licensed in Both Florida and New York states. My concierge practice specializes in medication management to treat psychiatric issues including ADHD, anxiety, depression, and all other psychiatric needs of the patient. I approach each client in a nonjudgmental manner to help decrease and eliminate symptoms and achieve treatment goals. I integrate complementary methodologies and techniques to offer a highly personalized approach tailored to each individual.
Awards and Publications: ASAM Essentials of Addiction Medicine Second Edition, Chapter 98 Comorbid Pain And Addiction.
I am a board certified psychiatrist with a telepsychiatric practice seeing patients in Florida and NY. I am licensed in Both Florida and New York states. My concierge practice specializes in medication management to treat psychiatric issues including ADHD, anxiety, depression, and all other psychiatric needs of the patient. I approach each client in a nonjudgmental manner to help decrease and eliminate symptoms and achieve treatment goals. I integrate complementary methodologies and techniques to offer a highly personalized approach tailored to each individual.
(332) 263-3922 View (332) 263-3922
Photo of Tahara Miah, Psychiatric Nurse Practitioner in New York, NY
Tahara Miah
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
New York, NY 10011
I am a board-certified psychiatric mental health nurse practitioner. I graduated with my masters from New York University. I have worked on an inpatient psychiatry unit and in an outpatient clinic. I have experience working with chronic mental illness such as schizophrenia, bipolar disorder, depression, and anxiety. I work with an amazing team of mental health providers at Orenda Psychiatry.
I am a board-certified psychiatric mental health nurse practitioner. I graduated with my masters from New York University. I have worked on an inpatient psychiatry unit and in an outpatient clinic. I have experience working with chronic mental illness such as schizophrenia, bipolar disorder, depression, and anxiety. I work with an amazing team of mental health providers at Orenda Psychiatry.
(347) 707-7735 View (347) 707-7735
Photo of NP Psychiatry Services, Psychiatric Nurse Practitioner in New York, NY
NP Psychiatry Services
Psychiatric Nurse Practitioner, PMHNP, BC
Verified Verified
2 Endorsed
New York, NY 10011
I have specific training with youth, older adults, substance use and those who have chronic illness.
I am a board certified psychiatric nurse practitioner. I provide a holistic approach to ensuring your highest-quality care and safety. I prescribe medication and lifestyle changes in the context of a therapeutic relationship to support both biochemical and psychosocial interventions in support of your personal treatment goals. I treat children and adults of all ages seeking to support their wellness in a variety of ways including strengthening academic and work performance, improving interpersonal relationships, and decreasing debilitating anxiety, sleep and mood disturbances.
I have specific training with youth, older adults, substance use and those who have chronic illness.
I am a board certified psychiatric nurse practitioner. I provide a holistic approach to ensuring your highest-quality care and safety. I prescribe medication and lifestyle changes in the context of a therapeutic relationship to support both biochemical and psychosocial interventions in support of your personal treatment goals. I treat children and adults of all ages seeking to support their wellness in a variety of ways including strengthening academic and work performance, improving interpersonal relationships, and decreasing debilitating anxiety, sleep and mood disturbances.
(646) 863-5357 View (646) 863-5357
Photo of Matthew Benjamin Smith, Psychiatrist in New York, NY
Matthew Benjamin Smith
Psychiatrist, MD
Verified Verified
New York, NY 10016
I have additional experience in treating people with attention deficit disorder, brain injuries, and chronic pain syndromes.
I am a general adult psychiatrist, practicing individual psychotherapy, group psychotherapy, couple psychotherapy, psychopharmacology, and neuropsychiatry. My approach can be described as eclectic and practical. I routinely treat people with mood disorders, anxiety disrders, addiction disorders, and personality disorders.
I have additional experience in treating people with attention deficit disorder, brain injuries, and chronic pain syndromes.
I am a general adult psychiatrist, practicing individual psychotherapy, group psychotherapy, couple psychotherapy, psychopharmacology, and neuropsychiatry. My approach can be described as eclectic and practical. I routinely treat people with mood disorders, anxiety disrders, addiction disorders, and personality disorders.
(646) 832-4841 View (646) 832-4841
Photo of Addiction and General Psychiatry, Psychiatrist in New York, NY
Addiction and General Psychiatry
Psychiatrist, MD
Verified Verified
New York, NY 10016
In my work with individuals with chronic medical, psychiatric, pain and substance disorders I have come to truly appreciate how very individual and uniquely these manifest in the suffering patient. In the experience of of the one afflicted, their disorder is as distinct as the sufferer him or herself. As no two persons or illnesses could possibly be alike, neither should their most effective prescribed treatments be expected to be.
In my work with individuals with chronic medical, psychiatric, pain and substance disorders I have come to truly appreciate how very individual and uniquely these manifest in the suffering patient. In the experience of of the one afflicted, their disorder is as distinct as the sufferer him or herself. As no two persons or illnesses could possibly be alike, neither should their most effective prescribed treatments be expected to be.
(917) 746-1905 View (917) 746-1905
Photo of Lindsey Carey Wright, Psychiatric Nurse Practitioner in New York, NY
Lindsey Carey Wright
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
1 Endorsed
New York, NY 10025
I know that adding therapy to your life might feel overwhelming, particularly if you are living with illness, disability or caregiving responsibilities, but I'm committed to do everything I can to help you address barriers to treatment and will work with you in the here and now to help you survive and thrive.
My patients come to me searching for a mental health provider who is well-rounded, experienced, thorough, and attentive to their life’s story. While I work as a generalist, I have extensive experience treating patients and families who have been coping with chronic stress, fatigue, anxiety, depression, pain or other difficult to control physical symptoms associated with medical illness. I also have experience working with individuals and families who are dealing with advanced illness and want to find a psychiatric provider who "get's it."
I know that adding therapy to your life might feel overwhelming, particularly if you are living with illness, disability or caregiving responsibilities, but I'm committed to do everything I can to help you address barriers to treatment and will work with you in the here and now to help you survive and thrive.
My patients come to me searching for a mental health provider who is well-rounded, experienced, thorough, and attentive to their life’s story. While I work as a generalist, I have extensive experience treating patients and families who have been coping with chronic stress, fatigue, anxiety, depression, pain or other difficult to control physical symptoms associated with medical illness. I also have experience working with individuals and families who are dealing with advanced illness and want to find a psychiatric provider who "get's it."
(917) 725-0516 View (917) 725-0516
Photo of Manhattan Behavioral Medicine, Psychiatrist in New York, NY
Manhattan Behavioral Medicine
Psychiatrist, MD
Verified Verified
New York, NY 10036
We offer no-cost, no-fee treatment to clients who meet criteria for clinical studies in psychiatry, neurology and pain management.
We have an IVY League Trained Board Certified Psychiatrist who specialize in Adult and Child & Adolescent Psychiatry in New York City. Our specialty is in psychiatric medication management & psychopharmacology, as well as talk therapy. We help people in all stages of development including childhood, adolescence, young adulthood, adulthood and the elder years in a collaborative treatment to identify and achieve individual goals.
We offer no-cost, no-fee treatment to clients who meet criteria for clinical studies in psychiatry, neurology and pain management.
We have an IVY League Trained Board Certified Psychiatrist who specialize in Adult and Child & Adolescent Psychiatry in New York City. Our specialty is in psychiatric medication management & psychopharmacology, as well as talk therapy. We help people in all stages of development including childhood, adolescence, young adulthood, adulthood and the elder years in a collaborative treatment to identify and achieve individual goals.
(646) 791-3951 View (646) 791-3951
Photo of Marvin Kaplan, Psychiatrist in New York, NY
Marvin Kaplan
Psychiatrist, MD
Not Verified Not Verified
New York, NY 10128
I have been in practice for over 30 years and treat a wide range of problems, such as depression, anxiety, bipolar disorders, and attention deficit disorders.. I also treat difficulties in relationships, dissatisfaction with oneself or one's life , chronic pain, trouble coping with physical illness, and addictions (especially alcohol, in addition to other substances. I have a special interest in people with inflammatory bowel disease (ulcerative colitis and Crohn's disease). I have seen many such people and have found that some only become responsive to medical treatment after their psychiatric symptoms are addressed.
I have been in practice for over 30 years and treat a wide range of problems, such as depression, anxiety, bipolar disorders, and attention deficit disorders.. I also treat difficulties in relationships, dissatisfaction with oneself or one's life , chronic pain, trouble coping with physical illness, and addictions (especially alcohol, in addition to other substances. I have a special interest in people with inflammatory bowel disease (ulcerative colitis and Crohn's disease). I have seen many such people and have found that some only become responsive to medical treatment after their psychiatric symptoms are addressed.
(646) 798-9536 View (646) 798-9536
Photo of Menekse Alpay, Psychiatrist in New York, NY
Menekse Alpay
Psychiatrist, MD
Verified Verified
New York, NY 10025  (Online Only)
I work with individuals who have anxiety, depression, mood disorders, insomnia, relationship problems, trauma history, medical illness, neurological illness, and/or individuals who are helping family members with these problems. My experience over the last 25 years in psychiatry has shown that medications are helpful but do not take care of all problems in life. I offer combined psychiatric treatment. I received my psychiatric residency training from Georgetown University Hospital and fellowship in Psychosomatic Medicine from Massachusetts General Hospital, Harvard Medical School.
I work with individuals who have anxiety, depression, mood disorders, insomnia, relationship problems, trauma history, medical illness, neurological illness, and/or individuals who are helping family members with these problems. My experience over the last 25 years in psychiatry has shown that medications are helpful but do not take care of all problems in life. I offer combined psychiatric treatment. I received my psychiatric residency training from Georgetown University Hospital and fellowship in Psychosomatic Medicine from Massachusetts General Hospital, Harvard Medical School.
(914) 342-7750 View (914) 342-7750
Photo of Deepti Anbarasan, Psychiatrist in New York, NY
Deepti Anbarasan
Psychiatrist, MD
Verified Verified
1 Endorsed
New York, NY 10016
As a double-boarded neurologist and psychiatrist, my goal is to improve one's emotional well-being by combining my understanding of the mind-brain interface and each person's unique circumstances to create an individualized, integrative treatment plan. I have experience with treatment of intractable depression, anxiety, obsessive-compulsive disorder, functional neurological disorders (FND) including non-epileptic seizures (NES), somatic symptom disorder, chronic pain, and ADHD. I use a combination of both individual psychotherapy and medication management to serve the needs of my patients.
As a double-boarded neurologist and psychiatrist, my goal is to improve one's emotional well-being by combining my understanding of the mind-brain interface and each person's unique circumstances to create an individualized, integrative treatment plan. I have experience with treatment of intractable depression, anxiety, obsessive-compulsive disorder, functional neurological disorders (FND) including non-epileptic seizures (NES), somatic symptom disorder, chronic pain, and ADHD. I use a combination of both individual psychotherapy and medication management to serve the needs of my patients.
(347) 801-7490 View (347) 801-7490
Photo of The Neuro Well, Psychiatrist in New York, NY
The Neuro Well
Psychiatrist, MD, MS
Verified Verified
New York, NY 10001  (Online Only)
I am a Board-certified Neurologist and UCNS-certified Neuropsychiatrist who was trained at the Mount Sinai School of Medicine and Columbia University School of Medicine. I specialize in treating people with Neurological or Psychiatric symptoms (or both), including anxiety, depression, irritability, apathy, fatigue, insomnia, chronic pain, headache, addiction and cognitive difficulty. I use the fewest medications possible to achieve the most relief. I also use Neurological medications that target the stress system, which is a novel and effective way to treat more than one symptom simultaneously.
I am a Board-certified Neurologist and UCNS-certified Neuropsychiatrist who was trained at the Mount Sinai School of Medicine and Columbia University School of Medicine. I specialize in treating people with Neurological or Psychiatric symptoms (or both), including anxiety, depression, irritability, apathy, fatigue, insomnia, chronic pain, headache, addiction and cognitive difficulty. I use the fewest medications possible to achieve the most relief. I also use Neurological medications that target the stress system, which is a novel and effective way to treat more than one symptom simultaneously.
(929) 545-6429 View (929) 545-6429
Photo of Mary Mazgaj, Psychiatric Nurse Practitioner in New York, NY
Mary Mazgaj
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
1 Endorsed
New York, NY 10016
Mary is a dually certified family and psychiatric mental health nurse practitioner with ten years of unique clinical experience including pain management, primary care and psychiatry.
Mary utilizes a patient-centered/tailored approach with an emphasis on collaborative, mutually respectful patient-provider relationships. She follows The Perspective Approach to psychiatry, recognizing that mental illness is not linear, but dimensional. She strives to provide a warm and compassionate environment where her patients feel heard, validated and respected. Her aim is to provide top notch psychiatric care and guide her clients toward a rewarding life that is not defined by their mental illnesses.
Mary is a dually certified family and psychiatric mental health nurse practitioner with ten years of unique clinical experience including pain management, primary care and psychiatry.
Mary utilizes a patient-centered/tailored approach with an emphasis on collaborative, mutually respectful patient-provider relationships. She follows The Perspective Approach to psychiatry, recognizing that mental illness is not linear, but dimensional. She strives to provide a warm and compassionate environment where her patients feel heard, validated and respected. Her aim is to provide top notch psychiatric care and guide her clients toward a rewarding life that is not defined by their mental illnesses.
(646) 906-8545 View (646) 906-8545
Photo of Sarah Oreck, Psychiatrist in New York, NY
Sarah Oreck
Psychiatrist, MD, MS
Verified Verified
New York, NY 10024  (Online Only)
I'm a Columbia University-trained psychiatrist focusing on women's mental wellness. In addition to my expertise in general and addiction psychiatry, I'm one of a few doctors with specialized training in women's mental health and reproductive psychiatry. I provide highly personalized and empathic treatment to women throughout the reproductive life cycle. I believe in treating both body and mind through mindful breathing and meditation in addition to talk therapy and the most up-to-date medication treatments. I treat patients with mood and anxiety symptoms, chronic pelvic pain, trauma, ADHD, addiction and eating disorders.
I'm a Columbia University-trained psychiatrist focusing on women's mental wellness. In addition to my expertise in general and addiction psychiatry, I'm one of a few doctors with specialized training in women's mental health and reproductive psychiatry. I provide highly personalized and empathic treatment to women throughout the reproductive life cycle. I believe in treating both body and mind through mindful breathing and meditation in addition to talk therapy and the most up-to-date medication treatments. I treat patients with mood and anxiety symptoms, chronic pelvic pain, trauma, ADHD, addiction and eating disorders.
(424) 347-8259 View (424) 347-8259
Photo of Noam Koenigsberg, Psychiatrist in New York, NY
Noam Koenigsberg
Psychiatrist, MD
Verified Verified
3 Endorsed
New York, NY 10005  (Online Only)
Awards and Publications: ASAM Essentials of Addiction Medicine Second Edition, Chapter 98 Comorbid Pain And Addiction.
I am a board certified psychiatrist. I have a telepsychiatric practice where I see clients all over Florida and New York state. I am licensed in both states. My concierge practice specializes in medication management to treat psychiatric issues including ADHD, anxiety, depression, and all other psychiatric needs of the patient. I approach each client in a nonjudgmental manner to help decrease and eliminate symptoms and achieve treatment goals. I integrate complementary methodologies and techniques to offer a highly personalized approach tailored to each individual.
Awards and Publications: ASAM Essentials of Addiction Medicine Second Edition, Chapter 98 Comorbid Pain And Addiction.
I am a board certified psychiatrist. I have a telepsychiatric practice where I see clients all over Florida and New York state. I am licensed in both states. My concierge practice specializes in medication management to treat psychiatric issues including ADHD, anxiety, depression, and all other psychiatric needs of the patient. I approach each client in a nonjudgmental manner to help decrease and eliminate symptoms and achieve treatment goals. I integrate complementary methodologies and techniques to offer a highly personalized approach tailored to each individual.
(305) 440-4768 View (305) 440-4768
Photo of Daniel Bober, Psychiatrist in New York, NY
Daniel Bober
Psychiatrist, DO
Verified Verified
New York, NY 10022
I specialize in the treatment of adults and children with mental illness and addiction.
It is my belief that true peace and healing can only occur with a full understanding of the individual and how they relate to the world around them. Therefore, medication is only a small piece of the puzzle and although there is much talk about the use of evidence based treatments, the absence of evidence is not the evidence of absence and so I try to incorporate different schools of thought from not only Western Medicine, but Eastern Medicine as well. In the final analysis we are on this journey together and I find it a privilege to be able to join you.
I specialize in the treatment of adults and children with mental illness and addiction.
It is my belief that true peace and healing can only occur with a full understanding of the individual and how they relate to the world around them. Therefore, medication is only a small piece of the puzzle and although there is much talk about the use of evidence based treatments, the absence of evidence is not the evidence of absence and so I try to incorporate different schools of thought from not only Western Medicine, but Eastern Medicine as well. In the final analysis we are on this journey together and I find it a privilege to be able to join you.
(954) 967-6776 View (954) 967-6776
Photo of Alexander Ivan Gumbs, Psychiatric Nurse Practitioner in New York, NY
Alexander Ivan Gumbs
Psychiatric Nurse Practitioner, FNP-BC, PMHNP, -BC
Verified Verified
3 Endorsed
New York, NY 10001
He also provides care to those with chronic diseases associated with mental illness for example vitamin D deficiency, hypothyroidism, hyperthyroidism, diabetes, obesity, chronic kidney disease, chronic pain, and AIDS-associated dementia.
Alexander Gumbs, FNP/PMHNP-BC is a dual board-certified practitioner in psychiatry and family medicine. Mr. Gumbs uses an integrative holistic approach to treat the bodies and minds of his patients. He is proficient in treating those across the lifespan (children, adolescents, adults, and seniors). Community focus is his passion. He has experience treating disadvantaged populations, such as the homeless and those in the criminal justice system transitioning back to civilian life. Mr. Gumbs treats those with anxiety, bipolar disorder, PTSD, depression, autism, insomnia, dementia, and postpartum depression.
He also provides care to those with chronic diseases associated with mental illness for example vitamin D deficiency, hypothyroidism, hyperthyroidism, diabetes, obesity, chronic kidney disease, chronic pain, and AIDS-associated dementia.
Alexander Gumbs, FNP/PMHNP-BC is a dual board-certified practitioner in psychiatry and family medicine. Mr. Gumbs uses an integrative holistic approach to treat the bodies and minds of his patients. He is proficient in treating those across the lifespan (children, adolescents, adults, and seniors). Community focus is his passion. He has experience treating disadvantaged populations, such as the homeless and those in the criminal justice system transitioning back to civilian life. Mr. Gumbs treats those with anxiety, bipolar disorder, PTSD, depression, autism, insomnia, dementia, and postpartum depression.
(516) 464-3006 View (516) 464-3006
Photo of Sumit Naig, Psychiatrist in New York, NY
Sumit Naig
Psychiatrist, MD, PhD
Verified Verified
New York, NY 10003  (Online Only)
I believe in collaborating with my patients to understand their mental health needs using a four-part model:- the life story: where the patient is in her/his life, family history and upbringing- the personality: who she/he is as a person- the behavior: what coping methods does she/he employ to manage stressors and psychologic- the illness:  the symptoms that brought her/him to seek help.
I believe in collaborating with my patients to understand their mental health needs using a four-part model:- the life story: where the patient is in her/his life, family history and upbringing- the personality: who she/he is as a person- the behavior: what coping methods does she/he employ to manage stressors and psychologic- the illness:  the symptoms that brought her/him to seek help.
(323) 405-9480 View (323) 405-9480
Chronic Pain Psychiatrists

How does chronic pain therapy work?

Engaging with a psychotherapist to help treat chronic pain does not mean that one’s pain is all in their head. Therapy for chronic-pain patients has been shown to benefit both the mind and the body, targeting physical symptoms and increasing daily functioning. In other words, for many, addressing their emotional health through therapy affects their physical health. A therapist can help a client challenge unhelpful thoughts about pain and develop new ways to respond to it, such as distraction or calming breathing techniques. Studies have found that therapy can be as effective as surgery for certain cases of chronic pain and many doctors recommend trying psychotherapy in advance of considering invasive surgery.

What are the most effective treatment options for chronic pain?

Stress, anxiety, depression, catastrophizing, ruminating, lack of activity, and social withdrawal all make chronic pain worse. Addressing these issues, research shows, can help people gain control over their pain symptoms. Therapeutic approaches such as cognitive behavioral therapy, biofeedback, and mindfulness-based stress reduction, along with greater pain-management education, have been found to help people reduce fear and disability.

Are there new treatments for chronic pain?

Many cases of chronic pain, particularly those involving back pain, remain medically unexplained. But there is evidence that changes in the brain or nervous system are caused by previous physical ailments such as tissue damage; in such cases, the brain may continue to send out pain signals despite the physical cause having healed. To aid patients under these circumstances, a recently developed treatment known as pain reprocessing therapy (PRT) is designed to help the brain “unlearn” this response. A PRT practitioner helps individuals to reduce the “threat value” of their ongoing pain signals until they can reappraise them as less threatening and fear-inducing. They also help an individual to develop new emotional regulation skills.

How long does therapy for chronic pain take?

There is no set timeline for recovery from chronic pain, especially as there may be a range of physical and psychological causes for any individual’s discomfort, but most patients should expect to see a therapist for a number of weeks or months, typically spanning at least 12 sessions. Studies of pain reprocessing therapy found that many individuals’ experience of pain lessened in eight sessions over four weeks.