Photo of Kerniba Ghoneim, Psychiatric Nurse Practitioner in Montgomery County, MD
Kerniba Ghoneim
Psychiatric Nurse Practitioner, DNP, PMHNP, CMHIMP, MBL
Verified Verified
14 Endorsed
Germantown, MD 20874  (Online Only)
Her treatment approach endorses empathic support, Cognitive Behavior Therapy (CBT), wellness therapies, and mindfulness.
Dr. Ghoneim is a board-certified Doctorate Psychiatric Mental Nurse Practitioner (DNP, PMHNP-BC) and a Certified Mental Health Integrative Medicine Provider (CMHIMP). She incorporates complementary therapies, such as nutrition, vitamins, and supplementation, into conventional psychiatry methods. Holistic and individualized care are used to identify and address the root cause of your personal and professional challenges. She prescribes medications conservatively, safely, and effectively. She treats all ages (8yrs and above) and accepts most major insurance payors. Request an assessment at www.vigorintegrative.com
Her treatment approach endorses empathic support, Cognitive Behavior Therapy (CBT), wellness therapies, and mindfulness.
Dr. Ghoneim is a board-certified Doctorate Psychiatric Mental Nurse Practitioner (DNP, PMHNP-BC) and a Certified Mental Health Integrative Medicine Provider (CMHIMP). She incorporates complementary therapies, such as nutrition, vitamins, and supplementation, into conventional psychiatry methods. Holistic and individualized care are used to identify and address the root cause of your personal and professional challenges. She prescribes medications conservatively, safely, and effectively. She treats all ages (8yrs and above) and accepts most major insurance payors. Request an assessment at www.vigorintegrative.com
(240) 998-1561 View (240) 998-1561
Photo of Sandra Krotman, Psychiatric Nurse Practitioner in Montgomery County, MD
Sandra Krotman
Psychiatric Nurse Practitioner, PMH-NP, BC
Verified Verified
Gaithersburg, MD 20879
My approach is eclectic, and I incorporate cognitive, behavioral, and complementary therapies in my practice.
My name is Sandra Krotman. I am a Board certified Psychiatric and Mental Health Nurse Practitioner ( PMHNP-BC) with prescriptive privileges. Every person has concerns they struggle with during their lifetime. Some people struggle on and off, and for others, the path is filled with twists, turns, slippery rocks, and possibly big boulders. Wherever you are on your journey, I can meet you on your route, and help you navigate your mental health needs. We can create a comprehensive treatment plan after an assessment and evaluation, discuss options such as therapy, medication management, or combination of both.
My approach is eclectic, and I incorporate cognitive, behavioral, and complementary therapies in my practice.
My name is Sandra Krotman. I am a Board certified Psychiatric and Mental Health Nurse Practitioner ( PMHNP-BC) with prescriptive privileges. Every person has concerns they struggle with during their lifetime. Some people struggle on and off, and for others, the path is filled with twists, turns, slippery rocks, and possibly big boulders. Wherever you are on your journey, I can meet you on your route, and help you navigate your mental health needs. We can create a comprehensive treatment plan after an assessment and evaluation, discuss options such as therapy, medication management, or combination of both.
(240) 616-4388 View (240) 616-4388
Photo of Michelle Hornbaker-Park, Psychiatrist in Montgomery County, MD
Michelle Hornbaker-Park
Psychiatrist, MD
Verified Verified
Rockville, MD 20850  (Online Only)
Dr. Michelle Hornbaker-Park is a board-certified General and Child and Adolescent Psychiatrist with over nine years of experience. Her practice focuses on medication management founded not only on evidence-based medicine but on the understanding that a trusting therapeutic relationship is the cornerstone of behavioral health healing. She incorporates CBT, supportive therapy, and psychoeducation into her medication management appointments and may refer patients for additional psychotherapy to improve outcomes.
Dr. Michelle Hornbaker-Park is a board-certified General and Child and Adolescent Psychiatrist with over nine years of experience. Her practice focuses on medication management founded not only on evidence-based medicine but on the understanding that a trusting therapeutic relationship is the cornerstone of behavioral health healing. She incorporates CBT, supportive therapy, and psychoeducation into her medication management appointments and may refer patients for additional psychotherapy to improve outcomes.
(240) 376-5950 View (240) 376-5950
Photo of Absolute Mental Healthcare Solutions, Psychiatric Nurse Practitioner in Montgomery County, MD
Absolute Mental Healthcare Solutions
Psychiatric Nurse Practitioner, PMHNP, CRNP, MSN
Verified Verified
2 Endorsed
Silver Spring, MD 20904  (Online Only)
I am PMHNP-Board Certified, committed to offering mental health treatment and support to families and individuals struggling with depression, Anxiety, trauma-related issues, sleep disturbance, mood instability, psychosis, addiction, emotional distress, cognitive decline-related behaviors, and Hyperactivity in children. My GOAL is to provide Optimal mental healthcare for all through comprehensive evaluations and evidence-based interventions. Currently accepting new patients via Telehealth, initiate help via video or telephone consultation.
I am PMHNP-Board Certified, committed to offering mental health treatment and support to families and individuals struggling with depression, Anxiety, trauma-related issues, sleep disturbance, mood instability, psychosis, addiction, emotional distress, cognitive decline-related behaviors, and Hyperactivity in children. My GOAL is to provide Optimal mental healthcare for all through comprehensive evaluations and evidence-based interventions. Currently accepting new patients via Telehealth, initiate help via video or telephone consultation.
(301) 450-6093 View (301) 450-6093
Photo of Pinnacle Healthcare Services LLC, Psychiatric Nurse Practitioner in Montgomery County, MD
Pinnacle Healthcare Services LLC
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
Silver Spring, MD 20904  (Online Only)
Bridget is a board-certified Psychiatric Nurse Practitioner who specializes in schizophrenia, bipolar disorder, anxiety/panic attacks, depression, insomnia, obsessive-compulsive disorder, ADHD/ADD, and posttraumatic stress disorder (PTSD). She has worked in mental health as a nurse practitioner and as a cognitive behavioral psychotherapist. She does psychiatric evaluations, medication management, diagnosis, and treatment of people in need of mental health care.
Bridget is a board-certified Psychiatric Nurse Practitioner who specializes in schizophrenia, bipolar disorder, anxiety/panic attacks, depression, insomnia, obsessive-compulsive disorder, ADHD/ADD, and posttraumatic stress disorder (PTSD). She has worked in mental health as a nurse practitioner and as a cognitive behavioral psychotherapist. She does psychiatric evaluations, medication management, diagnosis, and treatment of people in need of mental health care.
(301) 215-3461 View (301) 215-3461
Photo of Mimi Jimenez, Psychiatric Nurse Practitioner in Montgomery County, MD
Mimi Jimenez
Psychiatric Nurse Practitioner, MSN, CRNP, PMH
Verified Verified
Cervello-Wellness aims to raise community awareness of mental health and cognitive disorders and eliminate the mental health stigma.
WE ARE ACCEPTING NEW CLIENTS*** Mimi Jimenez is a psychiatric Nurse Practitioner who uses various treatments, including psychiatric evaluations, psychosocial interventions, and medication management. Her specialty is devoted to diagnosing, preventing, and treating mental disorders.
Cervello-Wellness aims to raise community awareness of mental health and cognitive disorders and eliminate the mental health stigma.
WE ARE ACCEPTING NEW CLIENTS*** Mimi Jimenez is a psychiatric Nurse Practitioner who uses various treatments, including psychiatric evaluations, psychosocial interventions, and medication management. Her specialty is devoted to diagnosing, preventing, and treating mental disorders.
(301) 392-7120 View (301) 392-7120
Photo of Adeline Mangwa, Psychiatric Nurse Practitioner in Montgomery County, MD
Adeline Mangwa
Psychiatric Nurse Practitioner, PMHNP , BC
Verified Verified
Rockville, MD 20848
With her you shall use a whole self-approach, addressing the needs of your mind, body, and spirit, in combination with talk therapy, CBT, mindfulness, anything that will help you take control of your life.
Life can be very stressful and overwhelming, sometimes it leaves us feeling sad, depressed, anxious and scared. Your mental health is our priority. Adeline is a board-certified PMHNP and suboxone certified, with 15 years plus working in the mental health field. Now helping clients and families face with mental health challenges, like anxiety, depression, bipolar, schizophrenia, substance use disorder, schizoaffective disorder ,suboxone maintenance etc. After working together with Adeline, clients are successfully managing their symptoms, and now living their normal life. I believe your case is not different.
With her you shall use a whole self-approach, addressing the needs of your mind, body, and spirit, in combination with talk therapy, CBT, mindfulness, anything that will help you take control of your life.
Life can be very stressful and overwhelming, sometimes it leaves us feeling sad, depressed, anxious and scared. Your mental health is our priority. Adeline is a board-certified PMHNP and suboxone certified, with 15 years plus working in the mental health field. Now helping clients and families face with mental health challenges, like anxiety, depression, bipolar, schizophrenia, substance use disorder, schizoaffective disorder ,suboxone maintenance etc. After working together with Adeline, clients are successfully managing their symptoms, and now living their normal life. I believe your case is not different.
(240) 730-2995 View (240) 730-2995
Photo of Moronke O Aboyewa, Psychiatric Nurse Practitioner in Montgomery County, MD
Moronke O Aboyewa
Psychiatric Nurse Practitioner, CRNP, PMH
Verified Verified
Silver Spring, MD 20906  (Online Only)
As a board-certified Psychiatric Nurse Practitioner with 6+ years of experience in the evaluation and treatment of depression, anxiety, PD, PTSD, bipolar, and psychotic disorders in ages 18 and up, I incorporate therapy, specifically CBT and TF-CBT, a form of psychotherapy in conjunction with medication management.
Are you experiencing intense sadness or feeling depressed? Do you feel alone or unmotivated? Can’t get out of bed most days because you feel that there is nothing to live for? Are you consumed with fear that is stopping you from doing a lot of things and or preventing you from reaching your full potential? Maybe you are unable to control automated negative thoughts. I have good news for you –there is help! We will work with you to identify the root cause of your symptoms and to plan individualized and workable treatment plans .
As a board-certified Psychiatric Nurse Practitioner with 6+ years of experience in the evaluation and treatment of depression, anxiety, PD, PTSD, bipolar, and psychotic disorders in ages 18 and up, I incorporate therapy, specifically CBT and TF-CBT, a form of psychotherapy in conjunction with medication management.
Are you experiencing intense sadness or feeling depressed? Do you feel alone or unmotivated? Can’t get out of bed most days because you feel that there is nothing to live for? Are you consumed with fear that is stopping you from doing a lot of things and or preventing you from reaching your full potential? Maybe you are unable to control automated negative thoughts. I have good news for you –there is help! We will work with you to identify the root cause of your symptoms and to plan individualized and workable treatment plans .
(301) 205-5739 View (301) 205-5739
Photo of Dr. Temitope Akinladenu, Psychiatric Nurse Practitioner in Montgomery County, MD
Dr. Temitope Akinladenu
Psychiatric Nurse Practitioner, DNP, CRNP, PMHNP
Verified Verified
2 Endorsed
Gaithersburg, MD 20877
I believe the right for every individual is to receive quality mental health services. I am a doctoral prepared, nationally board certified Psychiatric Mental Health Nurse Practitioner trained to treat all ages. I have a decade of healthcare experience in inpatient, outpatient, PHP, and IOP settings. My passion is to provide comprehensive care that focuses on client needs and empower full participation in their own treatment. I incorporate supportive therapy, use of positive coping skills and medication management (if needed). I believe educating how medications work in the brain is important for clients to know and understand
I believe the right for every individual is to receive quality mental health services. I am a doctoral prepared, nationally board certified Psychiatric Mental Health Nurse Practitioner trained to treat all ages. I have a decade of healthcare experience in inpatient, outpatient, PHP, and IOP settings. My passion is to provide comprehensive care that focuses on client needs and empower full participation in their own treatment. I incorporate supportive therapy, use of positive coping skills and medication management (if needed). I believe educating how medications work in the brain is important for clients to know and understand
(240) 734-3384 View (240) 734-3384
Photo of Omiah Behavioral Health & Wellness LLC, Psychiatric Nurse Practitioner in Montgomery County, MD
Omiah Behavioral Health & Wellness LLC
Psychiatric Nurse Practitioner, DNP, CRNP, PMHNP
Verified Verified
1 Endorsed
Gaithersburg, MD 20877
Accepting New Clients in Maryland and Virginia. Whether online or in-person, we believe the right for every individual is to receive quality mental health services. Understanding each person’s experience is different, we consider all aspects of your life and treat the WHOLE person not just symptoms. Our clinicians are experienced providers who create partnership with each client, actively listen to your personal goals, what you are experiencing and response to treatment in each visit.
Accepting New Clients in Maryland and Virginia. Whether online or in-person, we believe the right for every individual is to receive quality mental health services. Understanding each person’s experience is different, we consider all aspects of your life and treat the WHOLE person not just symptoms. Our clinicians are experienced providers who create partnership with each client, actively listen to your personal goals, what you are experiencing and response to treatment in each visit.
(240) 693-5274 View (240) 693-5274
CareMind Health
Psychiatrist, PMHNP, LCSW, LCPC, PA-C
Verified Verified
Silver Spring, MD 20910  (Online Only)
CareMind Health is redefining the service of psychiatry and transforming behavioral health care. As a patient-centered organization, we are focused on supporting people with their mental health. We create access to convenient, high quality services delivered by compassionate and skilled clinicians. Our goal is to provide our clients with an exceptional experience that improves overall wellbeing, and restores the foundations of healthy living.
CareMind Health is redefining the service of psychiatry and transforming behavioral health care. As a patient-centered organization, we are focused on supporting people with their mental health. We create access to convenient, high quality services delivered by compassionate and skilled clinicians. Our goal is to provide our clients with an exceptional experience that improves overall wellbeing, and restores the foundations of healthy living.
(301) 825-5004 View (301) 825-5004
Photo of Kolossal Healthcare Services LLC, Psychiatric Nurse Practitioner in Montgomery County, MD
Kolossal Healthcare Services LLC
Psychiatric Nurse Practitioner, CRNP, PMH-BC
Verified Verified
Gaithersburg, MD 20877  (Online Only)
I am a compassionate and dedicated Psychiatric Nurse Practitioner (PMHNP-BC) with a deep passion for mental health wellness and a commitment to helping individuals achieve optimal well-being. I specialize in Anxiety disorders, Depression, Adjustment disorders Eating disorders, Mood disorders, Attention Deficit Hyperactivity Disorder (ADHD) in teens and adults.
I am a compassionate and dedicated Psychiatric Nurse Practitioner (PMHNP-BC) with a deep passion for mental health wellness and a commitment to helping individuals achieve optimal well-being. I specialize in Anxiety disorders, Depression, Adjustment disorders Eating disorders, Mood disorders, Attention Deficit Hyperactivity Disorder (ADHD) in teens and adults.
(443) 251-3050 View (443) 251-3050
Photo of Ezra Molina, Psychiatric Nurse Practitioner in Montgomery County, MD
Ezra Molina
Psychiatric Nurse Practitioner, CRNP, PMH
Verified Verified
Rockville, MD 20852
With a passion for restoring mental health, I am a board-certified Psychiatric Mental Health Nurse Practitioner dedicated to empowering clients to reach their mental health goals. My background includes an MSN from the University of Maryland, Baltimore, and a Post-Masters Certificate from George Washington University. I believe in providing personalized treatment plans that promote holistic well-being. I take the time to understand each client as unique, equipping them with the tools to participate actively in their healing journey.
With a passion for restoring mental health, I am a board-certified Psychiatric Mental Health Nurse Practitioner dedicated to empowering clients to reach their mental health goals. My background includes an MSN from the University of Maryland, Baltimore, and a Post-Masters Certificate from George Washington University. I believe in providing personalized treatment plans that promote holistic well-being. I take the time to understand each client as unique, equipping them with the tools to participate actively in their healing journey.
(301) 392-7120 View (301) 392-7120
Photo of Yvonne McKenzie, Psychiatric Nurse Practitioner in Montgomery County, MD
Yvonne McKenzie
Psychiatric Nurse Practitioner, PMHNP
Verified Verified
Bethesda, MD 20814  (Online Only)
Hello, I'm Dr. Yvonne. Do you feel pulled in a thousand directions and not able to put it all together? Are you struggling to keep up with your responsibilities? It's time to be kind to yourself and together we will address issues and come to a manageable regimen designed for you. Whether you're dealing with feeling overwhelmed, relationship issues or cycles of anxiety and depression, I'm here to help.
Hello, I'm Dr. Yvonne. Do you feel pulled in a thousand directions and not able to put it all together? Are you struggling to keep up with your responsibilities? It's time to be kind to yourself and together we will address issues and come to a manageable regimen designed for you. Whether you're dealing with feeling overwhelmed, relationship issues or cycles of anxiety and depression, I'm here to help.
(240) 226-1997 View (240) 226-1997
Photo of Letha Sunil, Physician Assistant in Montgomery County, MD
Letha Sunil
Physician Assistant, PA-C
Verified Verified
Rockville, MD 20850
Accepting NEW Patients! Letha received her MS in Physician Assistant Studies from Towson University, After practicing hospital medicine/ internal medicine for two years, she switched to direct patient care because she wanted to work closely with patients.
Accepting NEW Patients! Letha received her MS in Physician Assistant Studies from Towson University, After practicing hospital medicine/ internal medicine for two years, she switched to direct patient care because she wanted to work closely with patients.
(240) 219-3385 View (240) 219-3385
Photo of Jason Eliassaint, Psychiatric Nurse Practitioner in Montgomery County, MD
Jason Eliassaint
Psychiatric Nurse Practitioner, APRN, PMHNP, BC
Verified Verified
Silver Spring, MD 20902
My name is Jason, I am a licensed Psychiatric Mental Health Nurse Practitioner (PMHNP), specializing in anxiety, panic disorder, depression, trauma, ADHD, bipolar disorders, and schizophrenia. My goal is to create strong and trusting relationships with my patients in order to pursue the best course of effective treatment. I have experience working with adolescents, adults, and families. My sympathetic, kindhearted, and caring approaches to each individual patients make me capable of reaching the core of each of my patients’ issues and empowers them to enhance their awareness of their potentials in dealing with treatment and recovery
My name is Jason, I am a licensed Psychiatric Mental Health Nurse Practitioner (PMHNP), specializing in anxiety, panic disorder, depression, trauma, ADHD, bipolar disorders, and schizophrenia. My goal is to create strong and trusting relationships with my patients in order to pursue the best course of effective treatment. I have experience working with adolescents, adults, and families. My sympathetic, kindhearted, and caring approaches to each individual patients make me capable of reaching the core of each of my patients’ issues and empowers them to enhance their awareness of their potentials in dealing with treatment and recovery
(240) 209-9881 View (240) 209-9881
Photo of Robin Peterson, Psychiatric Nurse Practitioner in Montgomery County, MD
Robin Peterson
Psychiatric Nurse Practitioner, RN, MSN, PMHNP
Verified Verified
1 Endorsed
Rockville, MD 20852  (Online Only)
Hello. My name is Robin. I have been a psychiatric Nurse 30 years. I have experience, knowledge and expertise working with a variety of clients. I use a person centered approach in order to meet the individualized needs of each client. I graduated from University of Texas in Austin with a Bachelor in Nursing and received a post masters certificate as a psychiatric nurse practitioner from Vanderbilt university. I retired from active duty 2016.
Hello. My name is Robin. I have been a psychiatric Nurse 30 years. I have experience, knowledge and expertise working with a variety of clients. I use a person centered approach in order to meet the individualized needs of each client. I graduated from University of Texas in Austin with a Bachelor in Nursing and received a post masters certificate as a psychiatric nurse practitioner from Vanderbilt university. I retired from active duty 2016.
(919) 944-4369 View (919) 944-4369
Photo of Sergey Istomin, Psychiatric Nurse Practitioner in Montgomery County, MD
Sergey Istomin
Psychiatric Nurse Practitioner
Verified Verified
Bethesda, MD 20814  (Online Only)
Bilingual (English, Russian) Psychiatric Nurse Practitioner: my telehealth practice is open to new clients(18+) residing in Maryland. My background is in inpatient/outpatient treatment of adults through the use of safe non-addictive psychotropic medications and individually tailored psychotherapeutic supportive approaches for clients experiencing psychological problems.
Bilingual (English, Russian) Psychiatric Nurse Practitioner: my telehealth practice is open to new clients(18+) residing in Maryland. My background is in inpatient/outpatient treatment of adults through the use of safe non-addictive psychotropic medications and individually tailored psychotherapeutic supportive approaches for clients experiencing psychological problems.
(240) 474-0882 View (240) 474-0882
Photo of Swaminathan Thangaraj, Psychiatrist in Montgomery County, MD
Swaminathan Thangaraj
Psychiatrist, MD
Verified Verified
Silver Spring, MD 20910  (Online Only)
Dr. Swaminathan Thangaraj is board certified in both adult psychiatry and child and adolescent psychiatry. He received his medical degree from Lake Erie College of Osteopathic Medicine, then completed general psychiatry residency at Drexel College of Medicine, followed by child and adolescent psychiatry fellowship at Johns Hopkins Hospital. Before joining the outpatient psychiatry team at CareMind Health/Mindoula Clinical Services, Dr. Thangaraj worked as a child and adolescent psychiatrist at Sheppard-Pratt Hospital in Baltimore, Maryland, and McLean Hospital in Boston, Massachusetts.
Dr. Swaminathan Thangaraj is board certified in both adult psychiatry and child and adolescent psychiatry. He received his medical degree from Lake Erie College of Osteopathic Medicine, then completed general psychiatry residency at Drexel College of Medicine, followed by child and adolescent psychiatry fellowship at Johns Hopkins Hospital. Before joining the outpatient psychiatry team at CareMind Health/Mindoula Clinical Services, Dr. Thangaraj worked as a child and adolescent psychiatrist at Sheppard-Pratt Hospital in Baltimore, Maryland, and McLean Hospital in Boston, Massachusetts.
(301) 679-7790 View (301) 679-7790
Photo of Andre Gligor, Psychiatric Nurse Practitioner in Montgomery County, MD
Andre Gligor
Psychiatric Nurse Practitioner, NP
Verified Verified
Rockville, MD 20850
Services available include psychopharmacology consultations, mental health evaluation and treatment, medication management, psychotherapy and second opinion consultations. Appointment availability is generally between the hours of 1 PM and 8 PM. Areas of special interest include sleep disorders, ADHD, Autism, OCD, Depression and PTSD. Additional services available are Behavior Therapy for OCD and counseling for families of persons with Autism. The goals of the practice are to provide help and solutions for problems that affect a client's quality of life and to help clients continue on life's journey without distress.
Services available include psychopharmacology consultations, mental health evaluation and treatment, medication management, psychotherapy and second opinion consultations. Appointment availability is generally between the hours of 1 PM and 8 PM. Areas of special interest include sleep disorders, ADHD, Autism, OCD, Depression and PTSD. Additional services available are Behavior Therapy for OCD and counseling for families of persons with Autism. The goals of the practice are to provide help and solutions for problems that affect a client's quality of life and to help clients continue on life's journey without distress.
(301) 679-7492 View (301) 679-7492

See more therapy options for Montgomery County

Cognitive Behavioral (CBT) Psychiatrists

How does cognitive behavioral therapy work?

Cognitive behavioral therapy works by exploring how your thoughts affect your emotions and experiences. CBT helps you identify distortions in your thinking. For example, you may tend to jump to the worst case scenario catastrophizing or think in extremes (all-or-nothing thinking). A therapist can teach you how to push back against those thoughts to ultimately change your feelings and behavior for the better. They can also provide coping skills to better deal with stressors and challenges.

When do I know to seek treatment with cognitive behavioral therapy?

It’s reasonable to consider cognitive behavioral therapy if you struggle to manage difficult emotions or behaviors to such an extent that you are not getting the most out of life on a day-to-day basis. If you want a shorter term, concrete, skills-based approach, CBT is a great option. (By contrast, other types of therapy may devote more time to exploring your past and its effects.) The decision to seek CBT also depends on the condition you’re treating; CBT is an effective treatment for anxiety, depression, trauma, and many other disorders.

How can I find a cognitive behavioral therapist for someone else?

To find a cognitive behavioral therapist for someone else, you may want to begin by discussing the person’s problem, researching cognitive behavioral therapy, and assessing whether the approach is the right fit. You could then reach out to a few cognitive behavioral therapists in this directory, explain the scenario, have a consultation with those available, and determine who could be a good match.

Why is CBT such a popular form of therapy?

CBT has become a popular form of therapy because it is effective and accessible. Robust research has demonstrated that CBT is an effective treatment for many mental health conditions. And CBT can be learned in relatively few sessions, which means that many people can engage in the process, afford it, and see results quickly. It involves learning concrete skills such as disputing unhelpful thoughts; these skills can also be taught and spread widely.